Cognitive dissonance in the treatment of paranoid schizophrenia Academic Article uri icon


  • Paranoid thinking is often well organized, systemized and detailed so that treating a paranoid patient is a difficult challenge. It is suggested that cognitive dissonance, once created, may cause a person to change his cognitions in order to lower or eliminate it. The treatment of a paranoid schizophrenic is presented wherein by introducing strong group pressure the patient accepted an axiom, which created dissonance with his paranoid content. This axiom was "A wise man sees more than two alternatives in any given situation." Therefore, by stepwise pacing, alternative evaluations of affect "free" situations were made by the patient using the accepted basic axiom. This technique was gradually used with the patient's paranoid content, and later on with basic characteristics underlying the paranoid system. The patient exhibited curiosity and a willingness to investigate his paranoid inner state according to the new accepted axiom, and a significant symptomatic relief was seen within a few days, in contrast to past hospitalizations where only partial response to antipsychotic medication was noted. Research is needed in order to examine the effectiveness of this mode of treatment. There is nothing like a paranoid system to emphasize the dilemma of treating mental illness existing in delusional disorders or in paranoid schizophrenia. The person subject to paranoid states experiences the world as logical and organized and is often able to explain it down to the smallest detail. Within this world, which he or she perceives as hostile, the paranoid patient feels isolated, misunderstood, and persecuted. He or she feels that no one shares the under standing obtained through much emotional and intellectual difficulty (Fromm-Reichman, 1960). Treatment of paranoid patients thus presents therapists with exceptional therapeutic challenges: to find an opening into the closed, allinclusive and distorted logic of the intellectual apparatus, as Fried and Aggassi (1976) explain paranoia. Few authors have suggested cognitive interventions with delusional psychotic patients (Hole, Rush, & Beck, 1979; Jacobs, 1980; Milton, Patwa, & Hafner, 1978; Ferris, 1989). Chadwick and Lowe (1990) and Kingdom and Turkington (1991) used cognitive behavior techniques with delusional schizophrenics on medication. Both, taking care not to confront the delusional thoughts directly, tried using such techniques to encourage patients to explore these experiences and to consider alternative explanations (Hollon, 1993). Both authors reported positive results. Regarding paranoid psychotic patients, Colby, Faught, and Parkinson (1979) described a heuristic, computer-simulated model for a six-step procedure describing the logical development of paranoid behavior. These steps include the existence of beliefs of inadequacy within the individual (Step 1); such beliefs are activated "when evidence relevant to them enters the System" (Colby et al., 1979, p. 57). Feelings of shame and humiliation are produced (Step 2). Such feelings cause distress (Step 3). The individual searches for a locus of control (Step 4) and "finds" such a locus of control outside the system, developing a paranoid strategy (Step 5) which he or she uses over long periods of time (Step 6). Colby suggests in his model that cognitive interventions such as those used before in a variety of mental disorders (Beck, 1976; Beck, Freeman & Associates, 1990) may be tried in Steps 1 and 2. Such cognitive interventions are aimed at correcting these beliefs of inadequacy by locating and correcting cognitive distortions. It should be noted that Colby did not suggest any cognitive interventions in later stages, let alone in stages 5 and 6 when the paranoid strategy is fully developed. Two main problems arise in applying Colby's model. First, the model presented may encompass only a subgroup of paranoid patients in whom the paranoid strategy developed according to Colby's hypothetical model, and may not necessarily apply to the whole range of paranoia. …

publication date

  • January 1, 1995