ABSTRACT
In this chapter, we consider the role that cognitive therapy may have in helping people who are experiencing the “negative symptoms” of psychosis. Our discussion will be necessarily tentative, as cognitive therapists have so far devoted very little attention to these kinds of difficulties, preferring instead to focus on positive symptoms such as hallucinations and delusions. We begin by defining what negative symptoms are. The conventional view that these symptoms reflect a basic (almost certainly organic) deficit that is a core feature of schizophrenia will be considered alongside some ideas about how it might be possible to understand these difficulties from a psychological perspective. We shall argue that, in the case of many patients, negative symptoms are often exacerbated by depression, social isolation, a lack of reinforcement, overmedication, the trauma of hospital admission, and other sequelae of positive symptoms. Indeed, other marginalised groups in society, for example the longterm unemployed, often appear to experience phenomena similar to those classified by psychiatrists and psychologists as negative symptoms. We shall conclude by presenting some ideas about how these factors might be addressed in a formulation-based approach to the treatment of individual patients and present a case study that illustrates this approach.
