Washington State Institute for Public Policy
Cognitive behavioral therapy (CBT) for schizophrenia/psychosis
Adult Mental Health: Serious Mental Illness
Benefit-cost estimates updated December 2016.  Literature review updated December 2014.
Cognitive behavioral therapy for psychosis (CBTp) includes the application of cognitive strategies focused on changing thoughts to improve feelings and behaviors as well as behavioral techniques most often used to address negative symptoms. CBTp involves teaching patients methods of coping with their symptoms and training in problem solving, social skills and strategies to reduce risk of relapse. In this collection of studies, CBTp was provided in addition to antipsychotic medication.
The estimates shown are present value, life cycle benefits and costs. All dollars are expressed in the base year chosen for this analysis (2015). The chance the benefits exceed the costs are derived from a Monte Carlo risk analysis. The details on this, as well as the economic discount rates and other relevant parameters are described in our Technical Documentation.
Benefit-Cost Summary Statistics Per Participant
Benefits to:
Taxpayers $8,073 Benefits minus costs $12,758
Participants $1,076 Benefit to cost ratio $9.86
Others $1,905 Chance the program will produce
Indirect $3,144 benefits greater than the costs 61 %
Total benefits $14,197
Net program cost ($1,440)
Benefits minus cost $12,758
1In addition to the outcomes measured in the meta-analysis table, WSIPP measures benefits and costs estimated from other outcomes associated with those reported in the evaluation literature. For example, empirical research demonstrates that high school graduation leads to reduced crime. These associated measures provide a more complete picture of the detailed costs and benefits of the program.

2“Others” includes benefits to people other than taxpayers and participants. Depending on the program, it could include reductions in crime victimization, the economic benefits from a more educated workforce, and the benefits from employer-paid health insurance.

3“Indirect benefits” includes estimates of the net changes in the value of a statistical life and net changes in the deadweight costs of taxation.
Detailed Monetary Benefit Estimates Per Participant
Benefits from changes to:1 Benefits to:
Taxpayers Participants Others2 Indirect3 Total
Labor market earnings associated with major depression $730 $1,607 $0 $15 $2,352
Health care associated with major depression $199 $65 $246 $99 $608
Labor market earnings associated with anxiety disorder ($315) ($693) $0 $0 ($1,008)
Health care associated with anxiety disorder ($21) ($7) ($26) ($11) ($65)
Health care associated with psychiatric hospitalization $7,479 $102 $1,685 $3,763 $13,028
Adjustment for deadweight cost of program $1 $2 $0 ($721) ($718)
Totals $8,073 $1,076 $1,905 $3,144 $14,197
Detailed Annual Cost Estimates Per Participant
Annual cost Year dollars Summary
Program costs $1,436 2014 Present value of net program costs (in 2015 dollars) ($1,440)
Comparison costs $0 2014 Cost range (+ or -) 10 %
Per-participant cost of treatment by modality (group/individual) was weighted by treatment Ns reported in the studies. Cost per-session per-person was $37.91/session for group and $120.90 for individual therapy (2014 dollars), based on actuarial tables reported for disabled adults in Mercer (2013) Behavioral Health Data Book for the State of Washington For Rates Effective January 1, 2014.
The figures shown are estimates of the costs to implement programs in Washington. The comparison group costs reflect either no treatment or treatment as usual, depending on how effect sizes were calculated in the meta-analysis. The cost range reported above reflects potential variation or uncertainty in the cost estimate; more detail can be found in our Technical Documentation.
Estimated Cumulative Net Benefits Over Time (Non-Discounted Dollars)
The graph above illustrates the estimated cumulative net benefits per-participant for the first fifty years beyond the initial investment in the program. We present these cash flows in non-discounted dollars to simplify the “break-even” point from a budgeting perspective. If the dollars are negative (bars below $0 line), the cumulative benefits do not outweigh the cost of the program up to that point in time. The program breaks even when the dollars reach $0. At this point, the total benefits to participants, taxpayers, and others, are equal to the cost of the program. If the dollars are above $0, the benefits of the program exceed the initial investment.

Meta-analysis is a statistical method to combine the results from separate studies on a program, policy, or topic in order to estimate its effect on an outcome. WSIPP systematically evaluates all credible evaluations we can locate on each topic. The outcomes measured are the types of program impacts that were measured in the research literature (for example, crime or educational attainment). Treatment N represents the total number of individuals or units in the treatment group across the included studies.

An effect size (ES) is a standard metric that summarizes the degree to which a program or policy affects a measured outcome. If the effect size is positive, the outcome increases. If the effect size is negative, the outcome decreases.

Adjusted effect sizes are used to calculate the benefits from our benefit cost model. WSIPP may adjust effect sizes based on methodological characteristics of the study. For example, we may adjust effect sizes when a study has a weak research design or when the program developer is involved in the research. The magnitude of these adjustments varies depending on the topic area.

WSIPP may also adjust the second ES measurement. Research shows the magnitude of some effect sizes decrease over time. For those effect sizes, we estimate outcome-based adjustments which we apply between the first time ES is estimated and the second time ES is estimated. We also report the unadjusted effect size to show the effect sizes before any adjustments have been made. More details about these adjustments can be found in our Technical Documentation.

Meta-Analysis of Program Effects
Outcomes measured Primary or secondary participant No. of effect sizes Treatment N Adjusted effect sizes (ES) and standard errors (SE) used in the benefit-cost analysis Unadjusted effect size (random effects model)
First time ES is estimated Second time ES is estimated
ES SE Age ES SE Age ES p-value
Major depressive disorder 15 727 -0.123 0.070 37 -0.091 0.096 38 -0.123 0.078
Anxiety disorder 7 267 0.017 0.103 37 0.013 0.097 38 0.017 0.866
Global functioning 18 721 0.231 0.069 37 0.172 0.146 38 0.232 0.001
Hospitalization (psychiatric) 16 832 -0.124 0.106 37 -0.092 0.122 38 -0.124 0.241
Psychiatric symptoms 25 1172 -0.148 0.101 37 -0.110 0.127 38 -0.148 0.144
Suicidal ideation 2 115 -0.174 0.331 37 -0.129 0.325 38 -0.174 0.599
Psychosis symptoms (positive) 33 1477 -0.178 0.059 37 -0.132 0.115 38 -0.178 0.003
Psychosis symptoms (negative) 25 1143 -0.170 0.069 37 -0.126 0.116 38 -0.170 0.014
Medication adherence 2 75 -0.011 0.195 37 -0.008 0.183 38 -0.011 0.956
Hope 3 92 0.300 0.249 37 0.223 0.289 38 0.300 0.299
Citations Used in the Meta-Analysis

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For more information on the methods
used please see our Technical Documentation.