Cognitive Behavior Therapy for Psychosis in People with Intellectual Disability-A Scoping Review

Schizophr Bull. 2026 Aug 20;52(5):sbag115. doi: 10.1093/schbul/sbag115.

ABSTRACT

BACKGROUND AND HYPOTHESIS: Cognitive behavior therapy for psychosis (CBTp) is effective in reducing psychiatric symptoms. Most CBTp trials have excluded patients with intellectual disabilities, even though intellectual disabilities are associated with an at least 3 times higher psychosis prevalence. More understanding of evidence-based approaches for this population is needed. The aim of this review was to assess the current state of knowledge about CBTp for people with both intellectual disabilities and psychosis. Specifically, the interests were the efficacy and feasibility of CBTp for this population and possible adaptations in clinical practice.

STUDY DESIGN: A scoping review on CBTp for people with both psychosis and intellectual disabilities was performed using Cochrane library, EMbase, PUBMED, and PsycINFO, on October first, 2025.

STUDY RESULTS: A total of 185 unique articles were identified; full text screening was conducted on 50 of these. Eighteen studies were included. Four case study publications, together describing nine patients, tentatively showed efficacy of CBTp despite intellectual disability. Further, patients with intellectual disability seemed able to understand key elements of CBTp. Preliminary evidence showed that core CBTp components can be kept in place, with only practical adjustments necessary. An overview of these CBTp adjustments is presented. Additionally, 6 trials looking at CBTp outcome moderation showed that cognitive impairments generally do not reduce benefits.

CONCLUSION: Cognitive behavior therapy for psychosis seems feasible for people with psychosis and intellectual disabilities, with only practical adjustments necessary. Randomized controlled trials are needed to study the efficacy of CBTp for this population.

PMID:42700400 | DOI:10.1093/schbul/sbag115