"The therapeutic techniques used for patients with schizophrenia are based on the general principles of CBT. Links are established between thoughts, feelings, and actions in a collaborative and accepting atmosphere. Agendas are set and used but are generally more flexibly developed than in traditional CBT. The duration of therapy varies according to the individual's need, generally between 12 and 20 sessions, but often with an option of ongoing booster sessions. CBT for psychosis usually proceeds through the following phases." quote from

The ABCs of Cognitive-Behavioral Therapy for Schizophrenia

June 20, 2006 | Schizophrenia, Cognitive Behavioral Therapy By David Kingdon, MD, FRCPsych and Douglas Turkington, MD

http://www.psychiatrictimes.com/schizophrenia/abcs-cognitive-behavioral-therapy-schizophrenia

Dear Gopinath,

The word cure is maybe not so appropriate to schizophrenia, which takes sometimes lot of years of disease clashes and remissions. So CBT is performed constantly -  I agree with @Beatrice, however with different and individual effects.  The most important thing  in person with schizophrenia is to apply proper dosed pharmacological therapy which will be optimal support and will not increase person's  fatigue or hallucinations or delussions.

Dear Gopinath, thank you for your interesting question shared with me.  I agree @ Beatrice.

I don't think that there is anything that can "cure" "schizophrenia disorders".

I think people who experience hearing voices (or auditory hallucinations), heightened suspiciousness, demotivation and social withdrawal can be helped with a range of different psychotherapies including CBTp.

There is a vast amount of empirical knowledge in field of psychotherapy that unfortunately has been grossly neglected.

Unfortunately (and it's just my opinion!), the CBT framework has neglected the more dynamic and relational aspects of talking therapies - the core aspect of the treatment.

Paulo   

Paolo,

"CBT framework has neglected the more dynamic and relational aspects of talking therapies" . Perhaps it is worth bearing in mind that those who created CBT actually went through psychoanalysis themselves.  Albert Ellis is generally considered to be one of  the founders of cognitive-behavioral therapies. Ellis had come to believe that psychoanalysis was the deepest and most effective form of therapy. Like most psychologists of that time, he was interested in the theories of Sigmund Freud. He sought additional training in psychoanalysis and then began to practice classical psychoanalysis. Shortly after receiving his Ph.D. in 1947, Ellis began a Jungian analysis at the Karen Horney Institute (whose own analyst had been Hermann Rorschach). Contemporary teachers in CBT have been through their own psychoanalysis which is fruitful for an ecclectivistic approach to CBT, so I would not agree on that the core aspect of talking therapies is forgotten in CBT. The hours in CBT are twice as long as those in psychoanalysis. From psychoanalysis you get nothing home with you, in CBT to can have all the papers and homeworks home with you which adds to CBT:s effect.

Béatrice,

What you said about Ellis can also be said about Aaron Beck which doesn't change much of what I said above (Ellis didn't have any particular interest in Psychosis and apart from a few clinical cases Beck only got interested in Psychosis fairly recently).

In fact for a long time, several influential CBT professionals didn't believe that CBT could be effective with "Schizophrenia" and "BPAD".

Also, a recent meta-analysis has shown that the effect-sizes of CBT for psychosis are at best small (unfortunately! As I'm a big advocate of psychotherapies for Psychosis).

Most of the CBT researchers and clinicians that developed the framework for psychosis in the United Kingdom (and I can name a few) don't have training in Psychoanalysis or psychodynamic therapy. There is a huge gap in the CBT literature about the relational aspects of therapy (what happens between therapist and client, incidentally the most important aspect of psychotherapy).

Therapies don't have to have homework in the form of written exercises to be more effective (in fact, these exercises may be more helpful for therapist than clients). What you take home and into the world is the emotional growth and learnings you got in the therapy room.

It's not part of the current training in CBTp, at least in the UK, to learn psychodynamic therapy and most of the contemporary teachers of CBTp have not been taught psychoanalysis. 

Paulo

Paulo

You are completely right, I just lost focus, I concentrated on general CBT not on CBT for psychosis. Sorry for my mistake!

That's fine. 

Greeting from Algarve. 

Paulo

I support arguments given by @Paulo Sousa.

