Schizophrenia, obsessive covert mental rituals and social anxiety: Case report

This case study reports the outcomes of cognitive therapy for social anxiety in a 45-year-old man with a 27-year history of paranoid schizophrenia. The intervention targeted the overlapping and interrelated symptoms of social anxiety and delusional beliefs. After 11 sessions of treatment, the patient showed no improvement in social anxiety, avoidance or self-consciousness. Failure to make significant progress was potentially due to treatment of social anxiety rather than the obsessional delusional thoughts. Clinicians should be cautious to distinguish between anxiety associated with obsessional delusions, non-obsessional delusions and non-delusional thoughts when treating social anxiety in schizophrenia.