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Original research
Classification of psychotherapy interventions for people with schizophrenia: development of the Nottingham Classification of Psychotherapies
  1. Matthew T Roberts1,
  2. Farhad Shokraneh2,3,
  3. Yanli Sun4,
  4. Maddie Groom5,
  5. Clive E Adams6
  1. 1Academic Foundation Programme, Nottingham University Hospitals NHS Trust, Nottingham, UK, Nottingham, UK
  2. 2King’s Technology Evaluation Centre, London Institute of Healthcare Engineering, School of Biomedical Engineering and Imaging Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, UK
  3. 3Cochrane Schizophrenia, Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
  4. 4Perinatal Community Mental Health Team, Lincolnshire Partnership NHS Foundation Trust, Lincoln, UK
  5. 5School of Medicine, Division of Psychiatry and Applied Psychology, University of Nottingham, Nottingham, UK
  6. 6Institute of Mental Health, Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Cochrane Schizophrenia Group, Nottingham, UK
  1. Correspondence to Dr Matthew T Roberts, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK; Matthew_T_Roberts{at}outlook.com

Abstract

Background Currently, there is no accepted system for the classification of psychotherapies for application within systematic reviews. The creation of anuncomplicated, understandable and practical classification system is neccessary for conducting reliable systematic reviews.

Objective To devise a system for classification of psychotherapy interventions—for use, initially, in systematic reviews.

Methods Cochrane Schizophrenia’s Register used as the source of randomised controlled trial. After being piloted and refined at least twice, finally we applied it to all relevant trials within the register. Basic statistical data already held within the register were extracted and used to calculate the distribution of schizophrenia research by form of psychotherapy.

Findings The final classification system consisted of six definable broad ‘boughs’ two of which were further subdivided into ‘branches’. The taxonomy accommodated all psychotherapy interventions described in the register. Of the initial 1645 intervention categories within the register, after careful recoding, 539 (33%) were psychotherapies (234 coded as ‘Thought/Action’ (cognitive & behavioural)—1495 studies; 135 ‘Cognitive Functioning’—652 studies; 113 ‘Social’—684 studies; 55 ‘Humanistic’—272 studies; 23 ‘Psychoanalytic/dynamic’—40 studies; and 63 ‘Other’—387 studies). For people with schizophrenia, across categories, the average size of psychotherapy trial is small (107) but there are notable and important exceptions.

Conclusion We reported a practical method for categorising psychotherapy interventions in evaluative studies with applications beyond schizophrenia. A move towards consensus on the classification and reporting of psychotherapies is needed.

Clinical implications This classification can aid clinicians, clinical practice guideline developers, and evidence synthesis experts to recognise and compare the interventions from same or different classes.

  • schizophrenia & psychotic disorders
  • adult psychiatry
  • child & adolescent psychiatry
  • delirium & cognitive disorders
  • forensic psychiatry

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Footnotes

  • Twitter @FarhadShokrane

  • Contributors MTR has developed the protocol and ran the research and wrote the first draft of the manuscript and revised it. FS has developed the register, contributed in finding existing relevant classification literature, read the manuscript and made comments and prepared the manuscript for submission. YS contributed in refining the classification from a sample of trials and Chinese studies, double checking the classed and read and commented on the manuscript. MG research and commented on the classification and manuscript. CEA suggested the idea for this research and supervised the team on running this research. He read, commented and revised the manuscript several times.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement The full database of intervention categories analysed in this study is available from the authors on request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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