Institute of Psychiatry, King’s College London, UK.
Am J Psychiatry. 2011 May;168(5):472-85. doi: 10.1176/appi.ajp.2010.10060855. Epub 2011 Mar 15.
Cognitive remediation therapy for schizophrenia was developed to treat cognitive problems that affect functioning, but the treatment effects may depend on the type of trial methodology adopted. The present meta-analysis will determine the effects of treatment and whether study method or potential moderators influence the estimates.
Electronic databases were searched up to June 2009 using variants of the key words "cognitive," "training," "remediation," "clinical trial," and "schizophrenia." Key researchers were contacted to ensure that all studies meeting the criteria were included. This produced 109 reports of 40 studies in which ≥70% of participants had a diagnosis of schizophrenia, all of whom received standard care. There was a comparison group and allocation procedure in these studies. Data were available to calculate effect sizes on cognition and/or functioning. Data were independently extracted by two reviewers with excellent reliability. Methodological moderators were extracted through the Clinical Trials Assessment Measure and verified by authors in 94% of cases.
The meta-analysis (2,104 participants) yielded durable effects on global cognition and functioning. The symptom effect was small and disappeared at follow-up assessment. No treatment element (remediation approach, duration, computer use, etc.) was associated with cognitive outcome. Cognitive remediation therapy was more effective when patients were clinically stable. Significantly stronger effects on functioning were found when cognitive remediation therapy was provided together with other psychiatric rehabilitation, and a much larger effect was present when a strategic approach was adopted together with adjunctive rehabilitation. Despite variability in methodological rigor, this did not moderate any of the therapy effects, and even in the most rigorous studies there were similar small-to-moderate effects.
Cognitive remediation benefits people with schizophrenia, and when combined with psychiatric rehabilitation, this benefit generalizes to functioning, relative to rehabilitation alone. These benefits cannot be attributed to poor study methods.
认知矫正疗法被开发出来用于治疗影响功能的认知问题，但治疗效果可能取决于所采用的试验方法类型。本荟萃分析将确定治疗效果，以及研究方法或潜在的调节因素是否影响评估结果。
使用“认知”、“训练”、“矫正”、“临床试验”和“精神分裂症”等关键词的变体，对截至 2009 年 6 月的电子数据库进行了搜索。联系了主要研究人员，以确保纳入所有符合标准的研究。这产生了 109 份报告，涉及 40 项研究，其中 70%以上的参与者被诊断为精神分裂症，所有人都接受了标准护理。这些研究都有对照组和分配程序。可以计算认知和/或功能的效应大小。数据由两位具有良好可靠性的审查员独立提取。通过临床试验评估量表提取了方法学调节因素，并在 94%的情况下得到了作者的验证。
荟萃分析（2104 名参与者）对整体认知和功能产生了持久的影响。症状效应较小，在随访评估时消失。没有治疗元素（矫正方法、持续时间、计算机使用等）与认知结果相关。当患者临床稳定时，认知矫正疗法更有效。当认知矫正疗法与其他精神病康复一起提供时，对功能的影响更大，当采用策略方法并辅以辅助康复时，效果更大。尽管方法学严谨性存在差异，但这并没有调节任何治疗效果，即使在最严谨的研究中，也存在类似的小到中等效果。
认知矫正有益于精神分裂症患者，当与精神病康复相结合时，与单独康复相比，这种益处会扩展到功能。这些益处不能归因于较差的研究方法。
