COGNITIVE THERAPY OF DELUSIONAL BELIEFS

The present article articulates a cognitive theoretical perspective of delusional beliefs. In contrast to the focus of psychoanalytic therap y (theoretically-derived phenomena beyond personal awareness), the cog nitive therapist focuses primarily on the conscious cognitive-experien tial level in the treatment of delusional beliefs, thereby emphasizing a 'common-sense' level of analysis or reasoning shared by the delusio nal patient. Unlike noncognitive behavioral approaches, which focus on topographical 'verbal behavior' as such, cognitive therapy directly t argets specific delusional beliefs which theoretically give rise to th e disordered verbal behavior. In this article, the adaptation of cogni tive therapy to the treatment of delusions is described, with special attention to the following issues: special problems in collaboration; difficulties in obtaining conviction ratings; how to avoid and reduce confrontation through the Socratic method; the collaborative design of homework experiments; distancing strategies; interpersonal relationsh ip issues; and the necessity to identify and explore the emotions asso ciated with the various delusions, especially feelings about the possi bility that the delusions may be incorrect.