Cognitive Behavioral Therapy for Schizophrenia

Schizophrenia is a major psychiatric disorder, or cluster of disorders, characterized by psychotic symptoms that alter a person's perception, thoughts, affect and behavior (NICE, 2009). Tai and Turkington (2009) define Cognitive Behavior Therapy (CBT) as an evidence-based talking therapy that attempts cognitive and behavioral change, based on an individualized formulation of a client's personal history, problems and world views. CBT was built on behavioral principles that emphasized clear relationships between cognition, physiology and emotion (Beck, 1952). This essay will look at CBT as a therapy for individuals suffering from schizophrenia.

I'll talk briefly about the historical background and the development of CBT, and the aims and principles it creates.

According to Gamble and Brennan (2000), the effectiveness of medication for schizophrenia to relieve patients from psychotic symptoms is limited. Although patients have adequate medication, some get little or no benefit from it. They are also more likely to suffer from a relapse (Gamble and Brennan, 2000). Similarly, Turkington et, al. (2006), said that the high dose of medication can also further disable the patients, which could then worsen the cognitive deficits and negative symptoms. The worsening of symptoms can become a major impediment to the implementation of any psychological treatment of schizophrenia (Turkington, et al, 2006). Poor adherence to medication can also hinder the involvement of patients in any rehabilitation programs (Gould, 2004). This could lead to a progressive negative effect of repeated relapses and readmission to the hospital (Gould, et al, 2004). Pinninti, et al. (2006) suggested that there is a method that appears to have the potential to supply the missing element in the care of patients with schizophrenia. This method is called Cognitive Behavioral Therapy (CBT), an adjunctive psychosocial treatment that can improve therapeutic outcomes for patients with schizophrenia (Pinninti et al., 2006). Gould et al. (2004) explains that CBT for schizophrenia focuses on altering the thoughts, emotions and behaviors of patients by teaching the patients the skills to challenge and modify beliefs about delusions and hallucinations (Gould, et al., 2004).

The aim of CBT, according to Gamble and Brennan (2000) is to help patients gain knowledge about schizophrenia and its symptoms, to overcome hopelessness, to reduce distress from psychotic symptoms, to reduce dysfunctional emotions and behavior and to help them analyze and modify dysfunctional beliefs and assumptions. More importantly it examines, and challenges positive and negative symptoms experienced by patients with schizophrenia (Tai and Turkington, 2009). Wykes, et al. (2008) stated that, there is a considerable body of evidence that illustrate the efficacy of CBT for schizophrenia. Nelson (1997), on the other hand, argued that it is important for patients to be aware of the illness as this will increase their understanding of what is happening to them, to help understand the symptoms and to detect when symptoms occur so that the patient can put appropriate coping strategies or treatments into effect (Nelson, 1997). The earlier forms of CBT for schizophrenia, according to Tarrier (1992), aimed primarily on behavioral strategies to affect change. It focuses on improving coping, building social and independent living skills and increasing compliance using behavioral strategies such as linking tablets to another activity (Tarrier, 1992). Through the years of its evolution, according to Tai and Turkington (2009), cognitive models were developed to specify the role of faulty beliefs, increased attention to threat-related stimuli, biased information processing of confirmatory evidence and safety behaviors. The emphasis is on distress resulting not necessarily from difficult experiences, but the meaning placed on that very experience (Tai and Turkington, 2009).

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