|Benefit-Cost Summary Statistics Per Participant|
|Taxpayers||$8,766||Benefits minus costs||$13,586|
|Participants||$1,056||Benefit to cost ratio||$9.87|
|Others||$1,864||Chance the program will produce|
|Indirect||$3,431||benefits greater than the costs||61 %|
|Net program cost||($1,532)|
|Benefits minus cost||$13,586|
|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|
Major depressive disorder
Clinical diagnosis of major depression or symptoms measured on a validated scale.
Clinical diagnosis of an anxiety disorder (e.g., general anxiety, panic, social anxiety, obsessive compulsive disorder) or symptoms measured on a validated scale.
How well individuals (typically those who are developmentally disabled or seriously mentally ill) have adapted to activities of daily living.
Admission to a psychiatric ward or hospital.
Mental health symptoms (such as symptoms of psychosis) in individuals with serious mental illness, measured on a validated scale.
Thinking about and/or planning death by suicide.
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.
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.
Adherence to a specific prescribed medication regimen.
A positive motivational state, as measure on a validated scale such as the Kadzin Hopelessness Scale for Children.
|Detailed Monetary Benefit Estimates Per Participant|
|Affected outcome:||Resulting benefits:1||Benefits accrue to:|
|Major depressive disorder||Labor market earnings associated with major depression||$682||$1,602||$0||$0||$2,285|
|Mortality associated with depression||$1||$1||$0||$16||$17|
|Anxiety disorder||Labor market earnings associated with anxiety disorder||($279)||($655)||$0||$0||($933)|
|Health care associated with anxiety disorder||($24)||($7)||($24)||($12)||($67)|
|Hospitalization (psychiatric)||Health care associated with psychiatric hospitalization||$8,386||$114||$1,889||$4,193||$14,581|
|Program cost||Adjustment for deadweight cost of program||$0||$0||$0||($766)||($766)|
|Detailed Annual Cost Estimates Per Participant|
|Annual cost||Year dollars||Summary|
|Program costs||$1,436||2014||Present value of net program costs (in 2018 dollars)||($1,532)|
|Comparison costs||$0||2014||Cost range (+ or -)||10 %|
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.|
Bach, P., & Hayes, S.C. (2002). The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 70(5), 1129-39.
Barrowclough, C., Haddock, G., Lobban, F., Jones, S., Siddle, R., Roberts, C., & Gregg, L. (2006). Group cognitive-behavioural therapy for schizophrenia: Randomised controlled trial. The British Journal of Psychiatry, 189, 6, 527-532.
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.
Edwards, J., Cocks, J., Burnett, P., Maud, D., Wong, L., Yuen, H.P., Harrigan, S.M., ... McGorry, P D. (2011). Randomized controlled trial of clozapine and CBT for first-episode psychosis with enduring positive symptoms: A pilot study. Schizophrenia Research and Treatment.
Farhall, J., Freeman, N.C., Shawyer, F., & Trauer, T. (2009). An effectiveness trial of cognitive behaviour therapy in a representative sample of outpatients with psychosis. The British Journal of Clinical Psychology / the British Psychological Society, 48, 47-62.
Fowler, D., Hodgekins, J., Painter, M., Reilly, T., Crane, C., Macmillan, I., Mugford, M., ... Jones, P.B. (2009). Cognitive behaviour therapy for improving social recovery in psychosis: a report from the ISREP MRC Trial Platform Study (Improving Social Recovery in Early Psychosis). Psychological Medicine, 39(10), 1627-36.
Garety, P.A., Fowler, D.G., Freeman, D., Bebbinton, P., Dunn, G., & Kuipers, E. (2008). Cognitive-behavioural therapy and family intervention for relapse prevention and symptom reduction in psychosis: randomised controlled trial. The British Journal of Psychiatry, 192(6), 412-423.
Gaudiano, B.A., & Herbert, J.D. (2006). Acute treatment of inpatients with psychotic symptoms using Acceptance and Commitment Therapy: Pilot results. Behaviour Research and Therapy, 44 (3), 415-437.
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.
Jackson, H., McGorry, P., Edwards, J., Hulbert, C., Henry, L., Harrigan, S., Dudgeon, P., ... Power, P. (2005). A controlled trial of cognitively oriented psychotherapy for early psychosis (COPE) with four-year follow-up readmission data. Psychological Medicine, 35(9), 1295-306.
Jackson, H.J., McGorry, P.D., Killackey, E., Bendall, S., Allott, K., Dudgeon, P., Gleeson, J., ... Harrigan, S. (2008). Acute-phase and 1-year follow-up results of a randomized controlled trial of CBT versus Befriending for first-episode psychosis: the ACE project. Psychological Medicine, 38(5), 725-35.
Jolley, S., Garety, P., Craig, T., Dunn, G., White, J., & Aitken, M. (2003). Cognitive therapy in early psychosis: A pilot randomized controlled trial. Behavioural and Cognitive Psychotherapy, 31(4), 473-478.
Kuipers, E., Garety, P., Fowler, D., & Dunn, G. (1997). London-East Anglia randomised controlled trial of cognitive-behavioural therapy for psychosis. I: Effects of the treatment phase. The British Journal of Psychiatry, 171, 319.
Lecomte, T., Leclerc, C., Corbière, M., Wykes, T., Wallace, C. J., & Spidel, A. (2008). Group cognitive behavior therapy or social skills training for individuals with a recent onset of psychosis? Results of a randomized controlled trial. The Journal of Nervous and Mental Disease, 196(12), 866-75.