Paulo, greetings from Finland where I got my education

Béatrice,

All I can say is that you are very, very lucky!

Paulo

Schizophrenia has been shown to have a biological basis, thus the only effective treatment currently is a combination of psychopharmacological and psychotherapeutic treatment. Treatments will vary dependent on the type of schizophrenia as those with catatonia may for instance not respond to CBT, or variations thereof. Further to this there may be co-morbid physiological or psychological disorders, thus a multi-layered treatment program is required.

I've happened to know a few people (from different countries) suffering from this mental disorder. I really wish I could share some happy stories but I can't. CBT definitely wasn't working for them. Drugs... It's a different story - they couldn't cure only alleviate the symptoms for a limited period of time. But even for these moments, saying that these people can live "a happy and fulfilling life" would be a really big stretch. These are my personal observations, and I wish somebody to have a more positive outlook at this!

P.S. I'm not involved into any kind of research on this subject and don't have any formal education in this field.       

Dear Cheryl, 

I have some difficulties following your argument. First, I don't disagree that "symptoms" like auditory hallucinations and paranoia have a biological "basis" but I'm curious to know what you think the biological "basis" of "schizophrenia" is or what you mean by "biological basis".

Secondly, because there is a biological "basis" that does not mean that the "treatment" needs to be necessarily pharmacological quite the opposite. Regarding the catatonia would you please clarify what you mean by this (and please send the latest figures on the prevalence and incidence of catatonia). Negative symptoms have important psychological variables and are amenable to psychological treatment but funny enough not to pharmacology (I can send you the references).  

There is a interesting paper from Nancy Andreasen (Biological Psychiatrist) showing the long term impact of anti-psychotics on the brain (It's not pretty, I can send you the reference) and an extensive literature showing the real impact of anti-psychotics on voices and suspiciousness (grassy overestimated).

Serge,

I can send you literature on many testimonies of people that lead a very fulfilling life after having escaped the mental health system, polypharmacy, labelling, stigma, etc.  

Paulo

Dear Serge, I am sorry to hear this, it is not pleasant to stand by and watch the suffering of others. There is no cure for Schizophrenia, however there are effective treatments that can reduce certain symptomologies and allow patients to live outside of hospitals, or continue a semi-normal life. This once again is dependent on the severity of the disorder, the sub type and co-morbid disorders. I have worked with schizophrenics who are outpatients and in each case, so long as they kept to their treatment regime they were able to live independently and appeared to be happy that they could aspire to some semblance of normality. I also know of a medical student who suffered his first psychotic episode in second year medical school and was diagnosed with schizophrenia. He stuck to his treatment regime and made it through medical school to become a good doctor. A multitude of factors affect outcomes from family support and resources through to type of disorder etc. There is always hope, though sometimes it is difficult to perceive it and in cases where there is no possibility of normality as we define it the patient's version of normality and hope is what matters the most, as this is what will keep them struggling onwards, so they are able to find meaning in their lives. I hope this helps a little.

Being a scientist, I can only say that my observations can't be considered as a valid sampling that represents the true population statistics. Sure, it depends on a number of factors indeed. And I admit that life after the escape can be a happy one. The main question remains however, how many can escape it?

This is a good start

http://www.ted.com/talks/eleanor_longden_the_voices_in_my_head

Dear Paulo, there are physiological processes underlying disorders, that is what I mean by biological basis. I stated that treatment needs to be a combination of both psychotherapy and pharmacology, once again depenedent on the patient's case. The statistics you require, do you wish them to be country specific, internationally specific? If a patient is catatonic their ability to utilise cognitive processes is dramatically reduced, thus attentional networks, working memory and so forth are diverted to internal factors rather than to the external world. Have a look at some ofthe work for instance of Dr Wells. Are you advocating that treatments by pharmacotherapy have no place? Please just clarify this for me as I have worked with schizophrenics and seen the result of no pharmacological treatment. Pharmacological treatment such as anti-psychotics do have side effects, and the management of treatment is often reliant on the skill of Specialists, and long term use does have an impact, thus this should be properly managed so that long term effects are reduced. Are you advocating that the system of hospitalisation has no place, such that they need to escape? In some cases it does have a place and in others definitely not, once again it is dependent on the same factors, the skill of the treating specialist, the type of disorder and it's severity and whether there is available outcare facilities, homes to which they can return and so forth.

