Can Cognitive Behaviour Therapy be used to treat the positive symptoms of psychosis?

14 Mar

Cognitive behaviour therapy (CBT) is a psycho-social intervention which proposes that there is an interconnected and interdependent relationship between a person’s thoughts, feelings/emotions and behaviours (Lowenthal & House, 2010). According to CBT, modifications occurring in one domain (i.e., thoughts) can lead to modifications occurring in the other two domains (Rhodes, 2013). Therefore, unhelpful and unproductive behaviours, thoughts and feelings can be consciously altered, via a range of CBT based techniques, into more helpful, positive and productive ones (Rhodes, 2013). This psycho-therapeutic approach has been extensively researched over many decades, across multiple domains and has strong clinical and empirical support (Whittington & Grey, 2014; Hoffman et al, 2014). CBT has been highly effective in the treatment of anxiety, phobias, post-traumatic stress disorder, depression, eating disorders, drug and alcohol disorders, anger and stress management and other emotional, social, occupational, psychiatric, behavioural, intrapersonal and interpersonal domains in both adults and children (Halldorsdottir & Ollendick, 2016; Simos & Hoffman, 2013; Patrick, 2012.). Within the last two decades, CBT has been increasingly researched and applied to the treatment of psychosis, both individually and in groups, with a variety of results (Owen et al., 2015).

Psychosis, most importantly, is defined as a symptom rather than a disease, in which a person’s thoughts and emotions are impaired to the point of no longer being attached to external reality (Alford & Karns, 2000). Psychosis is a common symptom of multiple psychiatric, neurodevelopmental, neurologic and medical conditions which occur across a continuum with Schizoid Disorder and Schizophrenia representing, respectively, each end of the psychosis continuum (Arciniegas, 2015). Some of the symptoms of psychosis, as defined by the American Psychological Associations (APA) Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and the International Classification of Diseases, Tenth Revision (ICD-10) include; Hallucinations (inclusive of all sense modalities), delusions (false beliefs), impaired reality testing, depersonalization and derealization, delusional misidentification syndromes and emotional lability (Barch et al., 2013; Castagnini & Berrios, 2009; Jensen & Ketter, 2009). People that experience psychosis can have great difficulty in their day-to-day lives as they struggle to organise their thoughts properly, can experience severe depression, experience stigma and ridicule from some members of the public, experience anxiety, have difficulty maintaining relationships and can have difficulty finding and maintaining employment (Alford & Karns, 2000).

Ultimately, CBT is designed to work in collaboration with an individual in order to assist them to alter their unhealthy, unproductive and unhelpful thoughts, behaviours or emotions into more healthy, adaptive and productive ones (Robertson, 2010). CBT techniques include journaling, cognitive restructuring, re-framing exercises, reality testing exercises, exposure and response prevention, role-playing, mindfulness, meditation, progressive muscle relaxation (PMR) or breathing exercises (Beck, 2011). The aims of specific CBT techniques such as journaling, mindfulness, cognitive restructuring, re-framing and reality testing exercises is to identify, challenge, dispute and reform irrational, false, distorted and maladaptive beliefs and thoughts into more rational, adaptive, realistic and functioning ones (Beck, 2011). Therefore, since delusions are a core symptom within psychosis, it is easy to see how CBT techniques which challenge and dispute false and irrational beliefs can be useful in the treatment of psychosis (Gottlieb et al., 2011; Garrett & Turkinton, 2011). Similarly, the same thought challenging and reforming techniques mentioned above can be utilized to treat hallucinations which are also a core part of psychosis (Gottlieb et al., 2013). With respect to the emotional lability component of psychosis, CBT techniques which are feeling and emotion based, such as PMR, meditation, mindfulness and breathing exercises, can serve to assist a person to gain greater awareness and control over their emotional responses and triggers (Perry, Henry & Grisham, 2011).


Alford, G., & Karns, L. (2000). Psychosis. (Vol. 6). American Psychological Association.

Retrieved from

Arciniegas, D. B. (2015). Psychosis. Behavioural Neurology and Neuropsychiatry,

21(3); 715-736.

Barch, D. M., Bustillo, J., Gaebel, W., Gur, R., Heckers, S., Malaspinaj, D., Owen, M. J., Schultz, S., Tandon, R., Tsuang, M., Van, J., & Carpenter. W. (2013). Logic and justification for dimensional assessment of symptoms and related clinical phenomena     in psychosis: Relevance to DSM-5. Schizophrenia Research, 150; 15-20.

Beck, J. S. (2011). Cognitive behavior therapy, second edition: Basics and beyond. Retrieved from

Castagnini, A., & Berrios, G. E. (2009). Acute and transient psychotic disorders (ICD-10 F23): a review from a European perspective. European Archives of Psychiatry &            Clinical Neuroscience, 259(8), 433–443. https://doi-

Garrett, M., & Turkinton, D. (2011). CBT for psychosis in a psychoanalytic frame. Psychosis, 3(1): 2-13.

Gottlieb, J. D., Romeo, K. H., Penn, D. L., Muesar, K. T., & Chiko, B. P. (2013).

Web-based cognitive–behavioral therapy for auditory hallucinations in persons with psychosis: A pilot study. Schizophrenia Research, 145; 82-87.

Gottlieb, J. D., Cather, C., Shanahan, M., Creedon, T., Macklin, E. A., & Goff, D. C. (2011).

D-cycloserine facilitation of cognitive behavioural therapy for delusions in schizophrenia. Schizophrenia Research, 131; 69-74.

Halldorsdottir, T., & Ollendick, T. H. (2016). Long-term outcomes of brief, intensive CBT for specific phobias: The negative impact of ADHD symptoms. Journal of Consulting and Clinical Psychology, 84(5), 465–471.

Hofmann, S., Asnaani, A., Vonk, I., Sawyer, A., & Fang, A. (2012). The Efficacy of Cognitive Behavioral Therapy: A Review of Meta-analyses. Cognitive Therapy & Research, 36(5), 427–440.

Jensen, P. S., & Ketter, T. A. (Eds.). (2009). Dsm-iv-tr casebook and treatment guide for child mental health. Retrieved from

Loewenthal, D., & House, R. (2010). Critically engaging cbt. Retrieved from


Owens. M., Sellwood, W., Kan, S., Murray, J., & Sarsam, M. (2015). Group CBT for psychosis: A longitudinal, controlled trial with inpatients. Behaviour Research andTherapy, 65, 76-85.


Patrick, S. (2012). Trauma focused CBT for PTSD in young children is feasible, and may reduce PTSD symptoms. Evidence - Based Mental Health, 15(1), 18. doi:

Perry, Y., Henry, J. D., & Grisham, J. R. (2011). The habitual use of emotion regulation strategies in schizophrenia. British Journal of Clinical Psychology, 50(2), 217–222.

Robertson, D. (2010). The philosophy of cognitive-behavioural therapy (cbt): Stoic philosophy as rational and cognitive psychotherapy. Retrieved from

Rhodes, J. (2013). Narrative cbt: Distinctive features. Retrieved from

Simos, G., & Hofmann, S. G. (2013). Cbt for anxiety disorders: A practitioner book. Retrieved from

Whittington, A., & Grey, N. (2014). How to become a more effective cbt therapist: Mastering metacompetence in clinical practice. Retrieved from

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