Schizophrenia Bulletin 2008 34(6):1021-1023; doi:10.1093/schbul/sbn124
© The Author 2008. Published by Oxford University Press on behalf of the Maryland Psychiatric Research Center. All rights reserved. For permissions, please email: journals.permissions@oxfordjournals.org.
Morita Therapy for Schizophrenia
Chunbo Li1,2 and
Yanling He3
2 Department of Biological Psychiatry
3 Department of Clinical Epidemiology, Shanghai Mental Health Center, Shanghai Jiaotong University, Shanghai 200030, China
Keywords: cochrane / Morita therapy / schizophrenia
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Background
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As well as drug treatment, management of schizophrenia should
also focus on wider social aspects of living in the community.
There are many kinds of intervention strategies available involving
both the patient and the wider family unit; Morita therapy is
one of these. It is a systematic psychotherapy based on Eastern
psychology, named in 1919 after Shoma Morita, a Japanese psychiatrist.
Morita therapy involves a behavioral, structured program and
tries to lead patients from preoccupation with somatic symptoms
and attempts to eliminate neurotic symptoms through 4 phases
by accepting it as natural, while engaging an outward perspective
on life and increased social functioning.
1 It is in wide use
in China
2 and also in Japan and a few Western countries.
3,
4 Full details of this work are published on the Cochrane Library.
5
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Objective
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To evaluate the clinical effects of Morita therapy for schizophrenia
and schizophrenia-like psychoses.
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Search Strategy
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We searched the Cochrane Schizophrenia Groups Trials Register
(July 2008), the Chongqing VIP Database (July 2008), the Wanfang
Database (July 2008), all references of relevant articles and
contacted the first author of each included study.
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Selection Criteria
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All relevant randomized control trials (RCTs). Quasirandomized
studies, such as those allocating by using alternate days of
the week, were included in a sensitivity analysis.
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Data Collection and Analysis
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We reliably selected studies and extracted data independently
by 2 researchers (Y.H., C.L.). For homogenous dichotomous data,
we calculated random effect, relative risk (RR), 95% confidence
intervals (CIs), and, where appropriate, numbers needed to treat
(NNT) on an intention-to-treat basis. For continuous data, we
calculated weighted mean differences (WMD).
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Main Results
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We found 12 small studies of medium-poor quality (total
n =
1123). Attrition was low in the Morita therapy vs standard care
comparison (
n = 761, 10 RCTs, <2%, RR = 1.01, CI = 0.4 to
2.8). Mental status did tend to improve with Morita therapy
(
Fig. 1,
n = 76, 1 RCT, >25%–30% decline in Brief Psychiatric
Rating Scale (BPRS), RR = 0.36, CI = 0.1 to 0.9, NNT = 5, CI
= 4 to 25). For negative symptoms
Fig. 2, data were inconsistent,
with data from 4 trials favoring Morita therapy (
n = 323, Scale
for the assessment of negative symptoms endpoint, WMD = –12.94,
CI = –21.6 to –4.3), but heterogeneity was considerable
(
I2 = 97%). Morita therapy did significantly improve daily living
score compared with standard treatment alone (
n = 104, 1 RCT,
ADL endpoint WMD = –4.1, CI = –7.7 to –0.6).
When compared with a rehabilitation program, Morita therapy
showed better effect on mental state (
n = 278, 2 RCTs, BPRS
endpoint WMD = –6.95 CI = –9.3 to –4.6,
I2 = 0%) and insight (
n = 278, 2 RCTs, global insight assessment
endpoint WMD = –1.11 CI = –1.3 to –0.9,
I2 = 0%) and social functioning (
n = 278, inpatient psychiatric
rehabilitation outcome scale endpoint WMD –18.14, CI =
–21.3 to –15.0,
I2 = 0%).
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Reviewers' Conclusions
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Morita therapy may have some positive effects, but there are
no data to assess whether this is sustained. For schizophrenia,
therefore, Morita therapy remains an experimental intervention.
Implications for Practice
The clinical effects of Morita therapy, as far as we were able to demonstrate, are modest, and these are found in the hands of skilled and committed practitioners. For people with long-term schizophrenia, residual symptoms are often problematic. Morita therapy, although experimental, may have some beneficial effects. It would seem preferential, however, that people with schizophrenia receive such treatment within the context of a well-designed, patient-focused randomized trials. If this is not possible, generating better evidence than we have been able to find here should be a priority for clinicians as well as researchers. Currently we have almost no data to help managers and policy makers balance the costs and benefits of this treatment.
Implications for Research
We do think that this review supports the need for more studies. Although Morita therapies have mostly been practiced within hospital inpatient settings, we see no reason not to implement this package of care within, eg, day care centers. We would encourage those designing such trials to add patient-focused outcomes such as "healthy days," "family burden," "quality of life," adverse effects as well as some cost effectiveness and cost-benefit evaluations.
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Funding
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Davis Family Foundation (to C.L., Y.H.); National Basic Research
Program of China (973 Program, 2007CB512306 to C.L.).
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Footnotes |
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1 To whom correspondence should be addressed; tel: +86-21-64387250, ext 3243, fax: +86-21-64387986, e-mail: chunbo_li{at}yahoo.com.
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Acknowledgments
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We would like to thank Judy Wright, Tessa Grant, Sam Roberts,
and Beth York of the Cochrane Schizophrenia Group for their
help; Prof John M. Davis and Dr Stefan Leucht for their supporting;
and Prof Clive E. Adams for editing and supporting with this
review. Disclosures: None relevant.
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References
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- Takeda K. Morita therapy. J Religion Health (1964) 3::335–344.[CrossRef]
- Wen QR. Development of Morita therapy in China. Health Psychol J (2001) 9::233–235.
- Reynolds DK, Kiefer CW. Cultural adaptability as an attribute of therapies: the case of Morita psychotherapy. Culture, Medicine and Psychiatry (1977) 1::395–412.[CrossRef][Medline]
- Kitanishi K, Mori A. Morita therapy: 1919 to 1995. Psychiatry Clin Neurosci (1995) 49::245–254.[Medline]
- He Y, Li C. Morita therapy for schizophrenia. Cochrane Database Systematic Rev (2007) Issue 1::CD006346.
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Background
Objective
