Cognitive Behavioural Therapy

Question 1

Define the term “cognitive behavioural therapy”

Answer 1

A combination of cognitive therapy ( a way of changing maladaptive thoughts and beliefs) and behavioural therapy ( a way of changing behaviour in response to these thoughts and beliefs)

Question 2

What are the 6 stages of CBT?

Answer 2

1) assessment
2) engagement
3) abc model
4) normalisation
5) critical collaborative analysis
6) developing alternative explanations

Question 3

Describe the Assessment stage

Answer 3

• Patient expresses his or her thoughts to therapists

- Current distress is used as motivation

Question 4

Describe the engagement phase

Answer 4

• therapist emphasises with patients perspective and their feelings of distress
• develops explanations

Question 5

Describe the ABC model phase

Answer 5

• A=Activating effects
• B=what causes emotion and behaviour
• C=consequences
• patients own belief which is the cause of C can be rationalised, disputed & changed

Question 6

Describe the normalisation phase

Answer 6

• therapist will say hallucinations and delusions are common = reduce anxiety & isolation
• psychotic experiences on same level as normal experiences = feel less stigmatised and ^recovery

Question 7

Describe the critical collaborative analysis phase

Answer 7

• therapist uses gentle questioning to help patient understand their conclusions. “ if your voices are real, why can’t people hear them?”

Question 8

Describe the developing alternative explanations phase

Answer 8

• the patients develops alternative explanations for their previous unhealthy assumptions.

Question 9

Outline the role of CBTp as a whole in treating schizophrenia

Answer 9

• recommend start least 16 sessions
• help people establish links between their thoughts, feelings and actions and their symptoms and general level of functioning
• by monitoring thoughts etc, people can develop alternative way of thinking which reduces distress and improves functioning

Question 10

What is the patient expected to do in CBTp, the techniques?

Answer 10

• 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.
• Patient might be set behavioural tasks to improve their general level of functioning

Question 11

AO3

Is CBTp better than standard care (antipsychotic medication alone)

Answer 11

P: NICE 2014 - CBT compared to standard care = more effective in reducing hospitalisation rates up to 18 months following the end of treatment
E: CBT - reduce symptom severity & improves social functioning
E: However most studies - CBT used while taking standard care (medication) - difficult to assess effectiveness of CBTp independent of antipsychotic medication

Question 12

AO3

Is CBT only effective during certain stages of the disorder ?

Answer 12

P: More effective at specific stages, and when the delivery of treatment is adjusted to the stage the individual is currently in
E: Addington and Addington (2005) - start = self reflection is not appropriate.
But while one has positive symptoms and takes medication - group CBT can help normalise their experience and improve functioning
E: Research = those with more experience of schizophrenia and greater realisation of their problems benefit more from CBTp

Question 13

AO3

Is CBT being used effectively around the country?

Answer 13

P: Lack of availability- only 1 in 10 of those who could benefit get access to CBT
E: Survey by Haddock et al (2013) - of 187 randomly selected patients diagnosed with schizophrenia only 13 has been offered CBTp
E: However those who were offered - either refuse or fail to attend therapy sessions, thus limiting it’s effectiveness

Question 14

AO3

Explain why there are problems with meta-analyses of CBTp as a treatment for schizophrenia

Answer 14

P: Some meta-analyses fail to take into account study quality
E: - 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 subsequent assessments of symptoms and general functioning
E: Juni et al (2001) - problems with methodologically weak trials = biased findings about effectiveness of CBTp.
Wykes et al (2008) - the more rigorous the study, the weaker the effect of CBTp

Question 15

AO3

Were the benefits of CBT overstated?

Answer 15

P: Research from meta-analyses of the effectiveness of CBTp as a sole treatment for schizophrenia = low
E: Jauhar et al (2014) = large meta analysis - effect was small on positive symptoms.
These small differences disappeared when symptoms were assessed ‘blind’
E: This uncertainty > conflict within UK.
England and Wales = NICE = non drug therapies
Scotland = SIGN = antipsychotic medication