CBT Beneficial for Reducing Risk of Relapse in First Episode Schizophrenia

psychotherapy therapist making notes while female patient is lying on the couch
psychotherapy therapist making notes while female patient is lying on the couch
Investigators in China found that cognitive behavioral therapy helped prevent relapse in patients after their first episode of schizophrenia.

Patients with first-episode schizophrenia (FES) benefit from cognitive behavioral therapy (CBT) in the prevention of relapse and improving symptoms up to 1 year after treatment. This is according to randomized controlled trial findings published in Psychiatry Research.

Outpatients from a hospital in China were recruited for the study if they had a diagnosis of schizophrenia, were between the ages of 16 and 45, had a current illness that was their first schizophrenia episode, were being treated with a single atypical antipsychotic drug for ≥2 weeks, had a Positive and Negative Syndrome Scale (PANSS) score of ≥4 on the delusion (P1) or hallucination (P3) symptoms scales, and experienced their first psychotic symptoms <3 years ago. Research investigators randomly assigned patients to either 10 sessions of individual CBT (n=35) adjunctive to treatment as usual (TAU) or TAU only (n=29). Assessments of symptoms, relapse, hospitalization, insight, and social function were conducted at baseline and 10 weeks, 6 months, and 12 months following treatment.

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At baseline, all patients were clinically stable and no difference was observed between the 2 groups in terms of antipsychotic medication use to week 62. A significantly higher percentage of patients in the TAU-only group relapsed at the end of the trial vs the CBT plus TAU group (32.5% vs 10%, respectively; P =.044). A similarly higher percentage of patients in the TAU-only group also experienced hospitalization during the study, a finding that trended toward significance (20% vs 7.5%; P =.06). In addition, patients receiving CBT plus TAU had a 25% greater reduction in the PANSS total score compared with the TAU-only group (47.5% vs 25%, respectively; P =.036). A higher number of participants in the CBT group also had a current employment position at 62-week follow-up vs patients in the TAU group (24 vs 15, respectively; P =.044).

Study limitations include its relatively short follow-up and the lack of patients with severe symptoms necessitating hospitalization, which may reduce generalizability of the findings.

Despite the limitations, findings from this study are promising and suggest “that more research is warranted exploring the effects of CBT for first episode psychosis, specifically targeting relapse prevention and positive symptom,” according to the researchers.


Liu Y, Yang X, Gillespie A, et al. Targeting relapse prevention and positive symptom in first-episode schizophrenia using brief cognitive behavioral therapy: A pilot randomized controlled study. Psychiatry Res. 2018;272:275-283.