On Schizophrenia

By Dr. Shane Pienaar

As clinical psychologists we are trained to understand various psychopathological conditions from differing theoretical perspectives, which universities adhere to. In our internships we are more or less exposed to psychotic patients, depending on the population of the institution. Thereafter some psychologists who work in hospital settings may from time to time come across schizophrenic patients, whereas the majority of our colleagues in private practice may very rarely see a schizophrenic patient. The following update on effective treatment strategies is for those who do work with individuals who live with schizophrenia.

Schizophrenia is a psychiatric condition that seriously affects an individual’s personal, social and vocational life. Positive symptoms include hallucinations, delusions, bizarre behavior, and positive formal thought disorders (language difficult to understand). Negative symptoms include limited verbal and non-verbal expressivity and limited engagement in constructive, pleasurable activities, whether socially or on one’s own. Research has shown that the factor primarily linked to improvement is the schizophrenic’s acts of reasoning.

Cognitive approaches to schizophrenia, as described in Schizophrenia, Cognitive Theory, Research and Therapy (Beck A, et al, The Guilford Press, NY, 2009, p. 3), are based on the formulation and treatment strategies (Cognitive Therapy)

of non-psychotic conditions, but take the unique neurocognitive and psychological-cognitive aspects of schizophrenia into account. The treatment protocol herein is based on a theoretical understanding of and related treatment strategies for the four primary psychopathological dimensions of the disorder, ie. delusions, hallucinations, thought disorders, and negative symptoms. Cognitive conceptualizations, assessments of and therapy for each of these symptoms are taught. This work includes an integration of cognitive and neurobiological models of schizophrenia.

Continuing with the premise that psychological and cognitive factors affect the pathogenesis of the disorder, Metacognitive Training (MCT), as applied by Professor Steffen Moritzs’ University Medical Center in Hamburg, Germany, aims at targeting cognitive biases (thinking distortions and processing preferences). This is done in eight 1:1 or small group setting modules. Each module includes an introduction, exercises and learning aims which address cognitive errors and problem solving biases. These disturbances may contribute to the formulation of delusions. Awareness and reflection of these thinking errors are encouraged by the training, as well as improving problem solving skills.

The eight modules consist of:

  1. Attributional style and self-esteem
  2. Jumping to conclusions bias
  3. Bias against disconfirmatory evidence
  4. Problems in social cognition
  5. Over confidence in memory errors
  6. Problems in social cognition
  7. Jumping to conclusions bias
  8. Depressive cognitive patterns


To read the full article Metacognitive training in schizophrenia: from basic research to intervention (Moritz S, et al) and download the manual click on

h t t p : / / u n i p a r k . d e / u c / hh_uni_psych_inst_LJ/72d8/ .

A demonstration of MCT administration is available at

https://www.youtube.com/user/ AGNeuropsychologie?feature=mhee.

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