Abstract
Background. Despite evidence supporting cognitive behavioural therapy for psychosis (CBTp), engagement and treatment response remain highly variable, and robust predictors are lacking. Existing research may overlook clinically relevant factors. We aimed to identify candidate predictors of CBTp engagement and outcomes by integrating clinicians’ perspectives with the existing literature. Methods. Twenty clinical psychologists experienced in delivering CBTp participated in semi-structured interviews. Using a mixed-methods design, we first identified candidate predictors through inductive framework analysis of unprompted accounts. Clinicians subsequently rated the perceived importance of these and 32 literature-derived factors on a 10-point scale. Mean ratings and variability were examined to characterise clinician agreement. Findings were integrated into a candidate predictor framework linked to available measurement instruments. Results. Clinicians spontaneously identified 38 factors, of which 16 were absent from the literature-derived list. Frequently identified factors included readiness and motivation (90%), cognitive flexibility (85%), social support (80%), previous experiences of care and therapy (70%), and socioeconomic and environmental stability (70%). Clinicians emphasised therapy-related, contextual, and clinical management factors, including expectations of therapy, substance misuse, and medication, which remain underrepresented in prediction research. Literature-derived factors receiving relatively high importance ratings and agreement included insight, cognitive flexibility, hopelessness, and social functioning. Demographic characteristics were generally considered less important. Conclusion. Clinicians identified factors extending beyond those conventionally investigated as predictors of CBTp engagement and outcomes. The resulting clinician-informed measurement framework provides a broader, clinically grounded candidate predictor set to guide prospective studies and the development of personalised prediction models in psychosis. Keywords: Precision psychotherapy, psychological intervention, CBT, psychosis, schizophrenia