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Cognitive behavioral therapy (CBT) for prodromal psychosis

Adult Mental Health: Serious Mental Illness
  Literature review updated September 2016.
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Studies in this review examined cognitive behavioral therapy in help-seeking adolescents and young adults identified as being prodromal, or at high-risk for developing psychosis. The primary purpose of treatment was to prevent or delay onset of psychosis. Treatments typically involved offering six months of weekly individual therapy, and focused on stress management, helping patients understand and cope with symptoms, and crisis management. In this review, cognitive behavioral therapy is compared with either assessment and monitoring only, or non-specific supportive therapy.
 
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META-ANALYSIS
CITATIONS

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases. See Estimating Program Effects Using Effect Sizes for additional information.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured No. of effect sizes Treatment N Adjusted effect size(ES) and standard error(SE) Unadjusted effect size (random effects model)
ES SE Age ES p-value
Anxiety disorder
Clinical diagnosis of an anxiety disorder (e.g., general anxiety, panic, social anxiety, obsessive compulsive disorder) or symptoms measured on a validated scale.
 21 2 101 -0.195 0.246 22 -0.195 0.427
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
 21 2 116 0.101 0.663 22 0.101 0.878
Global functioning
How well individuals (typically those who are developmentally disabled or seriously mentally ill) have adapted to activities of daily living.
 21 3 142 0.121 0.229 22 0.121 0.597
Hospitalization (psychiatric)
Admission to a psychiatric ward or hospital.
 21 1 59 -0.326 0.397 22 -0.326 0.411
Psychosis symptoms (positive)
Symptoms of psychosis that are experienced in addition to normal function (e.g., delusions, hallucinations, or agitation) measured on a validated scale, for individuals with serious mental illness.
 21 2 54 -0.311 0.294 22 -0.311 0.290
Psychiatric symptoms
Mental health symptoms (such as symptoms of psychosis) in individuals with serious mental illness, measured on a validated scale.
 21 3 180 -0.287 0.172 22 -0.287 0.096
Psychosis symptoms (negative)
Symptoms of psychosis that reflect a decrease or loss of normal function (e.g., diminished emotional expression, lack of motivation) measured on a validated scale, for individuals with serious mental illness.
 21 2 46 0.165 0.290 22 0.165 0.571
Psychosis onset
Initial development or onset of a diagnosed psychotic disorder such as schizoaffective disorder or schizophrenia.
 21 5 344 -0.653 0.275 22 -0.653 0.018

Citations Used in the Meta-Analysis

Addington, J., Epstein, I., Liu, L., French, P., Boydell, K M., & Zipursky, R.B. (2011). A randomized controlled trial of cognitive behavioral therapy for individuals at clinical high risk of psychosis. Schizophrenia Research, 125(1), 54-61.

Ising, H.K., Kraan, T.C., Rietdijk, J., Dragt, S., Klaassen, R.M., Boonstra, N., Nieman, D.H., . . . van der Gaag, M. (2016). Four-year follow-up of cognitive behavioral therapy in persons at ultra-high risk for developing psychosis: The Dutch Early Detection Intervention Evaluation (EDIE-NL) Trial. Schizophrenia Bulletin, 42(5), 1243-1252.

McGorry, P.D., Nelson, B., Phillips, L.J., Yuen, H.P., Francey, S.M., Thampi, A., Berger, G.E., . . . Yung, A.R. (2013). Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: twelve-month outcome. The Journal of Clinical Psychiatry, 74(4), 349-356.

Morrison, A.P., French, P., Walford, L., Lewis, S.W., Kilcommons, A., Green, J., et al. (2004). Cognitive therapy for the prevention of psychosis in people at ultra-high risk: Randomised controlled trial. The British Journal of Psychiatry, 185(4), 291-297.

Morrison, A.P., French, P., Stewart, S.L., Birchwood, M., Fowler, D., Gumley, A.I., Jones, P.B., . . . Dunn, G. (2012). Early detection and intervention evaluation for people at risk of psychosis: multisite randomised controlled trial. BMJ, 344.

van der Gaag, M., Nieman, D.H., Rietdijk, J., Dragt, S., Ising, H.K., Klaassen, R.M., Koeter, M., . . . Linszen, D.H. (2012). Cognitive behavioral therapy for subjects at ultrahigh risk for developing psychosis: a randomized controlled clinical trial. Schizophrenia Bulletin, 38(6), 1180-8.