Dropout from individual cognitive behavioral psychotherapy for schizophrenia: a systematic review and meta-analysis of randomized clinical trials.

Authors

Alberto Stefana, Stefano Damiani, Stefano Barlati, Elisa Bortolin, Matteo Cimberle, Nicoletta Cruciani, Aldo D'Imperio, Margherita Rovida, Riccardo Stefanelli, Paolo Fusar-Poli

Published in

Nordic journal of psychiatry. Pages 1-7. Oct 10, 2026. Epub Oct 10, 2026.

Abstract

Cognitive behavioral therapy (CBT) is a recommended psychological treatment for schizophrenia spectrum disorders (SSDs), often delivered alongside pharmacotherapy, but dropout may limit its effectiveness. In this secondary analysis of a parent systematic review and meta-analysis focused on negative-symptom outcomes, we synthesized dropout among individual, face-to-face, outpatient CBT arms identified within that parent-review dataset. We investigated exploratory associations between dropout and arm-level sociodemographic, clinical, treatment-related, and study-design characteristics.
This study was a secondary analysis of a comprehensive database from a recent systematic review and meta-analysis of treatments for SSDs, which searched PsycINFO and all Web of Knowledge databases. Eligible studies were randomized clinical trials that included at least one arm delivering in-person, individual CBT in outpatient settings and reported dropout. Thirteen studies, comprising 16 psychotherapy arms and 865 participants, met eligibility criteria. Random-effects models were used to estimate the pooled dropout rate, and mixed-effects meta-regression models were conducted to examine sociodemographic, clinical, treatment-related, and study-design moderators.
Across this heterogeneous set of individual CBT arms, the pooled dropout estimate was approximately one in five participants, with substantial between-arm heterogeneity. Associations with available arm-level moderators were exploratory and should not be interpreted as causal or as evidence that a moderator has no effect when the analysis was underpowered.
This secondary analysis provides a descriptive estimate of dropout within the individual CBT arms retained by the parent review. The estimate is an average across heterogeneous studies and settings, and the moderator analyses are exploratory.

PMID:
42856083
Bibliographic data and abstract were imported from PubMed on 10 Oct 2026.

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