Expanding Your Potential: Integrating Cognitive Behavioral Therapy in Schizophrenia Treatment

So what is CBT? Brendan Pease of the Harvard Science Review writes:

CBT differs from traditional psychotherapy in that it focuses on behavioral and cognitive processes that negatively affect the patient’s life. It is also goal-oriented, requiring the therapist and the patient to work together toward the ultimate goal of changing harmful thought processes that the patient experiences.

The flexible and versatile nature of CBT allows therapists to tailor treatment to the needs of each client, focusing on each person’s unique symptoms while drawing on their interests and strengths to engage in a natural healing process. Therapists use techniques such as role-play, journaling, validity testing, and guided discovery to help you examine and remove emotional and behavioral barriers to healing. By adding CBT to your treatment plan, you can not only increase adherence to psychotropic treatment, but you can go beyond medication to create lasting emotional and behavioral changes that augment your self-awareness, independence, confidence, and overall quality of life.

Cognitive Behavioral Therapy can also help you manage the side effects of medication to increase tolerability and encourage adherence. Atypical antipsychotics such as Seroquel and Zyprexa are particularly notorious for causing weight gain and sedative effects, often leading to emotional distress, limiting function, impairing self-image, and causing some people to discontinue medication. By giving you behavioral management tools, CBT can help you engage in positive behaviors like exercise, healthy sleep patterns, and good eating habits to increase energy and minimize weight gain, optimizing your chances of staying on track with medication.

Even when you find a medication that works well for you, many people with schizophrenia continue to have relapses and residual symptoms—particularly negative symptoms, like lack of motivation, inability to experience pleasure, and emotional numbness. CBT techniques can be employed to help you stay active and increase motivation while exploring distorted and automatic thoughts, and help you break through emotional and cognitive obstacles. This is particularly important to enhancing your ability to cope if you develop tolerance to your medication and you experience decreased therapeutic benefit over time.

A major part of CBT for many people with schizophrenia includes targeting delusional symptoms through reality testing, or an evaluation of the validity of beliefs. For example, you may be asked to explore the basis for your beliefs and find evidence that what you believe is true. You may also engage in behavioral experiments to test your beliefs. For example:

If a patient believes his or her neighbor is communicating threats by sneezing, the patient may set up an experiment in which he or she watches a television program to evaluate other theories that could explain the neighbor’s sneezing—such as sickness or allergies.

Behavioral experiments give you ways of exploring the reality of your thoughts through simple observation and logic. By learning how to confirm or dispel your beliefs, you can increase your sense of control and self-reliance while actively challenging delusional or paranoid thoughts.

One of the hardest things many people with schizophrenia face is the feeling that they are crazy. While some mental health disorders have enjoyed increased public awareness and destigmatization campaigns, schizophrenia remains a highly stigmatized illness, and that stigma can become internalized by those who suffer from it, leading to emotional distress, shame, anxiety, and isolation. Therapists using CBT often employ a technique called normalization to help you reframe schizophrenic symptoms like delusions and hallucinations as existing on a continuum of normal human experiences. Knowing that what you are experiencing is normal and understandable can help you feel less frightened, and reduce catastrophic thinking while enhancing your self-esteem and confidence.

CBT can also help you overcome the negative beliefs you may have about yourself based on your experiences with your illness. Many people with schizophrenia have suffered major roadblocks as the result of their symptoms, including the inability to hold down a job or complete educational pursuits, the fracturing of relationships with loved ones, and difficulties with forming and maintaining new relationships. As a result, you may have developed beliefs about yourself grounded in a sense of hopelessness, self-blame, and anxiety about the future. Researchers at the Boonshoft School of Medicine at Wright State University note:

These multiple experiences of failure and loss, not surprisingly, can cement negative core beliefs, an obvious target for CBT. The same techniques that one would use to combat these core beliefs and the automatic thoughts that arise from them in depression can be used to help the person with schizophrenia.

Through CBT, you can begin to counteract these beliefs by remembering successes, forming realistic and achievable goals, and improving your sense of hope, possibility, and self-assurance. Meanwhile, you can learn concrete skills to enhance your social and occupational functioning such as forming reality-based understandings of social encounters, learning how to manage conflict, and developing increased emotional regulation.