Cognitive behavioural therapy for the treatment of delusional systems

Abstract

This article describes the use of Cognitive Behavioural Therapy (CBT) for treatment-resistant delusional systems in a cohort of three service users with a diagnosis of schizophrenia. Key stages of CBT are outlined, including engagement, the use of scaffolding to reinitiate social functioning, improving coping styles and metacognitive techniques (such as rumination postponement). These were followed by the use of formulation, examination of the antecedents/timeline to identify core schema vulnerabilities and schema-focused techniques to deal with underlying unbearable affect. Systematization, conviction, overall symptomatology, clinically significant improvement, schema profile and social functioning are described pre and post-therapy. Following a 50-session course of CBT, all parameters including social functioning and schema vulnerability improved in two of the case examples; however, recovery was limited in the other. The authors recommend a synthesis between expert CBT and psychodynamic understanding, to improve engagement and schema change in the psychotherapy of delusional systems.