Cognitive-behavioral therapy of delusions: mental imagery within a goal-directed framework.

Central to psychotic disorders, delusions are associated with disability and often respond inadequately to pharmacotherapy. Cognitive-behavioral treatments have been developed over the last 20 years that successfully address delusions. However, meta-analyses suggest only a modest improvement in psychotic symptoms. Because delusions share considerable overlap with anxiety, adapting principles and techniques that have demonstrated efficacy in the treatment of anxiety disorders might improve the impact of cognitive-behavioral treatment of delusions. We report a case illustrating a cognitive-behavioral approach to delusions with an emphasis on mental imagery techniques. A 25-year-old male diagnosed with paranoid schizophrenia whose clinical presentation was dominated by paranoid delusions received 6 months of treatment. At the end of the follow-up period, the patient's delusions were minimal and his negative symptoms had significantly improved. Mental imagery may be an important treatment tool for delusions.