Home›Psychiatry› One in five outpatients drops out of individual CBT for schizophrenia, moderator findings exploratory
One in five outpatients drops out of individual CBT for schizophrenia, moderator findings exploratoryOne in Five May Drop Out of CBT for Schizophrenia
Nordic journal of psychiatryPublished November 1, 2026Study authors: Stefana Alberto, Damiani Stefano, Barlati Stefano, Bortolin Elisa, Cimberle Matteo, Cruciani Nicolet…PubMed ↗DOI ↗Editorial oversight: Dr. Ji-eun Park, MD · Brain, Mind & Pain
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Key Takeaway
Recognize that about 1 in 5 outpatients may drop out of individual CBT for schizophrenia.
This is a secondary analysis of a systematic review and meta-analysis examining dropout from individual, face-to-face, outpatient cognitive behavioral therapy (CBT) for schizophrenia spectrum disorders. The analysis included 865 participants across CBT arms.
The main finding is that approximately one in five participants dropped out of treatment. No effect size, absolute numbers, or statistical significance for the dropout estimate were reported.
The authors also conducted exploratory analyses of associations between dropout and arm-level sociodemographic, clinical, treatment-related, and study-design characteristics. These moderator analyses were underpowered, and the authors note substantial between-arm heterogeneity. The associations with moderators are exploratory and should not be interpreted as causal.
No information on adverse events, serious adverse events, discontinuations, or tolerability was reported. Funding and conflicts of interest were not reported, and practice relevance was not specified.
The estimate is an average across heterogeneous studies and settings, and the certainty of the evidence was not reported. Clinicians should recognize that roughly one in five patients may not complete individual outpatient CBT for schizophrenia spectrum disorders, but the factors associated with dropout remain uncertain.
How this fits prior evidence
This analysis addresses a gap in prior coverage, which has focused on neuroimaging markers, symptom predictors, and adjunctive treatments in schizophrenia rather than on psychotherapy engagement. Prior items noted shared gray matter reductions in ventromedial prefrontal cortex and insula across schizophrenia, MDD, and AUD, distinct resting-state functional MRI patterns across these conditions, and that higher baseline PANSS Negative scores predict 21% lower relapse risk. Another item considered vitamin C as a low-cost adjunct for psychotic symptoms. None of these addressed dropout from CBT. The current estimate that approximately one in five participants drop out of individual outpatient CBT extends this coverage by quantifying a treatment engagement challenge, though the exploratory moderator findings and substantial heterogeneity limit firm conclusions.
A new analysis looked at dropout from individual, face-to-face cognitive behavioral therapy (CBT) for schizophrenia spectrum disorders. It pooled data from 865 people in outpatient CBT treatment arms. The main finding: about one in five participants dropped out.
The researchers also explored whether things like age, symptoms, treatment details, or study design were linked to dropout. These analyses were exploratory and underpowered, so they cannot show cause and effect. The authors also noted substantial differences between the treatment arms included.
No information on side effects or safety was reported in this analysis. Because the estimate is an average across many different studies and settings, the real dropout rate in any one clinic could be higher or lower.
What to take from it: dropping out of therapy is common and not a personal failure. If you or someone you know is struggling to stay in treatment, talking with the care team about it may help.
What this means for you:
About 1 in 5 people in face-to-face CBT for schizophrenia may drop out, but rates vary widely.
Common questions
How common is dropping out of CBT for schizophrenia?
In this analysis, about one in five participants in individual, face-to-face outpatient CBT for schizophrenia spectrum disorders dropped out. That is an average across the studies included, so the rate in any single clinic could be higher or lower.
Why do people stop CBT for schizophrenia?
This analysis explored possible links between dropout and factors like demographics, symptoms, treatment details, and study design. Those analyses were exploratory and underpowered, so they cannot show what caused dropout. If you are thinking about stopping therapy, talk with your care team first.
Does this analysis report side effects of CBT?
No. The analysis did not report adverse events, serious adverse events, or tolerability. It focused on how many people dropped out of treatment. For questions about risks or benefits of a specific therapy, speak with a qualified clinician.
How reliable is the one in five dropout estimate?
The authors note substantial differences between the treatment arms included, and the estimate is an average across varied studies and settings. That means the true rate for any one person or program may differ. The moderator analyses were exploratory and should not be read as causal.
BACKGROUND AND HYPOTHESIS: 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.
STUDY DESIGN: 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.
STUDY RESULTS: 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.
CONCLUSIONS: 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.
