Recovery From Schizophrenia: Psychiatry And Political Economy

284 DESEGREGATING SCHIZOPHRENIACOGNITIVE-BEHAVIORAL THERAPY FORPSYCHOTIC SYMPTOMSDespite the long-held belief that it is a pointless exercise to try and dissuadepeople from tenacious delusional beliefs, recent research reveals that talking topeople about their psychotic symptoms, and about their personal meaning, canlead to an improvement in symptoms. It emerges that the gentle challenge of theevidence used by people with psychotic disorders to support their delusions—presenting alternative viewpoints, reality-testing and enhancing coping strategies—can be helpful.In a study conducted by British psychologist Nicholas Tarrier and hiscolleagues, 37 people with schizophrenia who continued to experience positivesymptoms of psychosis, despite optimal drag treatment, improved when theyreceived a cognitive-behavioral treatment called “coping strategy enhancement.”In this approach, patients were helped to identify coping strategies that could beused to reduce both the cues and the reactions to symptoms like hallucinations ordelusions. For one person, for example, being alone or bored may be a cue to anincrease in hallucinations; he or she can be taught to adopt strategies to reduceisolation or boredom. Others can learn to reduce auditory hallucinations byhumming, conversing with others, or even reasoning with the voices and tellingthem to go away and come back later. Similarly, a person might be taught to testthe reality of delusional beliefs against the therapist’s interpretation of events and,for example, return to a church social group about which he or she had harboredparanoid fears. After six months, the people who received this type of copingstrategy treatment had less intense delusions and anxiety, compared to those whoreceived a less specific form of cognitive therapy called “problem solvingtraining.” However, people who received problem solving therapy also improvedto a degree, so, in a later study, the researchers combined both of these cognitiveapproaches with a third, called “relapse prevention,” in an attempt to maximizebenefits. One year after the end of the treatment, patients receiving this cognitivebehavioraltherapy were experiencing significantly lower levels of positivesymptoms than a control group of patients receiving routine care. 38Another randomized study of cognitive-behavioral therapy for people withpersistent symptoms of schizophrenia, conducted at three centers in East Angliaand London, UK, achieved a 25 per cent reduction in total psychopathology,primarily in hallucinations and delusions. 39 In this study, about half of those withpersistent symptoms appeared to show benefit from cognitive therapy, primarilythose with persistent delusions who initially accepted, to a degree at least, thatthey might be mistaken in their beliefs. 40 Benefits were sustained over a longperiod and the treatment led to a reduced need for services in the followingmonths. 41 A study conducted in London demonstrated that cognitive-behavioraltherapy provided as group therapy is as effective as individual treatment inteaching coping strategies to people with persistent psychotic symptoms andgiving them control over their hallucinations. 42