Computerized cognitive behavioral therapy with sertraline in schizophrenia with depressive episodes: A 12-week randomized controlled trial

Table 1 Computerized cognitive behavioral therapy modules

Module	Module title	Content description
1	Psychoeducation and self-assessment	Introduction to the structure and objectives of CCBT. Includes completion of mood and cognition self-assessments, and identification of target symptoms and treatment goals
2	Relaxation and stress regulation	Training in abdominal breathing, progressive muscle relaxation, and guided imagery. Includes multimedia demonstrations and interactive practice tasks
3	Behavioral activation	Education on the relationship between behavior and mood. Activity scheduling tasks to promote engagement in enjoyable or meaningful routines, with daily tracking tools
4	Cognitive restructuring	Explanation to negative automatic thoughts and common cognitive distortions. Includes interactive exercises to identify and challenge maladaptive beliefs
5	Homework assignments	Review and reinforcement of prior modules through structured tasks. Examples include mood logs, thought records, and activity diaries, with feedback and reminders
6	Relapse prevention	Review of core skills. Identification of early warning signs for relapse. Development of personalized prevention plans. Includes future-oriented coping strategies

CCBT: Computerized cognitive behavioral therapy.

Table 2 Sociodemographic and clinical data

Characteristic	All patients (n = 68)	Experimental group (n = 34)	Control group (n = 34)	P value
Age, mean ± SD, years	36.54 ± 9.96	36.18 ± 9.33	36.91 ± 10.68	0.763
Gender, n (%)				0.806
Male	39 (57.4)	19 (55.9)	20 (58.8)
Female	29 (42.6)	15 (44.1)	14 (41.2)
Year of education, mean ± SD, years	10.50 ± 2.64	10.32 ± 2.78	10.68 ± 2.52	0.585
Marital status, n (%)				0.314
Single	42 (61.8)	20 (58.8)	22 (64.7)
Married	18 (26.5)	8 (23.5)	10 (29.4)
Divorced	8 (11.8)	6 (17.6)	2 (5.9)
Family history, n (%)	12 (17.6)	6 (17.6)	6 (17.6)	1.000
Disease duration, mean ± SD, years	13.62 ± 6.44	13.52 ± 6.42	13.72 ± 6.57	0.902
Sertraline dosage at 4 weeks, median (IQR), mg	150 (100-150)	150 (100-150)	150 (100-150)	0.509
Sertraline dosage at 12 weeks, median (IQR), mg	150 (100-150)	150 (100-150)	150 (100-150)	0.314

Table 3 Comparison of Calgary depression scale for schizophrenia scores between experimental and control groups

Outcome	Experimental group (n = 34)	Control group (n = 34)	MD (95%CI)	P value	Cohen’s d1
Baseline	12.32 ± 2.67	12.12 ± 2.90	0.21 (-1.14, 1.56)	0.762	-
2-week follow up	10.15 ± 2.73	10.91 ± 2.09	-0.76 (-1.94, 0.41)	0.200	-
4-week follow up	8.32 ± 1.84	9.65 ± 1.72	-1.32 (-2.19, -0.46)	0.003	0.74
8-week follow up	6.88 ± 1.43	8.41 ± 1.35	-1.53 (-2.20, -0.86)	< 0.001	1.10
12-week follow up	4.00 ± 2.10	5.68 ± 1.70	-1.68 (-2.60, -0.75)	< 0.001	0.88

¹Effect sizes are shown when t-tests are significant; small effect (> 0.2), medium effect (> 0.5), large effect (> 0.8).

95%CI: 95% confidence interval.

