20 – Cognitive Therapy for Delusions and Hallucinations

1. An Overview 2. The Role of Emotions in Cognitive Therapy 3. The Therapeutic Relationship: Application to Cognitive Therapy 4. Structure of the Therapeutic Interview 5. The Initial Interview 6. Session by Session Treatment: A Typical Course of Therapy 7. Application of Behavioral Techniques 8. Cognitive Techniques 9. Focus on Target Symptoms 10. Specific Techniques for the Suicidal Patient 11. Interview with a Depressed Suicidal Patient 12. Depressogenic Assumptions 13. Integration of Homework into Therapy 14. Technical Problems 15. Problems Related to Termination and Relapse 16. Group Cognitive Therapy for Depressed Patients Steven D. Hollon and Brian F. Shaw 17. Cognitive Therapy and Antidepressant Medications 18. Outcome Studies of Cognitive Therapy Appendix: Materials *The Beck Inventory *Scale for Suicide Ideation *Daily Record of Dysfunctional Thoughts *Competency Checklist for Cognitive Therapists *Possible Reasons for Not Doing Self-Help Assignments *Research Protocol for Outcome Study at Center for Cognitive Therapy *Further Materials and Technical Aids

Cognitive Therapy of Depression

We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices-fear, reassurance, engagement and resistance-reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either 'benevolent' or 'malevolent'. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31% of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.

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The omnipotence of voices. A cognitive approach to auditory hallucinations.

The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions.

Delusional thinking and perceptual disorder.

PSYCHIATRIC symptom rating scales can be used for testing and reformulating clinical concepts as well as for categorizing patients. Hallucinations and delusions are two symptoms that take on new meanings when defined more operationally for use in such scales. It is especially important to conceptualize these symptoms adequately because they are key diagnostic criteria of the psychoses, especially of schizophrenia. Even those who classify hallucinations and delusions as "secondary" tend to use these symptoms to establish the diagnosis of psychosis since they are among the easier symptoms to identify clinically. Generally hallucinations and delusions are considered to be discrete and discontinuous, a patient either has them or he does not. The notion of the discreteness of these symptoms encourages the conception of psychosis and schizophrenia as states that are also discrete and discontinuous and the further conception that patients with these diagnoses are somehow qualitatively different from other

20 – Cognitive Therapy for Delusions and Hallucinations

References

Cognitive Therapy of Depression

The omnipotence of voices. A cognitive approach to auditory hallucinations.

The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions.

Delusional thinking and perceptual disorder.

Hallucinations and delusions as points on continua function. Rating scale evidence.

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Hallucinations, delusions, and ideas of reference treated with psychotherapy.

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Chronic delusions and sociogensis

Childhood memories as contents of schizophrenic hallucinations and delusions.