4.6 Cognitive Behavioural Therapy Flashcards
list the steps in CBTp
assessment engagement the ABC model normalisation critical collaborative analysis developing alternative explanations
describe the difference between CBT and CBTp
CBT = cognitive behavioural therapy CBTp = cognitive behavioural therapy for psychosis
how does the process of assessment work during CBTp
The patient expresses his or her thoughts about their experience to the therapist. Realistic goals for therapy are discussed, using the patient’s current distress as motivation for change.
how does the process of engagement work during CBTp
The therapist empathises with the patient’s perspective and their feelings of distress, and stress that explanations for their distress can be developed together.
how does the process of ‘the ABC model’ work during CBTp
The patient gives their explanation of the activating events (A) that appear to cause their emotional and behavioural (B) consequences (C). The patient’s own beliefs, which are actually the cause of C, can then be rationalised, disputed and changed. For example, the belief that ‘People wont like me if i tell them about my voices’ might be changed to a more healthy belief e.g. ‘Some may, some may not. Friends may find it interesting’
how does the process of normalisation work during CBTp
Information that many people have unusual experiences such as hallucinations and delusions under many different circumstances (e.g. in situations of extreme stress) reduces anxiety and the sense of isolation. By placing psychotic experiences on a continuum with normal experiences, the patient feels less alienated and stigmatised, and the possibility of recovery seems more likely.
how does the process of critical collaborative analysis work during CBTp
The therapist uses gentle questioning to help the patient understand illogical deductions and conclusions. For example, ‘If your voices are real, why can’t other people hear them?’ Questioning can be carried out without causing distress, provided there is an atmosphere of trust between the patient and the therapist, who remains empathetic and non-judgemental.
how does the process of developing alternative explanations work during CBTp
The patient develops their own alternative explanations for their previously unhealthy assumptions. These healthier explanations might have been temporarily weakened by their dysfunctional thinking patterns. If the patient is not forthcoming with alternative explanations, new ideas can be constructed in cooperation with the therapist.
define cognitive behavioural therapy
a combination of cognitive therapy (a way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs)
what effect does CBTp have on the symptoms of schizophrenia, why do we use it?
This type of treatment has been shown to be effective for reducing the positive symptoms of schizophrenia, for reducing relapse and for enhancing recovery when schizophrenia is diagnosed early.
CBTp originally developed to provide treatment for residual symptoms that persist despite the use of antipsychotic medication, treatment with antipsychotic drugs still leaves many psychotic patients with persistent positive and negative symptoms
what did Chadwick and Lowe find regarding the application of CBTp to schizophrenic patients, is there any research that contradicts their findings?
Chadwick and Lowe (1993) found that CBT reduced delusions in 10/12 of the patients in their study.
However, whilst it helps around 70% of patients, it has made the other 30% deteriorate (Kingdom and Turkington, 1996).
summarise the use of cognitive behavioural therapy for psychosis
basic assumption is that people have distorted beliefs which need to be changed through therapy
CBTp techniques - client encouraged to test validity of their faulty beliefs and set behavioural assignments to improve functioning
therapist helps patient develop alternative explanations to replace maladaptive beliefs
how does it work? assessment, engagement, the ABC model, normalisation, critical collaborative analysis, developing alternative explanations
evaluate the use of cognitive behavioural therapy for psychosis
advantages of CBTp over standard care - consistent evidence that it reduces hospitalisation rate and symptom severity
effectiveness of CBTp is dependent on stage of disorder - more effective after stabilisation of symptoms with antipsychotic medication
lack of availability of CBTp - research (e.g. Haddock et al.) suggests only small proportion of people are offered CBTp
problems with meta-analysis of CBTp - they fail to control for study quality, leading to biased findings
benefits of CBTp may have been overstated - as sole treatment may produce only a small beneficial effect (Jauhar et al.)