Table 4 Comparison of MATRICS consensus cognitive battery scores between experimental and control groups

Outcome	Pre-treatment (baseline)					Post-treatment (12 weeks)
	Experimental group (n = 34)	Control group (n = 34)	MD (95%CI)	P value	Cohen’s d1	Experimental group (n = 34)	Control group (n = 34)	MD (95%CI)	P value	Cohen’s d1
ProcSpeed	42.35 ± 9.07	42.21 ± 8.89	0.15 (-4.20, 4.49)	0.946	-	47.03 ± 7.85	42.97 ± 8.35	4.06 (0.13, 7.98)	0.043	0.50
AttnVig	41.65 ± 9.21	39.71 ± 10.10	1.94 (-2.74, 6.62)	0.411	-	45.76 ± 8.25	44.76 ± 6.58	1.00 (-2.61, 4.61)	0.583	-
WorkMem	40.15 ± 9.22	41.06 ± 7.88	-0.91 (-5.07, 3.24)	0.663	-	46.62 ± 7.96	42.74 ± 8.91	3.88 (-0.21, 7.97)	0.063	-
VerbLrn	42.00 ± 9.95	41.94 ± 10.25	0.06 (-4.83, 4.95)	0.981	-	46.09 ± 8.57	43.50 ± 5.56	2.59 (-0.91, 6.08)	0.144	-
VisLrn	41.44 ± 8.77	40.29 ± 8.22	1.15 (-2.97, 5.26)	0.580	-	46.56 ± 6.33	46.47 ± 6.76	0.09 (-3.08, 3.26)	0.956	-
ProbSolv	42.62 ± 6.56	43.24 ± 11.08	-0.62 (-5.63, 4.39)	0.806	-	46.00 ± 7.60	44.79 ± 8.11	1.21 (-2.60, 5.01)	0.529	-
SocCog	33.38 ± 9.02	34.26 ± 8.89	-0.88 (-5.22, 3.45)	0.686	-	39.82 ± 6.92	34.91 ± 7.21	4.91 (1.49, 8.33)	0.006	0.70
Total	40.47 ± 8.96	40.38 ± 8.82	0.09 (-4.22, 4.39)	0.967	-	45.35 ± 7.57	42.85 ± 6.87	2.50 (-1.00, 6.00)	0.159	-

¹Effect sizes are shown when t-tests are significant; small effect (> 0.2), medium effect (> 0.5), large effect (> 0.8).

95%CI: 95% confidence interval; ProcSpeed: Processing speed; AttnVig: Attention vigilance; WorkMem: Working memory; VerbLrn: Verbal learning; VisLrn: Visual learning; ProbSolv: Reasoning and problem solving; SocCog: Social cognition.

Table 5 Comparison of 36-item short form survey scores between experimental and control groups

Outcome	Pre-treatment (baseline)					Post-treatment (12 weeks)
	Experimental group (n = 34)	Control group (n = 34)	MD (95%CI)	P value	Cohen’s d1	Experimental group (n = 34)	Control group (n = 34)	MD (95%CI)	P value	Cohen’s d1
Physical function	73.56 ± 13.19	74.12 ± 13.89	-0.56 (-7.12, 6.00)	0.865	-	84.47 ± 6.97	78.85 ± 11.96	5.62 (0.88, 10.36)	0.021	0.57
Vitality	53.82 ± 11.95	53.38 ± 12.44	0.44 (-5.46, 6.35)	0.882	-	64.26 ± 8.52	58.82 ± 11.41	5.44 (0.56, 10.32)	0.029	0.54
Social function	60.32 ± 13.31	60.03 ± 12.89	0.29 (-6.05, 6.64)	0.927	-	73.44 ± 8.35	68.74 ± 8.37	4.71 (0.66, 8.76)	0.023	0.56
Mental health	62.12 ± 14.89	61.79 ± 14.28	0.32 (-6.74, 7.39)	0.927	-	70.88 ± 11.96	62.82 ± 9.24	8.06 (2.88, 13.23)	0.003	0.75

¹Effect sizes are shown when t-tests are significant; small effect (> 0.2), medium effect (> 0.5), large effect (> 0.8).

95%CI: 95% confidence interval.