Cognitive Therapy for Schizophrenia

Here’s what Kevin Benbow emailed to us about his experience supervising a clinician with her first schizophrenia patient:

As a clinical supervisor for a small, rural mental health clinic in Arizona I get the opportunity to supervise and train behavioral health technicians.  Such individuals have a wide range of experience and education levels and are allowed to practice under Arizona State law if they receive supervision from a licensed Behavioral Health Professional.

One of these clinicians has been particularly receptive to the cognitive model and has been helping many of her clients identify their automatic thoughts and subsequently test them.  Recently she assessed a client who was subsequently diagnosed with schizophrenia.  She had only weeks before experienced her first psychotic episode. Naturally, she was hesitant to provide therapy for such a person and seemed relieved when this client instead opted to receive treatment from a more experienced therapist who lived closer to her home.

After 2 months of seeing the other therapist the client contacted my supervisee because things were not going well.  Both therapists met with the client.  According to my supervisee, the other therapist made several statements to the effect that “this client is not ready for therapy” etc.  Naturally, the client felt both stigmatized and hopeless as a result.

I discussed the issue with my supervisee, who, with fear and trepidation, as well as the client’s grateful consent, decided to begin therapy with her.  In only a few short sessions, the client had uncovered dysfunctional thinking related to how her illness had stigmatized her and made her feel useless.  She wonders if she will ever return to her premorbid level of functioning.  CT is being used to address and evaluate her beliefs in this regard.

My supervisee was naturally happy to see how CT can be applied to such a serious condition.  Soon after she accepted another individual with schizophrenia on her caseload.  This person has been suffering with the illness for quite some time, continually experiences auditory and visual hallucinations.  My counsel was for the trainee to treat the hallucinations as automatic thoughts and help the client determine if there might be some detectable meaning behind them.   For confidentiality reasons, I won’t go into the nature of what was uncovered, but taking this approach with the client visibly lessened the client’s level of distress, helped him understand the nature of his experience, and at least in the session made some of the more prominent hallucinations disappear.

Naturally, my trainee was excited and emboldened to continue working with this very misunderstood population.  Readers will be interested to know that the course of treatment comes from Kingdon and Turkington’s “Cognitive Therapy of Schizophrenia (Guides to Individualized Evidence Based Treatment).”  This protocol seems to be a highly useful adjunct to family support and pharmacotherapy for management of this devastating disease.

Kevin L. Benbow, MA, LAC
Yuma

10 replies
  1. Howard Schneider
    Howard Schneider says:

    This is my first time on the blog — it’s very useful to see other therapists considering issues that also come up in my clinical practice.

    In the majority of my patients suffering from schizophrenia, medications work reasonably well for hallucinations (which in my patients are almost always auditory but visual ones do sometimes occur). (If hallucinations are a problem, you should make sure that psychopharmacology is reasonably well optimized by the caregiver who handles that function, as well as ruling out any less common causes for the visual hallucinations.)

    However, the negative symptoms of schizophrenia are very difficult to treat, and it is here that CT seems to be most useful, and help my patients to have better lives. I try to work through the Greenberger/Padesky manual with patients. ‘Go slow and easy’ seems to be the rule, and we work on AT’s and behavioural strategies and problem solving, rather than jumping in and trying to change core beliefs in session 1 (or session 10 even).

    I also often add an antidepressant. This seems to help many patients deal with the depression that often accompanies the schizophrenia, but it may just be the CT I am also doing, since an evidence-based review by the Cochrane Foundation a few years ago of antidepressant medication effect in schizophrenia showed little evidence to support (or evidence of harm) such usage.

    I hope my experiences are useful to you.

    Sincerely,

    Howard Schneider, MD
    Toronto, Canada

    Reply
  2. CT Today
    CT Today says:

    Aaron T. Beck, M.D. says:

    Howard, thank you for your comments. They add to our body of knowledge.

    We actually have a full program for treating negative symptoms in Schizophrenia. It resembles our treatment of depression. I’m currently working on a book about CT for Schizophrenia, in which I describe the treatment of both positive and negative symptoms.

    Reply
  3. Kevin Benbow
    Kevin Benbow says:

    Dr. Schneider:

    I share your observation that “go slow” is the key with these folks. I always work in concert with a prescriber. At times, the focus of CT is medication compliance.

    I had not thought of using mind over mood for the negative symptoms, but that would certainly make sense.

    Dr. Beck: When can we expect your book on Schizophrenia?

    Kevin L. Benbow, MA, LAC
    Yuma, Arizona

    Reply
  4. CT Today
    CT Today says:

    Dr. Beck’s book on Schizophrenia should be out in 2008… we’ll be sure to post an announcement here when it’s available.

    Reply
  5. Joe
    Joe says:

    Hi, I’m 19 years old. and considering getting into this line of work. because aside from it being one of the most interesting things. no doubt, CT, saved my life, and helps get through it every.

    Question. this is regarding OCD. I read somewhere that OCD is incurable without medication. is it true? and, is OCD a manifestation of an organic neurological brain disorder. or is it because of perhaps faulty, or dysfunctional schema, as a result of some sort of experience(‘s)?

    i did see your other post on OCD, if I’m not mistaken, unless i misunderstood. that was just talking about that cognitive behavioral therapy reduces the severity of OCD, in that it relieves the overall distress, but can it actually CURE IT? (cure, the OCD itself.)

    btw, regarding Schizophrenia, I guess I would have the same question, is it just a manifestation of something organic, or is it deeper then that, perhaps after a very traumatic event where a person totally breaks with reality?

    I would very much like to know,

    Joe,
    Brooklyn, NY

    thanks

    Reply
  6. CT Today
    CT Today says:

    Joe, we’re glad to hear that you’re interested in CT and that it’s been so helpful to you. As for OCD, there are many, many studies on CT treatment for OCD (we have been posting about recent studies, but there are many other studies out there). For more information about how CT treatment works for OCD (alone, and in combination with medication), please see the Academy of Cognitive Therapy’s article on OCD.

    As for what causes OCD, please see the OCD Fact Sheet at the bottom of the above-mentioned article, especially the paragraph, “What Causes OCD?”

    And for information about the cause of Schizophrenia, please see the Academy’s article on Schizophrenia, particularly the paragraph, “What Causes Schizophrenia?”

    Hope that helps.

    Reply
  7. lungi
    lungi says:

    I leave in the Phoenix, AZ area & would like a therapist for a 14 year old daughter in the area who treats OCD using the tactics as mentioned above without medication. Please help us.

    Reply
  8. CT Today
    CT Today says:

    We typically recommend cognitive therapists who have been certified by the Academy of Cognitive Therapy, at http://www.academyofct.org. If you go to their website and click on “Find a Certified Cognitive Therapist,” you’ll be able to search by zip code.

    I looked in Phoenix, AZ and there is a certified Cognitive Therapist who treats OCD and adolescents. I would suggest contacting her to see if she is taking new patients and if she would be an appropriate fit for your daughter, and if not, perhaps she can recommend someone else in your area. Her contact info is:

    Susan R. Westover Ph.D.
    Founding Fellow
    Director, Center for Cognitive Therapy of Phoenix
    P.O. Box 32748
    Phoenix, Arizona
    85064
    USA
    Phone: 480.949.7995
    Email: srwestover@cox.net

    Good luck to you!

    Reply

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