Dropout from individual cognitive behavioral psychotherapy for schizophrenia: a systematic review and meta-analysis of randomized clinical trials.
Alberto Stefana, Stefano Damiani, Stefano Barlati et al.
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In 30 seconds
This secondary analysis of a systematic review and meta-analysis examined dropout from individual, face-to-face outpatient cognitive behavioral therapy (CBT) for schizophrenia spectrum disorders. It included 13 randomized clinical trials, with 16 psychotherapy arms and 865 participants, and used random-effects models to estimate dropout and exploratory meta-regression to assess arm-level moderators. The pooled dropout estimate was approximately one in five participants. Dropout varied substantially between arms, and the moderator analyses were exploratory rather than evidence of causal effects.
Key findings
- Across 16 CBT arms involving 865 participants, the pooled dropout estimate was approximately one in five.
- There was substantial between-arm heterogeneity in dropout.
- Analyses of arm-level sociodemographic, clinical, treatment-related, and study-design moderators were exploratory.
Why it matters
Dropout is relevant to the practical effectiveness of CBT, which is often delivered alongside pharmacotherapy for schizophrenia spectrum disorders. This pooled estimate offers a descriptive benchmark across outpatient individual CBT trials, while the substantial variation between arms cautions against assuming that retention is consistent across settings or studies.
What to keep in mind
The estimate averages across heterogeneous studies and settings. Moderator analyses were exploratory and may have been underpowered; findings should not be interpreted causally or as showing that a moderator has no effect.