Effectiveness of Cognitive and Behavioral Interventions in the Treatment of Schizophrenia: An Umbrella Review of Meta-Analyses.

Background: Cognitive and behavioral interventions have risen in popularity both as an adjunctive treatment to antipsychotic medication and as an alternative treatment for schizophrenia. With the growing number of such interventions, we performed an umbrella review to provide a comprehensive summary comparing the effectiveness of the different interventions among populations with schizophrenia. Methods: This umbrella review included meta-analyses evaluating cognitive and behavioral interventions for schizophrenia. Following PRISMA guidelines, the initial search yielded 4888 records, and after a three-stage screening procedure, 33 meta-analyses met the inclusion criteria for the final analysis. Results: Our findings from the 33 meta-analyses support the efficacy of cognitive and behavioral interventions in reducing total symptoms (Median g = -0.38; Range g = -1.56 to -0.08), positive symptoms (Median g = -0.30; Range g = -0.84 to 0.00), and negative symptoms (Median g = -0.39; Range g = -0.66 to -0.09) of schizophrenia. Cognitive Behavioral Therapy, being the most common intervention studied, exhibited small to medium effects on total and positive symptom alleviation. In addition, there is evidence supporting the effectiveness of family psychoeducation combined with patient behavioral and skills training, exercise therapy, horticultural therapy, and music therapy. Conclusions: While our umbrella review solidifies the current evidence supporting cognitive and behavioral interventions as effective treatments for schizophrenia, it also reveals that treatment efficacy is highly dependent on the type of intervention used.