title: Clinical effectiveness and cost-effectiveness of body psychotherapy in the treatment of negative symptoms of schizophrenia: a multicentre randomised controlled trial.
abstract: BACKGROUND
  The negative symptoms of schizophrenia significantly impact on quality of life and social functioning, and current treatment options are limited. In this study the clinical effectiveness and cost-effectiveness of group body psychotherapy as a treatment for negative symptoms were compared with an active control.
  
  
  METHODS
  A parallel-arm, multisite randomised controlled trial. Randomisation was conducted independently of the research team, using a 1 : 1 computer-generated sequence. Assessors and statisticians were blinded to treatment allocation. Analysis was conducted following the intention-to-treat principle. In the cost-effectiveness analysis, a health and social care perspective was adopted.
  
  
  METHODS
  
  
  
  METHODS
  age 18-65 years; diagnosis of schizophrenia with symptoms present at > 6 months; score of ≥ 18 on Positive and Negative Syndrome Scale (PANSS) negative symptoms subscale; no change in medication type in past 6 weeks; willingness to participate; ability to give informed consent; and community outpatient.
  
  
  METHODS
  inability to participate in the groups and insufficient command of English.
  
  
  METHODS
  Participants were recruited from NHS mental health community services in five different Trusts. All groups took place in local community spaces.
  
  
  METHODS
  Control intervention: a 10-week, 90-minute, 20-session group beginners' Pilates class, run by a qualified Pilates instructor. Treatment intervention: a 10-week, 90-minute, 20-session manualised group body psychotherapy group, run by a qualified dance movement psychotherapist.
  
  
  RESULTS
  The primary outcome was the PANSS negative symptoms subscale score at end of treatment. Secondary outcomes included measures of psychopathology, functional, social, service use and treatment satisfaction outcomes, both at treatment end and at 6-month follow-up.
  
  
  RESULTS
  A total of 275 participants were randomised (140 body psychotherapy group, 135 Pilates group). At the end of treatment, 264 participants were assessed (137 body psychotherapy group, 127 Pilates group). The adjusted difference in means of the PANSS negative subscale at the end of treatment was 0.03 [95% confidence interval (CI) -1.11 to 1.17], showing no advantage of the intervention. In the secondary outcomes, the mean difference in the Clinical Assessment Interview for negative symptoms expression subscale at the end of treatment was 0.62 (95% CI -1.23 to 0.00), and in extrapyramidal movement disorder symptoms -0.65 (95% CI -1.13 to -0.16) at the end of treatment and -0.58 (95% CI -1.07 to -0.09) at 6 months' follow-up, showing a small significant advantage of body psychotherapy. No serious adverse events related to the interventions were reported. The total costs of the intervention were comparable with the control, with no clear evidence of cost-effectiveness for either condition.
  
  
  CONCLUSIONS
  Owing to the absence of a treatment-as-usual arm, it is difficult to determine whether or not both arms are an improvement over routine care.
  
  
  CONCLUSIONS
  In comparison with an active control, group body psychotherapy does not have a clinically relevant beneficial effect in the treatment of patients with negative symptoms of schizophrenia. These findings conflict with the review that led to the current National Institute for Health and Care Excellence guidelines suggesting that arts therapies may be an effective treatment for negative symptoms.
  
  
  CONCLUSIONS
  Determining whether or not this lack of effectiveness extends to all types of art therapies would be informative.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN842165587.
  
  
  BACKGROUND
  This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 20, No. 11. See the NIHR Journals Library website for further project information.
authors: Unit for Social and Community Psychiatry, World Health Organization Collaborative Centre for Mental Health Services Development, Queen Mary University of London, London, UK.
authors: Stefan
authors: S
authors: Priebe
authors: Unit for Social and Community Psychiatry, World Health Organization Collaborative Centre for Mental Health Services Development, Queen Mary University of London, London, UK.
authors: Mark
authors: M
authors: Savill
authors: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors: Til
authors: T
authors: Wykes
authors: Department of Psychiatry, University of Liverpool, Liverpool, UK.
authors: Richard
authors: R
authors: Bentall
authors: Services Psychiatriques Jura bernois, Bienne-Seeland, Bellelay, Switzerland.
authors: Christoph
authors: C
authors: Lauber
authors: Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.|Department of Psychiatry and Psychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands.
authors: Ulrich
authors: U
authors: Reininghaus
authors: Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors: Paul
authors: P
authors: McCrone
authors: Centre for the Economics of Mental and Physical Health, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
authors: Iris
authors: I
authors: Mosweu
authors: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
authors: Stephen
authors: S
authors: Bremner
authors: Centre for Primary Care and Public Health, Queen Mary University of London, London, UK.
authors: Sandra
authors: S
authors: Eldridge
authors: Unit for Social and Community Psychiatry, World Health Organization Collaborative Centre for Mental Health Services Development, Queen Mary University of London, London, UK.
authors: Frank
authors: F
authors: Röhricht
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003362:Cost-Benefit Analysis; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011615:Psychotherapy, Group / Q000191:economics* / Q000379:methods; D019057:Quality-Adjusted Life Years; D012559:Schizophrenia / Q000191:economics / Q000628:therapy*; D055815:Young Adult