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Ask the Experts


What specific treatment options are available for eliminating or minimizing referential thinking in patients with schizoaffective disorder?

Answered by: Thomas Smith

Referential thinking involves the belief that neutral, everyday occurrences carry specific personal meaning to the individual. It varies in intensity: some individuals have minor, fleeting moments of referential thinking with no significant consequences, while others develop fixed, detailed, and even bizarre beliefs that guide their behavior. These referential delusions may be seen in someone with schizoaffective disorder, and can be quite problematic for the individual and family/friends.

Strategies for eliminating or minimizing referential thinking include:

a) when the thinking is severe enough to be delusional, antipsychotic medications should be considered. Sometimes only minor dose adjustments can lead to significant improvement in referential thinking. Most psychiatrists are comfortable diagnosing and treating delusions of reference;

b) referential thinking of any severity can also be helped with counseling/psychotherapy. Therapists use cognitive behavioral techniques to help individuals evaluate the logic underlying their thoughts and "reframe" their assumptions. Therapy also helps individuals "unlink" behavioral responses from specific referential thoughts, to minimize negative consequences;

and c) Friends, family members, and therapists can help individuals struggling with referential thinking by providing opportunities to discuss alternative beliefs. Often, however, efforts to prove to individuals that their beliefs are unfounded lead to increased tension and arguments. When this happens, look instead for other, neutral topics to discuss, as an effort to help individuals distract themselves from the thoughts.

Many people live with persistent referential thinking but develop strategies to distract themselves so that the thinking no longer leads to confrontations or other difficulties in everyday life.