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Cognitive behavioral therapy (CBT) for schizophrenia/psychosis

Adult Mental Health: Serious Mental Illness
Benefit-cost methods last updated December 2023.  Literature review updated December 2014.
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Cognitive behavioral therapy for psychosis (CBTp) includes the application of cognitive strategies focused on changing thoughts to improve feelings and behaviors as well as behavioral techniques most often used to address negative symptoms. CBTp involves teaching patients methods of coping with their symptoms and training in problem solving, social skills and strategies to reduce risk of relapse. In this collection of studies, CBTp was provided in addition to antipsychotic medication.
For an overview of WSIPP's Benefit-Cost Model, please see this guide. The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2022). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $9,566 Benefits minus costs $14,930
Participants $1,395 Benefit to cost ratio $9.70
Others $2,012 Chance the program will produce
Indirect $3,671 benefits greater than the costs 60%
Total benefits $16,645
Net program cost ($1,715)
Benefits minus cost $14,930

^WSIPP’s benefit-cost model does not monetize this outcome.

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 Treatment age No. of effect sizes Treatment N Adjusted effect sizes(ES) and standard errors(SE) used in the benefit - cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
36 15 727 -0.123 0.070 37 -0.091 0.096 38 -0.123 0.078
36 7 267 0.017 0.103 37 0.013 0.097 38 0.017 0.866
36 18 721 0.231 0.069 37 n/a n/a n/a 0.232 0.001
36 16 832 -0.124 0.106 37 -0.092 0.122 38 -0.124 0.241
36 25 1172 -0.148 0.101 37 n/a n/a n/a -0.148 0.144
36 2 115 -0.174 0.331 37 n/a n/a n/a -0.174 0.599
36 33 1477 -0.178 0.059 37 n/a n/a n/a -0.178 0.003
36 25 1143 -0.170 0.069 37 n/a n/a n/a -0.170 0.014
36 2 75 -0.011 0.195 37 n/a n/a n/a -0.011 0.956
36 3 92 0.300 0.249 37 n/a n/a n/a 0.300 0.299
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Affected outcome: Resulting benefits:1 Benefits accrue to:
Taxpayers Participants Others2 Indirect3 Total
Major depressive disorder Labor market earnings associated with major depression $926 $2,182 $0 $0 $3,109
Mortality associated with depression $1 $2 $0 $17 $20
Anxiety disorder Labor market earnings associated with anxiety disorder ($384) ($904) $0 $0 ($1,288)
Health care associated with anxiety disorder ($26) ($7) ($26) ($13) ($72)
Hospitalization (psychiatric) Health care associated with psychiatric hospitalization $9,049 $123 $2,038 $4,524 $15,734
Program cost Adjustment for deadweight cost of program $0 $0 $0 ($858) ($858)
Totals $9,566 $1,395 $2,012 $3,671 $16,645
Click here to see populations selected
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,436 2014 Present value of net program costs (in 2022 dollars) ($1,715)
Comparison costs $0 2014 Cost range (+ or -) 10%
Per-participant cost of treatment by modality (group/individual) was weighted by treatment Ns reported in the studies. Cost per-session per-person was $37.91/session for group and $120.90 for individual therapy (2014 dollars), based on actuarial tables reported for disabled adults in Mercer (2013) Behavioral Health Data Book for the State of Washington For Rates Effective January 1, 2014.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Benefits Minus Costs
Benefits by Perspective
Taxpayer Benefits by Source of Value
Benefits Minus Costs Over Time (Cumulative Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in discounted dollars. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Citations Used in the Meta-Analysis

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Bateman, K., Hansen, L., Turkington, D., & Kingdon, D. (2007). Cognitive Behavioral Therapy reduces suicidal ideation in schizophrenia: Results from a randomized controlled trial. Suicide and Life-Threatening Behavior, 37(3), 284-290.

Bechdolf, A.,Knost, B.,Kuntermann, C.,Schiller, S, Klosterkötter, J., Hambrecht, M., & Pukrop, R. (2004). A randomized comparison of group cognitive-behavioural therapy and group psychoeducation in patients with schizophrenia. Acta Psychiatica Scandivica, 110, 21-28.

Bradshaw, W. (2000). Integrating cognitive-behavioral psychotherapy for persons with schizophrenia into a psychiatric rehabilitation program: results of a three year trial. Community Mental Health Journal, 36(5), 491-500.

Cather, C., Penn, D., Otto, M.W., Yovel, I., Mueser, K.T., & Goff, D.C. (2005). A pilot study of functional Cognitive Behavioral Therapy (fCBT) for schizophrenia. Schizophrenia Research, 74, 2-3.

Daniels, L. (1998). A group cognitive-behavioral and process-oriented approach to treating the social impairment and negative symptoms associated with chronic mental illness. The Journal of Psychotherapy Practice and Research, 7(2), 167-76.

Durham, R.C., Guthrie, M., Morton, R.V., Reid, D.A., Treliving, L.R., Fowler, D., & Macdonald, R.R. (2003). Tayside-Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. Results to 3-month follow-up. The British Journal of Psychiatry : the Journal of Mental Science, 182, 303-11.

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Granholm, E., McQuaid, J.R., McClure, F.S., Link, P.C., Perivoliotis, D., Gottlieb, J.D., Patterson, T.L., ... Jeste, D. V. (2007). Randomized controlled trial of cognitive behavioral social skills training for older people with schizophrenia: 12-month follow-up. The Journal of Clinical Psychiatry, 68(5), 730-7.

Granholm, E., Holden, J., Link, P.C., McQuaid, J.R., & Jeste, D.V. (2013). Randomized controlled trial of cognitive behavioral social skills training for older consumers with schizophrenia: Defeatist performance attitudes and functional outcome. American Journal of Geriatric Psychiatry, 21 (3), 251-262.

Gumley, A.I., O'Grady, M., Mcnay, L., Reilly, J., Power, K.G., & Norrie, J. (2003). Early intervention for relapse in schizophrenia: results of a 12-month randomized controlled trial of cognitive behavioural therapy. Psychological Medicine, 33(3),419-431.

Haddock, G., Tarrier, N., Morrison, A.P., Hopkins, R., Drake, R., & Lewis, S. (1999). A pilot study evaluating the effectiveness of individual inpatient cognitive-behavioural therapy in early psychosis. Social Psychiatry and Psychiatric Epidemiology, 34(5), 254-8.

Haddock, G., Barrowclough, C., Shaw, J.J., Dunn, G., Novaco, R.W., & Tarrier, N. (2009). Cognitive-behavioural therapy v. social activity therapy for people with psychosis and a history of violence: randomised controlled trial. The British Journal of Psychiatry : the Journal of Mental Science, 194(2), 152-7.

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