Schizophrenia Bulletin Advance Access originally published online on June 4, 2007
Schizophrenia Bulletin 2007 33(4):859-860; doi:10.1093/schbul/sbm058
Published by Oxford University Press 2007.
Supportive Therapy for Schizophrenia
L Buckley2 and
T Pettit1,2
2 Cochrane Collaboration Schizophrenia Group
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Introduction
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One common feature of psychotherapies and professional interventions
for people with schizophrenia is to provide support. For example,
in a consultation, there will often be time allocated to listening
to patients' concerns, giving encouragement, or arranging help
with day-to-day living.
There is, however, no universally accepted definition of supportive therapy. We used a wide definition to include any intervention from a single person with the aim of maintaining current functioning or to assist with a person's preexisting abilities. This includes interventions that require a trained therapist, such as supportive psychotherapy, as well as other interventions that require no training, such as "befriending." We did not include interventions that sought to educate, train, or change a person's way of coping.
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Objectives
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To assess the effects of supportive therapy for people with
schizophrenia, primarily on the outcomes of relapse, hospitalization,
important change in mental state, global functioning, engagement
with services, and satisfaction with care.
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Search Strategy
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We searched the Cochrane Schizophrenia Group's Register of trials
(January 2004), supplemented by manual reference searching and
contact with authors of relevant reviews or studies.
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Selection Criteria
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All randomized trials involving people with schizophrenia comparing
supportive therapy with any other treatment or standard care.
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Data Collection and Analysis
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We independently selected articles to be read fully from the
abstracts, and, again working independently, selected articles
for inclusion in the review, and extracted data for analysis.
We resolved all disagreement by discussion.
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Main Results
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We could include 22 studies but data were limited. We found
no significant differences in the primary outcomes when supportive
therapy was compared with standard care. When, however, supportive
therapy was the control intervention and was being compared
with other psychological therapies, some differences were apparent—all
favoring the other therapies (see
table 1). More detailed findings
are reported in the full version of this review.
1
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Reviewer's Conclusions
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There is insufficient data to identify a difference in outcome
between supportive therapy and standard care (4 randomized controlled
trial [RCT],
n = 354). For a variety of outcomes, including
hospitalization, general mental state, and satisfaction with
care, there is some indication of an advantage of other psychological
therapies over supportive therapy. However, there were always
few data, a lack of consistency on reporting of outcomes, and
the potential of inclusion bias favoring the group not receiving
supportive therapy.
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Implications for Practice
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From this review, data do not support the conclusion that supportive
therapy offers anything different to other forms of psychological
intervention. In addition, there is currently no evidence that
supportive therapy adds to standard care in terms of the outcomes
we sought. It seems intuitive that support be given to people
with schizophrenia. Whether this should be formalized into a
therapy package remains in doubt.
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Implications for Research
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Further trials are indicated for this common approach. Researchers
should consider using supportive therapy as the main treatment
arm rather than a comparator and should ensure therapists have
been specifically trained in a well-defined supportive therapy.
Outcome measures could also address areas that have been relatively
neglected to date, including adverse effects, social functioning,
occupational status, quality of life, and economic outcomes.
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Footnotes |
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1 To whom correspondence should be addressed; tel: +44-161-428-9511, fax: +44-161-495-4900, e-mail: tpettit{at}affinityhealth.co.uk.
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References
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- Buckley LA, Pettit T. Supportive therapy for schizophrenia. Cochrane Database Syst Rev. (2007) (1). Art. No.: CD004716. doi: 10.1002/14651858.CD004716.pub2.
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Introduction
Objectives