"The causes of catatonia are largely unknown although research indicates that brain structure and function are altered in this condition. While this and other information point to a physical cause, none has yet been proven. A variety of medical conditions also may lead to catatonia including head trauma, cerebrovascular disease, encephalitis, and certain metabolic disorders.....

Catatonic stupor is marked by immobility and a behavior known as cerea flexibilitas (waxy flexibility) in which the individual can be made to assume bizarre (and sometimes painful) postures that they will maintain for extended periods of time. The individual may become dehydrated and malnourished because food and liquids are refused. In extreme situations such individuals must be fed through a tube. Catatonic excitement is characterized by hyperactivity and violence; the individual may harm him/herself or others. On rare occasions, isolation or restraint may be needed to ensure the individual's safety and the safety of others

Treatment of catatonia includes medications such as benzodiazipines (which are the preferred treatment) and rarely barbiturates. Antipsychotic drugs may be appropriate in some cases, but often cause catatonia to worsen

Catatonia usually responds quickly to medication interventions" Medical dictionary

As previously mentioned there are times when pharmacological treatment is appropriate and other times when it is not.

If the information I have is out of date, and your information is more recent, I would be happy for you to correct me.

Dear Paulo please see a presentation on the "biological" basis for your interest

http://www.phil.gu.se/posters/schiz_Leiden.pdf and..

http://schizophrenia.com/research/chap07.htm

Dear Cheryl, 

There's so many problematic issues with the references that you sent that I honestly don't know where to start. The slides from Helge Malmgren seem to be a contradiction in themselves as: 

"that any judgement to the effect that schizophrenia is due to heredity plus somatic (organic) factors is premature" 

It seems to me that Helge is not sure if "schizophrenia" is a brain disorder but the problem is slightly different. The crucial aspect is if "schizophrenia" exists as a disorder? This issue is far from settled...

Also, there are several issues with the initial hereditary studies of schizophrenia (this would be a long discussion in itself). And most of MRI findings show that the areas of interest involved in "schizophrenia" seem to overlap with the regions of interest in people have experienced severe psychological trauma.

Paulo  

Dear Paulo, there are contradictions, and that is essentially my point, there is not enough evidence to indicate specific causes of Schizophrenia, to indicate which form of psychotherapy works best, to determine which environmental factors have the most impact and so forth. Until there is a large convergence of evidence (of which I hope you will be a wonderful contributor, as you appear to have great expertise) it is not feasible to target the disorder appropriately. However existing evidence does indicate certain patterns, such as the impact of cognitive processes on physiological processes and vice versa. Catatonia may have an impact on cognitive processes, and attenuate psychotherapy outcomes (that is my personal hypothesis). I am aware that catatonic schizophrenia is under consideration for removal as a sub type from the DSM V and is being looked at as a syndrome which may occur across a number of disorders (as mentioned in a previous post) my interest lies in how it impacts on psychotherapy. Pharmacological treatments in conjunction with psychotherapy when applied correctly do work on a specific patient under certain conditions. Often imaging studies are done with population groups that are too small for significant results to be shown and other variables also play their part, also there are issues with some of the studies done so I am in agreement with you there.  

Dear Cheryl, 

Again, I don't know where to start. I don't have experience working with "schizophrenics" but I do have clinical experience working with individuals with psychosis. Catatonia is a fairly rare condition these days in most cases the causes are organic. 

There are very good reasons to believe that "schizophrenia" is a very unhelpful construct for clinicians, researchers and obviously, and more importantly, for patients. 

There are too many issues with pharmacotherapy (this would be a discussion in itself) and these issues become even more problematic on day-to-day management.

There is a large body of consistent work showing that environmental factors seem to be crucial in psychosis and as I mentioned before most of the assumed "biological basis of schizophrenia" could well be the consequence of numerous traumas (this is a much more parsimonious explanation than to believe that schizophrenia is a genetic or an organic brain disease).

