CBT For Psychosis: A Schizophrenia Treatment Option
Schizophrenia is a mental illness typically involving symptoms of psychosis. People who develop the disorder usually begin to experience psychosis symptoms between ages 16 and 30. Treatment can help people with schizophrenia manage their symptoms, as well as improve depression and other mental health challenges they may be experiencing. Effective treatment can help a person with schizophrenia form healthy relationships, maintain employment, and avoid hospitalization or incarceration.
Multiple evidence-based practices can treat schizophrenia, including antipsychotic medications, therapy, training programs, and support groups. In this article, we focus specifically on cognitive behavioral therapy (CBT) for psychosis, a form of talk therapy that focuses on the relationships between an individual’s thoughts, feelings, and behaviors to reduce psychotic symptoms and improve quality of life.
What is cognitive behavioral therapy for psychosis (CBTp)?
CBT for psychosis is a form of cognitive behavioral therapy (CBT) designed to treat people experiencing psychosis. Often, cognitive behavioral therapy for psychosis is written as “CBTp” or “CBT-p.” CBTp is usually an individual treatment, involving one-on-one conversation with a therapist, rather than group treatment, which typically involves a practitioner and multiple clients talking together as a group. However, in recent years, some practitioners have effectively administered CBTp for groups as well.
Duration of CBTp sessions for effective treatment
Experts often recommend that a person receiving CBTp participate in the treatment plan for 12 to 16 sessions. However, shorter forms of CBTp may also exist. When provided in an inpatient setting, CBTp may only consist of six to eight sessions.
What psychotic symptoms can cognitive behavioral therapy for psychosis (CBTp) treat?
CBTp can be used to treat any psychotic disorder or mental health disorder involving psychotic symptoms. That said, CBTp is most commonly used to treat schizophrenia and schizophrenia spectrum disorders, such as schizophreniform disorder, schizoaffective disorder, delusional disorder, and brief psychotic disorder.
Other disorders that may include psychotic symptoms are schizotypal personality disorder, major depressive disorder, bipolar disorder with psychotic features, and post-traumatic stress disorder. CBTp may also be used to treat people who haven't yet experienced psychosis but have a high risk of developing the condition.
What are psychotic symptoms?
Psychotic symptoms can be seen as mental health symptoms that indicate a break from reality and impact how a person thinks and acts. Hallucinations, or seeing, hearing, smelling, tasting, or feeling stimuli that are not actually there, tend to be one of the most notable psychotic symptoms. Delusions are also psychotic symptoms, and they usually involve having strong beliefs that aren't true. In many cases, convincing someone who is having a delusion that what they believe is untrue is impossible, even if you have clear evidence against their beliefs.
Psychotic and negative symptoms
Disordered or disorganized thoughts and speech can also be classified as psychotic symptoms. A person may think illogically, struggle to organize their thoughts, and have trouble speaking in an orderly way that makes sense to others. Along with psychotic symptoms, which can also be called “positive” symptoms, individuals with schizophrenia typically experience negative symptoms. These generally refer to the loss of “typical” thoughts, emotions, or behaviors. A person with negative symptoms may struggle to engage in daily activities, like grocery shopping, or they may lack interest in maintaining a social life. Negative symptoms can also manifest as a lack of emotion, low energy, isolation, extreme social awkwardness, and a lack of movement and speech.
What is the history of CBT for psychosis?
Cognitive behavioral therapy was initially developed by psychologist Aaron Beck to treat distress and other mental health symptoms by changing a person's thoughts and behaviors. In 1952, Beck applied cognitive behavioral therapy to a person experiencing delusions, which can be a symptom of psychosis. In the 1990s, other psychology experts developed a model of cognitive behavioral therapy for psychosis (CBTp). Over the past 25 years, researchers have conducted over 60 research trials on the effectiveness of CBTp. Different approaches to CBTp have been developed over time, but they all tend to have commonalities.
