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Original Paper

Cognitive-Behavioral Therapy for Schizophrenia: A Critical Evaluation of Its Theoretical Framework from a Clinical-Phenomenological Perspective

Škodlar B.a-c · Henriksen M.G.b, c · Sass L.A.d · Nelson B.e · Parnas J.b, c

Author affiliations

aUniversity Psychiatric Clinic Ljubljana, University of Ljubljana, Ljubljana, Slovenia; bDanish National Research Foundation, Centre for Subjectivity Research, University of Copenhagen, and cPsychiatric Center Hvidovre, University of Copenhagen, Copenhagen, Denmark; dDepartment of Clinical Psychology, Rutgers University, New Brunswick,N.J., USA; eORYGEN Research Centre, University of Melbourne, Melbourne, Vic., Australia

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Psychopathology 2013;46:249-265

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 08, 2011
Accepted: August 09, 2012
Published online: October 03, 2012
Issue release date: June 2013

Number of Print Pages: 17
Number of Figures: 0
Number of Tables: 0

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: https://www.karger.com/PSP

Abstract

Background: Cognitive-behavioral therapy (CBT) has played an increasingly important role in psychotherapy for schizophrenia since the 1990s, but it has also encountered many theoretical and practical limitations. For example, methodologically rigorous meta-analyses have recently found only modest overall effect sizes of CBT treatment, and therefore questions have emerged about forwhat and for whom it actually works. Method: The focus of the present paper is to elucidate the theoretical assumptions underlying CBT for schizophrenia and to examine their consistency with abnormalities of experience and self-awareness frequently reported by schizophrenia patients and systematically studied in phenomenological psychopathology from the beginning of the 20th century. Results: We argue that a strong theoretical emphasis on cognitive appraisals with only subsidiary attention devoted to affective and behavioral processes - as is characteristic of many forms of CBT - cannot satisfactorily account for the complex subjective experiences of schizophrenia patients. We further argue that certain theoretical strategies widely employed in CBT to explore and explain mental disorders, which involve atomization and, at times, a reification of mental phenomena, can be problematic and may result in a loss of explanatory potential. Finally, we provide a detailed account of how negative symptoms and delusions are conceptualized in CBT and consider the question of how these concepts fit the actual phenomenology of schizophrenia. Conclusion: We suggest that further advancement of CBT theory and practice can benefit from a dialogue with phenomenological psychiatry in the search for effective psychotherapeutic strategies for schizophrenia patients.

© 2012 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 08, 2011
Accepted: August 09, 2012
Published online: October 03, 2012
Issue release date: June 2013

Number of Print Pages: 17
Number of Figures: 0
Number of Tables: 0

ISSN: 0254-4962 (Print)
eISSN: 1423-033X (Online)

For additional information: https://www.karger.com/PSP


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