Jay Joseph has written very interesting papers and books on the problems with the hereditary studies of schizophrenia.

Joanna Moncrieff has written interesting papers and books on the misconceptions around pharmacotherapy.

And Richard Bentall has written interesting books and papers on the inconsistencies of diagnostic constructs such as Schizophrenia.

Paulo.   

that is very interesting Paulo, I am going to go and have a look at the information you mention,  especially the possible trauma hypothesis.

Gopinath,

I would really avoid using terms such as 'cure' - I think, from my personal experience, all anyone with a serious mental illness like schizophrenia can do is first of all, accept their mental illness, then learn how to manage it through knowing what they can do to increase self awareness regarding symptoms. Finally, use techniques to ease their distress learnt from psychotherapy sessions/groups etc.

I think Dr Peter Breggin's perspective as a psychiatrist looking at his profession objectively regarding the treatment of schizophrenia in 'Toxic Psychiatry' is a good starting place - here is a link to where you can find this title:  http://www.amazon.co.uk/Toxic-Psychiatry-Drugs-Electroconvulsive-Therapy/dp/000637803X 

I think also compassionate mind theory may have some interesting ideas r.e. threat repsonses etc. - Paul Gilbert's website is a good place to start http://www.compassionatemind.co.uk/ 

See NIH RESEARCH MATTERS link below for a brief update on 108 genetic regions linked to schizophrenia, including 83 that were previously unrecognized.  These are posited as confirming suspected molecular pathways associated with an increased risk for developing schizophrenia.

http://www.nih.gov/researchmatters/august2014/08182014schizophrenia.htm

Not sure about the 'cure' aspect of the question, but if you are interested in whether CBT reduces symptoms (positive, negative, hallucinations), then our meta-analysis is here: http://bjp.rcpsych.org/content/204/1/20.short

According to my learning and the behavioral sciences background, CBT does play a significant role. Although the techniques consumes time to understand the behavior and guide the client but its worthy at the end, The psychologist is a better than to treat the effected individual with medication.

It is easier to do with Paranoid Schizophrenia because the logic is intact outside of the delusion.

http://www.the-iacp.com/assets/CBTBR/cbtbr-vol_54b.pdf

Well, schizophrenia can be managed. First, it depends of the severity. The person will need drug therapy first in order to subdue all those symptoms of delusions and hallucination before he or she is capable of responding well to psychotherapy. Of course CBT is deal and van be very effective after the drug therapy. 

Hi Francesca

Have you heard of the work of Rufus May? - he is a clinical psychologist in the NHS in Bradford England (rufusmay.com)  He does work around recovery from psychosis including engaging with voices in order to understand their origins and try to gain  control over them. 

I'm not sure I agree with Abiodun Musbau Lawal that a person with schizophrenia will need drugs to subdue all symptoms before they can engage with psychotherapy.   Obviously what is best depends on the individual and the strength and nature of their beliefs and/or experiences - but in my experience many anti psychotics will simply sedate a person to the point where they can't engage with therapy (and if the therapy involves engaging with voices then obviously this wouldn't work).

It is not possible to cure the acute phase of Schizophrenia with CBT. It is possible to treat some cognitive and behaviural problem by schizophrenic patient in remission or after acute episode.

Among the core feature of schizophrenia is impaired reality testing.

Empirical evidence suggested drug improved this symptom.

While it is true that in EBM, CBT influence biological milieu and physiological system in psychiatric conditions such as depression, the issue about schizophrenia has to be cautiously discussed because of issue surrounding the question, which is to cure.

Cure as defined in dictionary is a process or drug that restore good health.

In medical practice, cure is defined as a process that involved reversal of morbid or disease state to its expected normal anatomic or physiological condition without the concern of return to the disease state permanently except , another disease inducing state is facilitated or initiated.

Till date cure in schizophrenia management is a guarded state that is difficult to state with any management modalities hence issue of curing schizophrenia with CBT does not arise.

However the stem question could be modified to, manage or treat.

With regard to the latter the poor insight associated with this disease would apparently not make schizophrenia amenable by CBT only. 

However it has role to play as adjuvant.

I appreciate Gopinath, as this question should serve as lead way to further research in schizophrenia management.