ABSTRACT
Although metacognitive training (MCT) and cognitive-behavioural therapy (CBT) have been proven to be effective interventions for the treatment of symptoms of schizophrenia, still little is known about the effects on quality of life (QoL). This systematic review compares the effectiveness of MCT and CBT-based interventions for QoL in individuals with schizophrenia spectrum disorders (SSD). Three electronic databases were screened up to October 2025 for MCT and CBT studies reporting QoL outcomes for patients diagnosed with SSD. Data from 38 randomized controlled trials (RCTs) met the inclusion criteria, of which eight MCT and 30 studies included CBT-based interventions. When comparing MCT against control interventions, none of the eight MCT studies found significant differences in the overall score of QoL scales at posttest and at 1- or 6-month follow-up. Only one study has assessed the effects of MCT after 3 years, yet it demonstrated significant improvements in QoL. For CBT-based interventions, nine of 26 available between-group comparisons in overall QoL showed a significant improvement in QoL after CBT at the posttest, and five of 19 effects were observed at follow-up. This review provides modest evidence for improvements in QoL from CBT-based interventions and a small number of studies concerning QoL in MCT, emphasizing the need for further research that prioritizes QoL as a primary outcome as well as the need for research with longer follow-ups to capture the delayed effects of MCT and CBT on QoL. It awaits to be tested whether the recent extension of MCT (app, 2 modules on self-esteem and stigma) augments QoL.