CBT in Treating Schizophrenia

The basic assumption of CBT is that people often have distorted beliefs which influence their behaviour in maladaptive ways. 

In CBT, schizophrenia patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how the symptoms might have developed. They are also encouraged to evaluate the content of their delusions or of any internal voices they hear and to consider ways in which they might test the validity of their faulty beliefs.

Therapists may use logical (does it make sense?), empirical (where is the evidence?). and pragmatic (how is the belief helpful?) disputing techniques. Having attempted to dispute faulty beliefs, patients may also be set behavioural assignments with the aim of improving their general level of functioning.

During CBT, the therapist lets the patient develop their own alternatives to previous maladaptive beliefs, ideally by looking for alternative explanations and coping strategies that are already present in the patient's mind.

Once the patient has had several sessions (often between 5 and 20), they should be able to recognise the fact that their beliegs are not based on reality.

+ Jauhar et al (2014) found in a meta-analysis that CBT had an effect on positive and negative symptoms. This effect was significant, but quite small. This is therefore moderate support for the effectiveness of CBT in treating schizophrenia.

- CBT may involve challenging the validity of beliefs, which may interfere with freedom of thought. For example, trying to persuade an individual that the government is not watching or monitoring them in any way may interfere with their (possibly justifiable) fear of an over-controlling government. Therefore, CBT has potential ethical issues.

- Just challenging the dysfunctional thoughts through disputing may not be enough to change them if the thoughts have a biological basis. CBT is rarely used without drug therapy, suggesting that it is not enough on its own to treat schizophrenia.