CBT for schizophrenia

Question 1

What is the aim of CBT for schizophrenia?

Answer 1

To develop and apply coping strategies for the psychotic symptoms and the stress they produce. To increase social activity and the use of relaxation strategies

Question 2

What are the 3 ways CBT is used with schizophrenia patients?

Answer 2

Thought catching, the client is treated as a ‘scientist’, skills development

Question 3

What is thought catching?

Answer 3

• Develop a rapport with the client
• Identify triggers of psychotic symptoms
• Review existing coping strategies and discuss developing new ones

Question 4

What is the method of ‘the client is treated as a scientist’?

Answer 4

• Encourage patient to see the link between their thoughts (delusions) emotions and behaviour
• Target specific symptoms and find specific strategies to deal with them
• Challenging the reality of thoughts - offer alternative, rational interpretations - reality testing e.g. help patient to understand that voices are not real, and they are their own thoughts

Question 5

What is skills development?

Answer 5

• Practice new, structured, positive (or realistic/rational) ways of thinking in a range of scenarios both in their imagination and in real situations
• Adopt cognitive strategies - distraction, positive self-talk
• Adopt behavioural strategies - relaxation techniques (e.g. breathing exercises), increasing social contact, loud music to drown out voices, behavioural experiments

Question 6

What did Wykes report about the effectiveness of CBT for schizophrenia?

Answer 6

CBT for psychosis is most effective for reducing positive symptoms like delusions

Question 7

What did Jauhar report about the effectiveness of CBT for schizophrenia?

Answer 7

Jauhar (2014) reviewed 34 studies and found small but significant effects on both
positive and negative symptoms

Question 8

What does other research suggest about the effectiveness of CBT for schizophrenia?

Answer 8

Other research suggests that CBT may help moderate symptoms in addition to
medication. Most research includes patients who are receiving both CBT and
medication rather than CBT alone, so it is often difficult to isolate the effectiveness of
CBT alone.

Question 9

What does the NICE guidelines recommend for schizophrenia and what does this mean?

Answer 9

The NICE guidelines recommends CBT for schizophrenia, this means that both
research and clinical experience support the benefits of this approach to
treatment

Question 10

What is an issue for the effectiveness of CBT for schizophrenia and why?

Answer 10

CBT may improve the quality of life for patients with SZ but it does not offer a
cure
- As schizophrenia is largely a biological condition, we would expect that a
psychological therapy like CBT just benefits people by improving their ability to live
with schizophrenia

Question 11

What are issues for the appropriateness of CBT for schizophrenia?

Answer 11

CBT is a demanding treatment. It requires self-awareness and willingness to
engage with the process. It is time-consuming and often confrontational
- Patients with positive symptoms have a lack of self-awareness
- Patients with negative symptoms lack motivation and are likely to be
reluctant to engage.
- Patients with delusions will struggle with the confrontational aspects
during cognitive restructuring

CBT requires skilled, trained professionals with experience working with patients with psychosis. The availability of these clinicians is limited and so many patients may not be able to access CBT even if they wanted to