Cognitive behavioral therapy targeting persecutory delusions in chronic outpatients with schizophrenia: a randomized controlled trial on functional recovery and symptom severity

Front Med (Lausanne). 2026 May 15;13:1758031. doi: 10.3389/fmed.2026.1758031. eCollection 2026.

ABSTRACT

BACKGROUND: Cognitive behavioral therapy (CBT) is a recommended psychosocial intervention for schizophrenia; however, its integrated application in routine clinical settings warrants further empirical evaluation.

AIM: This study aimed to assess the effects of adjunctive, structured CBT on clinical symptoms, affective states, self-efficacy, and quality of life in hospitalized patients diagnosed with schizophrenia.

METHODS: In this randomized controlled study, 66 inpatients diagnosed with schizophrenia at the Affiliated Mental Health Center & Hangzhou Seventh People’s Hospital, Zhejiang University School of Medicine were recruited from August to October 2022. These participants were divided into two groups: a research group (RG, n = 33) and a control group (CG, n = 33). The CG received conventional pharmacotherapy, while the RG received pharmacotherapy in addition to a structured, individualized CBT intervention (once weekly, 60 min per session, for 4 weeks). Outcomes were assessed using the Positive and Negative Syndrome Scale (PANSS), Auditory Hallucinations Rating Scale (AHRS), Hamilton Anxiety Scale (HAMA), Hamilton Depression Scale (HAMD), General Self-Efficacy Scale (GSES), Brief Psychiatric Rating Scale (BPRS), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Data were analyzed using t-tests, χ² tests, and repeated-measures ANOVA where appropriate.

RESULTS: Compared to the CG, the RG showed significantly greater reductions in the PANSS total score (p < 0.05), AHRS score (p < 0.05), HAMA score (p < 0.05), HAMD score (p < 0.05), and BPRS score (p < 0.05). The RG also demonstrated significantly greater improvement in the GSES score (p < 0.05). In WHOQOL-BREF domains, the RG exhibited significant improvements in psychological, social relationship, and environmental scores, as well as in the total score (all p < 0.05), whereas the CG showed improvements only in psychological and social relationship scores.

CONCLUSION: Adjunctive CBT was associated with significant clinical benefits in this inpatient sample, including reduced psychotic and affective symptoms, enhanced self-efficacy, and improved quality of life. These findings support the systematic integration of structured CBT into multidisciplinary inpatient care for schizophrenia. Future studies with larger, multi-center samples and longer follow-up periods are recommended to strengthen generalizability and evaluate the long-term effects of this treatment.

PMID:42221071 | PMC:PMC13218966 | DOI:10.3389/fmed.2026.1758031