Patients with symptoms of anxiety and depression who are at a high risk of developing psychosis could benefit from talking therapies, according to new research.
Researchers at the University of Southampton conducted the first controlled trial of cognitive behavioural therapy (CBT) for depression and anxiety, minimally adapted for psychosis risk, in primary care.
Their analysis shows that simple tweaks to current CBT treatment, including a few additional questions at the beginning of the therapy, would allow clinicians to successfully identify those patients at risk of psychosis.
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CBT may reduce psychosis risk
The researchers say that the findings, published in BJPsych Open, could make a significant difference to patients at risk of developing psychosis.
Psychosis, which can include hearing voices, seeing things that do not exist and developing unusual beliefs, affects about one in 100 people. However, it can go untreated for several years due to unrecognised symptoms, stigmas associated with the condition, and delays within mental health services.
Individuals who are at high risk of psychosis access primary care to seek treatment for depression and anxiety, but despite receiving treatment, they often do not recover from these affective symptoms. CBT is currently offered by the NHS to 1.2 million patients with anxiety and depression every year.
Opportunity to identify psychosis symptoms
The research team conducted a longitudinal controlled trial working with patients seeking help for anxiety or depression through primary care in NHS trusts across Hampshire. The feasibility trial compared best practice CBT for depression and anxiety (CBT-BP) with CBT adapted for psychosis risk (CBT-PR), in patients who are at clinically high risk for psychosis.
They found that CBT for depression and anxiety, minimally adapted for psychosis risk, is likely to improve clinical and recovery outcomes and reduce psychosis risk. In addition, the adaptations can be delivered in routine NHS Talking Therapy services.
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Professor Katherine Newman-Taylor, consultant clinical psychologist and CBT lead at the University of Southampton, who led the study, explained that many people who access NHS Talking Therapies services for anxiety and depression have low-level psychotic type experiences, but that these symptoms often go unnoticed.
The findings show that primary care mental health services present a ‘unique opportunity’ to identify and treat people at risk of psychosis at a time when they are seeking help.
Professor Newman-Taylor added: ‘We know that people accessing talking therapy are presenting with more complex problems than the service was designed for. We also know that people are often too ashamed or fearful to talk about their unusual experiences. If we can intervene very early in this way, we may be able to prevent some people from developing psychosis.’
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Further research is planned to estimate clinical and cost-effectiveness.
Reference: Newman-Taylor K, Maguire T, Smart T, et al. CBT for depression and anxiety adapted for psychosis risk in primary care: controlled trial to assess feasibility, acceptability and signals of efficacy. BJPsych Open. 2025;11(3):e101. doi:10.1192/bjo.2025.27
