From Theory to Therapy: The Evolution and Future of Cognitive-Behavioral Therapy for Psychosis in U.S. Mental Health Care.

Cognitive-behavioral therapy for psychosis (CBTp) is an evidence-based intervention targeting distress and impairment associated with psychotic symptoms. Despite strong empirical support and international endorsement, it remains underutilized in U.S. psychiatric and forensic settings. This article traces CBTp's theoretical foundations and chronicles its U.S. development, highlighting key milestones, policy shifts, and clinical applications. A narrative review of cognitive-behavioral models, landmark trials, and federal and state implementation initiatives reveals CBTp's evolution from educational and behavioral intervention models into a flexible approach incorporating cognitive, behavioral, motivational, and environmental strategies for the full psychosis spectrum. Recent years have seen diversification into group-based, low-intensity, and digital formats, with growing access via state-sponsored training. Persistent barriers include clinician training, reimbursement, and integration into routine care. Understanding CBTp's theoretical roots, evidence base, and U.S. history can help mental health practitioners advance its integration. Psychiatrists are well positioned to advocate for and participate in enhancing access.