Cognitive-Behavioral Therapy for Severe Mental Illness

With growing evidence for the usefulness of cognitive-behavioral therapy (CBT) for severe conditions such as schizophrenia, bipolar disorder, and medication-refractory depression, there has been increased interest in learning CBT methods that can be combined with pharmacotherapy to manage difficult-to-treat patients. The presenters at the seminar “CBT for Severe Mental Illness” at APA’s 2014 annual meeting today have helped develop CBT methods for these indications and have conducted studies on effectiveness of therapy. Their book on this topic won the British Medical Association’s Mental Health Book of the Year Award in 2009.

Key modifications of CBT that were illustrated and practiced in this seminar included strategies for engaging patients with severe conditions in treatment, helping people reduce delusions and hallucinations, mitigating suicide risk, developing relapse-prevention plans, using cognitive and behavioral methods for hypomania, and enhancing adherence to pharmacotherapy. Because a major goal of CBT is to teach patients skills that they can use to manage symptoms and cope with psychiatric illnesses, methods for psychoeducation with challenging patients were highlighted. Also, CBT methods for helping patients develop adaptive meanings for chronic and severe disorders were modeled.

After beginning with a brief review of key studies on the effectiveness of CBT for severe mental disorders, the presenters explained and demonstrated core treatment methods for psychosis, severe depression, and bipolar disorder. Role plays and videos were used to illustrate methods that participants can use in their clinical practices. For example, the presenters showed how to develop comprehensive case formulations and put these into action in treatment scenarios. They demonstrated how to use CBT techniques to modify delusional thinking and moderate the impact of drug-resistant hallucinations. Creative behavioral methods for helping patients who appear to be stuck in a depressive pattern of low activity and social isolation were illustrated, and techniques for building an “early warning signs” defense against bipolar relapses were featured. In addition, the CBT approach to negative symptoms of schizophrenia was detailed.

Although CBT offers substantial promise as a component of treatment plans for severe mental illnesses, the therapeutic work can be demanding, and additional training may be needed to assist clinicians in gaining expertise in effective use of cognitive and behavioral methods with these patients.

Jesse Wright, M.D. is a coauthor of Cognitive-Behavior Therapy for Severe Mental Illness: An Illustrated Guide, which APA members can order at a discount here. The book includes a DVD demonstrated CBT methods in use.