Transformation: Recovery Oriented Cognitive Therapy for Schizophrenia

A common image of schizophrenia is the person who spends all day staring at the wall. Such loss of motivation and social withdrawal are known as negative symptoms. These are the most disabling features of this condition, and have been considered virtually permanent—no treatment has been discovered that would help to alleviate them.

In the late 1990s, we decided to see if we could understand negative symptoms better and find a way to improve them. The prevailing belief in the field has been that the observed social withdrawal and inactivity is based on impairment of brain function, specifically, attention, memory and executive function. However, we could not comprehend how these impairments could translate into the profound inactivity we saw in the person staring at the wall.

After conducting many interviews with individuals experiencing negative symptoms, we came to a startling conclusion: these individuals appeared to have a system of negative beliefs that could account for their low functioning.

Specifically, we speculated that defeatist and asocial beliefs reduce access to the motivation needed to initiate and sustain activity. The defeatist beliefs consisted of attitudes such as “there’s no sense in trying anything, I’m only going to fail,” and “failing at one thing is the same as being a total failure.” The asocial beliefs included "people are better off if they stay aloof from emotional involvements with most others,” and "making friends isn’t worth the energy it takes.”

We conducted a series of studies and found, as predicted, that these negative attitudes had a direct impact on the negative symptoms, while the impairments in attention, memory, and executive functioning had only an indirect effect. It stood to reason that if we could modify these disabling attitudes, then we could relieve the disabling behavior.

Not a big fan of CBT.It is grossly overhyped by CBT fanbois and its benefits for psychosis highly questionable .


CBT has been wonderful for me personally.

I think this is crap. I have very little in the way of negative beliefs such as they mentioned but I still have negative symptoms. I’m sure such beliefs affect negative symptoms, but I really don’t think they are a major cause of them.


I am not sure what to make of the claim. I think it certainly underplays the effect of cognitive factors such as executive functioning. For me lots of tasks involving some degree of organising and planning and a multi step process( executive functioning skills) are ones that I tend to back away from hence the lack of motivation.
Perhaps this could be called defeatist but the fact is they are stemming from a real problem ie executive functioning difficulties. To say that it is just down to attitude of mind(a mainstay of CBT philosophy) glaringly misses the point.
Without help for those executive functioning difficulties I will always have difficulties with and tend to back away from certain tasks. The truth is we tend to be more motivated to doing those things we are good at. That applies to people with or without psychosis.

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Same here. I don’t have defeatist beliefs. In fact I am an incurable optimist, I have achieved things in my life that I’m really proud of, such as graduating from a high-profile engineering school, making good friends, working really hard, earning money, running a marathon, learning 2 foreign languages… the list goes on and on. However, I still suffer from horrendous negative symptoms and I guarantee there’s no link (at least in my case) between feelings of self-worth and negative symptoms.


Maybe not the cause but CBT is extremelly helpful with negative symptoms, if you’re willing for it to be.

I am sorry but comments like that really irritate me. It pushes the notion that CBT is infallible and that the reason it doesn’t work for some is down to the individual. Intellectually it’s a whole pile of horse dung.

I’m not trying to start an argument with you firemonkey.

It might not work for some people and work for others. It’s what I’m saying. Over and out.

That is more to the point but not what you implied with your previous post. I think people need to accept that CBT is not a perfect cure all for all mental problems and has definite limitations.
Sometimes/often it doesn’t work and that has nothing to do with the individual not buying into it enough or not trying hard enough.
CBT practitioners need to stop transferring blame as to why it doesn’t work for some/many people. A little humility would not be misplaced.

With sz symptoms being extreme enough to the point of causing suicide, it’s no wonder CBT is important. With my brother CBT hasn’t been a cure, but it seems to have been a critical part of helping him deal with all that he has gone through.

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I don’t think I implied anything more than what I said. It works for me. It helps my negative symptoms.
My therapist says he can’t help me during a psychotic break, so I think they don’t say CBT is the cure for all mental issues. You’re playing the extremes there, I’m not, just that.

Helpful for some, but you have to be in the mindset also. Otherwise its just wasting your time.

So we come back to the CBT practitioners main line of defence when it doesn’t work rather than accepting that it has its limitations ie "Oh, you weren’t in the right mindset. It’s that pesky faulty thinking again "

Negative attitudes definitely have a strong impact on anyone’s life, not just the person with SZ. Even in high achievers, areas of negativity limit outcomes. A person might be brilliant at their career, but their internal experiences of negativity keep them from developing in other specific areas of life.

Before I found this forum, I existed in isolation as concerns my illness. Consequently, I didn’t know how to manage it - my illness could take me up or down. It all seemed so real, so very real. I didn’t literally sit and stare at the wall, but I did ruminate, sleep, avoid my areas of talent and skill, give up on things, and feel otherwise feel terrible. After a couple of therapy sessions, which led me to find this forum, I learned how successful others are at managing their symptoms. Symptoms are not a “death” sentence, even though the illness might never go away. Symptoms can be cognitively/emotionally managed successfully and life can be highly fulfilling. It’s a form of cognitive-emotive therapy that we do here. Because of that, I was able to challenge and change my own personal cognitions

The take home message for me is this: my symptoms induce highly problematic elements in my life. Rather than becoming victim to them, I can actively manage the negative detrimental cognitions. The more I engage in positive cognitions (the more I drop any negative attitude concerning anything), the better my life becomes.

firemonkey - thanks for an excellent topic.


You’re generalizing. Read your comments and then think to yourself if it’s worth fighting for.

Any sort of talk therapy is useless if you don’t want to change/add/subtract behaviors.

Not at all. I made a pertinent point. CBT practitioners need to stop transferring blame for when CBT fails to work. Just because CBT fails to work doesn’t mean that its always down to deficits in the individual’s way of thinking. You may want to change/add/subtract behaviours but it doesn’t follow from that that CBT is necessarily the solution.

Have you had CBT? Its not really that difficult to understand why it works once you try it.

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You know, the only reason I’m fighting you on this it’s because it does work. Might not work for everyone, and only the therapist and the person will know why it didn’t work for the person. But the truth is it’s very effective, I can testify because it’s effective with me.

The hate is what I don’t get.

I’ve had some basic CBT orientated stuff for anxiety and other problems. One of my main intellectual quibbles with CBT is it pushes blame on the individual(their thinking is faulty) and downplays the effects of negative experiences.
By all means help me to cope better with those negative experiences but acknowledge and don’t dismiss those experiences. If you are bullied for example ditto if you are emotionally abused you can’t just say you were bullied or emotionally abused because you had the wrong mindset. That amounts to victim blaming.

My experience with CBT is nothing like that I assure you. Instead of blaming myself for being abused, my therapist made sure I blamed the abuser, for example.

A similar line of argument?