CBT for Psychosis(CBTp)
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Overview
CBT for psychosis is an adapted form of CBT designed to reduce distress and improve functioning in people experiencing psychotic symptoms such as hallucinations and delusional beliefs. It does not require symptom elimination as the goal; it focuses on reducing distress, impairment, and risk.
What this therapy focuses on
Understanding triggers, meanings, and maintaining factors around psychotic experiences; building coping strategies; testing beliefs safely; improving functioning and reducing relapse risk.
What sessions are usually like
Session length: 50–60 minutes
Frequency: Weekly
Time-limited: Variable (often 16–26 sessions)
Between-session work: Gentle, collaborative experiments and coping practice
Flexible pacing: engagement may take longer
Session profile
Common uses and suitability
What problems it is commonly used for
Who this therapy may suit best
- People distressed by psychotic experiences
- Those who want to understand their experiences
- Individuals who are stable enough for outpatient therapy
When it may need adapting or may not be suitable
- Acute intoxication or withdrawal
- Extremely disorganised thinking (may need stabilisation first)
- Must be integrated with multidisciplinary care
Where this therapy may not be enough
CBTp is not a replacement for antipsychotic medication where indicated. It works best as part of comprehensive care.
What happens in therapy
Normalising and Engagement
Building a trusting relationship and helping you understand that many people have unusual experiences.
Coping Strategy Enhancement
Building on what already helps and adding new coping strategies for voices, beliefs, or paranoia.
Collaborative Belief Evaluation
Gently exploring the evidence for beliefs that are causing distress, without arguing or dismissing.
Relapse Signature Planning
Creating a personalised plan that identifies early warning signs and what to do if they appear.
Evidence Base
Guideline support
Present in multiple psychosis care pathways. NICE CG178 recommends CBT for all people with psychosis and schizophrenia.
Strength of evidence
Moderate; strongest for distress reduction and functioning. Effect sizes are modest but clinically meaningful.
Limitations
Works best integrated with medication and multidisciplinary care. Effect sizes for symptom reduction are modest. Engagement can be challenging.
Evidence claims by condition
CBTp helps reduce distress from voices, beliefs, and paranoia, and can reduce the risk of relapse.
Resources & Printables
For Adults
Understanding Voices and Beliefs
A 2-page guide explaining psychotic experiences from a CBT perspective.
Coping Strategy Menu
A menu of strategies for managing voices, beliefs, and paranoia.
Relapse Signature Plan
A template for creating a personalised relapse prevention plan.
For Parents & Caregivers
Practitioner & Training Notes
Typical professional background
Clinical psychologists and specialist therapists with CBTp training.
Recognised training routes
Post-qualification CBTp training with supervised practice. Available through specialist training programmes.
Registration considerations
BABCP and core professional registrations.
Source Registry
Link and cite.
Last evidence review: January 2026. All sources are verified and checked on a scheduled cadence.