Cognitive-behavioral treatment for the psychotic spectrum – schizophrenia in particular – is quite similar approach-wise to what would be employed for depression or anxiety. But CBT for schizophrenia also addresses issues more relevant to the psychotic features themselves such as positive and negative symptoms as well as overall life management.
Over 90 studies regarding the efficacy of CBT for schizophrenia have been conducted; sample sizes however, are on the small side. The conclusion to be drawn is that CBT appears to be most effective for positive symptoms (delusions, hallucinations, exaggerated, disorganized speech and behavior) and is a suggested treatment in the American Psychiatric Association practice guidelines. Here’s an example: when it comes to hallucinations, the psychotherapist could suggest that the affected person try to increase the volume of the voices he’s hearing – attempt to make them louder and more belligerent-sounding. The goal is that if the person insisted that he had no control over the voices and is then able to tell the therapist that he was able to make the voices louder and more vocal, the professional could then say “well if you can make them louder and more intense, let’s try to make them softer and less volatile.”
Treating negative symptoms (loss of pleasure, emotional withdrawal, passivity, apathy) with CBT is similar to behavioral interventions utilized in depression. Getting them moving and avoiding social isolation are key steps. People with schizophrenia are no different from healthy subjects when it comes to how they view pleasure. Inertia sets in when thoughts about pleasure don’t square with actually experiencing something pleasurable. So CBT is built around teaching them not to downplay the fun and enjoyment associated with getting together with friends in their thoughts before actually going out and finding how enjoyable it turned out to be.
Cognitive-behavioral therapy and medication management work hand-in-hand. CBT can serve as a tool for patients who are medication non-compliant by helping them chart their symptoms, and if uncontrollable, realize that medication may be worth a try.
Multifamily work involves bringing together several families, including the identified patients, for what amounts to an educational get-together. This family-style intervention may run for up to a year and typically consists of bi-monthly sessions. The focus of this work is on simple problem-solving. Basically one problem is selected for the group to work on with family members from the different groups drawing on the social support of each other. Ideas about how to solve commonly shared problems are exchanged and solutions are reached. For example, an issue that may be discussed is how to encourage the affected individual to develop and maintain a routine. Families reach a consensus that this begins with getting out of bed at a regular time each morning, then grooming oneself, eating breakfast and deciding on the steps to be stressed for maintaining structure for the rest of the day. Less is more here while the individual is in a fragile state of learning, and families learn from each other how much to push patients toward desired behaviors and possibly invite disobedience versus when to back off. Also, families are taught how to recognize the prodromal, or early warning signs of symptom return with emphasis placed on contacting the treating professional(s) promptly – if or when this occurs.
