Mike: Hello, I’m Mike Clarke podcast editor for the Cochrane Library. In its nearly 30 years, the Cochrane Schizophrenia Group produced more than 250 reviews. One of its last, published in March 2024, looked at cognitive behavioural therapy for first episode and recent-onset psychosis. Here's lead author, Susanna Mayer from the Technical University of Munich in Germany to tell us more.

Susanna: Schizophrenia is a very serious mental disorder that affects people's perception and the way they think, feel and act. It not only causes extreme suffering for those affected, but also for their relatives and loved ones. The high rates of hospitalisation and unemployment, as well as loss of productivity, also lead to enormous economic costs. Effective treatment, especially in the early stages, is therefore crucial to prevent chronic progression of the disease or, at least, to minimise the chance of it happening.
We know that psychological interventions such as cognitive behavioural therapy (CBT), are an effective treatment for people with schizophrenia but we did this review to try to conclusively clarify whether adding it to standard care is also helpful for people in the early stages of their illness. 
We looked for randomised trials in people with a first episode or recent-onset of schizophrenia that compared any type of CBT in addition to standard care with non-CBT interventions. These included standard care, treatment as usual, a waiting list, inactive treatments, or other psychosocial interventions such as family therapy or psychoeducation.
We were most interested in the effects on the person's general mental state, measured with a general mental state scale but we also wanted to cover secondary outcomes such as other measures of mental state, global state, relapse, admission to hospital, functioning, leaving the study early, quality of life, adverse events, and mortality.
We found a total of 28 studies and could use data from just over 2400 participants in 26 of these. Most studies had a treatment phase/duration of up to 6 months.
Based on results from about one year after the intervention, our review shows that CBT added to standard care is more effective than control conditions in reducing the symptoms of schizophrenia. It also improves the global state, measured with scales that consider the general level of symptoms of participants. Finally, it's more effective than control conditions in improving functioning, such as participating in social life or taking part in everyday activities. However, the certainty of the evidence for our outcomes is between moderate and very low, which means that we have moderate to very little confidence in the effect estimates.
In summary, CBT added to standard care is a very promising and supportive treatment for patients with a first episode or recent-onset psychosis. Nevertheless, there is still a need for the development of clinically based criteria and the consistent use of standardised definitions in research and clinical practice for people in the early stages of schizophrenia. Finally, further research is also needed to deal in particular with the potential negative side effects and adverse events of psychotherapeutic interventions.

Mike: To learn more about the current evidence and watch for updates of the review if that new research gets done, the full review can be found online. If you visit CochraneLibrary.com and search 'CBT for first episode psychosis', you'll see a link to it.