Jirei de manabu tōgō shitchō-shō no tame no ninchi kōdō ryōhō (Learning from Case Studies of Cognitive Behavioral Therapy for Schizophrenia)

Since the latter half of the 20th century, scientific psychologies, such as neuropsychology and cognitive psychology, have shown that cognitive impairment is the root of the complex symptoms that characterize schizophrenia. In schizophrenia, basic cognitive functions such as attention, memory, and concept formation are temporarily impaired. While these impairments link directly to the “hard-wiring” of brain functions, there are also more psychological and "soft" cognitive distortions. Commonly cited examples include JTC, the tendency to jump to conclusions with little evidence, or cognitive bias, the excessive confidence in mistaken memories.
 
Cognitive behavioral therapy is, by and large, an evidence-based practice that emphasizes the interaction between research and practice, while the technique of applying the results of scientific psychological research on schizophrenia as described above to clinical practice is known as Cognitive Behavioral Therapy for psychosis (CBTp). The latter, in particular, with the addition of a symptom-centered approach focusing on delusions and auditory hallucinations has developed rapidly in the UK, most notably since the 1990s. Current UK treatment guidelines cite CBTp as one of the standard psychosocial treatments, especially for schizophrenia, in a national undertaking influenced by numerous scientific studies of treatment effectiveness.
 
While CBTp has been gradually introduced into Japan as well since the 2000s, it has struggled to take hold due to a persistent misconception among medical professionals that psychotherapy for schizophrenia is ineffective and compounded by a lack of research on the treatment effectiveness of clinical psychology itself. To remedy this situation, the author, together with co-editors Kikuchi and Matsumoto, initiated a CBTp Network of psychiatrists and clinical psychologists in 2011 for the purpose of information sharing, supervision, and clinical research collaboration on practical experiences with CBTp in Japan. This book represents one of the outcomes of this network and is meant to provide a foundation for future clinical research in Japan.
 
Through case studies in the three fields of Early Intervention, Forensic Cases, and Community Support, this book covers the essence of CBTp, including such aspects as intervention goals that vary according to the needs and symptoms of the patient and the crossover of basic and applied techniques.
 
At the same time, it is the author’s belief that the essence of CBTp, which is more than just a technique, lies in dialogue that shows respect for people with schizophrenia while ensuring that they are not psychosocially isolated. Readers are encouraged to view CBTp not only as a psychotherapeutic technique, but also as one of the many and varied methods of support for people with mental disorders. It should be noted that in actual clinical situations, applying CBTp alone—that is psychological intervention alone—will not be enough to support people with schizophrenia. The practice and effectiveness of therapy should be examined within the context of an interprofessional collaboration for comprehensive psychiatric treatment encompassing biological, psychological, and societal aspects.

 

(Written by ISHIGAKI Takuma, Professor, Graduate School of Arts and Sciences / 2020)