Search Google for cognitive-behavioral therapy (CBT) and you’ll find this: “A type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression.”
On the surface, it seems unlikely that this type of therapy would be associated with people suffering from schizophrenia, a serious mental disorder affecting approximately one percent of the world’s population. But it may be an effective supplementary therapy to pharmacological treatment for those with the disorder.
Post-hospital care often begins while patients are still in the hospital, and applies the principles of treatment engagement, goal-setting, positive actions and removing roadblocks to recovery (Moran, 2014). It is believed that utilizing these ideas will allow patients to assume more control in their daily lives and allow for a return of functionality where they may previously have lost some.
CBT is considered an effective way to apply these principles and teach the patient how to practice them on their own. It is the most universal treatment in addition to medication in the UK, as well as recommended to become a second frontline treatment by the UK National Health Service (Schizophrenia.com, 2014).
According to the Beck Institute website (2016), “the goal of CBT is to help people get better and stay better.” The website also explains that the therapy is a platform for the therapist and client to work together to change the clients’ thinking, behavior and emotional responses. This ties in with the ideas of treatment engagement and setting goals. Through practicing this, schizophrenia patients feel that they can take more control in their daily lives. Once the barriers of feeling helpless and being defined by their illness are removed, it is easier to move forward. It is an important step in the life of anyone suffering from mental illness to feel hope for the future and be able to achieve some forms of independence.
CBT targeted toward schizophrenia was researched only after it had been proven effective for anxiety and depression, to provide a treatment for the residual symptoms (Kingdon & Turkington, 2006) that remained once the patient was on medication. It is common knowledge that even with compliant pharmacologic therapy, patients still experience both positive and negative symptoms, such as delusions, hallucinations or symptoms similar to depression. Additional symptoms include a reduction in motivation, emotional expression and feeling, and a lack of pleasure and interest in life, among other cognitive impairments affecting memory, thought organization and task priority (Schizophrenia.ca, 2016). Medication side effects such as uncontrollable movements, weight gain, seizures and sexual dysfunction also can be debilitating (Konkel, 2015).
Mental health professionals have reiterated over the years that CBT and medication have been demonstrated to be effective treatments for schizophrenia. According to the UK’s National Institute for Health and Care Excellence (NICE), “almost half of all practitioners, people using mental health services and their families say that CBT is the most important intervention alongside the use of medication” (NICE, 2012).
One study comparing CBT to other forms of psychosocial interventions found that CBT and routine care together were more effective than any of the other therapies examined (Rector & Beck, 2012). The authors acknowledged that there are many flaws in the studies they combined and compared, but it holds promising results that may be tested in more rigorous and controlled studies in the future.
There also have been studies showing that there is little to no effect from cognitive behavioral therapy in reducing symptoms of schizophrenia. Jauhar et al. (2014) concluded that CBT has a small, if any, therapeutic effect on the symptoms of schizophrenia when they conducted a systematic review and analysis, including accounting for potential bias, of previous studies that showed positive results.
There is an argument to be made that acutely psychotic patients would be unable to participate in psychological interventions, which would make it difficult to provide them CBT. Through encouragement to take up small activities that are possible for psychotic patients, they can move toward being in a well enough state to be able to take up formal CBT (NICE, 2012). Attending the sessions and doing the homework associated with therapy could also become a problem. The rates of medication noncompliance alone would suggest that it would become an issue.
Logically speaking, if CBT works to alleviate depression, it would apply to the negative symptoms associated with schizophrenia, since they are essentially the same. Once negative symptoms are less of an issue for the patient, it may help them handle positive symptoms as well. Even if the positive symptoms couldn’t be helped, at least the individual wouldn’t have to deal with the full range of symptoms that contributes to reduced social and occupational functions.
CBT might not work as well as some studies claim, but it may. It is clear that more research needs to be done with better control methods, but in the meantime, as there are answers still being sought, it is worth a try.