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Table 3 Characteristics of recovery focused interventions

From: Disability and recovery in schizophrenia: a systematic review of cognitive behavioral therapy interventions

Study (country) Recovery Study design n Intervention group Control group Follow up Outcome measures Impact on disability Quality of rating
Farhall et al., 2009 Australia Recovery concept: recovery.
Main content: the recovery therapy intervention is a form of CBTp, which focuses on agreed recovery goals using one or more recovery therapy components such as everyday coping, working with symptoms, understanding experience of psychosis, strengthening adaptive view of self, personal/emotional issues or comorbid disorders, relapse prevention, and family or social reintegration.
RCT 94 total
45 intervention
49 control
Recovery therapy (CBTp) + TAU
Individual
12–24 sessions
TAU 9 months Primary measures: PANSS; HADS.
Secondary measures: RSE; Self Report Insight Scale; LSP.
No statistically significant differences between CBTp + TAU and TAU. Weak
Fowler et al., 2009 The UK Recovery concept: social recovery.
Main content: stage one involved formulation of the person in social recovery as well as identifying day-to-day meaningful personal goals to address motivation and hopelessness. Stage two involved identifying and working towards medium- to long-term goals and promotion of a sense of agency and addressing hopelessness, feelings of stigma and negative beliefs about self and others. Stage three involved the active promotion of social activity, work, education and leisure linked to meaningful goals, while managing symptoms of anxiety and low-level psychotic symptoms.
CCT* 77 total
35 intervention
42 control
Social Recovery Cognitive Behaviour Therapy (SRCBT) + TAU
Mean of 12 sessions
TAU No follow up Primary measures: Time Use Survey
Secondary measures: PANSS; BHS; QLS;
Tertiary assessments: BDI-II; BAI; SOFAS; CAN.
No main effects of CBT treatment for any of the outcome variables for the total sample.
Global scores:
Non-affective psychosis group improved on PANSS.
Non-affective psychosis group improved on constructive economic activity and structured activity (Time Use Survey).
Moderate
Grant et al., 2012
The USA
Recovery concept: the Recovery Movement with central features referring to goal-directed framework, personalized and person-oriented therapeutic approach highlighting the patients’ interests, assets, and strengths.
Main content: initial sessions focused on enhancing the therapeutic relationship and stimulating patients’ interest and motivation to focus respectively on achievable goals. Impediments to goals achievement were also addressed in the later phases of the intervention.
RCT 60 total
31 intervention
29 control
Cognitive Therapy plus standard treatment (ST)
Flexible
Standard treatment (ST) 6 months;
12 months;
18 months.
Primary measures: GAS.
Secondary measures: SANS, SAPS.
Mental functions:
Avolition-apathy (SANS) across the trial
Global scores:
Positive symptoms (SAPS) across the trial.
Global functioning (GAS) across the trial.
Moderate
Johns et al., 2015
The UK
Recovery concept: recovery referred to as “living a satisfying, hopeful and contributing life even with limitations caused by the illness” and “having a sense of purpose and direction”.
Main content: the authors described the interventions as compatible with conceptualizations of recovery. The intervention promoted psychological flexibility (a more accepting, mindful, and de-fused approach) in response to symptoms of psychosis and associated emotions/thoughts, in order to help the person act in accordance with their personal values.
Pre + post 89 total Acceptance and Commitment Therapy
Group
4 sessions,
one optional telephone session
No control group 20 weeks The Sheehan Disability Scales, HADS, AAQ-II, CFQ, SMQ. Mental functions:
Mood over time (HADS)
Global scores:
Functioning over time (The Sheehan Disability Scales)
Other:
Processes targeted by the intervention (AAQ-II, CFQ, SMQ).
Weak
Laithwaite et al., 2009
The UK
Recovery concept: recovery.
Main content: a recovery intervention was based on the compassionate mind training. During the first module of the intervention participants were encouraged to think about their recovery beyond symptom reduction and as a journey of experience. Further modules targeted compassion with reference to working on strength, acceptance, forgiveness as well as developing the ideal friend. The last module focused on developing plans for recovery after psychosis.
Pre + post 19 total Compassionate mind training (CMT)
Group
20 sessions
No control group 6 weeks Primary measures: SCS, OAS, SeCS, BDI-II, RSE, SIP-AD. Secondary measures: PANSS. Mental functions:
Depression (BDI-II)
Global scores:
General psychopathology (PANSS)
Personal factors:
Comparisons to others (SCS), self-esteem (RSE), external shame (OAS).
