CBT Flashcards
How many sessions does CBT last
Patients with schizophrenia usually receive between 5 and 20 sessions either in groups or on an individual basis.
What is the assumption of CBT
The basic assumption of CBTp is that people often have distorted beliefs, which influence their feelings and behaviours in maladaptive ways. For example, someone with schizophrenia may believe that their behaviour is being controlled by someone or something else. Delusions like these are thought to result from faulty interpretations of events, and CBTp is used to help the patient identify and correct these faulty interpretations.
What is the aim of CBT
In addition, the aim of CBTp is to help people establish links between their thoughts, feelings or actions and their symptoms and general level of functioning. By monitoring their thoughts, feelings or behaviours with respect to their symptoms, patients are better able to consider alternative ways of explaining why they feel and behave in the way that they do. This reduces distress and improve functioning.
What do patients do in CBT
Patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how they might have developed. They are also encouraged to evaluate the content of their delusions or of any voices and to consider ways in which they might test the validity of their faulty beliefs. Patients might also be set behavioural assignments so that they might improve their general level of functioning. In CBTp the therapist helps the patient develop their own alternatives to maladaptive beliefs, ideally looking for alternative explanations and coping strategies that are already present in the patient’s mind.
What are the phases of CBT
Assessment: Patient discusses their experiences and realistic goals are discussed
Engagement: Therapist empathises with the patient’s distress and states that explanations for their distress can be developed.
The ABC Model: The patient explains their activating event (A) that causes their distorted beliefs (B) which lead onto consequences (C). The patient’s own beliefs which are the causes of C can then be rationalised and disputed.
Normalisation: Therapist normalises psychotic symptoms which helps the patient feel less alienated and stigmatised.
Critical collaborative analysis: The therapist uses gentle questioning to help the patient understand distorted beliefs, e.g. ‘If your voices are real, why can’t other people hear them?’
Developing alternative explanations: The patient and therapist develop new alternative explanations for their previously distorted beliefs
Evaluation of CBT
P - One strength of CBT for schizophrenia is the evidence for its effectiveness.
E - Jauhar et al. reviewed 34 studies of patients using CBT with schizophrenia, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Similarly, other studies have focused on symptoms, for example Pontillo et al. found reductions in frequency and severity of auditory hallucinations due to CBT. Clinical advice from NICE, the National Institute for Health and Care Excellence, recommends CBT for schizophrenia as it has been reported this treatment drastically reduces rehospitalisation rates.
E - This means that both research and clinical experience support the benefits of CBT for schizophrenia. Additionally, this research benefits the economy as reducing symptoms and rehospitalisation’s decrease costs spent on further treatment.
HOWEVER
P - There are issues with the evidence for the effectiveness of using CBT to treat schizophrenia.
E ¬- Most studies of the effectiveness of CBTp have been conducted with patients treated at the same time with antipsychotic medication. Therefore, it is difficult to assess the extent to which CBTp is useful in treating schizophrenia independent of antipsychotic medication. Additionally, meta-analyses in this area can reach unreliable conclusions about CBTp effectiveness due to the failure to consider study quality. Some studies fail to randomly allocate participants to either a CBTp or control condition; others fail to mask the treatment condition for interviewers carrying out assessments of symptoms and general functioning and despite such differences and failing, all studies are grouped together for a meta-analysis. Research has found that there is clear evidence that the problems associated with methodologically weak trials translated into biased findings about the effectiveness of CBTp.
E - This is a limitation as it makes it hard to determine how effective CBTp will be for a person with schizophrenia and whether there are better treatment therapy options like family therapy.
P - Another limitation of CBTp is that there is a lack of availability for patients to take part in the treatment
E - Despite being recommended by NICE as a treatment for people with schizophrenia, in the UK around 1 in 10 of schizophrenic patients get access to this form of therapy, or even lower in some areas of the country. A survey carried out in England found that only 13 out of 187 randomly selected patients diagnosed with schizophrenia had been offered CBTp as a treatment for their disorder. Additionally, those offered often refuse or fail to attend the therapy sessions, thus limiting its effectiveness even more.
E - This limited use of CBTp makes it difficult to assess its effectiveness with such a small sample of the population having access to it. Furthermore, patients who refuse to undergo such treatment may benefit more by using this therapy in conjunction with antipsychotics as research has found this dual treatment motivates patients to attend their CBTp sessions. Therefore, this interactionist approach may be a more suitable option suitable for a wider range of patients, increasing the effectiveness of the treatment.
