Lesson 5: Psychological Therapies For SZ Flashcards
Cognitive Behaviour Therapy
- NICE (National Institute for Health and Care Excellence) recommend that all people should be offered CBT - this form of therapy is referred to as CBTp (cognitive behavioural therapy for psychosis) when used in the treatment of SZ.
Why was CBTp developed?
- developed to provide treatment for residual symptoms that persist despite the use of antipsychotic medication.
- treatment with antipsychotic drugs still leaves many patients with persistent positive and negative symptoms hence the introduction of CBTp to deal with these symptoms and improve patients’ functioning
CBTp (first phase)
Assessment - the patient expresses his thoughts to the therapist. Realistic goals for therapy are discussed - using the patient’s current distress as motivation for change
CBTp (second phase)
Engagement - the therapist emphasises with the patient’s perspective and their feelings of distress, and stresses that explanations for their distress can be developed together
CBTp (third phase)
The ABC Model - the patient gives their explanation of the activating events that appear to cause their emotional and behaviour consequences. The patient’s own beliefs which are actually the cause of C can then be rationalised, disputed and changed.
CBTp (fourth phase)
Normalisation - conveying to patients that many people have unusual experiences such as hallucinations and delusions under many circumstances reduces anxiety and the sense of isolation. By doing this the patient feels less alienated and stigmatised, and the possibility of recovery seems more likely
CBTp (fifth phase)
Critical collaborative analysis - the therapist uses gentle questioning to help the patient understand illogical deductions and conclusions. For example, ‘if your voices are real, why can’t other people hear them?’ Questioning can be carried out without causing distress, provided there is an atmosphere of trust between the patient and the therapist, who remains empathetic and non-judgemental.
CBTp (sixth phase)
Developing alternative explanations - the patient develops their own alternative explanations for their previously unhealthy assumptions. If the patient is not forthcoming with healthy alternative explanations - new ideas can be constructed in cooperation with the therapist. e.g. positive self talk - where the therapist encourages the client to repeat things such as ‘I can do this, I don’t need to think like this’
How is CBTp delivered?
- can be delivered in groups but more usual that it is delivered on a one-to-one basis
How many sessions are needed to treat SZ?
- 16 sessions recommended
CBTp’s aim
- aims to help people establish links between their thoughts, feelings or actions and their symptoms and general level of functioning
- patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how they might have developed
- encouraged to 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
- during CBTp, the therapist lets the patient develop their own alternatives to these previous maladaptive beliefs, ideally by looking for alternative explanations and coping strategies that are already present in the patients mind
Strengths (effectiveness of CBTp)
- seems to be more effective in treating SZ compared to standard care (antipsychotic medication alone). NICE (2014) review of treatments for SZ found consistent evidence that when compared with standard care, CBTp was effective in reducing rehospitalisation rates up to 18 months following the end of treatment. CBTp was also shown to be effective in reducing the severity of symptoms as well as improvements in social functioning. Although it is difficult to assess the effectiveness of CBTp alone as patients were being treated with both medication and CBTp.
Strengths ( stage of the disorder)
- effectiveness of CBTp is dependent on the stage of the disorder - CBTp appears to be more effective when it is made available at certain stages of the disorder and when the delivery of CBTp is adjusted to the stage the individual is currently at.
Strengths (Addington and Addington)
Addington and Addington (2005) claim that in the initial acute phases of SZ, self reflection is not particularly appropriate. However following stabilisation of the psychotic symptoms with medication, patients can benefit from group based CBTp which can normalise their experience by meeting similar individuals. This research has shown that it is individuals with more experience of the SZ and a greater realisation of their problems are most likely to benefit from CBTp.
Weaknesses (lack of availability)
- lack of availability and patients refusal to attend sessions
- estimated that in the UK only one in ten individuals with SZ actually have access to CBTp. This figure is lower in some areas of the UK. In a survey by Haddock et al (2013), they found that in the North West of England out of 187 SZ patients, only 13 (7%) had been offered CBTp. However, of those who are offered CBTp as a treatment for SZ, a significant number either refuse or fail to attend the therapy sessions thus limiting its effectiveness even more.
