Efficacy of psychological interventions targeting cognitive biases in schizophrenia: A systematic review and meta-analysis.

Cognitive biases, which are tendencies to systematically process, select and remember certain information (e.g., jumping to conclusions), are exacerbated in schizophrenia and associated with delusions. Here we review and quantitatively assess psychological interventions targeting cognitive biases (e.g., metacognitive training, reasoning training, Maudsley review training programme) to evaluate their efficacy in improving cognitive biases, positive symptoms, and insight. Overall, thirty-two studies, including 15 distinct interventions and 2738 participants, were identified through a comprehensive keyword database search. Meta-analytic effect sizes were calculated and heterogeneity, publication bias, and subgroup analyses (study bias, active/passive intervention) were conducted. We observed significant small to moderate beneficial effects of cognitive interventions on cognitive biases (Hedges' g = 0.27; 95% CI = [0.13-0.41]; z = 3.77; p < .001), positive symptoms (Hedges' g = 0.30; 95% CI = [0.13-0.48]; z = 3.44, p < .005), and insight (Hedges' g = 0.35; 95% CI = [0.15-0.56]; z = 3.37,p < .005). Interestingly, studies with high risk of bias or passive control condition did not differ significantly from those with low risk or active control condition, respectively. Thus, cognitive biases are malleable via psychological interventions, which also exert, either directly or indirectly through reduced cognitive biases, beneficial effects on positive symptoms and insight.
Competing Interests: Declaration of Competing Interest Role of funding sources: This research was not funded by a specific granting agency, commercial or/not-for-profit sector. Salary awards include: doctoral award from the Fonds de Recherche du Québec – Santé (FRQS) for author GS; postdoctoral fellowship from the Canadian Institutes of Health Research (CIHR) for author KML; FRQ-S Research Scholar salary award for author MBB; and James McGill Professorship from McGill University and Research Chair from the FRQ-S for author ML. The funding sources had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication. Contributors: GS, MB and ML designed the study and wrote the protocol. GS, KML and GP conducted literature searches and data extraction. GS and GP conducted the statistical analysis. GS and KML wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript. Conflict of Interest Statement: Authors GS, KML, GP and MBB declare no conflicts of interest. Author ML reports grants from Otsuka Lundbeck Alliance, personal fees from Otsuka Canada, personal fees from Lundbeck Canada, grants and personal fees from Janssen, and personal fees from MedAvante-Prophase, all outside the submitted work.
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