Levine, J., Barak, Y., & Granek, L. (1998). Cognitive Group Therapy for Paranoid Schizophrenics: Applying Cognitive Dissonance. Journal of Cognitive Psychotherapy, 12(1), 3.
Lewis, D., Tarrier, N., Haddock, G., Bentall, R.,Kinderman, P., Kingdon, D., Siddle, R., Drake, R., Everitt, J., . . . Leadley K., (2002). Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes. British Journal of Psychiatry, 181(Supplement), s91-s97.
Lincoln, T.M., Ziegler, M., Mehl, S., Kesting, M.L., Lüllmann, E., Westermann, S., & Rief, W. (2012). Moving from efficacy to effectiveness in cognitive behavioral therapy for psychosis: a randomized clinical practice trial. Journal of Consulting and Clinical Psychology, 80(4), 674-86.
Moritz, S., Veckenstedt, R., Bohn, F., Hottenrott, B., Scheu, F., Randjbar, S., Aghotor, J., ... Roesch-Ely, D. (2013). Complementary group Metacognitive Training (MCT) reduces delusional ideation in schizophrenia. Schizophrenia Research, 151, 1-3.
Peters, E., Landau, S., McCrone, P., Cooke, M., Evans, R., Carswell, K., . . . Kuipers, E. (2010). A randomised controlled trial of cognitive behaviour therapy for psychosis in a routine clinical service. Acta Psychiatrica Scandinavica, 122 (4), 302-318.
Pinninti, N.R., Rissmiller, D.J., & Steer, R.A. (2010). Cognitive-behavioral therapy as an adjunct to second-generation antipsychotics in the treatment of schizophrenia. Psychiatric Services (Washington, D.C.), 61(9), 940-3.
Pinto, A., La, P.S., Mennella, R., Giorgio, D., & DeSimone, L. (1999). Cognitive-behavioral therapy and clozapine for clients with treatment-refractory schizophrenia. Psychiatric Services (washington, D.c.), 50(7), 901-4.
Rector, N.A., Seeman, M.V., & Segal, Z.V. (2003). Cognitive therapy for schizophrenia: a preliminary randomized controlled trial. Schizophrenia Research, 63, 1-2.
Sensky, T., Turkington, D., Kingdon, D., Scott, J.L., Scott, J., Siddle, R., O'Carroll, M., ... Barnes, T.R. (2000). A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57(2), 165-72.
Startup, M., Jackson, M.C., & Bendix, S. (2004). North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: outcomes at 6 and 12 months. Psychological Medicine, 34(3), 413-22.
Startup, M., Jackson, M.C., Evans, K.E., & Bendix, S. (2005). North Wales randomized controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: two-year follow-up and economic evaluation. Psychological Medicine, 35(9), 1307-16.
Tarrier, N., Beckett, R., Harwood, S., Baker, A., Yusupoff, L., & Ugarteburu, I. (1993). A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. The British Journal of Psychiatry : the Journal of Mental Science, 162, 524-32.
Tarrier, N., Wittkowski, A., Kinney, C., McCarthy, E., Morris, J., & Humphreys, L. (1999). Durability of the effects of cognitive-behavioural therapy in the treatment of chronic schizophrenia: 12-month follow-up. The British Journal of Psychiatry, 174(6), 500-504.
Tarrier, N., Haddock, G., Lewis, S., Drake, R., & Gregg, L. (2006). Suicide behaviour over 18 months in recent onset schizophrenic patients: The effects of CBT. Schizophrenia Research, 83(1), 15-27.
Trower, P., Birchwood, M., Meaden, A., Byrne, S., Nelson, A., & Ross, K. (2004). Cognitive therapy for command hallucinations: randomised controlled trial. The British Journal of Psychiatry, 184(4), 312-320.
Turkington, D., & Kingdon, D. (2000). Cognitive-behavioural techniques for general psychiatrists in the management of patients with psychoses. The British Journal of Psychiatry : the Journal of Mental Science, 177, 101-6.
Turkington, D., Kingdon, D., Turner, T., & Insight into Schizophrenia Research Group. (2002). Effectiveness of a brief cognitive-behavioural therapy intervention in the treatment of schizophrenia. The British Journal of Psychiatry : the Journal of Mental Science, 180, 523-7.
Turkington, D., Kingdon, D., Rathod, S., Hammond, K., Pelton, J., & Mehta, R. (2006). Outcomes of an effectiveness trial of cognitive-behavioural intervention by mental health nurses in schizophrenia. The British Journal of Psychiatry, 189(1), 36-40.
Valmaggia, L.R., van der Gaag. M., Tarrier, N., Pijnenborg, M., & Slooff, C.J. (2005). Cognitive-behavioural therapy for refractory psychotic symptoms of schizophrenia resistant to atypical antipsychotic medication: Randomised controlled trial. The British Journal of Psychiatry, 186(4), 324-330.
van der Gaag, M., Stant, A.D., Wolters, K.J., Buskens, E., & Wiersma, D. (2011). Cognitive-behavioural therapy for persistent and recurrent psychosis in people with schizophrenia-spectrum disorder: cost-effectiveness analysis. The British Journal of Psychiatry : the Journal of Mental Science, 198(1), 59-65.
White, R., Gumley, A., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2011). A feasibility study of Acceptance and Commitment Therapy for emotional dysfunction following psychosis. Behaviour Research and Therapy, 49(12), 901-907.
Wykes, T., Hayward, P., Thomas, N., Green, N., Surguladze, S., Fannon, D., & Landau, S. (2005). What are the effects of group cognitive behaviour therapy for voices? A randomised control trial. Schizophrenia Research, 77, 2-3.