We performed all the necessary steps that are part of a systematic review and network and meta-analysis:
- study protocol , in which all the methods are defined a priori, as a guarantee of methodological rigor (available here:
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=67795(opens in new window) and published here:
https://bmjopen.bmj.com/content/8/3/e019280)(opens in new window);
- systematic searches in the main relevant databases, in order to identify studies comparing psychological interventions with each other or with a non-pharmacological control condition in people with schizophrenia who presented active positive symptoms;
- screening of the 21772 records search results by titles and abstracts, and then by reading 2754 articles in full;
- data extraction from the 53 included studies on an Access database specifically prepared for this project (Figure 1);
- data analysis with the software R;
- writing, submitting and publishing scientific reports;
- oral presentations in international conferences;
- organization of other dissemination and outreach activities (see below).
Treatments included are shown in Figure 2. The greater amount of information was available for the comparison between cognitive behavioral therapy (CBT) and treatment as usual (TAU). The results showed that CBT was associated with a higher reduction of positive symptoms compared to TAU (Figure 3). CBT showed a benefit in comparison to TAU also for other outcomes that we measured, i.e. reduction of overall and negative symptoms of schizophrenia (Figure 4), number of patients who benefitted from the therapy, quality of life and functioning, but it was also associated with a higher number of patients leaving the study before the end of the treatment (Figure 3).
The results are reported in full and discussed in details in our publication (
https://onlinelibrary.wiley.com/doi/epdf/10.1002/wps.20577(opens in new window)). In synthesis, our interpretation is that CBT can be challenging and requires a substantial investment of energies from the person, and for this reason it might be not suitable for every patient and was associated with high dropout rates. These results may contribute to the decision process of the best treatment for the individual patient, which should be discussed individually with the therapist.
The following activities were carried out for exploitation and dissemination of results to different target audiences:
1) 2 scientific publications, available open access on international peer-reviewed journals (BMC Psychiatry, World Psychiatry);
2) oral presentations and posters at 5 international conferences and at a national one, “10th Psychoedukations-Kongress an der TU München. Psychoeducation für Patienten und Angehörige: ein starkes Trio!”, specifically addressing patients and relatives;
3) lectures and seminars (for professionals at the Department of Psychiatry and Psychotherapy at TUM, workshop with staff at University of Bern during the secondment period there, lecture for medical students of the course “Evidence based medicine”);
4) affiliation and collaboration with the patient organization “BASTA – Bündnis für psychisch erkrankte Menschen”, involving patients, relatives and professionals. In this context, three meeting in schools with high schools students classes;
5) preparation of a lay version of the project, understandable by non-professionals, prepared in collaboration with the patients organization BASTA and disseminated through their newsblog;
6) author’s websites and profiles on Google Scholar and Researchgate;
7) creation of a project webpage (
https://www.psykl.mri.tum.de/node/69(opens in new window)) including additional analyses and data, and the lay version of the project;
8) participation with a talk at the event “Munich 15x4”, aiming at disseminate research results to the general public and organized for February 2019.
