The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: A meta-analysis
Introduction
To date meta-analyses of CBT for psychosis (CBTp) have evaluated the effects in terms of effects on the frequency and severity of positive symptoms (Gould et al., 2001, Rector and Beck, 2001, Zimmermann et al., 2005, Wykes et al., 2008, NICE, 2009), negative symptoms (Rector and Beck, 2001, Wykes et al., 2008) and general symptoms (Tarrier and Wykes, 2004, NICE, 2009, Jones et al., 2012), but none focussed on and differentiated between auditory hallucinations and delusions. CBTp does not aim to reduce the frequency and severity of symptoms, but rather to reappraise the meaning and purpose of hallucinations and delusions to reduce distress and improve coping in daily life (Birchwood and Trower, 2006). Therefore, a symptom-specific measure may be better suited to measure multiple aspects such as objective characteristics and subjective experiential aspects of delusions and hallucinations. Recent findings have shown that formulation based CBTp, tailored to the individual and carried out by a skilled therapist is the most efficacious (Steel et al., 2012).
In this review we present the results of a meta-analysis on published trials that report on the effects of CBTp using individually tailored case-formulation on hallucinations and/or delusions with the use of a symptom-specific measure. We expect that individually tailored case-formulation CBT will show larger effect-sizes than broad CBT including standard training programmes. We anticipate larger effect sizes in studies comparing CBTp with treatment as usual (TAU) to those comparing CBTp to an active treatment condition. Furthermore, we expected larger effect size in studies that were not blinded compared to those, which were blinded.
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Eligibility criteria
To be included in the review studies had to meet the following criteria: 1) had to be randomised controlled trials, 2) the experimental treatment was (formulation-based) CBT for psychosis, 3) any control condition was accepted, 4) patients were diagnosed with a psychotic disorder with at least 75% schizophrenia patients, 5) were published in peer reviewed journals, and 6) no conference abstracts, only full papers were selected. Individually tailored case-formulation CBT was expected to yield
Characteristics of the included studies
Eighteen studies were included in the meta-analyses (Lewis et al., 2002, Durham et al., 2003, Trower et al., 2004, Cather et al., 2005, Valmaggia et al., 2005, Wykes et al., 2005, McLeod et al., 2007a, McLeod et al., 2007b, O'Connor et al., 2007, Garety et al., 2008, Haddock et al., 2009, Penn et al., 2009, Foster et al., 2010, Peters et al., 2010, Lincoln et al., 2012, Krakvik et al., 2013, Leff et al., 2013, Rathod et al., 2013, Morrison et al., 2014). Fifteen studies reported on
Discussion
The results of this meta-analyses support the general conclusion that CBTp is effective in treating auditory hallucinations and delusions. The effect-sizes vary from small to medium and are in line with other meta-analyses (Pfammatter et al., 2006, Wykes et al., 2008, Jauhar et al., 2014, Turner et al., 2014). There was no statistically significant heterogeneity in the hallucination trials, while moderate heterogeneity was found in the delusion trials. All trials had improved hallucinations in
Role of funding source
The meta-analysis was performed without funding.
Contributors
The design of the study and the selection of studies were done by L Valmaggia and M van der Gaag.
The analyses were conducteded by M van der Gaag and fF Smit.
The paper was drafted by M van der Gaag and co-authored by L Valmaggia and F Smit.
Conflict of interest
The authors declare that they do not have conflicting interests.
Acknowledgements
We thank Stynke Castelein PhD, senior researcher of Mental Health Organisation Lentis and Dignis Research Centre, Groningen and Tonnie Staring PhD of Mental Health Center Altrecht, Utrecht, The Netherlands for assessing the quality of all included studies with the use of the CTAM.
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