CBTp

CBTp, or Cognitive Behavioral Therapy for psychosis, is a specialized form of cognitive-behavioral therapy designed for individuals with psychotic disorders such as schizophrenia. It aims to reduce distress and improve functioning by addressing the psychological processes that maintain psychotic symptoms rather than attempting to directly eliminate the symptoms.

Typical components include collaborative case formulation, psychoeducation about psychosis, identifying and challenging unhelpful beliefs, cognitive restructuring to reframe voices or delusional thoughts, behavioral experiments to test beliefs, coping strategies for distress, and relapse prevention. The approach emphasizes a non-judgmental stance, practical strategies, and gradual exposure to avoided situations to reduce fear.

Delivery and scope: CBTp is delivered by trained therapists, usually in one-on-one sessions but can be offered in groups. Most protocols involve a time-limited series of sessions, commonly around 12–20, and are often provided alongside antipsychotic medication and other supports. It can be adapted to address issues such as command hallucinations, paranoia, or distress related to relapse.

Evidence and effectiveness: Systematic reviews report small-to-moderate reductions in positive symptoms and distress, with more consistent improvements in psychological well-being and functioning. Benefits may persist after treatment, though effects vary. CBTp is generally considered an effective adjunctive treatment, not a replacement for medication, with outcomes influenced by therapist expertise and patient engagement.

Limitations and considerations: Access to trained therapists is limited in many regions. Effectiveness depends on factors such as therapeutic alliance, motivation, and symptom severity. Some patients may struggle with engagement. Ongoing research seeks to refine protocols and identify who benefits most.

Guidelines: National and international guidelines commonly recommend offering CBTp to individuals with persistent psychotic symptoms as part of comprehensive care, noting variability in implementation and resources.