Psychological therapies- CBT

Question 1

What are 3 psychological therapies for schizophrenia?

Answer 1

1. Cognitive behavioural therapy for psychosis (CBTp)
2. Family Therapy
3. Token Economies

Question 2

What is cognitive behavioural therapy?

Answer 2

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

Question 3

What is the main aim of CBTp?

Answer 3

Helps patients to identify irrational thoughts and challenge them by reality testing

Question 4

What framework does CBTp make use of?

Answer 4

Ellis’ ABCDE model

Question 5

How does the ABCDE model work?

Answer 5

Identify activating events (A) which trigger irrational beliefs (B) and cause emotional and behavioural consequences(C). The beliefs can be disputed (D) and changed leading to an effect (E) which is the restructured belief

Question 6

What is normalisation?

Answer 6

Therapist shares with patient that many people have unusual experiences making them feel less isolated and stigmatised

Question 7

What behavioural assignments can be set during CBTp?

Answer 7

Tasks to improve general level of functioning- shower every day, go out and socialise with friends

Question 8

What is the strength of CBT for schizophrenia?

Answer 8

Advantages over drug therapy:
The NICE (2014) review of treatments for schizophrenia found consistent evidence that, when compared with standard care (antipsychotic medication alone), CBTp was effective in reducing rehospitalisation rates up to 18 months. CBTp was also found to be more effective in reducing symptom severity and improving social functioning compared to standard care.
COUNTER-ARGUMENT: Most studies of the effectiveness of CBTp have been conducted with patients treated at the same time with antipsychotic medication. Therefore, it is difficult to assess the effectiveness of CBTp independent of antipsychotic medication.

Question 9

What are the three limitations of CBT for schizophrenia?

Answer 9

Dependent on the stage of disorder:
CBTp may not be effective for all stages of the disorder.
Addington and Addington (2005)- in the initial acute phase of schizophrenia, self-reflection is not particularly appropriate- positive symptoms lead to lack of self-awareness and negative symptoms lead to reluctance to engage, both of which are vital for CBTp.
It has been found that CBTp is more effective for individuals with more experience of their schizophrenia and a greater realisation of their problems.

Effectiveness may have been overstated:
One recent large-scale meta-analysis revealed only a ‘small’ therapeutic effect on the key symptoms of schizophrenia. Even these small effects disappeared when symptoms were assessed ‘blind’ (assessors were unaware of whether the patient was in the therapy or control condition).
This uncertainty regarding the effectiveness of CBTp has resulted in conflicting recommendations even within the UK. England and Wales emphasise use of CBTp, whereas Scotland places more emphasis on antipsychotic medications.

Lack of availability:
Despite being recommended by NICE as a treatment for people with schizophrenia, it is estimated that in the UK only one in 10 of those who could benefit get access to this form of therapy.
Haddock et al. (2013)- carried out survey in North West of England. Found that of 187 randomly selected patients diagnosed with schizophrenia, only 13 had been offered CBTp. Even those that were offered CBTp, a significant number failed to attend the therapy sessions. As they struggled to commit to large amount of sessions and further limiting its effectiveness.