Department of Psychological Clinical Science, University of Toronto Scarborough, CA, USA.
Ontario Shores Centre for Mental Health Sciences, CA, USA.
Schizophr Bull. 2023 Jul 4;49(4):973-986. doi: 10.1093/schbul/sbac209.
Schizophrenia is among the most persistent and debilitating mental health conditions worldwide. The American Psychological Association (APA) has identified 10 psychosocial treatments with evidence for treating schizophrenia and these treatments are typically provided in person. However, in-person services can be challenging to access for people living in remote geographic locations. Remote treatment delivery is an important option to increase access to services; however, it is unclear whether evidence-based treatments for schizophrenia are similarly effective when delivered remotely.
The current study consists of a series of systematic reviews and meta-analyses examining the evidence-base for remote-delivery of each of the 10 APA evidence-based treatments for schizophrenia.
Of the 10 treatments examined, only cognitive remediation (CR), cognitive-behavioral therapy (CBT), and family psychoeducation had more than 2 studies examining their efficacy for remote delivery. Remote delivery of CBT produced moderate effects on symptoms (g = 0.43) and small effects on functioning (g = 0.26). Remote delivery of CR produced small-moderate effects on neurocognition (g = 0.35) and small effects on functioning (g = 0.21). There were insufficient studies of family psychoeducation with equivalent outcome measures to assess quantitatively, however, studies of remotely delivered family psychoeducation suggested that it is feasible, acceptable, and potentially effective.
Overall, the evidence-base for remotely delivered treatment for schizophrenia is limited. Studies to date suggest that remote adaptations may be effective; however, more rigorous trials are needed to assess efficacy and methods of remote delivery that are most effective.
精神分裂症是全球最持久和致残的精神健康状况之一。美国心理协会 (APA) 确定了 10 种有证据支持治疗精神分裂症的心理社会治疗方法，这些治疗方法通常是亲自提供的。然而，对于居住在偏远地区的人来说，亲自接受服务可能具有挑战性。远程治疗是增加服务可及性的重要选择；然而，目前尚不清楚精神分裂症的循证治疗方法在远程治疗时是否同样有效。
本研究包括一系列系统评价和荟萃分析，旨在检查远程提供 APA 针对精神分裂症的 10 种循证治疗方法中的每一种方法的证据基础。
在所检查的 10 种治疗方法中，只有认知矫正 (CR)、认知行为疗法 (CBT) 和家庭心理教育有超过 2 项研究检查了它们远程治疗的疗效。CBT 的远程治疗对症状产生了中等程度的影响（g = 0.43），对功能产生了较小的影响（g = 0.26）。CR 的远程治疗对神经认知产生了较小到中等程度的影响（g = 0.35），对功能产生了较小的影响（g = 0.21）。由于缺乏具有等效结果测量的家庭心理教育的远程研究，因此无法进行定量评估；然而，远程提供的家庭心理教育研究表明，这种方法是可行的、可接受的，并且可能是有效的。
总体而言，精神分裂症远程治疗的证据基础有限。迄今为止的研究表明，远程适应可能是有效的；然而，需要更严格的试验来评估疗效和最有效的远程治疗方法。
