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Module 3 Discussion: Selecting Inclusion/Exclusion Criteria for PICO Research
Emmanuel Rodriguez
ST. Thomas University
NUR 670 Psych Management Integration
Dr. Mays
07/17/2025
Abstract
This discussion explores the systematic identification of inclusion and exclusion criteria for the PICO question: In adult patients diagnosed with Schizotypal Personality Disorder (STPD) treated as outpatients in psychiatric units, does Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) affect symptoms of social anxiety? The literature search used a broad search of five major U.S.-based databases in a strict filter that only searched Level 1 and 2 evidence published in the last five years. Boolean terms and keyword phrases were used to limit the search. The selection was reduced to study samples of adult outpatients, comparisons of CBT and DBT, and quantifiable outcomes of social anxiety, to be most relevant and clinically feasible.
PICO Question:
In adults with Schizotypal Personality Disorder (STPD) receiving outpatient psychiatric care, how does Cognitive Behavioral Therapy (CBT) compared to Dialectical Behavior Therapy (DBT) affect social anxiety symptoms?
Inclusion/Exclusion Criteria Table:
|
Database Searched |
Search Terms / Keywords |
Boolean Operators Used |
Limits / Filters Applied |
Number of Results Found |
|
PubMed |
“Schizotypal Personality Disorder” AND “Cognitive Behavioral Therapy” AND “Dialectical Behavior Therapy” AND “social anxiety” |
AND |
English; Humans; Adults; Last 5 years; U.S.-based studies |
67 |
|
CINAHL |
“STPD” OR “Schizotypal Personality Disorder” AND “CBT” OR “DBT” AND “outpatient psychiatric care” |
OR, AND |
Peer-reviewed; English; Published 2019–2024; United States |
52 |
|
PsycINFO |
“CBT” AND “DBT” AND “social anxiety” AND “Schizotypal Personality Disorder” |
AND |
Adults; English; Empirical studies; U.S. only; Last 5 years |
89 |
|
Cochrane Library |
“Cognitive Behavioral Therapy” AND “Dialectical Behavior Therapy” AND “STPD” |
AND |
Adults; English; Published in last 5 years; U.S.-based research only |
24 |
|
Medline (via EBSCO) |
“STPD” AND “CBT” AND “DBT” AND “social functioning” |
AND |
English; Academic journals; U.S. authors; Adults 18+; Published after 2020 |
41 |
Database Search and Evidence Gathering Process:
To find high-quality and evidence-based research that would support the PICO question, I made a systematic search of several respected databases, including PubMed, CINAHL, PsycINFO, Cochrane Library, and Medline. I have deliberately chosen these databases, as they have the reputation of including peer-reviewed and scholarly information concerning psychiatric nursing and psychological therapies (Goossen et al., 2020). Combinations of words and MeSH terms that I employed were: distinctions between CBT/DBT and schizotypal personality disorder, as well as social anxiety. The refinement of search results was possible with the help of Boolean operators, such as the word AND and OR, and the search finally found results that compared the two therapy modalities and focused on the specific symptom of social anxiety in STPD adults (Jha et al., 2022).
The limits and filters played a paramount role in the refinement of the search to include only Level 1 and Level 2 evidence and those conducted in the US. The reason why such restrictions were implemented was to make sure that the research is not obsolete and relevant to outpatient psychiatric practice in the United States. I chose to retrieve research published not earlier than five years, with only English-language articles being included, and studies on human adults only being accepted. Also, only peer-reviewed and empirical research studies were incorporated to fulfill the requirements of high-levels of evidence (Vatkar et al., 2025). Relevance to the adult outpatient population, direct comparison between CBT and DBT and the evaluation of the results in terms of social anxiety symptoms became the major inclusion criteria. Articles with inpatient populations, adolescents or children, non-peer-reviewed articles, non-U.S. who wrote the article, and failure to directly compare CBT and DBT were all an exclusion criterion.
Through the five databases, I found out about 273 total articles. I also narrowed down these findings to abstract reading and using other criteria, like the study design (RCTs, systematic reviews, and meta-analyses) so that the studies would provide Level 1 or 2 evidence. Those articles containing mixed personality disorders without emphasis on STPD or those articles that contained either CBT or DBT but neither were an exclusion criteria. I focused on randomized controlled trials and meta-analysis of the relevance of CBT and DBT approaches to treating social anxiety symptoms in this specific population such as Bhattacharya et al. (2022) and Sadat et al. (2025).
References
Bhattacharya, S., Goicoechea, C., Heshmati, S., Carpenter, J. K., & Hofmann, S. G. (2022). Efficacy of Cognitive Behavioral Therapy for anxiety-related disorders: A meta-analysis of recent literature.
Current Psychiatry Reports,
25(1), 19–30.
Goossen, K., Hess, S., Lunny, C., & Pieper, D. (2020). Database Combinations to Retrieve Systematic Reviews in Overviews of reviews: a Methodological Study.
BMC Medical Research Methodology,
20(1).
Jha, R., Sondhi, V., & Vasudevan, B. (2022). Literature search: Simple Rules for Confronting the Unknown.
Medical Journal Armed Forces India,
78(1), S14–S23.
Sadat, P., Khakpour, M. S., Kazemi, M., Mousavi, S. E., Nitsche, M. A., Salehinejad, M. A., & Mohsen Dadashi. (2025). Efficacy of CBT, intensified tDCS and their combination for reducing clinical symptoms and improving quality of life in social anxiety disorder with comorbid depression: a randomized controlled trial.
BMC Psychiatry,
25(1).
Vatkar, A., Kale, S., Shyam, A., & Srivastava, S. (2025). Understanding the Levels of Evidence in Medical Research.
Journal of Orthopaedic Case Reports,
15(5), 6–9.
