Abstract: Four new trials were added after the 2012 search. The review now includes 24 relevant studies, with 2126 participants. Overall, the evidence was very low quality. We found no significant differences in the primary outcomes of relapse, hospitalisation and general functioning between supportive therapy and standard care. There were, however, significant differences favouring other psychological or psychosocial treatments over supportive therapy. These included hospitalisation rates (4 RCTs, n = 306, RR 1.82 CI 1.11 to 2.99, very low quality of evidence), clinical improvement in mental state (3 RCTs, n = 194, RR 1.27 CI 1.04 to 1.54, very low quality of evidence) and satisfaction of treatment for the recipient of care (1 RCT, n = 45, RR 3.19 CI 1.01 to 10.7, very low quality of evidence). For this comparison, we found no evidence of significant differences for rate of relapse, leaving the study early and quality of life. When we compared supportive therapy to cognitive behavioural therapy CBT), we again found no significant differences in primary outcomes. There were very limited data to compare supportive therapy with family therapy and psychoeducation, and no studies provided data regarding clinically important change in general functioning, one of our primary outcomes of interest. There are insufficient data to identify a difference in outcome between supportive therapy and standard care. There are several outcomes, including hospitalisation and general mental state, indicating advantages for other psychological therapies over supportive therapy but these findings are based on a few small studies where we graded the evidence as very low quality. Future research would benefit from larger trials that use supportive therapy as the main treatment arm rather than the comparator.

Plain-language summary: The aim of this review is to assess the effectiveness of supportive therapy compared to other specific therapies or treatment as usual. This update is based on a search run in 2012; the review now includes 24 randomised studies with a total of 2126 people. The studies compared supportive therapy either with standard care alone or a range of other therapies such as CBT, family therapy and psychoeducation. The participants continued to receive their antipsychotic medication and any other treatment they would normally receive during the trials. Overall, the quality of evidence from these studies was very low. There is not enough information or data to identify any real therapeutic difference between supportive therapy and standard care. There are several outcomes, including hospitalisation, satisfaction with treatment and general mental state, indicating advantages for other psychological therapies over supportive therapy. However, these findings are limited because they are based on only a few small studies where the quality of evidence is very low. There was very limited information to compare supportive therapy with family therapy and psychoeducation as most studies in this review focused on other psychological therapies, such as CBT. Apart from one study presenting data on death, there was no information on the adverse effects of supportive therapy. In summary, there does not seem to be much difference between supportive therapy, standard care and other therapies. Future research would benefit from larger studies where supportive therapy is the main treatment. Ben Gray, Senior Peer Researcher, McPin Foundation: http://mcpin.org/