Cognitive Behavioural Therapy for Psychosis

Cognitive behavioural therapy for psychosis (CBTp) is an evidence-based and flexible therapeutic approach to support clients to meet their goals. The appraisal of anomalous experiences, such as voice hearing, is given a central role in cognitive models of psychotic symptoms. Recent developments in the psychological model of persecutory beliefs have focused on key causal and maintenance processes, and CBTp trials targeting these factors have reported large treatment effects. This chapter illustrates the key principles of CBTp using two case examples - a client with persecutory beliefs and a client distressed by voice hearing. The case examples highlight each stage of CBTp: (i) Development of a therapeutic relationship, particularly focusing on engagement, as well as working within the client’s delusional beliefs and consideration of illness beliefs and stigma. (ii) A non-challenging approach to assessment, which aims to understand key appraisals of unusual experiences and belief maintenance factors. (iii) Establishing a shared problem and goal list for therapy. (iv) Collaborative case formulation. (v) Cognitive behavioural interventions derived from the formulation, which often focus on maintenance factors plus a cautiousness about challenging strongly held beliefs. (vi) Planning for the future and relapse management.