Abnormal Psychology

Schizophrenia and Other Psychotic Disorders 559

to take traditional antipsychotics; Myra was on a low dose of an atypical antipsy-

chotic. These medications helped reduce their symptoms (Mirsky et al., 2000).

Brain Stimulation: ECT and TMS

Medication is not the only treatment that targets neurological factors. As men-

tioned in Chapter 1, electroconvulsive therapy (ECT) was originally used to treat

schizophrenia, but generally was not successful. Although currently used only infre-

quently to treat this disorder, a course of ECT may be administered to people with

active schizophrenia who are not helped by medications. ECT may reduce symp-

toms, but its effects are short-lived; furthermore, “maintenance” ECT—that is, regu-

lar although less frequent treatments—may be necessary for long-term improvement

(Keuneman, Weerasundera, & Castle, 2002). Three of the Genain sisters—Nora, Iris,

and Hester—received numerous sessions of ECT before antipsychotic medication

was available. After ECT, their symptoms improved at least somewhat but, usually

within months if not weeks, worsened again until the symptoms were so bad that a

course of ECT was again administered (Mirsky et al., 1987; Rosenthal, 1963).

In experimental studies with small numbers of patients, transcranial magnetic

stimulation (TMS) appears to decrease hallucinations, at least in the short term

(Brunelin, Poulet, et al., 2006; d’Alfonso et al., 2002; Hoffman et al., 2000; Poulet

et al., 2005). However, not all studies have found TMS to have this positive effect

(McNamara et al., 2001; Saba et al., 2006). The specifi cs of ECT and TMS admin-

istration are discussed in Chapter 4.

Targeting Psychological Factors

in Treating Schizophrenia

Treatments for schizophrenia that target psychological factors address the four gen-

eral treatment steps; they (1) reduce psychotic symptoms through cognitive-behavior

therapy (CBT); (2) reduce negative symptoms through CBT; (3) improve neurocog-

nitive functioning through cognitive rehabilitation; and (4) improve overall func-

tioning and quality of life through psychoeducation and motivational enhancement

(Tarrier & Bobes, 2000).

Cognitive-Behavior Therapy

CBT addresses the patient’s symptoms and the distress that they cause. Treatment may

initially focus on understanding and managing symptoms, by helping patients to:

• learn to distinguish hallucinatory voices from people actually speaking,


• highlight the importance of taking effective medications,


• discuss issues that interfere with compliance, and


• develop more effective coping strategies.

When a therapist uses CBT to address problems arising from delusions, he or she

would not try to challenge the delusions themselves, but instead would try to help the

patient move forward in life despite these beliefs. For instance, if someone believes that

the CIA is after him, the CBT therapist might focus on the effects of that belief: What

if the CIA were following him? How can he live his life more fully in spite this belief?

Patient and therapist work together to implement new coping strategies and monitor

medication compliance. In fact, such uses of CBT not only improve overall function-

ing (Step 4), but also can decrease positive symptoms (Step 1) (Bustillo et al., 2001;

Pfammatter, Junghan, & Brenner, 2006; Rector & Beck, 2002a, 2002b) as well as nega-

tive symptoms (Step 2) (Dickerson, 2004; Tarrier et al., 2001; Turkington et al., 2006).

Cognitive Rehabilitation

Once psychotic symptoms have subsided, people with schizophrenia often continue

to struggle with neurocognitive defi cits that limit their ability to function. Cognitive

rehabilitation(also called neurocognitive remediation orcognitive mediation)

Cognitive rehabilitation

A form of psychological treatment that is

designed to strengthen cognitive abilities

through extensive and focused practice;

also called neurocognitive remediation or

cognitive mediation.