CLINICAL HANDBOOK OF SCHIZOPHRENIA

23. Cognitive-Behavioral Therapy 227ment of psychosis. It is likely that psychotic experiences are essentially normal phenomenathat occur on a continuum in the general population, and it appears that catastrophicor negative appraisals of such psychotic experiences result in the associated distress. It ishypothesized that psychotic experiences and distressing appraisals are maintained by cognitiveand behavioral responses (e.g., selective attention, thought suppression, and safetybehaviors), as well as by emotional and physiological responses and environmental factors.This model is represented graphically in Figure 23.1.STRUCTURE, PROCESS, AND PRINCIPLESOF COGNITIVE THERAPY FOR PSYCHOSISCognitive therapy for psychosis is based on the same principles that were outlined forstandard cognitive therapy for emotional disorders (Beck, 1976): that cognitive therapy(CT) is collaborative, problem-oriented, and educational, involving guided discovery andthe inductive method. CT is also time-limited, based on a cognitive model of the disorderin question, and on idiosyncratic case formulations derived from the model. The structureof CT for psychosis also parallels the structure of standard CT. Therefore, sessions startwith a review of current mental state and feedback from the previous session, followed bythe setting of an agenda, which is performed collaboratively by the patient and therapist.The agenda typically involves a review of the previous week’s homework task(s), one ortwo discrete session targets based on the model or formulation (usually one such item issufficient), followed by the assignment of new homework, feedback, and a summary ofthe current session. Time should be allocated to each agenda item and a timekeeperagreed upon by patient and therapist. It is important that the agenda is not followed unthinkingly;rather, it is intended as a guide to ensure productive use of the limited timeavailable.FIGURE 23.1. A cognitive model of psychosis. From Morrison (2001). Copyright 2001 by CambridgeUniversity Press. Reprinted by permission.