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Schizophrenia is a very disabling psychiatric illness affecting about 2 to 3 million Americans. Contrary to popular perception, it has nothing to do with a "split personality." Schizophrenia is a chronic brain disorder involving "positive" and "negative" symptoms. Positive symptoms include hallucinations (hearing voices or seeing visions that aren't real), delusions (fixed false beliefs), and disorganized thinking or speech. A recent study in the Archives of General Psychiatry by Paul Grant, Aaron Beck, and their colleagues found that a modified version of cognitive-behavioral therapy (CBT), a specific type of talk therapy, can produce clinically significant improvement in patients with schizophrenia. Importantly, significant improvement was seen in certain negative symptoms-apathy/avolition (lack of drive)-as well as in positive symptoms. These results are impressive, especially considering that the participants had been ill for an average of 18 years and suffered from severe symptoms. In this study, study participants were divided into two groups. One group received CBT in addition to "standard treatment," which included treatment with antipsychotic medications. The other group received standard treatment alone. CBT has been shown to be effective in a variety of psychiatric illnesses. It uses pragmatic techniques to help a person correct inaccurate or dysfunctional thoughts and emotions by promoting critical comparison of those thoughts with observable facts. For example, if a person believes that he/she is "doing absolutely nothing," one CBT technique would be to encourage the person to keep a detailed diary of daily activities. The therapist would later review this diary with the patient and facts would be compared to perceptions. Homework assignments would include strategies to increase productive activities. In the study mentioned above, the researchers focused CBT "on identifying and promoting concrete goals for improving quality of life and

Why does psychotherapy favorably compare to medication in treating depression? One reason may be rooted in the evolutionary origins of depression. Scholars suggest humans may become depressed to help us focus attention on a problem that might cause someone to fall out of step with family, friends, clan or the larger society-an outcast status that, especially in Paleolithic times, would have meant an all-but-certain tragic fate. Depression, by this account, came about as a mood state to make us think long and hard about behaviors that may have caused us to become despondent because some issue in our lives is socially problematic. Steven D. Hollon, a professor of psychology at Vanderbilt University, explores the implications of helping a patient come to grips with the underlying causes of a depression-which is the goal of CBT (cognitive behavioral therapy), and is also in line with an evolutionary explanation. The anodyne effects of an antidepressant, by contrast, may divert a patient from engaging in the reflective process for which depression evolved-a reason perhaps that psychotherapy appears to produce a more enduring effect than antidepressants. Hollon notes that depression has a purpose--it spurs rumination about complex social problems, and that CBT can expedite rumination and make it more effective. He states, "For most people, depression motivates them to think more deliberately about the causes of their problems and the solutions they can apply. In most instances in our ancestral past this worked well enough; most depressions remit spontaneously even in the absence of treatment. Cognitive therapy, at the least, hurries the process along and, at the most, helps unstick that subset of individuals who get stuck making negative ascriptions about themselves, typically about personal competence or lovability."

hour-long video of a small presentation at UNM

interactive introduction to cognitive behavioral therapy (self-talk). Has lots of self-quizzes and coaching.