Group programmes for recovery from psychosis: a systematic review

Background

Pharmacotherapy can improve some of the symptoms of schizophrenia but has limited effect on the social impairments that characterize the disorder and limit functioning and quality of life. The review will consider the current evidence for effectiveness of group therapy as an adjunct to pharmacotherapy for schizophrenia and schizoaffective disorders.

Materials and methods

We reviewed published outcome studies since 1985 identified in MEDLINE and PsycINFO searches, based on the following key variables:psychotic-disorders-therapy, schizophrenia, schizoaffective disorders, group therapy, psychoeducation, psychotherapy, psychosocial treatments, social skills training.

Results

We identified 20 studies: 13 on social-occupational skills training, 4 on psychoeducational interventions, 1 on group cognitive behaviour therapy, 1 on psychoanalytic group psychotherapy and 1 on supportive group therapy. Controls were included in 14 and all studies included medication. Benefits in symptoms as well as social and vocational functioning associate with group therapy. Many studies lack appropriate control groups, follow-up and standardised measures of symptoms and diagnosis.

Conclusions

Adjunctive group therapy augment the benefits of pharmacotherapy and enhance social functioning in psychosis. Better designed studies would reduce the risk of over-estimates of effect sizes. Few studies, small sample sizes, brief treatment durations, nonstandardized assessment instruments, differences in patient (i.e., acute versus treatment resistant) and variable staff training may have contributed to the limited positive outcomes.