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.
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。