Cognitive Therapy for Delusions in Schizophrenia: Models, Benefits, and New Approaches Corinne Cather Massachusetts General Hospital and Harvard Medical School Boston, MA David Penn University of North Carolina Chapel Hill Michael Otto Donald C. Goff Massachusetts General Hospital and Harvard Medical School Boston, MA The main purpose of the review is to demonstrate how cognitive models of psychosis translate into cognitive-behavioral approaches for intervening with psychotic symptoms in schizophrenia. Several cognitive-behavioral factors which play a role in the mainte- nance and possibly formation of delusional beliefs are discussed, including attentional bias to threat, “data gathering” deficits, dysfunctional metacognition, and safety behav- iors. Strategies for engagement, problem formulation, and psychoeducation with deluded patients are described. Cognitive-behavioral interventions are presented, specifically, cog- nitive restructuring, behavioral experiments, and coping skills training. Challenges to conducting cognitive-behavioral therapy (CBT) with delusions in schizophrenia are reviewed. Novel cognitive therapies, which address these challenges, are presented. Keywords: cognitive behavioral therapy; delusions; schizophrenia A dvances in the pharmacologic management of schizophrenia spectrum disorders have not eliminated the need for new psychosocial strategies. Moreover, research over the last decade has supported an expanded role for cognitive-behavioral interventions for psychosis. In particular, cognitive-behavioral approaches have been used for residual psy- chotic and negative symptoms not adequately managed by medication. In this article, we present cognitive models of delusional beliefs and examples of interventions. The main pur- pose of the review is to demonstrate how cognitive models of psychosis translate into cog- nitive-behavioral interventions for psychosis. Consistent with this purpose, we have provided brief clinical examples of the processes described by the models reviewed herein. © 2004 Springer Publishing Company 207 Journal of Cognitive Psychotherapy: An International Quarterly Volume 18, Number 3 • 2004