Cognitive-Behavioral Therapy for Schizophrenia and Related Psychoses

Schizophrenia spectrum disorders are heterogeneous in symptom presentation and have a complex etiology, with contributions from genetic and environmental factors. Treatment outcome research conducted in the past decade has confirmed and extended the promise of cognitive-behavioral therapy for psychosis (CBTp). CBTp is based on a shared formulation of thoughts and behaviors that maintain psychosis and requires a strong therapeutic alliance. Psychoeducation is used to help normalize and destigmatize psychosis, as well as to help clients reattribute distressing psychotic experiences to established risk factors, such as trauma, environmental stressors, or drug use. This chapter reviews tips for forming a collaborative relationship with clients experiencing psychosis as well as CBT techniques for addressing distress and functional impairment associated with hallucinations and delusions. Considerations for adapting CBTp for selected specific populations, including LGBTQ+ individuals, and people of color are discussed. Innovative approaches that use technology with or without face-to-face CBTp are also reviewed. Although training in CBTp remains somewhat limited in the United States, a positive development has been the increased availability of coordinated specialty care models, the gold standard for treatment for first-episode psychosis, which include many CBTp components. A case illustration about a patient diagnosed with first-episode psychosis is provided.