The efficacy of cognitive behavioral therapy for persecutory delusions: A systematic review and meta-analysis

Persecutory delusions, prevalent in disorders like schizophrenia, significantly impair daily functioning and cause distress. Although cognitive behavioral therapy (CBT) has shown promise in treating delusions, no meta-analysis has specifically evaluated its effectiveness for persecutory delusions.

To identify studies on CBT specifically designed for patients with persecutory delusions and to evaluate its impact on delusion-related symptoms, including the conviction of persecutory delusions, paranoia severity, and psychological well-being.

A comprehensive search of 10 electronic databases was conducted until December 4, 2025, to identify randomized controlled trials on CBT for persecutory delusions. Two independent reviewers screened studies, assessed quality, and extracted data.

Ten studies including 904 participants were included. CBT was associated with a small reduction in the conviction of persecutory delusions (SMD = -0.31, 95% CI, -0.45 to -0.18, p < 0.001; moderate-quality evidence), a small reduction in the severity of paranoia (SMD = -0.29, 95% CI: -0.43 to -0.15, p < 0.001; high-quality evidence), and a small improvement in psychological well-being (SMD = 0.36, 95% CI: 0.09 to 0.63, p = 0.01; moderate-quality evidence). Subgroup analyses revealed comparable effect sizes across intervention duration, session frequency, gender composition, and follow-up interval, with no evidence of effect modification.

CBT shows promising efficacy for treating persecutory delusions. Further rigorous trials are required to determine optimal intervention parameters and long-term effects.