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Abstract：
OBJECTIVE: Following 2 decades of research on cognitive behavioral therapy for psychosis (CBTp), it is relevant to consider at which point the evidence base is considered sufficient. We completed a cumulative meta-analysis to assess the sufficiency and stability of the evidence base for hallucinations and delusions.
METHODS: We updated the systematic search from our previous meta-analytic review from August 2013 until December 2019. We identified 20 new randomized controlled trials (RCTs) resulting in inclusion of 35 RCTs comparing CBTp with treatment-as-usual (TAU) or active controls (AC). We analyzed data from participants with psychosis (N = 2407) over 75 conventional meta-analytic comparisons. We completed cumulative meta-analyses (including fail-safe ratios) for key comparisons. Publication bias, heterogeneity, and risk of bias were examined.
RESULTS: Cumulative meta-analyses demonstrated sufficiency and stability of evidence for hallucinations and delusions. The fail-safe ratio demonstrated that the evidence base was sufficient in 2016 for hallucinations and 2015 for delusions. In conventional meta-analyses, CBTp was superior for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01) when compared with any control. Compared with TAU, CBTp demonstrated superiority for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01). Compared with AC, CBT was superior for hallucinations (g = 0.34, P < .01), but not for delusions although this comparison was underpowered. Sensitivity analyses for case formulation, primary outcome focus, and risk of bias demonstrated increases in effect magnitude for hallucinations.
CONCLUSIONS: The evidence base for the effect of CBTp on hallucinations and delusions demonstrates sufficiency and stability across comparisons, suggesting limited value of new trials evaluating generic CBTp.
METHODS: We updated the systematic search from our previous meta-analytic review from August 2013 until December 2019. We identified 20 new randomized controlled trials (RCTs) resulting in inclusion of 35 RCTs comparing CBTp with treatment-as-usual (TAU) or active controls (AC). We analyzed data from participants with psychosis (N = 2407) over 75 conventional meta-analytic comparisons. We completed cumulative meta-analyses (including fail-safe ratios) for key comparisons. Publication bias, heterogeneity, and risk of bias were examined.
RESULTS: Cumulative meta-analyses demonstrated sufficiency and stability of evidence for hallucinations and delusions. The fail-safe ratio demonstrated that the evidence base was sufficient in 2016 for hallucinations and 2015 for delusions. In conventional meta-analyses, CBTp was superior for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01) when compared with any control. Compared with TAU, CBTp demonstrated superiority for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01). Compared with AC, CBT was superior for hallucinations (g = 0.34, P < .01), but not for delusions although this comparison was underpowered. Sensitivity analyses for case formulation, primary outcome focus, and risk of bias demonstrated increases in effect magnitude for hallucinations.
CONCLUSIONS: The evidence base for the effect of CBTp on hallucinations and delusions demonstrates sufficiency and stability across comparisons, suggesting limited value of new trials evaluating generic CBTp.
摘要：
目的：在对精神病认知行为疗法（CBTp）进行了20年的研究之后，有必要考虑在什么时候证据基础被认为是足够的。我们完成了一项累积荟萃分析，以评估幻觉和妄想证据的充分性和稳定性。
方法：我们更新了从2013年8月到2019年12月之前的荟萃分析综述的系统搜索。我们确定了20个新的随机对照试验（RCTs），结果纳入了35个RCTs，比较CBTp与照常治疗（TAU）或主动对照（AC）。我们分析了来自精神病患者（N=2407）的75个常规荟萃分析比较的数据。我们完成了关键比较的累积荟萃分析（包括故障-安全比率）。出版偏见，异质性，并对偏倚风险进行了检查。
结果：累积荟萃分析显示幻觉和妄想证据的充分性和稳定性。故障安全比表明，证据基础在2016年足以用于幻觉，在2015年足以用于妄想。在传统的荟萃分析中，与任何对照组相比，CBTp在幻觉（g=0.34，P<0.01）和妄想（g=0.37，P<0.01）方面均优于对照组。与TAU相比,CBTp在幻觉（g=0.34，P<0.01）和妄想（g=0.37，P<0.01）方面具有优势。与AC相比,CBT优于幻觉（g=0.34，P<0.01），但不是妄想，尽管这种比较是不足的。案例制定的敏感性分析，主要结果焦点，和偏倚的风险表明幻觉的影响幅度增加。
结论：CBTp对幻觉和妄想的影响的证据基础证明了比较的充分性和稳定性，提示新试验评估通用CBTp的价值有限。
方法：我们更新了从2013年8月到2019年12月之前的荟萃分析综述的系统搜索。我们确定了20个新的随机对照试验（RCTs），结果纳入了35个RCTs，比较CBTp与照常治疗（TAU）或主动对照（AC）。我们分析了来自精神病患者（N=2407）的75个常规荟萃分析比较的数据。我们完成了关键比较的累积荟萃分析（包括故障-安全比率）。出版偏见，异质性，并对偏倚风险进行了检查。
结果：累积荟萃分析显示幻觉和妄想证据的充分性和稳定性。故障安全比表明，证据基础在2016年足以用于幻觉，在2015年足以用于妄想。在传统的荟萃分析中，与任何对照组相比，CBTp在幻觉（g=0.34，P<0.01）和妄想（g=0.37，P<0.01）方面均优于对照组。与TAU相比,CBTp在幻觉（g=0.34，P<0.01）和妄想（g=0.37，P<0.01）方面具有优势。与AC相比,CBT优于幻觉（g=0.34，P<0.01），但不是妄想，尽管这种比较是不足的。案例制定的敏感性分析，主要结果焦点，和偏倚的风险表明幻觉的影响幅度增加。
结论：CBTp对幻觉和妄想的影响的证据基础证明了比较的充分性和稳定性，提示新试验评估通用CBTp的价值有限。
