Using Cognitive Therapy to treat Delusions

Dr. Aaron Beck recently responded to an interviewer’s questions about addressing delusions among Schizophrenic patients. One of the central tenets of Cognitive Therapy is that individuals learn to evaluate their thinking and look for evidence that supports and/or contradicts their perceptions. The interviewer asked Dr. Beck how this pursuit of evidence plays out when individuals are having delusions and literally ’seeing’ objects/people that aren’t really there.

Interviewer: How… do you persuade someone to ignore the evidence of their own eyes and believe you?

Dr. Aaron Beck: The treatment of delusions and schizophrenia is a very tricky one. One of the definitions of delusions is that they do not yield to corrective feedback from other people. Consequently, attempting to persuade an individual that the delusion is incorrect is obviously self-defeating. There is a whole body of literature on how to address delusions. In brief, questioning the patient like a journalist without indicating disbelief is one way. This tends to get the patient into a questioning mode. However, that approach is used much later in treatment. Initially, we train the patients to recognize their automatic thoughts and then lead them to recognize some of their non-psychotic misinterpretations. After a strong basis is made on this, we then lead them to consider the more paranoid interpretations of their experiences (which we have labeled as their “upsetting interpretations”).

Thus, in treating delusions, we try to develop or enhance the patient’s skills in handling some of their emotional problems and then later apply these skills to the delusional misinterpretations. Another technique is something we call “behavioral experiments”– we might have the patient who is afraid of going out of his ‘comfort zone’ go with the therapist or a trusted person for a few feet or yards, or even further, just to test out whether he is vulnerable. This of course is dependent on the patient’s having a great deal of confidence in the therapist’s wisdom and trustworthiness. For further information on this topic, I suggest that you review the book by David Kingdon and Doug Turkington titled Cognitive Therapy of Schizophrenia.