CBTp & Family Therapy

Question 1

Why use CBTp?

Answer 1

• Normal CBT inappropriate for psychotic disorders
• SZ highly biological - cannot yet be ‘cured’
• CBT for depression - try to change behaviours to SOLVE the problem
• CBTp for SZ - try to change behaviours to COPE with the problem

Question 2

CBTp for Psychosis

Answer 2

• Aims to help patients identify irrational thoughts and challenge/reality test them to reduce distress
• Usually takes place over 5-20 sessions - NICE recommends 16+
• Doesn’t ‘get rid’ of SZ, but helps patients cope better with symptoms by reducing distress
• Patients may be set behavioural assignments to improve general level of functioning - eg. to shower daily

Question 3

ABCDE Model

Answer 3

1. Identifying (A)ctivating events
2. Identifying the resulting (B)eliefs
3. That cause their emotional & behavioural (C)onsequences
4. These beliefs can be rationalised, (D)isputed, and changed through critical collaborative analysis
5. This leads to the (E)ffect of restructured beliefs

Question 4

Critical Collaborative Analysis

Answer 4

Therapist uses gentle questioning to help the patient to understand and challenge illogical deductions and conclusions

Question 5

Normalisation

Answer 5

• Therapist tells the patient that many people have unusual experiences in many different circumstances
• Reduces anxiety and sense of isolation - makes the patient feel less alienated/stigmatised
• Makes possibility of recovery seem more likely

Question 6

Family Therapy & Relapse

Answer 6

• NICE recommends it to all SZ families due to success in reducing relapse - based on findings that hostile/overly expressive families lead to more relapses
• Garety et al (2008): Reduces chance of relapse by up to 50%

Question 7

What does Family Therapy involve?

Answer 7

• Lasts 3-10 months (minimum 10 sessions)
• Family educated about SZ & how to help relatives cope
• Learn to support patient through treatment and spot/discuss problems positively
• Range of interventions aimed at family - should involve patient if practical
• Aims to improve quality of communication & interaction - reduce stress of living as a family and reduce hospitalisation
• Commonly used with durg therapy & outpatient clinical care

Question 8

Aims of Family Therapy

Answer 8

• Encourage patient to talk to family about what support is helpful - improve relationships
• Use strategies to improve family functioning
• Form therapeutic alliance with all relatives
• Reduce stress & calm emotional climate in family
• Improve family’s ability to anticipate & solve problems
• Reduction of anger & guilt
• Help achieve care/life balance
• Improve knowledge about SZ
• Maintain reasonable expectations for patient performance

Question 9

Pharoah et al (2010): Method

Answer 9

• Reviewed 53 studies published 2002 - 2010
• Studied effectiveness of family intervention
• Studies conducted in Europe, Asia, North America
• Compared outcomes of FT v. standard care alone
• Concentrated on randomised control trials

Question 10

Pharoah et al (2010): Findings

Answer 10

• Mental State - mixed views, generally no great improvement
• Compliance with Medication - increased
• Social Functioning - not much influence from FT
• Reduction in Relapse & Readmission - found reduction in followwing 24 months