Effectiveness of Psychological Intervention Methods for the Management of Positive and Negative Symptoms in Schizophrenia Patients: A Systematic Review and Network Meta-analysis

Abstract

Purpose of the Review: There is a dearth of research on determining the optimal psychological intervention approach for symptom-specific management in schizophrenia. Hence, the current study aimed to assess the efficacy of therapeutic strategies in the management of various symptom subtypes, such as positive symptoms (PS) and negative symptoms (NS), hallucinations, and delusions in schizophrenia. Collection and Analysis of Data: Six electronic journal databases, namely Web of Science, Scopus, EBSCOhost, PubMed, Ovid, and Taylor and Francis were searched up to November 2023 using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) for Network Meta-Analyses (NMA) guidelines. Articles were identified using predefined keywords and subsequently screened by pre-specified inclusion and exclusion criteria. Data from the included randomized controlled trials (RCTs) were extracted for PS, NS, hallucinations, and delusions, both for pre- and post-trial conditions. The effect size and standard errors of each trial were computed using the “metafor” library, and further NMA was performed using the “netmeta” package of R software version 4.2.1. The analysis was conducted on 100 RCTs involving 7,036 patients with schizophrenia undergoing eight different psychological interventions and treatment-as-usual (TAU). Meta-cognitive training (MCT+), social skills training (SST), cognitive behavioral therapy (CBT), and cognitive remediation therapy (CRT) were found to be effective in treating both PS and NS of schizophrenia. However, virtual reality therapy (VRT) was found to be effective only in the management of hallucinations and overall PS, and MCT+ and CBT were found to be effective treatment measures in the management of delusions. Conclusions: Psychotherapies were found to be more effective compared to TAU, except acceptance and commitment therapy (ACT) and supportive psychotherapy (ST). PROSPERO Registration ID: CRD42022385392. © 2025 The Author(s). This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access page (https://us.sagepub.com/en-us/nam/open-access-at-sage).