Psychological therapy for schizophrenia
Cognitive behaviour therapy
Cognitive behavioural therapy (CBT) is a type of therapy commonly used to treat people with
schizophrenia. It usually takes over a period of 5-20 sessions and can either be done in a group or an
individual basis. Cognitive behavioural therapy has two main components: the cognitive part and the
behavioural part. The cognitive component helps the person challenge their dysfunctional and
irrational thinking (eg delusions and hallucinations) in the aim to restructure it, and the behavioural
component helps them challenge their negative thoughts and understand how their irrational
cognitions impact their feelings and behaviour. The therapist will set tasks and homework in order to
gather evidence to challenge these negative thoughts and it allows the patient to consolidate their
learning of strategies between sessions. This will not eliminate the symptoms of schizophrenia but
can make it easier to cope, in turn reducing the distress and improving their ability to function
adequately. Tarrier devised a specific type of CBT for schizophrenia, called coping enhancement
strategy (CSE), which involves building upon the existing coping strategies of those people with
schizophrenia. Tarrier noted that individuals were able to identify their triggers for schizophrenic
episodes, such as certain people or being put under stress, and had devised their own personalised
coping strategies (iodographic approach). The aim of CSE is to develop and apply coping strategies
for psychotic symptoms and the accompanying stress they produce. There are two types of coping
strategy that are developed in the therapy: cognitive strategies and behavioural strategies. Cognitive
strategies involve tasks such a distraction, concentrating on a specific tasks and positive self talk, and
behavioural strategies involve relaxation techniques or playing loud music to drown out the voices.
There are two parts to CSE. Firstly, the patient and the therapist develop a rapport, the patient is
seen as a scientist and identify the triggers of psychotic episodes as well as reviewing existing coping
strategies and developing new ones. Secondly, they target specific symptoms and find strategies to
deal with them. The overall aim of CSE to have two effective strategies for each distressing
symptom.
One strength of CBT for schizophrenia is the evidence for its effectiveness. Jauhar et al (2014)
reviewed 34 studies of using CBT with schizophrenia and concluded that there is clear evidence for
small but significant effects on both positive and negative symptoms. Other studies, for example
Pontillo et al (2016) found reductions in frequency and severity of auditory hallucinations. Clinical
advise from NICE (2019), the National Institute for Health and Care Excellence, recommends CBT for
schizophrenia. This is a strength of the use of CBT for treating schizophrenia because it means that
both research and clinical experience support the benefits of CBT for schizophrenia.
One limitation of CBT for schizophrenia is the wide range of techniques and symptoms included in
studies. CBT techniques and schizophrenia symptoms vary widely from one case to another. For
example, Thomas (2015) points out that different studies have involved the use of different CBT
techniques and people with different combinations of positive and negative symptoms. The overall
modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT
techniques on different symptoms. This is a limitation as it makes it hard to say how effective CBT
will be for a particular person with schizophrenia.
Cognitive behaviour therapy
Cognitive behavioural therapy (CBT) is a type of therapy commonly used to treat people with
schizophrenia. It usually takes over a period of 5-20 sessions and can either be done in a group or an
individual basis. Cognitive behavioural therapy has two main components: the cognitive part and the
behavioural part. The cognitive component helps the person challenge their dysfunctional and
irrational thinking (eg delusions and hallucinations) in the aim to restructure it, and the behavioural
component helps them challenge their negative thoughts and understand how their irrational
cognitions impact their feelings and behaviour. The therapist will set tasks and homework in order to
gather evidence to challenge these negative thoughts and it allows the patient to consolidate their
learning of strategies between sessions. This will not eliminate the symptoms of schizophrenia but
can make it easier to cope, in turn reducing the distress and improving their ability to function
adequately. Tarrier devised a specific type of CBT for schizophrenia, called coping enhancement
strategy (CSE), which involves building upon the existing coping strategies of those people with
schizophrenia. Tarrier noted that individuals were able to identify their triggers for schizophrenic
episodes, such as certain people or being put under stress, and had devised their own personalised
coping strategies (iodographic approach). The aim of CSE is to develop and apply coping strategies
for psychotic symptoms and the accompanying stress they produce. There are two types of coping
strategy that are developed in the therapy: cognitive strategies and behavioural strategies. Cognitive
strategies involve tasks such a distraction, concentrating on a specific tasks and positive self talk, and
behavioural strategies involve relaxation techniques or playing loud music to drown out the voices.
There are two parts to CSE. Firstly, the patient and the therapist develop a rapport, the patient is
seen as a scientist and identify the triggers of psychotic episodes as well as reviewing existing coping
strategies and developing new ones. Secondly, they target specific symptoms and find strategies to
deal with them. The overall aim of CSE to have two effective strategies for each distressing
symptom.
One strength of CBT for schizophrenia is the evidence for its effectiveness. Jauhar et al (2014)
reviewed 34 studies of using CBT with schizophrenia and concluded that there is clear evidence for
small but significant effects on both positive and negative symptoms. Other studies, for example
Pontillo et al (2016) found reductions in frequency and severity of auditory hallucinations. Clinical
advise from NICE (2019), the National Institute for Health and Care Excellence, recommends CBT for
schizophrenia. This is a strength of the use of CBT for treating schizophrenia because it means that
both research and clinical experience support the benefits of CBT for schizophrenia.
One limitation of CBT for schizophrenia is the wide range of techniques and symptoms included in
studies. CBT techniques and schizophrenia symptoms vary widely from one case to another. For
example, Thomas (2015) points out that different studies have involved the use of different CBT
techniques and people with different combinations of positive and negative symptoms. The overall
modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT
techniques on different symptoms. This is a limitation as it makes it hard to say how effective CBT
will be for a particular person with schizophrenia.
