Jones Christopher, Hacker David, Meaden Alan, Cormac Irene, Irving Claire B
School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK, B15 2TT.
Cochrane Database Syst Rev. 2011 Apr 13(4):CD000524. doi: 10.1002/14651858.CD000524.pub3.
Cognitive behavioural therapy (CBT) is now a recommended treatment for people with schizophrenia. This approach helps to link the person's feelings and patterns of thinking which underpin distress.
To review the effects of CBT for people with schizophrenia when compared to other psychological therapies.
We searched the Cochrane Schizophrenia Group Trials Register (March 2010) which is based on regular searches of CINAHL, EMBASE, MEDLINE and PsycINFO. We inspected all references of the selected articles for further relevant trials, and, where appropriate, contacted authors.
All relevant clinical randomised trials of cognitive behaviour therapy for people with schizophrenia-like illnesses.
Studies were reliably selected and assessed for methodological quality. Two reviewers, working independently, extracted data. We analysed dichotomous data on an intention-to-treat basis and continuous data with 65% completion rate are presented. Where possible, for dichotomous outcomes, we estimated a relative risk (RR) with the 95% confidence interval along with the number needed to treat/harm.
Twenty-nine papers described 20 trials. Trials were often small and of limited quality. When CBT was compared with other psychosocial therapies no difference was found for outcomes relevant to adverse effect/events (2 RCTs, n=202, RR death 0.57 CI 0.12 to 2.60). Relapse was not reduced over any time period (5 RCTs, n=183, RR in long term 0.91 CI 0.63 to 1.32) nor was rehospitalisation (5 RCTs, n=294, RR in longer term 0.86 CI 0.62 to 1.21). Various global mental state measures failed to show difference (4 RCTs, n=244, RR no important change in mental state 0.84 CI 0.64 to 1.09). More specific measures of mental state failed to show differential effects on positive or negative symptoms of schizophrenia but there may be some longer term effect for affective symptoms (2 RCTs, n=105, MD BDI -6.21 CI -10.81 to -1.61). Few trials report on social functioning or quality of life. Findings do not convincingly favour either interventions (2 RCT, n=103, MD SFS 1.32 CI -4.90 to 7.54; n=37, MD EuroQOL -1.86 CI -19.20 to 15.48). For the outcome of leaving the study early we found no significant advantage when CBT was compared with either non-active control therapies (4 RCTs, n=433, RR 0.88 CI 0.63 to 1.23) or active therapies (6 RCTs, n=339, RR 0.75 CI 0.40 to 1.43)
AUTHORS' CONCLUSIONS: Trail-based evidence suggests no clear and convincing advantage for cognitive behavioural therapy over other and sometime much less sophisticated therapies for people with schizophrenia.
认知行为疗法（CBT）目前是针对精神分裂症患者的一种推荐治疗方法。这种方法有助于将导致痛苦的人的情感和思维模式联系起来。
与其他心理疗法相比，综述认知行为疗法对精神分裂症患者的疗效。
我们检索了Cochrane精神分裂症研究组试验注册库（2010年3月），该注册库基于定期检索CINAHL、EMBASE、MEDLINE和PsycINFO。我们检查了所选文章的所有参考文献以寻找进一步的相关试验，并在适当情况下联系作者。
所有针对精神分裂症样疾病患者的认知行为疗法的相关临床随机试验。
可靠地选择研究并评估其方法学质量。两名独立工作的评审员提取数据。我们在意向性分析的基础上分析二分数据，并给出完成率为65%的连续数据。对于二分结局，在可能的情况下，我们估计相对风险（RR）及其95%置信区间以及治疗/伤害所需人数。
29篇论文描述了20项试验。试验通常规模较小且质量有限。当将认知行为疗法与其他心理社会疗法进行比较时，在与不良反应/事件相关的结局方面未发现差异（2项随机对照试验，n = 202，RR死亡0.57，CI 0.12至2.60）。在任何时间段内复发率均未降低（5项随机对照试验，n = 183，长期RR 0.91，CI 0.63至1.32），再住院率也未降低（5项随机对照试验，n = 294，长期RR 0.86，CI 0.62至1.21）。各种整体精神状态测量未显示出差异（4项随机对照试验，n = 244，RR精神状态无重要变化0.84，CI 0.64至1.09）。更具体的精神状态测量未显示出对精神分裂症阳性或阴性症状的差异影响，但对情感症状可能有一些长期影响（2项随机对照试验，n = 105，MD BDI -6.21，CI -10.81至-1.61）。很少有试验报告社会功能或生活质量。研究结果并未令人信服地支持任何一种干预措施（2项随机对照试验，n = 103，MD SFS 1.32，CI -4.90至7.54；n = 37，MD EuroQOL -1.86，CI -19.20至15.48）。对于提前退出研究的结局，当将认知行为疗法与非活性对照疗法（4项随机对照试验，n = 433，RR 0.88，CI 0.63至1.23）或活性疗法（6项随机对照试验，n = 339，RR 0.75，CI 0.40至1.43）进行比较时，我们未发现显著优势。
基于试验的证据表明，对于精神分裂症患者，认知行为疗法相对于其他有时不太复杂的疗法没有明显且令人信服的优势。
