Cognitive Behavioral Therapy is an Effective Treatment for Schizophreni form Disorder: A Case Study
Haroon Ur Rashid and Syeda Ishrat Fatima*
Armed force institute of mental health, Pakistan
Submission: May 18, 2018; Published: May 23, 2018
*Corresponding Author: Syeda Ishrat Fatima, Armed force institute of mental health, Pakistan, Tel: +923418929072;
How to cite this article: Haroon Ur R, Syeda I F. Cognitive Behavioral Therapy is an Effective Treatment for Schizophreni form Disorder: A Case Study. J of Pharmacol & Clin Res. 2018; 5(5): 555672. DOI:10.19080/JPCR.2018.05.555672
Background: Patient was 32 years old female, who visited Armed Force Institute of mental health with the symptoms of schizophrenia, delusion (paranoid), speech incoherence, shivering of head and hands, severe aggression, sleep disturbance, loss of appetite, severe conflicts with authority and malfunctioning of daily life.
Methods: Cognitive behavioral therapy was used to treat the client. Total 20 sessions was planned for treatment along with 04 follow up sessions.
Results: Patient showed significant progress in middle phase. She was motivated toward treatment in whole therapy sessions. In termination phase she overcome her ideation, conflict with authority and was able to face the realistic problems effectively.
Conclusion: Cognitive Behavioral Therapy is useful for the treatment of schizophrenia
Schizophrenia considered as one of the most severe mental disorder. Its abnormalities are in the form of delusions, hallucinations, disorganized thinking, abnormal behavior and negative symptoms. Delusions are fixed believes that are difficult to amend through evidence. Delusions are of two types one is bizarre and other is non bizarre. Bizarre delusions are unusual odd believes that do not originate from daily life experiences. On the other hand non bizarre delusions are usual make sense and originate from daily life experiences. Delusions are specifying with erotomanic type, grandious type, jealous type, persecutory type (paranoid), somatic type and mixed type .
In paranoid type of delusion the content includes that he is going to be harmed, poisoned, cheated, spied, followed and harassed by someone. In paranoid delusion patient is not bizarre and socially cut off. He does his work properly but he thinks that people spy on him. The duration of delusion symptoms are one month . Cognitive behavior therapy is useful for Schizophrenia Disorder. Different techniques were used with patients. Cognitive techniques that were used with psychotic patients: improved sympathetic and insight into psychotic experience, recover coping strategies, decrease distress that is linked with hearing hallucination and preservation of gains and avoidance from reversion . Cognitive behavioral therapy for Schizophrenia helps the patient to make sense of delusional experiences through making association between beliefs and previous life events. Through discussing psychological formulation assists the people to formulate the logic of psychological experience that helped them to make links between apparently unlinked beliefs and upset psychotic symptoms .
Ms. R. is 32 years old lady. She is last born in sib ship and she is unmarried. She has four sisters and one brother. Her brother is businessman and all sisters are professional. She was high achiever during her whole academic carrier. She is currently working as assistant professors in a renounced university last from three years. Her father is businessman and mother is house wife. She came with complains of: people are follow me and when I delivered lecture every student stare at me, speech incoherence, shivering of head and hands, severe aggression, sleep disturbance, loss of appetite, disturbed daily functioning,sensitive for criticism, and severe conflicts with authority. She
thought herself as neglected child. She presented flat responses
with lot of speech pressure. She also presented poor memory
and concentration issues. She reported limited friends. Her
problem started from approximately four months ago according
to Ms. R and seeks assistance because she had attended a lecture
on stress management by authors in her university.
She used anti psychotic medicine by the advice of psychiatrist
but she discontinue medication because of heavy sedation by
her own and adopted psychotherapy for future treatment. So
she approached clinical psychologist treatment. Clinician-Rated
Dimensions of Psychosis Symptom Severity  and Positive and
Negative Syndrome Scale (PANSS)  were administered to
gauge her severity of symptoms. After detailed assessment she
was diagnosed as Schizophrenia according to DSM 5. Cognitive
behavioral therapy was used to treat her problems. Total 20
sessions were planned for her treatment. First 16 sessions were
therapeutic sessions in nature and 04 sessions were planned
for follow up. Initial sessions were conducted to develop fair
understanding of her etiology then preservation and further
how to control her symptoms in a daily life functioning and
finally how to overcome on relapse issue.
Patient along with her father and elder sisters visited Armed
Force Institute of Mental Health for the purpose of psychotherapy.
She wanted to gain control on her psychological symptoms to
make herself comfortable in normal life as soon as possible. First
she assessed for Psychometric testing and further guided in the
light of analysis that she is facing severe psychological which she
is facing. She was recommended Cognitive Behavioral Therapy
for treatment. To get good knowledge about CBT she assigned to
consult internet and given some written in the form of pamphlets
and booklets. Initial phase contained 4 sessions. Initially sessions
were planned on alternative days per week. Treatment structure
was discussed with patient to relay information about psycho
therapeutic session. Firstly etiology of Paranoid schizophrenia
was discussed to get the basic understanding of her pathology
and illness history. Further basic symptoms were discussed in
detail and to gain adequate control on the symptoms an activity
program was developed with the interest of patient which was
based on religious activities, social activities, job activities,
physical activities, basis diet plan, sleep regulation techniques
and creative activities (Tables 1 & 2).
Home work was also assigned to keep her control on her
symptoms and further to enhance her insight. She regularly
followed the instructions. To address her cognitive errors she
was given visual-gram and which improved her symptoms. By
following the activity plan she gained confidence and developed
better relationship with family member and her colleagues.
To address her authority conflict, whole family member were
invited in the sessions in the middle phase of the therapy.
Cognitive errors and misinterpretation were focused and
challenged during the family sessions. Family combined sessions
remained fruitful and conflicts resolution techniques along
with tolerance bearing (cognitive errors related to impulsivity
and sensitiveness) were applied to address the issues. She
shared childhood imageries which were based on verbal and
physical abuse by her father on her mother and siblings when
her family lived in joint family system which turned into severe
psychological problems for her (Figures 1 & 2).
Mindfulness techniques were used to address these issues
along with thoughts monitoring which explained the linked
of negative thoughts and her current paranoia. Cognitive
restructuring helped her to move out from false beliefs. In this
phase stress model, mood monitoring, thought monitoring and
cognitive restructuring was concluded and she feels relaxed and
removed negative symptoms. In further session focused on early
warning sign in which she learned how to cope with problems.
She learned self management technique and learned how to face