School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove BN3 7HZ, UK.
Clin Psychol Rev. 2016 Apr;45:183-92. doi: 10.1016/j.cpr.2016.03.004. Epub 2016 Mar 23.
Sixteen sessions of individual cognitive behavior therapy for people with psychosis (CBTp) is recommended. However, access to CBTp is poor, so the potential of low intensity CBTp (fewer than 16 sessions of face-to-face contact) is being explored. A systematic review and meta-analysis was conducted of 10 controlled trials evaluating low intensity CBTp. Significant between-group effects were found on the primary outcome, symptoms of psychosis, at post-intervention (d=-0.46, 95% CI: -0.06, -0.86) and follow-up (d=-0.40, 95% CI: -0.06, -0.74). Study quality did not moderate post-intervention psychosis outcomes, nor did contact time/number of sessions or therapy format (individual versus group). Between-group effects on secondary outcomes (depression, anxiety and functioning) were not significant at post-intervention, but became significant at follow-up for depression and functioning outcomes (but not for anxiety). Overall, findings suggest that low intensity CBTp shows promise with effect sizes comparable to those found in meta-analyses of CBTp more broadly. We suggest that low intensity CBTp could help widen access. Future research is called for to identify mechanisms of change and to ascertain moderators of outcome so that low intensity CBTp targets key mechanisms (so that scarce therapy time is used effectively) and so that interventions offered are matched to patient need.
建议对精神病患者进行 16 个疗程的个体认知行为疗法（CBTp）。然而，CBTp 的可及性很差，因此正在探索低强度 CBTp（面对面接触少于 16 次）的潜力。对 10 项评估低强度 CBTp 的对照试验进行了系统评价和荟萃分析。在干预后（d=-0.46，95%CI：-0.06，-0.86）和随访（d=-0.40，95%CI：-0.06，-0.74）时，主要结局（精神病症状）的组间效应显著。研究质量并未调节干预后精神病结局，也未调节接触时间/疗程数或治疗形式（个体与团体）。干预后，次要结局（抑郁、焦虑和功能）的组间效应不显著，但在随访时对抑郁和功能结局的组间效应显著（但对焦虑不显著）。总体而言，研究结果表明，低强度 CBTp 具有前景，其效果与更广泛的 CBTp 荟萃分析发现的效果相当。我们建议低强度 CBTp 可以帮助扩大可及性。未来的研究需要确定变化的机制，并确定结局的调节因素，以便低强度 CBTp 针对关键机制（以便有效地利用稀缺的治疗时间），并使提供的干预措施与患者的需求相匹配。
