‘Seeing the wood from the trees’: a continuum model of psychopathology advocating cognitive behaviour therapy for schizophrenia

Abstract The present work examined the question ‘can cognitive behaviour therapy be successfully adapted to treat schizophrenia and become a recognized adjunct CBT treatment approach by frontline services?’ It was proposed that this was possible, and that a significant barrier to this was the ‘mental set’ of the wider clinical community. Prevailing attitudes of (1) believing that symptoms are not amenable to reasoning and may be made worse on enquiry, (2) patients are too severely disturbed to benefit from a psychological intervention, were related to a strict categorical model of psychopathology, where schizophrenia is viewed as a discrete entity. The premise was put forward that, the realistic benefits of categorical models, i.e. the identification of distinguishing features of a disorder, specific treatment approaches, and relatively homogeneous groups for research, have caused undue emphasis to be placed on identifying differences disorders. In consequence considerably less attention has been paid to scientific evidence showing important similarities across disorders. To protect against the error of unable to see the wood from the trees a preliminary descriptive continuum model of psychopathology was proposed to supplement existing categorical models. Analysis of the literature showed considerable support for a continuum model and the legitimacy of adapting traditional cognitive behaviour therapy approaches for use with schizophrenic patients. Reports of successful cognitive behaviour therapy interventions, particularly with positive symptoms suggest that patients can improve with this adapted approach and that the wider clinical community should be encouraged to assist its further development through research and training initiatives. Copyright © 2001 John Wiley & Sons, Ltd.