Cognitive Behavioral Therapy | Schizophrenia

Like with any therapy, the most important
aspect of therapy is the therapeutic relationship between the person and their therapist. And so, that element of trust, that element
of willingness to engage and interact is important. So, the first job of a therapist is to engage
the person in a trusting, working relationship. That’s the first element of cognitive behavioral
therapy, or CBT, for schizophrenia. The next is to develop motivation. And there’s a sort of offshoot of cognitive
behavioral therapy that’s called motivational interviewing, which identifies the person’s
goals and values, and then seeks to help them move through the process of change. So, to think, “Where am I at now? What are my goals and values, and how can
I make the journey from where I am to where I hope to be? And what does taking care of myself, exercise
and eating healthy, taking my medications, what does all of that have to do with my image
or goals and dreams?” So, that’s the motivation part of CBT for
schizophrenia. And then, the next is psychoeducation. It’s a big word to say, “learn about your
illness”. Learning about what schizophrenia is, so not
blaming yourself for the symptoms, but understanding that you have a condition. Just like diabetes or lupus are conditions,
you have schizophrenia. You can self manage it. So, learning how to recognize the things that
trigger your schizophrenia, the things that lead to relapse, and what a relapse looks
like, so that you can nip it in the bud, those are very important parts of CBT for schizophrenia. There’s a lot of skills training, too. So, learning to self manage and learning,
also, how to find support. Social skills development and life skills
development may be a part of, or related to, CBT for Schizophrenia. Then, once those things are addressed, once
there is a strong therapeutic relationship in place, a person with schizophrenia can
start to examine their delusions or hallucinations in therapy. So, some people have a delusion, a fixed false
belief that’s not shared by other people, that could be, for instance, that they’re
paranoid, for example, that the government has a plot against them and maybe they’re
being videotaped. So, the therapist then works with that person
to say, “Okay. What are the things that give you evidence
that you’re being taped by the government? Why would the government be interested in
you? What’s on the side of this being true, and
what kind of goes against that theory that the government is monitoring you” Starting to explore that, so the person can
sort of get the evidence together and break down some of these beliefs, so they can incorporate
more information from their environment to inform their decision that there’s a plot
against them. That helps a person to organize their thinking,
and also to relax a little bit, to be less anxious about the world if they’re less paranoid
that other people are out to hurt them. With hallucinations, what we work on in CBT
is to not necessarily be able to block out the hallucinations. It’s a brain phenomenon. It’s hard to shake it. Medication helps to reduce the symptom but,
for many people, they never are able to get rid of the symptom entirely. So, what CBT does is to help people to recognize,
“Okay. That’s a hallucination. It sounds like it’s a real person talking
to me, but I know from experience that I don’t see that person. I’ve never met them. I don’t know who they are. And my doctor tells me it’s part of something
that’s going on in my brain.” So, being able to recognize that and then
to be able to start to filter it out so you can pay attention to what you want to pay
attention to, and not the distracting voice, is really important. Also, for people who have command hallucinations,
or hear the voice telling them to do things, being able to say, “It’s just a voice. I don’t have to do that,” is really important. So, a learning exercise for somebody with
schizophrenia. If you’ve seen the movie, “A Beautiful Mind”,
you know that John Nash, at the end, the famous mathematician, at the end of the film, at
the end of his career, he’s still seeing visual hallucinations and yet he’s able to filter
it out, go and receive his award. And that’s sort of the goal for many people
with schizophrenia who aren’t able to shake their hallucinations. So, there’s managing delusions and hallucinations. And then, the history of CBT is that initially
we worked a lot on eliminating symptoms and saying, “Your thinking is distorted. Here is how to make it go the right way.” But, what we’re realizing is that there’s
not always a right answer to everything. In fact, our goal is often to live with the
medical conditions or disabilities that we have, rather than to say, “Let’s eliminate
them”. Sometimes, trying to eliminate something that
you legitimately have and cannot be cured is more frustrating than just living with
it. So, with mindfulness-based cognitive behavioral
therapy, what we try not to do is just say, “We have to get rid of your symptoms.” What we say is, “You have the symptom. It’s disruptive to you. But, let’s see if there are ways in which
you can live differently with the symptom.” So, it’s like watching a movie and you’re
sitting at the edge of the theater and there’s some other movie going on next door. It’s very loud and you’re hearing explosions,
and you’re watching a romantic comedy and going, “Well, that is really disruptive.” You could spend all your time focusing on
what’s going on next door and how disruptive it is to your experience. Or, you could say, “Alright. I’m just going to tune that out and watch
the movie that’s in front of me and enjoy it as much as I can.” And that’s what mindfulness-based CBT is about. Sometimes, you can’t kick all of the symptoms
of your illness, but you can learn to live with them and to still achieve your goals
and dreams and find the things that are important to you.

