CBT Paradigm for Schizophrenia Patients

Pronab Ganguly

One Door Mental Health, Sydney, Australia

*Correspondence to: Mr. Pronab Ganguly, One Door Mental Health, Sydney, Australia.

Copyright © 2023 Mr. Pronab Ganguly. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Schizophrenia is considered to be a kind of brain malfunctioning that affects the sufferer’s ability to function normally and engage in normal actions [1]. The symptoms of schizophrenia include delusions, hallucinations as well as disorganised speech and diminished emotional expression [2,3]. The root cause of schizophrenia is supposed to be malfunction related to dopamine secretion in the brain [4]. It is considered that schizophrenia is one of the top ten mental health disease in the world [5]. It has been observed that around 1% of the general population are affected by schizophrenia [6,7]. It is supposed that schizophrenia sets-in late teens or early adulthood. However, the onset of schizophrenia may also happen in middle ages as well [8]. Generally, severe positive and negative symptoms are associated with early onset of schizophrenia [9]. Men suffer more from schizophrenia than women [10,11]. Medication along with holistic management can effectively control schizophrenia symptoms. If schizophrenia is treated in the onset, the chances of recovery is highest [9]. Many individuals with schizophrenia can live a satisfactory life with antipsychotic medication and holistic management.

Schizophrenia is a long standing burden that is much worse than many other mental disorders [12]. For treatment of schizophrenia the direct cost amounts to 1-3% of the national health care cost in most of the developed nations [9]. The indirect costs that include accommodation, financial support, education, employment and training are equal or maybe more than the direct costs. The overall objective of holistic management of schizophrenia is reduction of the symptoms as well as improvement in the quality of life of the patients.

Cognitive Behaviour Therapy is important for holistic management of schizophrenia. Cognitive behaviour therapy (CBT) involves counselling techniques that intend to modify distressful types of thinking, feeling and behaviour. CBT involves self-support techniques that helps to decrease positive symptoms in schizophrenia. CBT consists of two different kinds of strategies: ‘cognitive therapy’ and ‘behavioural therapy’. The overall application of these two strategies often enables the client to modify their thoughts to healthy thoughts and behaviours. Morrison (2009) [13] suggests application of CBT for schizophrenia patients to reduce the symptoms and improve social integration. Morrison (2009) [13] suggested that that many schizophrenia symptoms cannot be addressed with medication only. He advised that CBT will be an add-on to antipsychotic medication to be more effective. As an example, many studies suggest that cognitive rehabilitation and CBT can decrease cognitive deficits and thereby improves the positive symptoms [14,15]. Many techniques exist to modify thoughts and behaviour with the help of CBT. One of the research studies suggested the important elements of CBT for schizophrenia [16], and advised that a number of CBT techniques can be deployed effectively in schizophrenia. The technique called cognitive restructuring is aimed to challenge the patient to prove with evidence that their beliefs are real. This technique is meant to help the patient to develop an insight that they have delusions. This technique is supposed to help the client to learn challenging negative thoughts. In this fashion this technique replaces the defective thoughts with more realistic and normal thoughts. CBT was supposed to be useful to manage homelessness. CBT is meant to reduce cognitive impairment thereby improving relationship and social integration. The aim of behavioural therapy is to assist the patient learn how to change their faulty behaviour. As an example they may practice conversational skills so that they can utilise these newly learned conversational skills in social integration. CBT helps the patients in engage in society so as to improve friendship and relationship.

There are many research studies about the applicability of CBT for schizophrenia patients over the last 15 years. In UK, CBT is commonly used as an add-on therapy along with medication for schizophrenia patients [13]. UK national health service recommends CBT as a first-line therapy for schizophrenia patients. CBT is also recommended by American Psychiatric Association for individuals with schizophrenia. CBT is also recommended by US Schizophrenia Patient Outcome Research Team as a preferred mode of therapy for schizophrenia patients with persistent symptoms [17].

Schizophrenia patients suffer from disorganised behaviour in their daily life. CBT has been found to restore normalcy to this disorganised behaviour. In USA and UK, one of the research studies [18] observed that compared to other mode of therapies CBT is preferred. This study discussed how CBT contributes to improve positive as well as negative symptoms of schizophrenia. This study also describes how CBT alleviate mood disorder as well as social anxiety effectively. However, hopelessness was not addressed. In CBT, the family of the patient is actively involved and this is welcomed by the patient as well as patient’s family. CBT encourages the family of the patient work collaboratively and actively participate in the therapy. The treatment of schizophrenia encompasses hallucination and delusion [19]. It also addresses the issues related to negative symptoms as well as depression [19]. CBT in its therapeutic process direct the patient to engage in homework. This is supposed to help the patient and their carers in reduction of the symptoms of schizophrenia. CBT is found to encourage taking medications regularly and work in collaboration with the community [13]. The effect of CBT along with antipsychotic medication far outweighs the effect of medication alone [20].

The major techniques of CBT in schizophrenia [13] involves:

1. An alliance is developed based on patient’s viewpoint
2. Different explanations are explored related to the symptoms
3. Decrease the effect of positive and negative symptoms
4. Suggest alternate explanations for medicinal adherence

Reduction of positive symptoms is addressed by peripheral questioning. In this technique the patient is asked of his or her delusional beliefs so as to comprehend how the patient has reached the conclusion. This comprehension is then attached to step wise reality testing to raise doubt and explore other explanation. As an example if a patient belief that he has invented a machine that will solve most of the problems of the world can be queried about how the idea came, what are the early design specification. He may also be asked if anybody has helped him to invent the machine and what steps he had taken to patent the machine. The objective to identify any gap in the thinking process of the patient and reduce the faulty conviction of the patient. In inference chaining, the issue of systematized delusions are addressed.

CBT is found to assist people suffering from schizophrenia to have a better quality of life, better capability to integrate with society and enhanced skill for daily living. CBT combines a collaborative approach to develop a shared understanding of the problem of the schizophrenia patients. CBT sets the goals and teaches the schizophrenia patient techniques to control their symptoms. It does not cure schizophrenia but helps to manage it thereby improving the quality of life.

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