Modifying Schizophrenia - CBT

Question 1

CBT for irrational thinking

Answer 1

Most schizo are not aware they have errors in cognitive thinking. Therapists will try to make maladaptive thinking process conscious and challenge them.

Mainly used to reduce positive behaviours, but once patient used to being in control of their symptoms, will have knock on effects in negative behaviours, which are harder to be treated by other people

Question 2

Key components

Answer 2

Behavioural skills training - More behavioural

Therapist and patient come up with methods to solve problems schizo may have regarding symptoms

1)identify the problem (hallucinations)
2)generate potential solution (ignore, acknowledge but learn to not act)
3)evaluate pros and cons of solution
4)decide on the solution
5)evaluate outcome (therapist ask did they still have the same extreme reactions to hallucinations)

Helps to create behavioural solutions to cope with any type of specific problems that cause difficulty in their lives. (Positive or negative symptoms)

Question 3

Cognitive strategies - more cognitive

Answer 3

Aims to change the maladaptive thinking pattern that causes schizophrenia.

Make schizo realise their thinking pattern are only influenced by them and know that previous thinking patterns is wrong (delusions)

When aware can work with therapist to have more positive thinking pattern.

Socratic questioning

-Asking curiosity driven questions to schizo who are suffering from maladaptive thoughts (delusions of persecution).
-Aim to help schizo identify what’s the worst that could happen to them + ask for evidence for these claims. Lack of evidence will undermine the the belief in delusions

Dysfunctional thoughts diary

Homework
-note down on book whenever they get maladaptive thoughts (delusions). Asked to challenge these thoughts by asking for evidence for these thoughts and outcome of these thoughts
-aim to come up with own solutions to cope with these thoughts by self

Question 4

Evaluation - effectiveness (strength)

Answer 4

Kupiers et al - 50% of schizophrenia given CBT reductions in symptoms. Into 31% control had.
-CBT is effectives
Tarrier et al behavioural skills training significant reduction in positive symptoms compare to waiting list. Improvement persist even after 6 months after end of CBT

Question 5

Evaluation - effectiveness (weakness)

Answer 5

Is CBT actually effective

CBT cannot solve imbalance of neurotransmitters, so antipsychotics used to increase effectiveness of treatment - Drury et la 25-50% reduction in recovery time with CBT + drugs
-but cannot assess how much CBT helped

Tarrier et al - short term benefits
-18 months after CBT
-relative rate same as those without CBT

Question 6

Evaluation - ethics

Answer 6

Does not cause as much harm

Does not produce side effects, Parkinsonism or weight gain. Take in patient consent, will only affect their cognitive ability if the patient allows to, unlike drugs were often given
-Kunipers et al - Client after CBT satisfied with experience + think CBT is appropriate for them

Does not take care of main cause

Bentall et al
-argue that CBT only control symptoms but not actual cause
-delusions could be trauma from childhood manifesting in adulthood
-can come back as other form (symptom substitution)

Question 7

Evaluation social implication

Answer 7

Strength - reduce treatment time

Kunipers
-CBT combine with treatment reduce treatment time
-lower chance of causing non-adherence leading to relapse
-although short term expensive long term less expensive since not continuously paying if treated

Not available to everyone

Royal college of psychiatrists
-NHS ‘trust’ organisation which are self managed in different area in UK has 67-16% of schizo in different areas having CBT, with 50% saying they were not offered
-Suggest some may not get treatment based on area they lived