Cognitive Behavioural Therapy (CBT) in SZ Flashcards
CBT recap…
- The cognitive approach has lead to the development of CBT; a talking therapy that focuses on cognitive restructuring.
- It works on the basis that thoughts, emotions and behaviours are linked and changing the way an individual thinks will change the way they feel and behave.
CBT for SZ (aims)
- 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.
What are the 3 stages of CBT?
- ‘Thought catching’.
- The client is treated as a ‘scientist’.
- Skills development.
- ‘Thought catching’
- Develop a rapport with the client.
- Identify triggers or psychotic symptoms.
- Review existing coping strategies + discuss developing new ones.
- The client is treated as a ‘scientist’
- Encourage the 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 patients to understand that voices are not real, and they are not their own thoughts.
- Skills development
- Practice new, restructured positive (or realistic/ rational) ways of thinking in a range of scenarios both in their imagination and in real life situations.
- Adopt cognitive strategies- distraction, positive self talk.
- Adopt behavioural strategies- relaxation techniques (e.g. breathing exercises), increasing social contact, ;oud music to drown out voices, behavioural experiments.
Support for the effectiveness of CBT (Wykes + Jauhar + other research)
- According to a review by Wykes, CBT for psychosis is most effective for reducing positive symptoms like delusions.
- Jauhar reviewed 34 studies and found small but significant effects in both positive and negative symptoms.
However….
- 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 is often difficult to isolate the effectiveness of CBT alone.
NICE guidelines
- The NICE guidelines recommends CBT for SZ, this means that both research and clinical experience support the benefits of this approach to treatment.
Issues for the effectiveness of CBT
- CBT may improve the quality of life for patients with SZ but it does not offer a cure.
- As SZ is largely a biological condition, we would expect that a psychological therapy like CBT just benefits people by improving their ability to live with SZ.
- CBT may enhance the ability of an individual to ignore auditory solutions+ so experience less anxiety, but this is not the same as eliminating those symptoms.
Issues for the effectiveness of CBT (pt.2)
- However, studies report significant reductions in the severity of both positive and negative symptoms. This suggests that CBT does more than enhance coping.
- E.g. a number of studies have reported that the frequency and intensity of hallucinations can be reduced by CBT as well as the anxiety associated with them.
Issues for the appropriateness of CBT
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.
Issues with the appropriateness of CBT (pt.2)
For these reasons it is usually necessary for patients to be taking antipsychotics to reduce symptoms and make this treatment more accessible.
- Patients with SZ will often rely on family support to make CBT work for them, they will need transport to and from appointments and support in completing tasks- many patients do not have this support, and this is an extra barrier that they face.
Issues for the appropriateness of CBT
- CBT requires skilled, trained professionals who have experience working with patients with psychosis. The availability of these clinicians is limited + so many patients may not be able to access CBT even if they wanted to.
