Group cognitive behavioral therapy for individuals on the early psychosis spectrum: a systematic review and a meta-analysis.

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.