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Cognitive Behavorial Therapy

 

Despite the long-held belief that it is a pointless exercise to try to dissuade people from holding tenacious delusional beliefs, recent research reveals that talking to people about their psychotic symptoms, and about their meaning to the individual, can lead to an improvement in symptoms. It emerges that gently challenging the evidence used by people with psychotic disorders to support their delusions, offering alternative viewpoints, testing reality and enhancing coping strategies can be helpful. After establishing a trusting relationship between therapist and patient, the therapist may gently test the patient’s beliefs as in the following illustration:


   Patient: “The Mafia has my house under surveillance.”
   Clinician: “Well, that is possible…. But why do you think it is the Mafia? Could it be some other organization? Or is something else happening altogether? How could we find out?” *


Cognitive behavioral therapy has been shown to be effective for persistent psychotic symptoms in people who are resistant to treatment with antipsychotic medication. The goal is not to persuade the patient that he or she has a mental illness. Rather, it is to reduce the severity of the symptom or the distress it causes. Patients are helped to identify coping strategies that may reduce both the cues and reactions to such symptoms as hallucinations or delusions. For one person, being alone or bored may be a cue to an increase in hallucinations; he or she can be taught to adopt strategies to reduce isolation or boredom. Others may learn to reduce auditory hallucinations by humming, conversing with others, or even reasoning with the voices and telling them to go away and come back later. Similarly, a person might be taught to test the reality of delusional beliefs against the therapist’s interpretation of events and, for example, return to a church social group about which he or she had harbored paranoid fears. The approach does not reduce relapse rates in psychosis: but is effective in reducing distress resulting from positive symptoms.

 

*Turkington, D. et al, American Journal of Psychiatry, 163:365-373, 2006, p. 367