Cognitive Behavioral Therapy for People with Schizophrenia

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There has been renewed interest in psychosocial interventions, including psychotherapy, in the treatment of schizophrenia. In recent years, this has included adapting cognitive behavioral therapy (CBT) techniques previously used mainly in the treatment of mood and anxiety disorders for use with individuals with more severe mental disorders. The core symptoms of schizophrenia in many people have proven to be resistant to treatment with medication alone and can be targeted for treatment with CBT. Impairments in major role function due to negative symptoms, some of which have proved especially recalcitrant to pharmacologic agents, can be addressed with CBT to improve relationships with family and friends and success at work. People with schizophrenia often struggle with comorbid mood and anxiety disorders, including past traumas, which can be successfully treated with CBT.Disseminating and implementing these treatments into a system of care that has, for more than a decade, focused on pharmacologic treatments and community support services has proven challenging especially in the United States.

This article will summarize the current literature on the use of CBT for people with schizophrenia for the primary symptoms of illness, the secondary social impairments, comorbid disorders, and enhancing the effectiveness of other treatments and services, such as medication and vocational support. Ways in which CBT techniques can be incorporated into the current mental health system will be suggested. It should be acknowledged, however, that a few recent reviews and studies have called into question the quality of the evidence or the true effectiveness for CBT in schizophrenia and other severe mental disorders and comorbid conditions.

Ann K. Morrison, MD

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