Simple Guide for CT-R of Negative Symptoms

I have listed below the strategies and techniques that are used for each of the negative symptoms in schizophrenia. While there is a considerable crossover of the techniques and the symptoms, this is a simple guide for beginners.

It is important to clarify that CT-R itself is much broader and encompasses many facets which will be described in future memos which are not laid out in the table above. The lesson from the present intervention is that is not necessary to use verbal techniques to modify negative biases in the individuals’ beliefs and expectancies. In my work with non-psychotic patients, it was possible to use verbal techniques, supplemented by “behavioral experiments” designed to test out these beliefs (relative to action plan). Thus, I would ask that we raise questions such as “What is the evidence…… does it logically follow that….. are their alternative explanations”. In working with psychotic individuals however, we have found that the action plan can accomplish the same purpose. In essence, it appears that after a successful experiential intervention, not only is the negative belief disconfirmed, but positive beliefs are energized. It appears that individuals have two sets of beliefs (as well as assets). When one set is activated, for example, the positive beliefs, the other set is deactivated. These corrective experiences gradually work their way into the memory system so that the positive (presumably unbiased) interpretations help to fortify positive beliefs. Thus, after each activity, it is important to “draw conclusions” regarding the meaning of the individual’s behavior in terms of success or failure.

Note: The sweet spot is regarded as something of special interest to the individual which is generally not apparent at initial contact. It should also be noted that identifying aspirations and setting these as goals is an important foundation of the treatment. In addition, the clinician takes into account values, interests, and assets in providing a strengths-based formulation of the case.

-ATB