Table 2

GRADE summary of evidence for the effects of CBT and personal recovery

Certainty assessment							Patients, n		Effect		Certainty	Importance
Studies, n	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	Other considerations	CBT	TAU	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Personal recovery
3	Randomised trials	Not serious	Not serious	Not serious	Not serious	None	212	230	–	MD 2.27 higher (0.1 higher to 4.45 higher)	⨁⨁⨁⨁ High	Critical
Follow-up (personal recovery)
3	Randomised trials	Not serious	Not serious	Not serious	Not serious	None	192	219	–	MD 2.62 higher (0.51 higher to 4.47 higher)	⨁⨁⨁⨁ High	Critical
Quality of life
10	Randomised trials	Serious*	Not serious	Not serious	Serious†	None	456	482	–	MD 0.01 higher (0.12 lower to 0.15 higher)	⨁⨁◯◯ Low	Critical
Follow-up (quality of life)
8	Randomised trials	Serious*	Not serious	Not serious	Serious‡	None	65	65	–	MD 0.06 higher (0.03 lower to 0.15 higher)	⨁⨁◯◯ Low	Critical
Hope
5	Randomised trials	Serious*	Serious§	Serious¶	Serious†	Publication bias strongly suspected**	189	178	–	MD 1.77 lower (3.29 lower to 0.25 lower)	⨁◯◯◯ Very low	Critical
Follow-up (hope)
3	Randomised trials	Serious*	Serious§	Serious¶	Serious†	None	131	126	–	MD 0.38 lower (2.78 lower to 2.02 lower)	⨁◯◯◯ Very low	Critical
Identity
10	Randomised trials	Serious*	Serious††	Not serious	Not serious	None	307	277	–	MD 1.85 higher (0.69 higher to 3.01 higher)	⨁⨁◯◯ Low	Critical
Follow-up (identity)
6	Randomised trials	Serious*	Not serious	Not serious	Serious‡	None	173	174	–	1.21 lower (2.45 lower to 0.04 higher)	⨁⨁◯◯ Low	Critical

*Allocation concealment bias. Blinding of participants bias and incomplete outcome data bias were observed in some included studies.
†The study included patients who were relatively small and the CIs were wide.
‡Some studies included patients who were relatively small.
§Some included studies reported a positive effect of CBT for hope, whereas other studies failed to find such effect.
¶Some studies use hopeless levels to reflect hope levels.
**Selective reporting.
††Some included studies reported no effect of CBT for identity.
CBT, cognitive–behavioural therapy; GRADE, Grading of Recommendations Assessment, Development and Evaluation; MD, mean difference; TAU, treatment as usual.