CBT treatment

Question 1

What is Cognitive Behavioural Therapy?

Answer 1

• largely based on work of Beck and Ellis - people with schizophrenia often have distorted beliefs which influence their behaviour in maladaptive ways
• usually takes place between 5-20 sessions either in groups or individually
• antipsychotics are often given first to reduce psychotic thought processes to make CBT more effective.

Question 2

How does CBT work?

Answer 2

• patients are encouraged to trace back origins of symptoms to get a better idea of how they developed
• encouraged to evaluate the content of their delusions or internal voices to consider ways they might test the validity of their beliefs
• may be set behavioural assignments to improve general level of functioning
• the therapist lets the patient develop their own alternatives to previous beliefs, ideally by looking for alternative explanations or coping strategies

Question 3

What are the 7 phases of CBT?

Answer 3

1. Assessment:
   - patient expresses thoughts about experiences, realistic goals are discussed, using their current distress as motivation to change
2. Engagement:
   - therapist emphasises with their perspective and stresses that explanations for their distress can be developed together
3. The ABC model
   - to identify certain triggers of their symptoms - A (activating events), B (behaviours that follow), C (concequences of behaviours)
4. Normalisation:
   - patient is told many people have unusual experiences to reduce their isolation to feel more normal
5. Reality testing:
   - therapist uses gentle questioning to help patient understand illogical deductions and conclusions
   - e.g. Chadwick reported case of someone who believed the could make things happen by thinking them, when shown a paused video and asked to guess next thing he could not predict a single thing, this made him understand that he could not do this.
6. Developing alternative explanations:
   - patient develops their own alternatives for their previous unhealthy assumptions
7. Behavioural assignments:
   - develop their own methods of coping (cognitive e.g. positive self-talk, distraction) (behavioral e.g. initiating social contact, breathing exercises)
   - Coping Strategy Enhancement (CSE) aims to teach people to develop and apply effective coping strategies to reduce symptoms and alleviate accompanying distress.

Question 4

What are 2 strengths of CBT?

Answer 4

CBT has proved more effective than drugs alone:
- Tarrier et al found people receiving 20 sessions of CBT in 10wks coupled with drug therapy and 4 booster sessions the next year did better than those receiving just drugs.
- 1/3 receiving CBT achieved 50% reduction, with 15% free from all positive symptoms
- no patients in drug only group were symptom free
- 1yr later similar differences existed
This kind of research is encouraging and suggests CBT provides an effective way of helping sufferers control their emotions

Cost effective over time for NHS:
- can lead to long term reduction in symptoms, due to fact they have been equipped with tools to help them cope without use of antipsychotics
- helps reduce amount of sufferers sectioned due to failures with medication
- thought NHS save £989 every time a patient treated with CBT rather than hospital
Although CBT incurs bigger initial investment, long term benefits make it more cost-effective as can cost up to £350 per patient, per month over their life.

Question 5

What are 2 limitations of CBT?

Answer 5

CBT is expensive and time-consuming for the patient:
- available to some patients through NHS but most go private due to long waiting times
- usually takes place over long period - months-years, costing upward of £100 each - not a feasibly form of treatment
Therefore it is understandable that a lot of patients would opt for drugs which are fast acting and easily available on NHS

Not suitable for all patients:
- use of CBT in conjunction with medication has benefits, but commonly believed within psychiatry not everyone with schizophrenia can benefit from CBT
- e.g. study of 142 patients in Hampshire, Kingdon & Kirschen believed many patients were not deemed suitable for CBT as psychiatrists believed they would not fully engage with the therapy
- in particular older patients less suitable than younger patients
Therefore CBT is not always an effective form of treatment.

Question 6

What is a conclusion of CBT?

Answer 6

A combined course of treatment may be most effective:
- antipsychotics are fast acting, cheap and effective in tackling positive symptoms
- psychologicals e.g. CBT proven more effective with negative symptoms, tackling the cause, and teaching individual skills for a long term solution
With this in mind, best approach would be a combination of drugs and psychological treatments