Psychological Therapies: CBT

Question 1

What are the uses of CBT for schizophrenia?

Answer 1

NICE recommend, may be that patients also require drugs if symptoms are severe, easily applied to negative symptoms but also used for positive symptoms

Question 2

What is the rationale and aim of using CBT for schizophrenia?

Answer 2

schizophrenia caused/maintained by beliefs that patients have about their experiences, their symptoms can be helped by identifying and changing their beliefs

Question 3

What is the process of CBT for schizophrenia?

Answer 3

Agendas between therapist an patient more flexible for schizophrenia, normally 12-20 sessions, cognitive and behavioural element

Question 4

What is the cognitive element of the CBT process for schizophrenia?

Answer 4

Make patients aware of the role of cognitions and how this impacts functioning, then question, challenge and try to change patient’s beliefs

Question 5

What is the behavioural element of the CBT process for schizophrenia?

Answer 5

Test patient’s beliefs against reality through experimentation, role play and homework, allow patient to become aware of the irrationality of their beliefs

Question 6

What is an example of CBT? Who is this influenced by?

Answer 6

Rational Emotive Behavioural Therapy (REBT) which is based on Ellis’ ABC model: activating event pinpointed ans subsequent consequences, belief which is cause of C is discussed, therapist gets patient to understand that their beliefs are illogical (pros/cons of maladaptive ideas)

Question 7

What is the role of gaol setting in CBT?

Answer 7

realistic goal discussed early in sessions, distressing consequences as motivation for change, therapist must make goals measurable and achievable, revisited at start/end of therapy

Question 8

What is the role of gaol setting in CBT?

Answer 8

realistic goal discussed early in sessions, distressing consequences as motivation for change, therapist must make goals measurable and achievable, revisited at start/end of therapy

Question 9

What is the role of the normalisation technique in CBT?

Answer 9

Help to show that some delusional fears are rooted in the normal, empathising with patient, delusion can be maintained but in a more realistic form

Question 10

What is the role of the decatastrophising technique in CBT?

Answer 10

educating patient that many people can have unusual experiences in a range of circumstances - reduces anxiety and sense of isolation, psychotic experiences placed on a continuum with normal ones, possibility of recovery seems less distant

Question 11

How is trust developed in CBT? What can happen after this trust is developed?

Answer 11

Being non judgemental, therapist uses gentle questioning to appreciate their illogical deductions, therapist must remain empathetic and open minded

Question 12

What is the role of developing alternative explanations in CBT?

Answer 12

important that patient develops own alternatives to previous maladaptive assumptions, preferably coping strategies/idea already present in patient or from earlier ideas (from leaflet/discussion) in the therapy

Question 13

According to Cohen what is a small, medium and large effect size?

Answer 13

0.2 = small, 0.5 = medium, 0.8+ = larger

Question 14

According to Cohen what is a small, medium and large effect size?

Answer 14

0.2 = small, 0.5 = medium, 0.8+ = larger

Question 15

Who conducted a review on CBT using a repeated measures design?

Answer 15

Rector and Beck 2001: pre vs post CBT, effect size = 1.23 improvements in all symptoms but spontaneous remission could influence results, possible cherry picking

Question 16

Who conducted a meta analysis on CBT using an independent groups design?

Answer 16

Gould 2001: RCTs, control and treatment conditions, effect size: 0.65 but no comparison to another treatment

Question 17

Who conducted a Cochrane review into CBT and other psychosocial treatments?

Answer 17

Jones 2012: RCTs, 20 trials (small, low quality), no difference between CBT and other talking therapies, relapses/re hospitalisation not reduced, no difference if left study early or continued, some long term advantage in dealing with emotions

Question 18

What is the advantage of CBT over drugs and psychoanalysis?

Answer 18

side effects unlikely, CBT more collaborative so no dependence on therapist like in psychoanalysis

Question 19

Do patients want CBT?

Answer 19

Tend to like CBT, trials tend to have lower attrition than drugs/talking therapies

Question 20

Do patients want CBT?

Answer 20

Tend to like CBT, trials tend to have lower attrition than drugs/talking therapies

Question 21

Should CBT remain as the only talking therapy available on the NHS?

Answer 21

Yes: cheaper than other therapies, doesn’t take as long, helps with independence. No: individual differences may mean other therapies would be better for others, would require more training if other therapies offered