The Application of a Cognitive Intervention as an Approach to Schizophrenia
Aaron Beck has integrated the cognitive approach as an intervention to the partly organic brain disease Schizophrenia. After over a century of man’s realization that some people are anatomically different from their peers in matters of brain physiology; no cure has been established as a one-size fits all. Put differently, we still don’t know all there is to know about the cause of Schizophrenia and as such, we are unable to spell out a complete list of criterion that comprise the diagnosis; let alone effectively treat all those who suffer all of the time.
Schizophrenia is like a moving target.
It is not easy to trap within the clinical parameters of psychiatry. For those engaged in the practice of mental health care it is soon realized that Schizophrenia is not the same disease in different people. It is too broad and currently too elusive a construct to be neatly wrapped and indexed (p.61). It refuses to play by the rules and continues to baffle practitioners of modern science.
Psychopharmacology is useful in treating Schizophrenia.
For example, many positive symptoms can be controlled through medicating patients with antipsychotic drugs (p.18). However, there are side-effects (p.21); some of which are rather unpleasant and perhaps as or more disturbing to patients than their untreated symptoms. Weight gain from psychotropic medication can be as unhealthy as it is unsightly. Such a side effect can lead to a patient needing additional drugs to manage the effects of hypertension, diabetes, and a variety of other issues born directly from the medicinal remedy aimed at treating the symptoms of Schizophrenia.
Mixing Neurobiology with Psychotherapeutic Treatment
Neurobiologists are attempting to “corner” Schizophrenia by determining the contributing factors to the etiology of the disease (p.61). How factors like nature and environment contribute to outward manifestations as well as the interplay between nature and environment as it relates to the etiology of Schizophrenia need to be pinpointed (pp. 11-13). Theories from prenatal complications, to genetics coupled with viruses still crowd each other out for center-stage (pp.39-41).
Other theories that couple the biological possibilities with poor parenting and environmental factors are eager for their chance to enjoy the spotlight. Just when one theory seems to carry real weight; another competing theory will emerge from the shadows to throw all knowing to the wind. Understanding Hallucinations within a Cognitive Framework Perhaps if one devalues himself as a result of early trauma and poor parenting (p.135), for example, his core belief may become, “I am a rotten, filthy, loser.” Such a person going through life with a negatively-skewed and thus, faulty, mental-construct, is likely to hallucinate (if Schizophrenic, of course) in a way that incorporates this negative, belief-system. The “perceived interpersonal inadequacy” (p.134) would become activated and the result would likely be the manufacture of a symphony of voices echoing their agreement within the head of the sufferer that, indeed, “you are a rotten, filthy loser!”
Trouble can surely arise for a patient whose nasty choir of hallucinated demons dictates that suicide (or homicide) is the order of the day. A common trait within the affected community of Schizophrenics with Positive symptoms is that the voices are external in origination (p.135). This perception may lead the sufferer into a psychotic-tailspin; deeming them capable of danger to themselves and/or others or arousing within them the likelihood of violence and institutionalization.
Cognitive Behavioral Therapy as an approach would attempt to levy the troublesome chorus of demonic-rabble-rousers by quieting them. An intervention of the cognitive variety would shift the sufferer’s focus away from accepting the intrinsic truth formerly awarded to the voices. A complete tear-down of the corroded and negative-scaffolding would commence and the rebuilding of constructive and better scaffolding would happen. The intervention strategy via cognitive behavioral theory would have the sufferer recoil from a “dysfunctional coping” (p.135) style and apply a more reasonable approach aimed at diminishing the validity of the negative schema and ultimately, their deeply-held core values.
Negative Symptoms and Formal Thought Disorder
Beck has identified several cognitive factors that “participate” (p.158) in exacerbating the manifestations of negative symptomology. Said differently, a negatively-slanted belief system that impacts the sufferer’s social abilities, chances of real intimacy, and personal satisfaction or success is actively maintained. A sour outlook is fed into which leads the person to avoid social situations which can lead to isolation which in turn feeds into the negative, defeat-centered schema. Such people are likely to become unemployable, drop out of school, avoid social networks comprised of their peers, and are rather off-putting to others who see the sufferer as bizarre or as an odd-ball.
It is not uncommon to see people who manifest the negative symptoms of Schizophrenia develop Formal Thought Disorder (p.161). Formal Thought Disorder can manifest as the inability to stay on topic or on point while engaged in a discussion. In fact, it is nearly impossible to properly engage this type in any meaningful discussion since their ideas derail often and they have trouble forming cohesive sentences about anything relevant. Talking to people who carry on this way is very frustrating and does not go unnoticed by the person trying to instill a pulse into the discussion so as to keep it salient and viable.
People with Formal Thought Disorder get confused easily, don’t seem to make sense, are poor communicators, and frustrate those who are trying to conduct some semblance of a rational discussion. Between the echolalia, sweeping-generalizations, neologisms and overt blocking; such difficult communication styles and patterns rarely escape even the untrained, layperson’s ears (p.162).
Schizophrenia is a disease that has been around since we stood in caves wearing animal skins and being spellbound by fire. Treatment modalities were few and far between and the mortality rate of sufferer’s was, not surprisingly, high. The Greeks recognized when citizens acted out and behaved oddly. The reining intervention involved institutionalizing sufferers for life and possibly life in the circus freak-show. The Victorians brought humanity to the equation and softer and gentler approaches ushered in a new era. Modern times leave us with more questions and a multitude of possible answers; however, each containing more questions.
Here is what we think we know; in truncated version.
We think Schizophrenia has at least two different forms. We call one form Positive and the other Negative. In Positive Schizophrenia the sufferer is likely to hallucinate and become delusional. In Negative Schizophrenia the sufferer can become isolated and withdrawn as well as difficult to communicate with due to severe echolalia.
Some medication works sometimes in some sufferers. Some studies indicate that a therapeutic approach that incorporates cognitive theory may serve to alleviate some of the manifested symptomology.
Better still, we think, is the use of antipsychotics, coupled with a cognitive approach to intervention. Beck gives us hope as practitioners in the field of mental health that we can make a difference in the lives of those who suffer from Schizophrenia via a cognitive treatment modality.
Beck, A., Rector, Neil, Stolar, N., & Grant, P. (2009). Schizophrenia: Cognitive Theory, Research, and Therapy. New York, New York. Guilford Press.