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Published Online:https://doi.org/10.1026/0033-3042.59.4.217

Zusammenfassung. Kognitive Umstrukturierung von Wahn und dysfunktionalen Kognitionen wird zunehmend in der Schizophreniebehandlung eingesetzt. Bisherige Meta-Analysen zur Wirksamkeit von CBT integrieren jedoch sehr heterogene Interventionen, was Schlussfolgerungen auf die Wirksamkeit kognitiver Elemente erschwert. Die vorliegende Meta-Analyse analysiert kurz- und langfristige Effekte aus 18 randomisiert-kontrollierten Studien zu kognitiven Interventionen für Schizophrenie. Im Bezug auf die Gesamtsymptomatik bestanden im Vergleich zu Standardbehandlung signifikante kleine Effekte zum Behandlungsende (n = 908) und zum Follow-Up (n = 663). Im Vergleich zu aktiven Kontrollinterventionen war CBT zum Behandlungsende nicht signifikant überlegen (n = 559), jedoch zum Follow-up (n = 416). CBT zeigte sich auch für die Reduktion von Rehospitalisierungen einer Standardbehandlung, nicht aber alternativen Therapien, überlegen. Eine kognitive Schwerpunktsetzung der Interventionen korrelierte – auch nach Kontrolle der methodischen Qualität – positiv mit der prä-post Effektstärke. Es erscheint aussichtsreich, weiter zu untersuchen, ob die Effektivität von CBT durch einen verstärkten Einsatz kognitiver Elemente gesteigert werden kann.


Effects of cognitive interventions for schizophrenia: a meta-analysis

Abstract. Cognitive interventions for delusions and dysfunctional cognitions are increasingly being used in the treatment of schizophrenia. So far, meta-analyses investigatating the effectiveness of cognitive behavioral therapy (CBT) have integrated heterogeneous interventions, making conclusions with regard to the cognitive elements difficult to draw. The present meta-analysis investigated 18 randomized controlled trials of cognitive interventions for schizophrenia. With regard to overall pathology, CBT produced small significant effects in comparison to treatment as usual (TAU) by the end of treatment (n = 908) and at follow-up assessment (n = 663). In comparison to active control interventions CBT did not produce significantly higher effects by the end of treatment (n = 559), but was superior at follow-up (n = 416). CBT significantly reduced rehospitalizations when compared to TAU, but not when compared to alternative therapies. The amount of cognitive elements in the intervention was positively correlated with the pre-post effect sizes, even after controlling for the methodological quality. It seems promising to further investigate whether the effectiveness of CBT might be augmented by increased use of cognitive elements.

In die Meta-Analyse einbezogene Studien sind mit * gekennzeichnet

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