CBT Flashcards
What is CBT?
A combination of cognitive (a way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs).
How does CBTp usually work?
Assessment Engagement The ABC model Normalisation Critical collaborative analysis Developing alternative explanations
What is CBTp?
Cognitive behavioural therapy for psychosis
What is assessment?
The patient expresses their thoughts about their experiences to the therapist.
Realistic goals for therapy are discussed, using the patients current distress as motivation for change.
What is engagement?
The therapist empathises with the patients perspective and their feelings of distress, and stresses that explanations for their distress can be developed together.
What is the ABC model?
The patient gives their explanation of the activating events (A) that appear to cause their emotional and behavioural (B) consequences (C).
The patients own beliefs, which are actually the cause of C, can then be renationalised, disputed and changed.
What’s an example of the ABC model being used?
The belief that ‘people won’t 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’.
What is normalisation?
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.
What is critical collaborative analysis?
The therapist uses gentle questioning to help the patient understand illogical deductions and conclusions.
For example, ‘if your voices are real, why can’t others 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.
What is developing alternative explanations?
The patient develops their own alternative explanations for their previously unhealthy assumptions.
These healthier explanations might have been temporality 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.
What does CBTp encourage?
Encourages the patient to trace back the origins of their symptoms in order to get a better idea of how they might have developed.
Also encourages them to evaluate the content of their delusions or any voices, and to consider ways in which they might test the validity of their faulty beliefs.
What can patients be set?
Might be set behavioural assignments so that they might improve their general level of functioning.
The learning of maladaptive responses to life’s problems is often the result of distorted thinking by the schizophrenic or mistakes in assessing cause an effect (for example, assuming something terrible has happened because they wished it).
What are the evaluative points?
Advantages of CBTp over standard care
Effectiveness of CBTp is dependent on the stage of the disorder
Lack of availability of CBTp
Problems with meta-analyses of CBTp as a treatment for schizophrenia
The benefits of CBTp may have been overstated
What is meant by advantages of CBTp over standard care?
The NICE (2014) review of treatments for schizophrenia found consistent evidence that, when compared with standard care (antipsychotic medication alone), CBTp was effective in reducing rehospitalisation rates up to 18 months following the end of treatment.
CBTp was also shown to be effective in reducing symptoms severity and, when compared with patients receiving standard care, there was some evidence for improvements in social functioning.
However, most studies of the effectiveness of CBTp have been conducted with patients treated at the same time with antipsychotic medication. It is difficult, therefore, to assess the effectiveness of CBTp independent of antipsychotic medication.
What is meant by effectiveness of CBTp is dependent on the stage of the disorder?
CBTp appears to be more effective when it is made available at specific stages of the disorder and when the delivery of the treatment is adjusted to the stage the individual is currently at.
Addington and Addington (2005) claim that, in the initial acute phase of schizophrenia, self-reflection is not particularly appropriate.
Following stabilisation of the psychotic symptoms with antipsychotic medication, however, individuals can benefit more from group-based CBTp. This can help normalise their experience by meeting other individuals with similar issues.
Research has consistently shown, therefore, that it is individuals with more experience of their schizophrenia and a greater realisation of their problems that benefit more from CBTp.
