Cognitive Behavioral Therapy (CBT) for Schizophrenia

Status: Strong Research Support

Description

Similar to Cognitive-Behavioral Therapy (CBT) for other types of problems, CBT for schizophrenia involves establishing a collaborative therapeutic relationship, developing a shared understanding of the problem, setting goals, and teaching the person techniques or strategies to reduce or manage their symptoms. Therapy is usually conducted in individual sessions and is time-limited (typically several months). The goal is not to “cure” schizophrenia, but rather to improve the person’s ability to function independently, manage their schizophrenia, and to reduce the distress they experience in their daily life. Specific CBT approaches used in treating schizophrenia include cognitive restructuring, behavioral experiments / reality testing, self-monitoring and coping skills training. Unique considerations in treating schizophrenia include emphases on being non-confrontational and on normalizing psychotic experiences insomuch as they are on a continuum with non-psychotic experiences. CBT for schizophrenia can focus specifically on psychotic symptoms (i.e. hallucinations or delusional beliefs) but has also been shown to be helpful for addressing depression and / or anxiety associated with psychotic symptoms and their impact on the person’s life.

Key References (in reverse chronological order)

• Dickerson, F.B. (2004). Update on cognitive behavioral psychotherapy for schizophrenia: Review of recent studies. Journal of Cognitive Psychotherapy: An International Quarterly.
• Rector, N.A.; Seeman, M.V.; and Segal, Z.V. Cognitive therapy for schizophrenia: A preliminary randomized controlled trial. Schizophrenia Research, 63:1-11, 2003.
• Rector, N.A. & Beck, A.T. (2001). Cognitive Behavioral Therapy for schizophrenia: An empirical review. The Journal of Nervous and Mental Disease, 189 (5) 278-287.
• Barrowclough, C.; Haddock, G.; Tarrier, N.; Lewis, S.W.; Moring, J.; O’Brien, R.; Schofield, N.; and McGovern, J. Randomized controlled trial of motivational interviewing, cognitive behavior therapy, and family intervention for patients with comorbid schizophrenia and substance use disorders. American Journal of Psychiatry, 158: 1706-13, 2001.
• Pinto, A.;La Pia, S.; Menella, R.; Giorgio, D.; and DeSimone, L. Cognitive-behavioral therapy and clozapine for clients with treatment-refractory schizophrenia. Psychiatric Services, 50: 901-4, 1999.
• Dickerson, F.B. (2000) Cognitive behavioral psychotherapy for schizophrenia: A review of recent empirical studies. Schizophrenia Research, 16:71-90.
• Sensky, T.; Turkington, D.; Kingdon, D.; Scott, J.L.; Scott, J.; Siddle, R.; O’Carroll, M.; and Barnes, T.R.E. A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication. Archives of General Psychiatry, 57: 165-72, 2000.
• Wykes, T.; Parr, A.; and Landau, S. Group treatment of auditory hallucinations: Exploratory study of effectiveness. British Journal of Psychiatry, 175: 180-5, 1999.
• Tarrier, N., L.; Yusupoff, L.; Kinney, C.; McCarthy, E.; Gledhill, A.; Haddock, G.; and Morris, J. Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia. British Medical Journal, 317: 303-7, 1998.
• Tarrier, N.; Beckett, R.; Harwood, S.; Baker, A; Yusupoff, L.; and Ugarteburu, I. A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients: I. Outcome. British Journal of Psychiatry, 162: 524-32, 1993.

Clinical Resources

• Kingdon, D.G. & Turkington, D. (2005). Cognitive Therapy of Schizophrenia. Guilford, New York.
• Chadwick, P., Birchwood, M.J., & Trower, P. (1999). Cognitive Therapy for Delusions, Voices and Paranoia (Wiley Series in Clinical Psychology). Wiley.
• Kingdon, D.G. & Turkington, D. (1994). Cognitive-Behavioral Therapy of Schizophrenia. Guilford Press, New York.

Training Opportunities