Huang RC, Wareesawetsuwan N, Lin N, Li XD. Computerized cognitive behavioral therapy with sertraline in schizophrenia with depressive episodes: A 12-week randomized controlled trial. World J Psychiatry 2025; 15(11): 112431 [DOI: 10.5498/wjp.v15.i11.112431]
Corresponding Author of This Article
Xiao-Dan Li, MD, PhD, Department of Psychiatry, Fuzhou Neuropsychiatric Hospital Affiliated to Fujian Medical University, No. 451 South Second Ring Road, Fuzhou 350004, Fujian Province, China. 810538265@qq.com
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Psychiatry
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Randomized Controlled Trial
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nov 19, 2025 (publication date) through Nov 3, 2025
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World Journal of Psychiatry
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2220-3206
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Huang RC, Wareesawetsuwan N, Lin N, Li XD. Computerized cognitive behavioral therapy with sertraline in schizophrenia with depressive episodes: A 12-week randomized controlled trial. World J Psychiatry 2025; 15(11): 112431 [DOI: 10.5498/wjp.v15.i11.112431]
World J Psychiatry. Nov 19, 2025; 15(11): 112431 Published online Nov 19, 2025. doi: 10.5498/wjp.v15.i11.112431
Computerized cognitive behavioral therapy with sertraline in schizophrenia with depressive episodes: A 12-week randomized controlled trial
Ren-Chun Huang, Nicha Wareesawetsuwan, Nan Lin, Xiao-Dan Li
Ren-Chun Huang, Nan Lin, Xiao-Dan Li, Department of Psychiatry, Fuzhou Neuropsychiatric Hospital Affiliated to Fujian Medical University, Fuzhou 350004, Fujian Province, China
Nicha Wareesawetsuwan, Department of Medicine Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02108, United States
Author contributions: Huang RC and Li XD designed the study; Huang RC, Li XD and Lin N collected the data; Wareesawetsuwan N analyzed the data and critically revised the manuscript; Huang RC drafted the manuscript; Li XD and Wareesawetsuwan N critically revised the manuscript.
Supported by Fuzhou Science and Technology Plan Project, No. 2023-S-028.
Institutional review board statement: This study has been approved by the Ethics Committee of The Second General Hospital of Fuzhou Neuropsychiatric Prevention and Treatment Hospital (2023 Ethics Review No.16).
Clinical trial registration statement: This study is registered at Chinese Clinical Trials Registry. The registration identification number is ChiCTR2500098302.
Informed consent statement: All participants and guardians signed informed consent forms before the start of the trial.
Conflict-of-interest statement: The authors disclose no conflicts.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Data sharing statement: The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xiao-Dan Li, MD, PhD, Department of Psychiatry, Fuzhou Neuropsychiatric Hospital Affiliated to Fujian Medical University, No. 451 South Second Ring Road, Fuzhou 350004, Fujian Province, China. 810538265@qq.com
Received: July 28, 2025 Revised: August 9, 2025 Accepted: September 4, 2025 Published online: November 19, 2025 Processing time: 99 Days and 17.4 Hours
Abstract
BACKGROUND
Schizophrenia is commonly associated with comorbid depression, which exacerbates cognitive impairments and negatively impacts quality of life. Despite the high prevalence and burden of these comorbidities, effective treatment options, particularly for cognitive dysfunction, remain limited.
AIM
To evaluate the efficacy of computerized cognitive behavioral therapy (CCBT) with sertraline vs sertraline monotherapy in improving depressive symptoms, cognitive function, and quality of life in schizophrenia and depressive episodes.
METHODS
In this single-center, randomized controlled trial, 68 adults [mean age (SD) = 36.5 (10.0), 57.4% male] with schizophrenia and depressive symptoms were randomly assigned to receive either CCBT with sertraline or sertraline monotherapy during a 4-week hospitalization. The CCBT intervention involved 45-60-minute sessions twice weekly for four weeks. Outcomes included comparisons of depressive symptoms (Calgary depression scale for schizophrenia), cognitive function [MATRICS consensus cognitive battery (MCCB)], and quality of life (36-item short form survey) between the groups.
RESULTS
The experimental group showed greater improvements in depressive symptoms at 4, 8, and 12 weeks compared to the controls, with the most notable difference at 12 weeks [mean difference (MD) = -1.7; P < 0.001; Cohen’s d = 0.9]. Cognitive function improved across all MCCB domains in the experimental group, with higher processing speed scores (MD = 4.1; P = 0.043; Cohen’s d = 0.5) and social cognition scores (MD = 4.9; P = 0.006; Cohen’s d = 0.7) than in the control group. Quality of life, particularly in mental health, was significantly better in the experimental group.
CONCLUSION
CCBT with sertraline was more effective than sertraline monotherapy for patients with schizophrenia and depressive episodes, supporting its use as an adjunctive therapy.
Core Tip: This randomized controlled trial demonstrates that combining computerized cognitive behavioral therapy (CCBT) with sertraline is more effective than sertraline alone in improving depressive symptoms, cognitive function, and quality of life in patients with schizophrenia and depressive episodes. Notably, CCBT significantly enhanced processing speed and social cognition. These findings support CCBT as a scalable, accessible, and effective adjunct to pharmacotherapy in this challenging population.
