A New Treatment for Schizophrenia? The benefit of long term cognitive behavioural therapy

ERIC WHITEHURST IS A QUALIFIED PSYCHOLOGIST AND IS NOW WORKING
AS A COGNITIVE BEHAVIOURAL THERAPIST/HYPNOTHERAPIST AT THE HALE VILLAGE THERAPY CENTRE IN MANCHESTER.

Shuresh Patel first came for therapy in March 2002. He told me he was a 36 year old Asian male who was suffering from schizophrenia with severe dyslexia and a phobia of birds of prey – especially owls. He’d asked his psychiatrist to write to the National Phobic Society for their agreement to undergo cognitive behavioural therapy and hypnotherapy through their services.
Shuresh had been free of positive psychotic symptoms for at least four years and was  regularly taking his medication Depixol. But he believed that “alternative support, like long term clinical hypnotherapy, long term Cognitive Behavioural Therapy (CBT), plus  psychotherapy and counselling, are effective in helping some schizophrenics (like myself) reduce their medication and improve their quality of life.”

Shuresh’s medication was reduced from this regular dose of 50mgs of Depixol down to 40mgs each week, and we then began the CBT and Hypnotherapy. His psychiatrist requested that only one therapeutic change should be made at a time, and that having reduced his dose of medication, to wait for at least four months before making another therapeutic change. He also advised that any interventions would take into account his diagnosis of schizophrenia and to be cautious not to elevate his level of arousal or focus on psychotic experiences. Also to be particularly cautious when addressing his phobia of birds because the origin of these phobias was in his psychotic illness. He added that although the psychotic symptoms had been resolved, Shuresh was still left with a residual fear of birds.

During the first therapy session, Shuresh gave an account of the events leading up to him being sectioned under the Mental Health Act 1983. The third eldest of four children, he’d been a model student, always in the top three of his class with hopes of advancing into further education.
Shuresh reported that his phobia of birds started in 1983 when he was a 17 year old student at college, and that “my life was pressurised and this was adversely affecting my studies. I psyched myself out around this time by staring at an owl poster for five hours. This was my way of running away from my failed attempt of doing the college course.

Ever since then, in fact for 20 years now, I have associated owls and any bird with failure. Every time I shut my eyes, I saw an owl or at least a bird and that scared me.” Shortly after this Shuresh was first diagnosed with schizophrenia.
Although he had other issues, it was agreed that we should work together on his phobia of owls. There followed three months of weekly sessions where systematic desensitisation techniques were used.
Firstly a cartoon drawing of an owl was introduced, followed by a picture of a real owl (a Tawny owl), then a picture of an eagle owl, as a more intimidating portrayal, onto a cuddly toy owl, and  then onto a model of an owl. After six sessions Shuresh was able to watch a Harry Potter movie, which contained scenes of a real owl. And on the final session of the treatment he was able to visit an owl sanctuary where, in Shuresh’s own words, “I was able to pick up an eagle owl, putting my bare hand in front of its mouth. In hindsight, I have actually discovered that owls are my friends, and if I could keep one in my council flat I would, just like Harry Potter.”

In July 2002, Shuresh asked his psychiatrist for an agreement to continue with CBT and Hypnotherapy, now that his phobia of birds had been resolved, so that other issues could be treated. However, before therapy restarted there was a discussion between all parties concerned as to the duration of the therapy and the possibility of dependence. Firstly, it was agreed that Shuresh’s own views  should be taken into account and he expressed that therapy should continue until he had reached the lowest dose of Depixol (cautious small reductions in the dose of Depixol were being made every 6 months.)

Secondly, the positive assessment of the therapeutic benefit of continuing therapy. With these points in mind, it  was agreed to continue therapy on a weekly basis.
Shuresh says “these weekly sessions enabled me to cope with substantial withdrawal symptoms including chronic irrationality, an increase in hearing voices, paranoia, delusional ideas and severe and terrifying hallucinations. For me it was my unconscious, not just my conscious, mind which needed addressing. I needed clinical hypnotherapy to get deep inside my head, so that the other therapies could penetrate those hidden recesses.”

Over the following months, we worked on reducing some of his excesses, for example, caffeine intake and later his smoking addiction, and improving his general health and tidiness. Saying that he had no social life, it was agreed that he should join a gym which would benefit both his health and his social well-being. It was during one of the therapy sessions that Shuresh expressed an interest in returning to further education and he
therefore applied to the University of Bolton to take a degree in psychology.
There were considerations to take into account before being accepted onto the course, as Shuresh suffered from severe dyslexia and learning difficulties. However, it was agreed that with the assistance of a support tutor, he should attempt the degree. During the first year he found the degree very stressful and costly, and so wrote to the University to change to part time study. This was accepted and so the studies continued. Whilst there have been many difficulties associated in studying, he has almost passed his degree, and has had further success being granted a driving licence.

His medication was reduced from 50mgs to 20mgs, and has now been replaced with 6 mgs of Risperidone.
Shuresh has put forward many articles with regard to his therapeutic experience expressing the benefits of long term therapy: “I did this for seven years, which was key to its success.
This is why I don’t think the 12 weeks CBT offered by the NHS is enough. In my opinion and experience – the NHS has got it wrong.”

His articles can be found in the International Association of Counselling 2009, The Europe Journal of Psychology, The Psychologist 2005 and the Hearing Voices Network Journal. He was even interviewed by the journalist Rosalind Hewitt to give an account of his experience, and there’s a reference to Shuresh in her book ‘Moving On’, pp. 183-184. In 2007, Shuresh addressed the AGM of the Hearing Voices Network to give a presentation about his article in the European Journal of Psychology and in 2008 he was invited to give 2 lectures at the Manchester Metropolitan University about his illness and treatment.

He says “because I am a severe case of schizophrenia I was only able to reduce my weekly depixol injection medication by 60% – milder cases might well be fully cured under a similar therapy and counselling regime. Also, I think this therapy and counselling regime could well prove to be effective for depression, bipolar, anxiety, alcoholism and drug abuse etc.”
In my opinion it is unlikely that Shuresh will ever be free of medication. He still suffers from hallucinations, but now deals with them by accepting that the images and voices cannot harm him. These positive symptoms may deteriorate, however it may be put forward that the intervention of CBT and hypnotherapy has helped to alleviate some deep-rooted psychotic       issues and has provided support and encouragement for Shuresh Patel.

References:
Bootzin, Acocella & Alloy (1993) Abnormal Psychology: Current Perspectives, 6th Edition, McGraw-Hill, Inc.
Hewitt, R. (2007), Moving On: A handbook of good health and recovery. For people with a diagnosis of schizophrenia. Karnac Publishers.
The International Association of Counselling 2009 (p. 29)
The Europe Journal of Counselling (May 2007)
The Psychologist (September 2005 p. 535)

Source: Your Voice, Summer 2010

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