Using Cognitive Therapy to treat Delusions

Dr. Aaron Beck recently responded to an interviewer’s questions about addressing delusions among Schizophrenic patients. One of the central tenets of Cognitive Therapy is that individuals learn to evaluate their thinking and look for evidence that supports and/or contradicts their perceptions. The interviewer asked Dr. Beck how this pursuit of evidence plays out when individuals are having delusions and literally ‘seeing’ objects/people that aren’t really there.

Interviewer: How… do you persuade someone to ignore the evidence of their own eyes and believe you? 

Dr. Aaron Beck: The treatment of delusions and schizophrenia is a very tricky one. One of the definitions of delusions is that they do not yield to corrective feedback from other people. Consequently, attempting to persuade an individual that the delusion is incorrect is obviously self-defeating. There is a whole body of literature on how to address delusions. In brief, questioning the patient like a journalist without indicating disbelief is one way. This tends to get the patient into a questioning mode. However, that approach is used much later in treatment. Initially, we train the patients to recognize their automatic thoughts and then lead them to recognize some of their non-psychotic misinterpretations. After a strong basis is made on this, we then lead them to consider the more paranoid interpretations of their experiences (which we have labeled as their “upsetting interpretations”).

Thus, in treating delusions, we try to develop or enhance the patient’s skills in handling some of their emotional problems and then later apply these skills to the delusional misinterpretations. Another technique is something we call “behavioral experiments”– we might have the patient who is afraid of going out of his ‘comfort zone’ go with the therapist or a trusted person for a few feet or yards, or even further, just to test out whether he is vulnerable. This of course is dependent on the patient’s having a great deal of confidence in the therapist’s wisdom and trustworthiness. For further information on this topic, I suggest that you review the book by David Kingdon and Doug Turkington titled Cognitive Therapy of Schizophrenia.        

10 replies
  1. Kevin Benbow
    Kevin Benbow says:

    I enjoyed the of the interview. Just finished a book on ptsd espousing a Similar idea: Treat Co_morbid depression or other issues before tackling an anxiety hierarchy!

  2. Steve
    Steve says:

    Cognitive psyschology has progressed alot since the founding days of psychology. It seems that the cognitive model has stood the test of time (that is after behaviourism had its turn). Please excuse my ignorance as I have not read much (in regards to the scope) of your work. Do you think Cognitive psychology will continue to flurish or is there another model of interest you think might start to take off? What are some of the main resons for Cognitive Psychology having more relevance in modern times as apposed to Behavioural?

  3. CT Today
    CT Today says:

    Cognitive Therapy continues to be successfully applied to new disorders all the time – research studies support its efficacy for more and more problems. We expect this model to continue flourishing…

    As for behavioral aspects of treatment, Cognitive Therapy actually includes behavioral change as an element of therapy. For more info, please see this CT Myths post.

  4. Katharine Cecilia
    Katharine Cecilia says:


    Where can I find a list and analysis of the “errors” in thinking?


    Katharine Cecilia

  5. CT Today
    CT Today says:

    Katharine, “errors in thinking” are described in many Cognitive Therapy books, including David Burns’s book, Feeling Good, and Judith Beck’s book, Cognitive Therapy: Basics and Beyond. (Feeling Good is written for the lay person, and Basics and Beyond is for mental health professionals).

    For links to these and other Cognitive Therapy books, please visit our website (reading lists are included under Consumers and Professionals).

  6. Barbara
    Barbara says:

    Is there any known relationship between e.g. acoustic hallucinations and automatic thoughts? Is there any evidence that delusions might be caused by what a person thinks/beliefs? What I read most of the time is that for example hallucinations are caused by something biological in the brain.

  7. CBT fan
    CBT fan says:

    That is amazing that those with actual Delusions don’t yield to correct feedback.
    Recently, Richard Dawkins wrote a book called The God Delusion. For the sake of argument, if the idea of “God” really was a Delusion, then by definition there is no direct way to address it.

    …very interesting…

    I wonder if every normal person has certain “delusions” they harbor?

  8. CT Today
    CT Today says:

    Cognitive Therapists theorize that auditory hallucinations/voices are actually thoughts that are mistaken for external voices. These voices/thoughts are often negative and/or distressing, and reflect an individual’s underlying beliefs about him or herself. Brain imaging of people who hear voices typically show activity in the speech area of the brain, suggesting that people are talking to themselves.

  9. Barbara
    Barbara says:

    Thank you for the answer. Maybe you are interested in some experience I had with sorting out automatic thoughts. Usually I discovered some new automatic thought a while before I found a way to deal with them (why I don`t believe them). So during that time I could either just “look” at the thought and somehow distance myself from it or give in to it and believe it.

    When I did the second sometimes (believe them) somtimes strange things happened, especially with that type of thought “there is something wrong with you” related to other people judging me. When I would believe this thought my brain would do crazy things: I would hear a person talk in the back of my head, my thoughts would go in circles making it hard to concentrate, things would seem to move and a couple of other things.

    But the same way that I switched into those experiences by believing these automatic thought I could switch out of them again by distancing myself from them. Then they would be just automatic thoughts again and my brain was working normal.

    This experience seems to go along well with your idea that hearing voices might have something to do with automatic thoughts.


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