The National Institute of Mental Health defines schizophrenia as “a chronic, severe, and disabling mental disorder characterized by deficits in thought processes, perceptions, and emotional responsiveness.” Patients suffering from schizophrenia exhibit a diverse range of symptoms which are categorized under positive and negative. The positive symptoms of Schizophrenia include delusions, thought disorders, and hallucinations. Negative symptoms include avolition (a lack of desire or motivation to accomplish goals) and lack of desire to form social relationships.
Though incurable in nature, schizophrenia can be treated through a combination of pharmacotherapy as well as psychotherapies to improve the patient’s condition. A lot of schizophrenic patients also tend to experience symptoms in spite of medication. In addition to medication, creative therapies, such as art therapy, may be helpful. Art therapy is a form of expressive psychotherapy that involves using the creative process of making art to improve a person’s physical, mental, and emotional well-being. Art therapy allows insight into the patient’s inner psyche in a non-threatening way through a therapeutic relationship and the use of art materials. Margaret Naumburg is recognized as one of the several founders of the “American Art Therapy” during the mid 20th Century. It was mainly developed in adult psychiatric inpatient units and was designed for use with people for whom verbal psychotherapy would be impossible which is seen in the case of schizophrenic patients.
The creative process carried out by the patient to express themselves artistically can help them resolve their inner psychological issues as well as develop and stabilize their behaviors and feelings, reduce stress, and improve self-esteem and awareness. Psychologists or counselors who use this therapy can interpret the underlying messages communicated through the art produced by the patient, which will aid in the healing process. Art therapy can achieve different results for different types of patients. It can be used for counseling by therapists, healing, rehabilitation, psychotherapy and can provide a deeper understanding of the patient’s psychology. Art therapy has been shown to benefit people of all ages. Research indicates art therapy can improve communication and concentration and can help reduce feelings of isolation and alienation. This type of therapy has also been shown to lead to increases in self-esteem, confidence, and self-awareness. Certified art therapists will typically have a comprehensive understanding of the powerful effect that the creative process can have on those in therapy. Art therapists often use psychological, spiritual, and artistic theories in conjunction with clinical techniques to achieve the desired therapeutic outcome. The approach has proven to be beneficial even for non-verbal individuals and professional artists. The common techniques used in art therapy include Painting, Finger painting, Doodling, Scribbling, Sculpting, Carving, Making pottery, Making cards, Using textiles and Making collages. Because art therapy allows people to express feelings on any subject through creative work rather than with speech, it is believed to be particularly helpful for inherently shy people and people who feel out of touch with their emotions or feelings. Individuals experiencing difficulty discussing or remembering painful experiences may also find art therapy especially beneficial. Psychodynamic art therapy shows promise in helping in-patients diagnosed with schizophrenia, according to a study by German psychiatric researchers in PLOS One.
In a randomized controlled trial involving 58 hospitalized patients diagnosed with schizophrenia who were given treatment as usual and twice-weekly art classes over 12 weeks or just treatment as usual, the researchers found that those who took the art therapy showed “a significantly greater mean reduction of positive symptoms and improved psychosocial functioning at post-treatment and follow-up” and “a greater mean reduction of negative symptoms at follow-up compared to standard treatment.”“Of secondary outcome parameters, patients in the art therapy group showed a significant improvement in levels of emotional awareness, and particularly in their ability to reflect on others’ emotional mental states,” they added, suggesting that the “results prove the feasibility of trials on art therapy during acute psychotic episodes and justify further research to substantiate preliminary positive results regarding symptom reduction and the recovery of mentalizing function.”Cognitive-behavioral therapy (CBT) in schizophrenia was originally developed to provide additional treatment for residual symptoms, drawing on the principles and intervention strategies previously developed for anxiety and depression. In the 1950s, Aaron Beck had already treated a psychotic patient with a cognitive approach, but thereafter the research in this specific area lay dormant for decades. Only after cognitive therapy had been firmly established for depression and anxiety, in the 1990s, did the research into psychological treatments for psychotic conditions gather force—again, with Beck in the forefront.
Pharmacologic therapy can leave as many as 60% of psychotic patients with persistent positive and negative symptoms, even when the patients are compliant with their medication instructions. Furthermore, medication compliance remains a major problem despite the introduction of modern atypical antipsychotics. Studies have shown treatment discontinuation in an estimated 74% of patients in both outpatient and inpatient settings. The evidence for the efficacy of CBT in treating patients with persistent symptoms of schizophrenia has progressed from case studies, case series and uncontrolled trials to methodologically rigorous, randomized, controlled trials that include patients from both the acute4 and the chronic end of the schizophrenia spectrum. Subsequent meta-analysis and systematic reviews have further strengthened the evidence base.
CBT is now recognized as an effective intervention for schizophrenia in clinical guidelines developed in the United States and in Europe. In spite of the evidence base and absence of side effects, however, the general availability of this treatment approach within community settings is still low. This article will examine the procedure of CBT for psychosis, the evidence for its use, and the implications for practicing psychiatrists.