Cognitive therapy of delusional beliefs

The present article articulates a cognitive theoretical perspective of delusional beliefs. In contrast to the focus of psychoanalytic therapy (theoretically-derived phenomena beyond personal awareness), the cognitive therapist focuses primarily on the conscious cognitive-experiential level in the treatment of delusional beliefs, thereby emphasizing a 'common-sense' level of analysis or reasoning shared by the delusional patient. Unlike noncognitive behavioral approaches, which focus on topographical 'verbal behavior' as such, cognitive therapy directly targets specific delusional beliefs which theoretically give rise to the disordered verbal behavior. In this article, the adaptation of cognitive therapy to the treatment of delusions is described, with special attention to the following issues: special problems in collaboration; difficulties in obtaining conviction ratings; how to avoid and reduce confrontation through the Socratic method; the collaborative design of homework experiments; distancing strategies; interpersonal relationship issues; and the necessity to identify and explore the emotions associated with the various delusions, especially feelings about the possibility that the delusions may be incorrect.