Efficacy and Moderators of Cognitive Behavioural Therapy for Psychosis Versus Other Psychological Interventions: An Individual-Participant Data Meta-Analysis

June 13, 2020

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Publicated to: Frontiers in Psychiatry. 11 402- - 2020-05-05 11(), DOI: 10.3389/fpsyt.2020.00402

Authors:

Turner, DT; Reijnders, M; van der Gaag, M; Karyotaki, E; Valmaggia, LR; Moritz, S; Lecomte, T; Turkington, D; Penadés, R; Elkis, H; Cather, C; Shawyer, F; O'Connor, K; Li, ZJ; Barretto, EMD; Cuijpers, P

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Affiliations

Capital Med Univ, Beijing Anding Hosp, Dept Clin Psychol, Beijing, Peoples R China - Author

Ctr Aging & Vital, Wolfson Unit, Newcastle Upon Tyne, Tyne & Wear, England - Author

Harvard Med Sch, Boston, MA 02115 USA - Author

Kings Coll London, Inst Psychiat Psychol & Neurosci, Dept Psychol, London, England - Author

Massachusetts Gen Hosp, Boston, MA 02114 USA - Author

Monash Univ, Monash Hlth, Sch Clin Sci,Southern Synergy, Dept Psychiat,Fac Med Nursing & Hlth Sci, Melbourne, Vic, Australia - Author

Parnassia Psychiat Inst, The Hague, Netherlands - Author

South London & Maudsley NHS Trust, London, England - Author

Univ Barcelona, IDIBAPS CIBERSAM, Hosp Clin Barcelona, Barcelona, Spain - Author

Univ Klinikum Hamburg Eppendorf, Arbeitsgrpe Klin Neuropsychol, Klin Psychiat & Psychotherapie, Hamburg, Germany - Author

Univ Montreal, Dept Psychiat, Montreal, PQ, Canada - Author

Univ Montreal, Dept Psychol, Montreal, PQ, Canada - Author

Univ Sao Paulo, Med Sch, Dept & Inst Psychiat, Sao Paulo, Brazil - Author

Vrije Univ, Amsterdam Publ Hlth Res Inst, Dept Clin Neuro & Dev Psychol, Amsterdam, Netherlands - Author

Abstract

Background Study-level meta-analyses have demonstrated the efficacy of cognitive-behavioural therapy for psychosis (CBTp). Limitations of conventional meta-analysis may be addressed using individual-participant-data (IPD). We aimed to determine a) whether results from IPD were consistent with study-level meta-analyses and b) whether demographic and clinical characteristics moderate treatment outcome. Methods We systematically searched PubMed, Embase, PsychInfo and CENTRAL. Authors of RCTs comparing CBTp with other psychological interventions were contacted to obtain original databases. Hierarchical mixed effects models were used to examine efficacy for psychotic symptoms. Patient characteristics were investigated as moderators of symptoms at post-treatment. Sensitivity analyses were conducted for risk of bias, treatment format and study characteristics. Results We included 14 of 23 eligible RCTs in IPD meta-analyses including 898 patients. Ten RCTs minimised risk of bias. There was no significant difference in efficacy between RCTs providing IPD and those not (p >0.05). CBTp was superior vs. other interventions for total psychotic symptoms and PANSS general symptoms. No demographic or clinical characteristics were robustly demonstrated as moderators of positive, negative, general or total psychotic symptoms at post-treatment. Sensitivity analyses demonstrated that number of sessions moderated the impact of treatment assignment (CBTp or other therapies) on total psychotic symptoms (p = 0.02). Conclusions IPD suggest that patient characteristics, including severity of psychotic symptoms, do not significantly influence treatment outcome in psychological interventions for psychosis while investing in sufficient dosage of CBTp is important. IPD provide roughly equivalent efficacy estimates to study-level data although significant benefit was not replicated for positive symptoms. We encourage authors to ensure IPD is accessible for future research.

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Keywords

cognitive-behavioural therapyhallucinationsindividual-participant datamedicationmeta-analysisnegative symptomspansspersistent symptomspsychological interventionremediationschizophrenia resistantBehavior therapyCognitive-behavioural therapyCognitive–behavioural therapyHallucinationsIndividual-participant dataIntervenció psicològicaMedicationMeta-analysisMetaanàlisiNegative symptomsPanssPersistent symptomsPsicosiPsychological interventionPsychosesPsychosisRandomized controlled-trialRemediationSchizophrenia resistantTeràpia de la conducta

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The work has been published in the journal Frontiers in Psychiatry due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2020, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Psychiatry and Mental Health.

From a relative perspective, and based on the normalized impact indicator calculated from World Citations provided by WoS (ESI, Clarivate), it yields a value for the citation normalization relative to the expected citation rate of: 1.32. This indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: ESI Nov 13, 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2026-04-01, the following number of citations:

WoS: 29
Europe PMC: 9

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Leadership analysis of institutional authors

This work has been carried out with international collaboration, specifically with researchers from: Australia; Brazil; Canada; China; Germany; Netherlands; United Kingdom; United States of America.

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