Resume of Recovery-Oriented CT (CT-R)

The delusions and apparently irrational thinking actually represent a translation or transformation of familiar beliefs and wishes. The trick is to back-translate or re-transform the delusions into their original, normal sounding beliefs. When this is done, it is possible then to understand the individual’s idiosyncratic behavior and unusual thinking patterns. The take home message is do not pathologize, NORMALIZE.

Second objective: guide individuals to do what comes naturally. The fundamentalists use the cognitive remediation approach to train individuals to improve supposed fundamental deficits in attention, recall, and flexibility, by practicing certain exercises on the computer. We cognitivists on the other hand, try to bolster the individual’s self-confidence, sense of worth and consequently, their motivation, by drawing on their intrinsic values: altruism, acceptance, and belongingness. On an individual basis, this is often accomplished by facilitating engagement in an activity that is meaningful to the individual and has purpose; examples are playing a musical instrument, or artwork. A further example is engaging in some service job in which the individual helps other people. On a group level, wehave found that group activities are valuable in themselves in increasing the individual’s feelings of belonging. Activities that are particularly effective involve helping the disadvantaged through participation in outings, such as Meals on Wheels. Also of great value is participation in talent shows, plays, group games, or clubs devoted to cooking, gardening, or sports. Providing service to animals is also a great booster: working with injured animals at an animal shelter or distributing canned food to animal shelters.

Rationale: The patients with negative symptoms are largely disengaged from interpersonal associations and productive work because of their low self-value and very low expectancies. We have already demonstrated the cycle from low self-worth to low expectancies for achievement or satisfaction, to low motivation, to poor performance. We have shown the cycle can be reversed when the individual engages in meaningful, potentially pleasurable activities, particularly, in a group. The trick is to facilitate activities that will engage the patient and thus, lead to the successful outcomes. The result is not only a negation of negative beliefs but also the activation of positive beliefs. The take-home message: negate negative beliefs, and activate positive beliefs.