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Cognitive–Behavioral and Psychopharmacological Treatment of Delusional Symptoms: A Preliminary Report

Several psychopathological conditions include delusional beliefs as central symptoms. A conceptual model highlighting the importance of cognitive factors in regulating the bizarre internal contingencies which characterize delusional systems is presented. Cognitive–behavioral treatment emphasizes the direct modification of expectations and beliefs as well as the disordered behavior patterns they support. The efficacy of neuroleptics in treating delusional states has also been reported. Two patients with predominate delusional beliefs were treated in a cross-over design by the sequential use of cognitive–behavior therapy and pimozide. A third patient received cognitive–behavioral training alone. The delusions as well as the anxiety associated with them diminished and behavioral functioning improved significantly following cognitive therapy. The relationship between delusional symptoms, perceptions of self, and social functioning, as well as the optimal application of cognitive–behavioral and psychopharmacological interventions are discussed.