An Updated Systematic Review and Meta-Synthesis of Service User's Experiences of Cognitive Behavioural Therapy for Psychosis (CBTp).

In 30 seconds

This pre-registered thematic meta-synthesis integrated qualitative research on service users’ experiences of cognitive behavioural therapy for psychosis (CBTp). Searches identified 24 studies involving 334 participants. Three connected themes emerged: active collaboration supports empowerment, safety fosters trust, and shared understandings help people accept or challenge distressing experiences. The synthesis suggests that CBTp techniques may support acceptance and new meanings when used sensitively and collaboratively, with perceived safety underpinning these processes. The authors conclude that collaborative safety-building is pivotal to therapeutic gains and that efforts to scale or digitise CBTp should preserve individualised care and the therapeutic relationship.

Key findings

• The meta-synthesis included 24 qualitative studies and a pooled sample of 334 participants.
• Three themes linked collaboration with empowerment, safety with trust, and shared understandings with acceptance or challenge of distressing experiences.
• Participants’ accounts suggested that CBTp techniques supported acceptance and new meanings when applied sensitively and collaboratively, in a context of safety.

Why it matters

The findings highlight relational conditions that service users associate with engaging in CBTp and making sense of distressing experiences. They suggest that therapeutic techniques alone may not capture what supports perceived benefit: collaboration, trust and individualised shared understanding also matter. These themes can inform how CBTp is delivered and evaluated, particularly when services consider scalable or digital formats.

What to keep in mind

The synthesis draws on qualitative studies and reports service users’ experiences; it does not establish the efficacy of CBTp or quantify treatment effects.