Cognitive behavioural therapy (CBT) is a psychotherapeutic approach that addresses dysfunctional emotions, behaviours, and cognitions through a goal-oriented, systematic process. The name refers to behaviour therapy, cognitive therapy, and to therapy based upon a combination of basic behavioural and cognitive research. CBT was primarily developed through an integration of behaviour therapy (first popularized by Edward Thorndike) with cognitive therapy (developed by Aaron Beckand and Albert Ellis). While rooted in rather different theories, these two traditions found common ground in focusing on the “here and now”, and on alleviating symptoms.
CBT is thought to be effective for the treatment of a variety of conditions; this includes psychotic disorders, in particular, schizophrenia. Within schizophrenia, the most common symptoms which may be amendable to CBT interventions are: * Hallucinations: Particularly auditory hallucinations (i. e. experiencing unusual or distorted sensory perceptions which do not seem to exist outside one’s perception) * Delusions: false beliefs that persist despite a lack of evidence and are not explained by cultural norms. * Problems with mood: Such as depression or anxiety Related problems: Such as low self-esteem, relationship problems and social withdrawal. The aims of CBT for psychosis are usually to help the client manage with psychotic symptoms better, to reduce the stress and disability caused by those symptoms and to reduce the risk of relapse. To do this building a collaborative relationship and a formulation which can give an alternative, non-stigmatising account of the symptoms is vital. In spite of the growing support for the role of CBT in treating psychosis, there are factors associated with the experience of psychosis that do not readily lend themselves to this framework.
These include issues of reintegration, feeling out of control, and alteration to the sense of self. What is emerging is the concept of flexible psychotherapy. This approach requires a therapist to conceptualise the patient’s issues in a number of ways and adapt the therapeutic strategies to the patient’s needs. Therapeutic orientations may also be integrated. For example, when assisting with psychological adjustment following the first or second episodes, increased adjustment and reduced secondary morbidity (depression and anxiety) has been found if they received a hybrid therapy based on CBT and self-psychology principles called cognitively oriented psychotherapy for early psychosis’. Another therapy newer to the scene is Cognitive Enhancement Therapy, Cognitive enhancement therapy (CET) was developed and piloted in the early to middle 1990s as an integrated approach to the enhancement of neurocognitive and social cognitive abilities. Cognitive enhancement therapy is based on the premise that schizophrenia is a brain disorder that affects attention and verbal memory, and that these deficits contribute to disorganized thoughts and loss of social competence.
This therapy involves a series of interactive drills and exercises, so that patients learn to improve aspects of cognitive function, such as appraisal of social context. Some of the techniques used during cognitive enhancement therapy were adapted from the treatment of traumatic brain injuries, and take advantage of the brain’s remarkable plasticity (its ability to form new neural connections that can help people compensate for loss of brain function).
In a two-year trial of the effectiveness of CET, investigators randomly assigned 31 patients to cognitive enhancement therapy, consisting of weekly computer training in attention, memory, and problem solving, coupled with group therapy sessions designed to improve social skills and ability to function at home and in the community. Patients underwent a total of 60 hours of computer training and 45 hours of group therapy.
The researchers assigned the other 27 participants to a control intervention, enriched supportive therapy, consisting of stress reduction techniques and coping skills to reduce risk of relapse. In their first paper, the investigators reported that patients assigned to cognitive enhancement therapy improved significantly more than the other participants on composite assessments of cognitive style (such as rigid or disorganized thinking), social cognition (foresight or emotional processing), social adjustment (ability to function socially or work), and overall symptoms.
One year after the trial ended, the researchers reassessed participants to see whether benefits were maintained over time. They found that participants assigned to cognitive enhancement therapy remained significantly better in terms of overall social adjustment than those assigned to enriched supportive therapy. For example, they were more likely to have friends and participate in social activities.