Who engages with, and responds to, CBT for psychosis remains largely unpredictable, systematic review finds

A systematic review of 23 studies (3,241 participants, most with established schizophrenia rather than first-episode psychosis or those at clinical high risk) examined what predicts engagement with, and response to, cognitive behavioural therapy for psychosis (CBTp) Synthesis (Gorina et al.1). The review found substantial heterogeneity in study design and outcome measures, and no consistently replicated predictor: associations between lower delusional conviction, higher insight, illness duration and symptom severity with outcome varied across studies rather than converging on a clear pattern.

The authors state plainly that the evidence does not allow definitive conclusions about what drives CBTp engagement or outcome, and call for further research, particularly in early psychosis, where evidence was most limited.

For services delivering CBTp, this review is a caution against assuming any single patient characteristic reliably predicts who will engage or benefit — targeting engagement support on the basis of current evidence would be speculative rather than evidence-based.