Cognitive-Behavioral Therapy

Medication is the treatment of choice for many types of hallucination, but a lack of results – due to noncompliance and the persistence of residual symptoms, for example – has led researchers to develop various ancillary treatment forms (Pantelis and Barnes 1996 ) . Two decades ago, psychological research focused primarily on coping strategies. But although many patients do apply self-developed coping strategies, they tend to lose confi dence in their effi cacy over time, while patients with a long history of voice hearing do not always appear to select the most effective coping strategies (Carter et al. 1996 ; Farhall et al. 2007 ) . Cognitive-behavioral therapy (CBT) advocates a wholly different approach. In the context of the traditional medical model, which also infused the coping model, the primary variable to be treated is the symptom of disease (e.g., “hallucination”) rather than the patient’s depression, anxiety, or dysfunctional behavior, which are all considered secondary to the hallucinations at hand and only amenable to treatment when the hallucinations themselves are being treated. The cognitive model differs from more conservative variants of the medical model in that its primary goal is not the eradication of the primary symptoms per se but the reduction of distress and dysfunctional behavior. After all, symptoms only become “real” symptoms (as defi ned in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and other psychiatric classifi cations) when they cause distress and/or dysfunctional behavior. However, within the context of the cognitive model, it is not so much the symptom itself that is held responsible for causing any distress or dysfunctional behavior but the patient’s appraisal of that symptom (Birchwood and Trower 2006b ) .