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This chapter describes the CBT techniques used to work with cognitive dysfunction in patients with severe mental illness. The most challenging situation is often found in individuals who exhibit schizophrenic thought disorder, such as “knight’s move thinking” (see the section “Major Thought Disorder” later in this chapter). Classically, no form of psychological treatment has been able to make much progress with seemingly incomprehensible dialogue. However, research on the emotional salience of disordered thinking has led to the description of a viable CBT model and the development of potentially useful intervention strategies. This approach is demonstrated here with video illustrations of the treatment of Daniel, a young man with rather severe disorganization of thought. In addition, methods are described for milder forms of schizophrenic thought disorder, such as pseudophilosophical thinking, concrete thinking, and thought blocking. Because cognitive impairment is a common manifestation of mood disorders, we also provide guidelines for using CBT to enhance cognitive functioning in bipolar disorder and severe or treatment-resistant depression.
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