Psychiatry research · 2026
Group cognitive behavioral therapy for individuals on the early psychosis spectrum: a systematic review and a meta-analysis.
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Livet Audrey, Yunus Fakir Md, Nolwenn Celli Goalec, Lecomte Tania
Аннотация
BACKGROUND: Group Cognitive Behavioral Therapy for psychosis (GCBTp) is increasingly implemented in early intervention services, yet no meta-analysis has examined its efficacy in early psychosis.
METHODS: The PRISMA 2020 method was followed. A systematic review and meta-analysis of 35 studies was conducted, examining GCBTp in early psychosis and high-risk populations. Random-effects meta-analyses were conducted with 25 studies for between-group randomized controlled trial (RCT) effects and within-group pre-post effects across 14 outcome domains. Hedges' g with 95% confidence intervals was used as the effect size metric, preferred for its correction of small-sample bias. Each outcome was modeled separately using random-effects models. Meta-regressions were also performed regarding GCBTp duration, type and outcome designation. Evidence quality was assessed using the GRADE framework.
RESULTS: Significant within-group pre-post effects were observed for positive symptoms (g=0.63, CI[0.09-1.18]), global psychotic symptoms (g=0.48, CI[0.13-0.82]), well-being (g=-0.39, CI[-0.58-0.21]), and self-esteem (g=-0.23, CI[-0.52-0.06]). Trend-level within-group pre-post effects emerged for functioning (g=-0.83, CI[-1.85-0.18]), depression (g=0.46, CI[-0.06 - 0.98]), and voices (g=0.24, CI[-0.06-0.54]). Negative symptoms yielded steady between-group effect across six RCTs (g=-0.26, CI[-0.46-0.06]), and 11 pre-post studies (g=0.34, CI[0.02 - 0.65]). Evidence quality ranged from poor to high. Between-group RCT effects did not reach significance for most outcomes, reflecting underpowered trials. No significant moderation by intervention duration, GCBTp type, or outcome designation was found.
CONCLUSIONS: GCBTp demonstrates meaningful efficacy in early psychosis, with small to medium effects for positive and overall symptoms, as well as well-being and self-esteem. GCBTp appears to consistently improve negative symptoms. More well-powered RCTs are needed.
METHODS: The PRISMA 2020 method was followed. A systematic review and meta-analysis of 35 studies was conducted, examining GCBTp in early psychosis and high-risk populations. Random-effects meta-analyses were conducted with 25 studies for between-group randomized controlled trial (RCT) effects and within-group pre-post effects across 14 outcome domains. Hedges' g with 95% confidence intervals was used as the effect size metric, preferred for its correction of small-sample bias. Each outcome was modeled separately using random-effects models. Meta-regressions were also performed regarding GCBTp duration, type and outcome designation. Evidence quality was assessed using the GRADE framework.
RESULTS: Significant within-group pre-post effects were observed for positive symptoms (g=0.63, CI[0.09-1.18]), global psychotic symptoms (g=0.48, CI[0.13-0.82]), well-being (g=-0.39, CI[-0.58-0.21]), and self-esteem (g=-0.23, CI[-0.52-0.06]). Trend-level within-group pre-post effects emerged for functioning (g=-0.83, CI[-1.85-0.18]), depression (g=0.46, CI[-0.06 - 0.98]), and voices (g=0.24, CI[-0.06-0.54]). Negative symptoms yielded steady between-group effect across six RCTs (g=-0.26, CI[-0.46-0.06]), and 11 pre-post studies (g=0.34, CI[0.02 - 0.65]). Evidence quality ranged from poor to high. Between-group RCT effects did not reach significance for most outcomes, reflecting underpowered trials. No significant moderation by intervention duration, GCBTp type, or outcome designation was found.
CONCLUSIONS: GCBTp demonstrates meaningful efficacy in early psychosis, with small to medium effects for positive and overall symptoms, as well as well-being and self-esteem. GCBTp appears to consistently improve negative symptoms. More well-powered RCTs are needed.