Welcome to my blog, a place to explore and learn about the experience of running a psychiatric practice. I post about things that I find useful to know or think about. So, enjoy, and let me know what you think.

Wednesday, February 26, 2014

It's All in the Spin

Another email from the APA today, oh joy:

CBT More Efficacious Than Other Psychological Interventions for Positive Symptoms of Psychosis.

This was based on the article: Psychological Interventions for Psychosis: A Meta-Analysis of Comparative Outcome Studies, published February 14th on AJP in Advance.

CBT was compared with supportive counseling, social skills training, psycho-education, cognitive remediation and befriending in 48 trials.

Results  Cognitive-behavioral therapy (CBT) was significantly more efficacious than other interventions pooled in reducing positive symptoms (g=0.16). This finding was robust in all sensitivity analyses for risk of bias but lost significance in sensitivity analyses for researcher allegiance, which suffered from low power. Social skills training was significantly more efficacious in reducing negative symptoms (g=0.27). This finding was robust in sensitivity analyses for risk of bias and researcher allegiance. Significant findings for CBT, social skills training, and cognitive remediation for overall symptoms were not robust after sensitivity analyses. CBT was significantly more efficacious when compared directly with befriending for overall symptoms (g=0.42) and supportive counseling for positive symptoms (g=0.23).

The APA seems rather pleased with itself about this result. The email even linked to a news article, CBT Addresses Most-Debilitating Symptoms in Chronic Schizophrenia.

A new cognitive-behavior therapeutic strategy [Recovery Oriented Cognitive Therapy (CT-R)] is helping patients overcome major obstacles to their recovery, especially the negative symptoms...that are considered to be the most intransigent and disabling for patients with schizophrenia. The strategy has been implemented throughout the Philadelphia public mental health system and in Georgia

You'd think they'd at least cross check their own links. CT-R is especially helpful with negative symptoms, but the meta-analysis demonstrated that social skills training was significantly more efficacious than CBT in reducing negative symptoms.

The email caught my eye because I had just finished reading this month's Carlat Report, in which there was an article entitled, "CBT for Schizophrenia: Is Talk Cheap?", which, in turn, references, "Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias," published in the British Journal of Psychiatry.

THIS study looked at 50 trials of CBT for schizophrenia, and found that when raters were blinded to the type of treatment provided, effect size of CBT relative to placebo dropped from 0.62 in unblinded studies, to 0.15 in blinded studies, for overall symptoms. For positive symptoms, the drop was from 0.57 to 0.08. 
Pooled effect sizes were 0.33 for overall symptoms, 0.25 for positive symptoms, and 0.13 for negative symptoms. 
Not sure why they didn't describe the difference between unblinded and blinded studies for negative symptoms. Maybe because the pooled effect size was so low to begin with.

It's kind of like what I wrote about the APA excitement about the meeting in May. Pick some highlight, maybe Alan Alda, talk about how great the meeting will be, and ignore all the annoying little facts that might put a damper on things. 

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