Conclusions of CBTP evidence

CBTP and other outcomes - result of systematic review

Media generates greater enthusiasm than warranted for CBTP with unhelpful headlines like “Time to flush the meds”

Seems to be a high rate of corrections or retractions in CBTP meta analyses due to over stating how beneficial CBTP is not supported by their own data

CBTP researchers write about how effective CBTP is even when their own results do not support these statements

These are where the outcome rater is blinded to treatment group - see how effectiveness is reduced

Crucial to how effective CBTP is in RCTs is if the outcome rater was unaware as to whether the participant received CBT or not. Open trials first

Jauhar et al 2014 found that CBTP had small and below small benefits for total, positive and negative symptoms. Many studies are negative results but studies in China are more likely to be positive

Lack of evidence for CBTP effectiveness on negative symptoms

Lack of evidence for CBTP effectiveness on positive symptoms

Befriending is an under investigated intervention for schizophrenia

Current NICE guidelines on schizophrenia hasn’t updated data since 2008 which made 110 meta analyses of CBTP. For some reason they did not update this data in later Guidance. No clear reason for this.

CBTP (CBT for psychosis) has been endorsed for various aims - positive & negative symptoms, distress, relapse prevention, functioning, depression, anxiety and (briefly) medication adherence and insight

Falling effect size of CBTP effectiveness with time in meta analysis - from 2008 onwards tend to be small or below small effect

Beck first used cognitively orientated psychotherapy for people with schizophrenia in 1952 - the same year that the first antipsychotic chlorpromazine was introduced! 0ver 50 RCTs and 20 meta analyses of RCT - large amount of re analysis of same data - to push a view ?

Keith Laws discusses oppositional views on the value of CBT for psychosis - no other area that he has researched has such entrenched views

Next talk is from Professor Keith Laws on CBT in psychosis

New muscarinic agonists probably work by acting on dopamine systems in the striatum