The Effects of Cognitive Therapy on Hallucinations in Patients with Schizophrenia

Email: alanna.propst@mail.mcgill. ca INTROdUCTION Cognitive therapy was initially developed by Aaron Beck in the 1960s as a short-term psychotherapy for depression (1). It was based on his findings that people suffering from depression exhibit altered cognition along common themes such as low self-esteem, ideas of deprivation, self-criticisms, magnification of problems, self-commands to accomplish tasks which are often large-scale and mutually exclusive, and thoughts of escaping from life’s problems. In addition, they tend to employ cognitive distortions such as arbitrary interpretation, selective abstraction, overgeneralization, magnification, minimization, and inexact labelling. These underlying themes and distortions lead to automatic and involuntary depressing and selfdeprecating thoughts in various situations, which in turn lead to emotions such as sadness, anger, embarrassment, and anxiety. Beck postulated that depression could be treated through identification and correction of the patient’s idiosyncratic cognitions and underlying depressive themes (2). Since then the cognitive model of therapy has expanded to include treatment of many psychopathologies including schizophrenia. This model suggests that cognitive distortions underlie both mood and behaviour in all psychopathologies; cognitive therapy targets and alters these underlying distortions leading to symptomatic improvement (3). Schizophrenia is a psychotic disorder characterized by two or more of the following for a 1-month period: delusions, hallucinations, disorganized speech, grossly disorganized or catatonic behaviour, and negative symptoms (i.e. affective flattening, alogia, or avolition). Continuous signs of disturbance must be present for at least 6 months, which may include prodromal and residual symptoms in addition to the 1 month of active-phase symptoms (4). While antipsychotic medications are often effective in diminishing symptoms, 10-60% of patients with schizophrenia respond poorly or incompletely to typical antipsychotics and 20-30% of patients taking typical antipsychotics as prescribed will relapse within the first year of maintenance treatment (5). Furthermore, medication non-compliance is a significant barrier to treatment in this population. The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) showed that 74% of patients discontinued their antipsychotic medication before 18 months, with discontinuation rates ranging from 64%-82% for various antipsychotics (6). AyusoGutierrez et al. report that 73% of schizophrenia exacerbations requiring hospitalization occurred in patients who were non-compliant with medication (7). As such, adjuvant interventions such as cognitive therapy may be beneficial in treating symptoms that are incompletely responsive to pharmacological treatment or in patients who are non-compliant to pharmacological therapy. While schizophrenia symptoms include delusions and hallucinations which may be differentially responsive to cognitive therapy, the disease differs from depressive disorders in that patients with schizophrenia have significant impairment in