Cognitive model and cognitive behavior therapy for schizophrenia: an overview

Schizophrenia causes great suffering for patients and families. Today, patients are treated with medications, but unfortunately many still have persistent symptoms and an impaired quality of life. During the last 20 years of research in cognitive behavioral therapy (CBT) for schizophrenia, evidence has been found that the treatment is good for patients but it is not satisfactory enough, and more studies are being carried out hopefully to achieve further improvement.

Clinical trials and meta-analyses are being used to try to prove the efficacy of CBT. In this article, we summarize recent research using the cognitive model for people with schizophrenia.

A systematic search was carried out in PubMed (Medline). Relevant articles were selected if they contained a description of cognitive models for schizophrenia or psychotic disorders.

There is now evidence that positive and negative symptoms exist in a continuum, from normality (mild form and few symptoms) to fully developed disease (intensive form with many symptoms). Delusional patients have reasoning bias such as jumping to conclusions, and those with hallucination have impaired self-monitoring and experience their own thoughts as voices. Patients with negative symptoms have negative beliefs such as low expectations regarding pleasure and success. In the entire patient group, it is common to have low self-esteem.

The cognitive model integrates very well with the aberrant salience model. It takes into account neurobiology, cognitive, emotional and social processes. The therapist uses this knowledge when he or she chooses techniques for treatment of patients.