How does cognitive behavioral therapy for psychosis (CBTp) work?
The CBTp model generally assumes that adverse childhood experiences caused people with psychosis to form unhelpful core beliefs about themselves and others. The model usually also assumes that psychotic symptoms are maintained by threat-based thoughts and behaviors. Much of CBTp involves identifying and changing these unhelpful core beliefs and threat-based thoughts, which can then change people’s emotions and behaviors.
Addressing delusions and hallucinations in cognitive behavioral therapy (CBT)
If a person undergoing CBTp has delusions, the therapist and client may discuss them, and the therapist may help the client understand why these beliefs are not true. If a person undergoing CBTp has hallucinations, they may be another topic of discussion. A therapist may help a person determine ways to identify whether something they are experiencing is an objective part of reality or a hallucination.
Improving daily functioning and quality of life
CBTp may also focus on other facets of life impacted by psychosis. For example, CBTp may be used to help a person with psychosis function better at work, experience less anxiety in social situations, improve their self-esteem, and learn how to communicate in ways that may improve rather than harm their relationships and quality of life.
Is cognitive behavioral therapy (CBT) for psychotic symptoms effective?
A systematic review of 21 research studies concluded that CBT and CBTp can help prevent and treat psychotic symptoms. The review authors found that CBTp could prevent first-episode psychosis in a large percentage of people deemed to be at high risk for psychosis, as well as prevent relapse in those who had experienced psychosis in the past. These results suggest that CBTp could help additional people beyond those currently experiencing psychotic symptoms. CBTp may also improve symptoms of schizophrenia and improve the quality of life among people with psychosis. People with psychosis who underwent CBTp were usually less likely to be hospitalized.
Effectiveness of CBTp during acute psychosis
While most studies have focused on CBTp for people living in a community, an article in the Community Mental Health Journal noted that CBTp could also be an effective treatment during acute psychosis in an inpatient setting. Some people seem to respond to CBTp better than others. For example, those who are open to the idea that their delusions may not be true tend to experience better results than those who are adamant about the validity of their delusions. People who have had psychotic symptoms for a shorter period of time also tend to respond better to CBTp. Women may also respond better to CBTp than men, though treatment can help people of all genders.
CBTp as a complement to medication therapy
Most studies of CBTp have found that the treatment can improve psychotic symptoms by a small or moderate amount. While the impact of CBTp may be promising, the experts who study this treatment usually do not propose that CBTp replace medication. Experts acknowledge that CBTp could be an immensely helpful treatment for people with psychosis, but they generally recommend that CBTp be used alongside other treatments, including antipsychotic medication, which must be prescribed and monitored by a doctor or psychiatrist.
Remote CBT for psychosis
Remote cognitive behavioral therapy may be helpful for individuals experiencing schizophrenia or other psychotic disorders, although the online format may not be appropriate during periods of acute psychosis.
Remote therapy generally allows people to receive treatment from the location of their choice, or anywhere with an internet connection. BetterHelp is a remote therapy platform that can connect individuals seeking help with therapists who practice CBT.
Although not much research has been conducted on remote CBT for psychosis, experts have suggested that remote CBTp could be a helpful treatment for people with schizophrenia or psychosis in general. Related research has found that remote therapy may be preferred by some people with psychosis, and brief forms of online therapy might be more effective than longer forms for this group.
Takeaway
CBT for psychosis is a form of cognitive behavioral therapy typically used to treat schizophrenia and other disorders involving psychotic symptoms. CBTp generally takes place one on one, but there are also some group forms of CBTp. Research suggests that CBTp can reduce psychotic symptoms and improve overall quality of life. Remote CBT may offer a convenient alternative to in-person treatment during times when acute symptoms aren’t present.
Frequently asked questions
Is it true that CBT leads to a decrease in psychotic and affective symptoms?
Is it accurate that CBTp is appropriate for adolescents and adults who recently started experiencing psychosis?
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