Cognitive therapy helps some patients with schizophrenia
Share with others:
For the eminent psychiatrist Aaron Beck, figuring out how to use talk therapy to help people with schizophrenia has been a passion and also a challenge far greater than "working out the structure of depression," the achievement that first brought him fame.
Dr. Beck, a University of Pennsylvania professor emeritus who is considered a founder of cognitive behavior therapy, has spent years trying to puzzle out why it can be so maddeningly hard to motivate people with schizophrenia and to change their behavior.
"It's the biggest challenge that I ever had," said Dr. Beck, who is now 90 and still works full time, albeit often from home with the aid of an iPad and iPhone.
Penn researchers are finally making headway. In a study published this month in the Archives of General Psychiatry, a team co-led by Penn psychologist Paul Grant reported that cognitive therapy aimed at changing 31 patients' dysfunctional beliefs and reaching concrete goals helped even very low-functioning people. Dr. Beck, the senior author on the study, supervised the therapy, which was conducted weekly over 18 months.
"I'd say it's most definitely a big step forward," said Gregory Strauss, an expert on schizophrenia with the University of Maryland School of Medicine who also has used cognitive therapy with schizophrenic patients. He said a somewhat skeptical team from his school went to observe Penn's work. "We were all actually very impressed," he said.
The Penn patients often had "nihilistic" ideas that sapped their will. They were highly risk averse and thought they could do nothing right. "They're very afraid ... to do anything because they're afraid of failure," Dr. Beck said.
Dr. Beck's cognitive behavior therapy, which he developed in the 1960s, emphasizes how people's beliefs about themselves and the world affect their emotional, physical, and behavioral reactions. People's perceptions are often distorted when they are distressed. In therapy, they learn to identify their inaccurate thoughts and change them.
The therapy used in this study was strongly influenced by the recovery movement. It helped patients see their strengths more realistically and take a series of small steps toward goals such as getting a job, going to school, or making friends. Dr. Beck described it as the equivalent of "moving up one grade." A patient who was not working at all could take a part-time job. Someone with no friends might make two.
First Published October 24, 2011 12:25 am
