Psychiatria pre prax 2/2016

Cognitive behavioral therapy of chronic hallucinations

The lifetime prevalence of schizophrenia varies according to epidemiological studies between 1–1.5 %. Although modern pharmacotherapy led to a significant reduction of patient’s suffering, about 25 % of schizophrenic patients are described as “pharmacologically resistant” and 20–60 % stop taking recommended medication. Except the symptoms that are resistant to the treatment, progression of the disease is negatively influenced by other factors, such as premorbid personality, cognitive deficit, family and interpersonal problems, drug and alcohol abuse, stigmatization. All these factors are pointing to the need to add systematic psychotherapeutic interventions to the biological treatment. Hallucinations are the manifestation of perception disorder. The most frequent hallucinations in schizophrenia are the auditory hallucinations, in which the patient hears voices. The patient often interprets the content of hallucinatory experiences as delusions, which leads to negative emotional reactions and obvious maladaptive behavior. The aim of CBT is to help the patient to use more critical approach to hallucinations and have them more like under control. The paper presents an overview of CBT approaches for therapeutic influence on chronic hallucinations.

Keywords: schizophrenia, hallucination, Socratic dialogue, behavioral experiment, narrative approach