Weak
Study
(country)
Recovery Study design n Intervention group Control group Follow up Outcome measures Impact on disability Quality of rating
Penn et al., 2011
The USA
Recovery concept: illness management and functional recovery.
Main content: the program placed an emphasis on personal goal pursuit to foster optimism and self-esteem, targeted malleable factors that may enhance recovery such as residual symptoms and substance use, and enlists external social support to maximize therapeutic gains and engagement. The intervention consisted of four phases: engagement and wellness management; substance use; persistent symptoms; and functional recovery.
RCT 46 total
23 intervention
23 control
Graduated Recovery Intervention Program (GRIP) (CBT) + TAU
Individual
36 sessions
TAU 3 months Primary outcomes: QLS; RFS, MCAS; SSPA.
Secondary outcomes: the PANSS; CDSS; subscales from the Scales of
Psychological Well-Being; MSPSS; AUS; DUS; BEMIB.
Activity and participation domain: Work functioning at follow-up (RFS)
Within-group analysis
Mental functions:
Depression (CDSS) across the trial
Activity and participation domain:
Extended social network (RFS) across the trial
Global scores:
Total role functioning (RFS) across the trial
Personal factors:
Social competence (MCAS) across the trial
Weak
Williams et al., 2014
The UK
Recovery concept: the recovery model described as building a meaningful and satisfying life defined by the person themselves, focusing upon strengths and wellness not illness and pathology, a sense of hope, and possibility of change, promotion of self-management and personal identity (not patient identity), the therapeutic relationship being one of partnership not “expert-patient”; and encouragement of group members to help each other in recovery.
Main content: The intervention was delivered in five modules. The first one focused on engagement and treatment preparation, module two on individual analysis of the person and schizophrenia, module three understanding and managing positive symptoms, module four maximizing mental health and module five reviews of personal aims and goals, reinforcement of protective factors, development of a detailed relapse recognition and staying well plan as well as discussion of future directions.
CCT 47 total
30 intervention
17 control
Cognitive-behavioural therapy
Individual and group
35 planned sessions
TAU No follow up SAPS, SANS, PSYRATS, DASS, IIP. Mental functions:
Delusions (SAPS)
Hallucinations (SAPS)
Affective flattening (SANS)
Alogia (SANS)
Anhedonia (SANS)
Avolition (SANS)
Depression (DASS)
Anxiety (DASS)
Overall interpersonal problems (social inhibition and self-sacrifice) (IIP)
Moderate
  1. CCT Clinical Controlled Trial, CCT* Clinical Controlled Trial (EPHPP criteria regarding RCTs where the allocation method is not described or allocation is transparent before assignment), Pre + post Cohort (one group pre + post (before and after)), RCT Randomized Controlled Trial, TAU Treatment as usual, n number of participants, PANSS Positive and Negative Syndrome scale, HADS The Hospital Anxiety and Depression Scale, RSE Rosenberg Self-Esteem scale, LSP the Life Skills Profile, BHS Beck Hopelessness Scale, QLS Quality of Life Scale, BDI-II the Beck Depression Inventory, BAI the Beck Anxiety Inventory, SOFAS the Social and Occupational Functioning Assessment Scale, CAN the Camberwell Assessment of Needs, GAS The Global Assessment Scale, SANS Scale for the Assessment of Negative Symptoms, SAPS The Scale for the Assessment of Positive Symptoms, AAQ-II The Acceptance and Action Questionnaire, CFQ The Cognitive Fusion Questionnaire, SMQ The Southampton Mindfulness Questionnaire, SCS Social Comparison Scale, OAS The Other as Shamer Scale, SeCS Self-Compassion Scale, SIP-AD The Self-Image Profile for Adults, RFS The Role Functioning Scale, MCAS The Multnomah Community Ability Scale, SSPA The Social Skills Performance Assessment, CDSS the Calgary Depression Scale for Schizophrenia, MSPSS The Multidimensional Scale of Perceived Social Support, AUS the Alcohol Use Scale, DUS Drug Use Scale, BEMIB The Brief Evaluation of Medication Influence and Beliefs, PSYRATS the Psychotic Symptom Rating Scales, DASS Depression Anxiety Stress Scale, IIP The Inventory of Interpersonal Problems