22 comments

  1. this is probably the best video I've seen about schizphrenia and treating it. it helped me understand and have more insight. her theater reference was great!

  2. i've suffered from paranoid schizophrenia for 24 years, im now 45 years old, 2014, i havent had any cbt, but im starting to use the STOP!!!! thing on my own, i usually say, get a grip, also im on 1 gram of amisolpride 'solian 200' every day, like janette lorenzo has said, this is by far the best schizophrenia video i have seen, have a fantastic day 🙂

  3. This is laughable. Any individual who believes the government is recording them…. ahem…  NSA is consuming all internet activities, and storing this information for future data mining. So….. if you are a Dr., and are trying to explain to your patient that their knowing about this NSA recording of all internet activities is proof if their illness, you are an idiot!  LOL. 

  4. Heres a blessing for those struggling with schizophrenia. If you trust in god, and believe in him with your whole heart, why not put it to the test and go to a highly annointed church from god called,"the Synagogue Church of All Nations," led by a very humbled pastor, named Prophet T.B Joshua, and I will tell you from my experience." Everyone who enter that church, will have an blessed encounter with god, and I bet my whole life on that. Its located in Lagos, Nigeria.

  5. The best presentation I have seen on the topic…clear simple concise and very easy to understand. Job well done.

  6. i know someone who has Religion schizophrenia. She dreams messages from god, every day. Any advice on this subject?

  7. I'm diagnosed skitzo effective and psychosis. just spent 14 days on a 5150, my longest 5150 was 6 months. this is really good advice probably the best I've heard I've been battling my illness 11 years now.

  8. Sorry….she doesn't get it either. SZ is not about the overt symptoms and controlling overt symptoms. It is about the emptiness inside and how to change that into something fulfilling and productive, or at least giving these people the freedom and responsibility (it will NEVER happen all by itself once the person is schizophrenia) of fulfilling THEMSELVES with more meaningful interactions, trustful conversations with people and all the good stuff that comes from that…like more cooperation, more recognition of other people's needs and the like. THIS STUFF CAN AND MUST BE TAUGHT. Same as we teach our toddlers.

  9. I really wonder how you hope to help those doped people whose cognitive abilities severely impaired? In order to be able to help those people their hippocampi should be active. Hippocampus needs emotions in order to be able to tag the informations to learn. That's how we can learn and keep or record the informatons and knowledge in our brain and process them when we need. Yet, as their emotions are seriously blunted due to the drugs they receive their hippocampi have no avail. Most probably most of your efforts with them completely disappear within a couple of hours time altogether. Psychotherapy programmes with schizophrenics on drugs are doomed to fail.What you say here that you can help those suffering individuals has no scientific basis what so ever. That defies logic and neuroscience.

  10. Everyone completely misses the mark. Once pleasure and interest is gone it is gonna get be. That is the foundation for everything in life. Ment ill takes all interest and feeling out of everything. Psychchiatrists have been going nuts with anhedonia. they wonder why substance always gets used.

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