L9: Psychological Therapies - CBT

Question 1

Describe CBT

Answer 1

• Individual/Group Sessions (between 5-20)

- NICE recommend all schiz patients inc those taking meds to undertake CBTp

Question 2

How does CBTp help?

Answer 2

• Helps identify irrational thoughts & change them
• Involves discussion, how likely their beliefs are true. Patients help to make sense of delusions and their impact on feelings/behaviour
• DOES NOT get rid of symptoms, helps cope better
• Patient is set hw to improve functioning

Question 3

What are stages of CBTp?

Answer 3

Assessment - Patient expresses thoughts & realistic goals discussed
Engagement - Therapist empathises and explanations for distress can be developed
ABC Model - Therapist disputes negative beliefs and to rationalise them. Homework is set inc roleplays and positive self talk
Normalisation - Therapist says some ‘normal people’ have unusual experiences of delusions when they are stressed - helps lessen anxiety
Critical Collaborative Analysis - Uses gentle questioning to help patient understand illogical conclusions
Develop Alternative Explanations - Patient develops other explanations for their unhealthy assumptions. New ideas constructed with patient & therapist.

Question 4

Evaluation of CBTp (+)

Answer 4

+ Most effective when combined with drug therapy. Combined therapy is the best way to treat a schiz patient
+ CBT Clinicians are highly trained and effective - they show empathy, honesty and unconditional positive regard
+ Less ethical issues, patient feels more in control of treatment. CBT doesnt involve physical harm - usually involves patient having more free will

Question 5

Evaluation of CBTp (-)

Answer 5

• Not suitable for all patients, esp those not vocal enough or paranoid/disorientated. It works best for those who refuse drugs. Those patients tend to be extremely disturbed and might not engage with CBT
• Expensive as a treatment, requires specialists. The NHS might be more willing to issue meds as drugs are cheaper
• CBTp is not offered in the UK. When it is, many patients do not attend. 1/10 have access in some parts of the UK.

Question 6

What did NICE research?

Answer 6

• Investigated patients that got CBT vs medication
• Tested effectiveness of CBT in 39 random trials
• 2118 patiemts were studied in the UK
• NICE recommended CBT to reduce chances of hospitalisation and 910 patients who got CBT showed a reduction in hospitalisation rates.
• Those who got CBT are less likely to leave the study early rather than those on meds
• No difference between rates of suicide and relapse between CBT and meds
• CBT should be added to standard care to reduce total symptom scores for schiz + depression

Question 7

NICE Research evaluation

Answer 7

(+) Economical issue. CBT saves NHS moneh as it reduces hospitalisation, so is more cost effective compared to meds which has a higher relapse rate.
(+) Supported by Interactionist which suggests a combo of treatments is the best way forward for patients. CBT should be used alongside drugs. When used together, they are more succesful than on their own
(-) Criticised as sample is smal so results may not be robust
(-) CBT is not always available as it depends on NHS funding. Even if CBT is benefical it may not be offered/available to them