Cognitive Behavioral Therapy May Be Effective in Preventing Transition to Psychosis

man in therapy
man in therapy
The researchers’ goal was to explore the efficacy of cognitive-behavioral therapy for psychosis in patients with a high clinical risk for psychosis.

Cognitive behavioral therapy for psychosis (CBTp) effectively lessened the severity of psychotic symptoms and rates of psychosis transition during the prodromal stage of psychosis. This is according to the results of a systemic review and meta-analysis published in Schizophrenia Bulletin.

CBTp is a first-line treatment for people at clinical high risk of psychosis. Previous studies to determine whether CBTp improves clinical outcomes in young adults at risk of psychosis were inconclusive, but the study authors believe CBTp is a promising preventive intervention.

This analysis included studies conducted in China and published in Chinese. The literature search included the following databases: MEDLINE via PubMed, Embase and PsycInfo® via Ovid, The Cochrane Library, Chinese Biomedical Literature Database (CBM), China Knowledge Resource Integrated Database (CNKI), VIP Database, and Wanfang Data.

The primary outcome was transition to psychosis. Secondary outcomes included psychotic symptoms, quality of life, depression, and distress. Of an initial 510 publications, 14 published papers met all inclusion and exclusion criteria. The results yielded 1128 total participants, 57.5% of whom were men.

Of the 7 trials that reported transition by 6 months, 5 compared CBTp with need-based intervention (NBI). The remaining trials compared CBTp plus NBI with NBI alone. At 6 months, no difference was seen in the fixed-effects analysis (relative risk, 0.52; 95% CI, 0.26-1.01; P = 0.06).

Regarding secondary outcomes, the researchers also found no statistically significant difference at 6 months in attenuated psychotic symptoms, functioning, depression, distress, and quality of life.

Follow-up at 12 and 24 months was significant. At 12 months, for example, effects on attenuated psychotic symptoms include SMD, -0.17; 95% CI, -0.33 to -0.02; 7 studies, N=623. By 24 months, effects on attenuated psychotic symptoms were SMD, -0.24; 95% CI, -0.43 to -0.06; 4 studies, N=442.

This study had some limitations. The transition criteria varied among studies analyzed, which may have influenced results. Significant heterogeneity was also present in secondary outcomes.

“While the case for beneficial effects on functioning, depression, quality of life and distress appears, from studies to date, to be weak, current evidence does support the hypothesis that CBTp could significantly reduce transition rates by 12 months, 24 months, and over 24 months,” the researchers concluded. “Benefits could also be observed in reducing attenuated psychotic symptoms by 12 months and 24 months, with less robust evidence.”


Zheng Y, Xu T, Zhu Y, et al. Cognitive behavioral therapy for prodromal stage of psychosis — outcomes for transition, functioning, distress, and quality of life: a systematic review and meta-analysis. Schizophr Bull. Published online May 4, 2021. doi:10.1093/schbul/sbab044