Predictors of engagement and response in cognitive behaviour therapy for psychosis: A systematic review.
D Gorina, M C Del Piccolo, A Georgiades et al.
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In 30 seconds
This systematic review examined predictors of engagement with and response to cognitive behavioural therapy for psychosis (CBTp) across clinical high risk, first-episode psychosis, and schizophrenia populations. It included 23 studies involving 3,241 participants: 3 studies in first-episode psychosis, 20 in schizophrenia, and none in clinical high risk. Findings were heterogeneous and did not establish reliable predictors. Some studies linked lower delusional conviction and greater insight with better outcomes, and longer illness duration with poorer outcomes, but these associations were not consistently replicated.
Key findings
- The review included 23 studies (N = 3241): 3 in first-episode psychosis, 20 in schizophrenia, and none in clinical high risk.
- Lower delusional conviction and greater insight were associated with more favourable outcomes in some studies, but findings were not consistently replicated.
- Longer illness duration was associated with poorer outcomes in some studies; symptom-severity findings varied across studies.
- Engagement evidence was limited; lower negative symptom severity was linked to better uptake or engagement in some studies.
Why it matters
Clinicians may encounter substantial variation in whether people engage with CBTp and benefit from it. This review indicates that currently studied clinical and psychological characteristics do not provide dependable ways to predict those outcomes. Recognising the uncertainty can help avoid overconfident expectations about who will respond and highlights the need for better evidence, especially in early psychosis.
What to keep in mind
The evidence base was heterogeneous in study design, outcome measures, and findings, and included no clinical high-risk studies. Associations were often inconsistent or based on limited evidence.