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Cognitive Therapy for Schizophrenia

Cognitive-Behavioral Psychotherapy

Cognitive psychotherapy, often incorporating behavioral therapy techniques, has been found to be more effective than other types of psychotherapy in treating several specific types of psychological problems, including depression and panic attacks. Sometimes this treatment approach is called cognitive-behavioral psychotherapy because of the ease with which the two approaches combine to effectively treat a variety of psychological problems. This combination of treatment techniques is also effective in the treatment of schizophrenia.

The basic premise of cognitive therapy is that beliefs, expectations, and cognitive assessments of self, the world, and the nature of personal problems in the world affect how we perceive ourselves and others, how we approach problems, and ultimately how successful we are in coping in the world and in achieving our goals. Schizophrenia results in distorted perceptions of the world, including self, and disordered or disorganized thinking. It seems reasonable that a cognitive treatment approach would be helpful in treating schizophrenia, assuming that medication is also employed to alleviate psychotic thought processes which would interfere with any psychotherapeutic interventions.

Behavioral therapy has been used in the treatment of schizophrenia for many years, but usually within a structured psychosocial rehabilitation program, rather than a part of an individual treatment approach. There are many reasons for this. First, schizophrenia is seen as a life-long illness, and few insurance plans were willing to provide coverage for treatment in the private sector because of the anticipated expense.  This continues to be true, especially with managed care. The psychosocial rehabilitation programs that incorporated behavioral treatments were usually either hospital based, or funded by public money or non-profit grants. As such, budget constraints would encourage group behavioral treatment, offered by treatment providers with limited training or experience. These approaches demonstrated some success, but the potential value of behavioral treatment was often lost within the greater structure of the broad rehabilitation program. In other words, the program as a whole was evaluated, rather than specific components of the program. This is further complicated by the variety of rehabiltation programs that incorporate many different behavioral treatment modalities. If no two rehabilitation programs are identical, then it is difficult, or impossible, to evaluate the relative effectiveness of specific components. However, an assessment of the interpersonal deficits produced by schizophrenia predicts which behavioral treatments are most likely to be effective.

Cognitive Therapy with Schizophrenia

The misinterpretation of events in the world is common in schizophrenia. Using cognitive therapy with schizophrenia requires the psychologist to accept that the cognitive distortions and disorganized thinking of schizophrenia are produced, at least in part, by a biological problem that will not cease simply because the "correct" interpretation of reality is explained to the client. Cognitive therapy can only be successful if the psychologist accepts the client's perception of reality, and determines how to use this "misperception" to assist the client in correctly managing life problems.  The goal is to help the client use information from the world (other people, perceptions of events, etc.) to make adaptive coping decisions. The treatment goal, for the cognitive therapist, is not to "cure" schizophrenia, but to improve the client's ability to manage life problems, to function independently, and to be free of extreme distress and other psychological symptoms.

Behavior Therapy with Schizophrenia

Behavior therapy assumes that certain skills increase our ability to function in the world, and to solve problems as they arise. Many psychosocial skills develop as a consequence of our experiences in the world.  We "learn from our mistakes" and from our successes in managing different types of problems.  Since people have different life experiences, some people learn skills well, and others do not learn as many skills. Another individual difference, is our ability to learn from our experiences. In order to learn from experience, we must correctly analyze what was effective and what was not effective in solving a problem. We can also "learn" ineffective or maladaptive responses to problems, especially if those responses lead to immediate reduction of pain or embarassment, despite having no affect on the long term solution to the problem. The learning of maladaptive responses top problems is often the result of cognitive distortions or making mistakes in assessing cause and effect.  That is why cognitive therapy and behavioral therapy are often combined.  Individuals with schizophrenia often make incorrect assessments of cause and effect. Also, they often do not learn as well from experience because of their disordered and disorganized thinking. Behavior therapy teaches them the social skills they never learned, and helps them understand when to apply those skills to problems in the world.

Examples of Behavioral Skills Training

  • Stress Management Training
  • Assertiveness Training
  • Communication Skills Training
  • Problem Solving Skills

Cognitive Family Therapy with Schizophrenia

Cognitive family treatment usually identifies the expectations of family members and how those expectations affect their interactions with the person diagnosed with schizophrenia. Additionally, connections are made between the family expectations and their emotional response to their ill relative.  Appropriate expectations are explored, and problem solving sessions allow family members to meet their own emotional needs. Family members frequently need stress management training as well, and need to learn what their limits are, and what to do when those limits are reached.

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Thanks and acknowledgment to The National Institute of Mental Health which was a primary resource for information on this topic

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