Psychological Therapies; CBT

Question 1

CBT

Answer 1

Cognitive Behavioural Therapy is used to treat schizophrenia; it is a psychological therapy that is also known as a ‘talking’ therapy

Question 2

Use

Answer 2

-To treat most patients with schizophrenia; NICE recommend that it is offered to all patients.It may be that patients will also require drug treatment, especially if their symptoms are particularly severe. As the treatment was developed for use with patients with depression it is easily applied to negative symptoms (which often resemble symptoms of depression), but it is routinely used for those with positive (psychotic) symptoms.

Question 3

Rationale

Answer 3

-Schizophrenia is caused, or at least maintained, by the beliefs that patients have about their experiences. They can be helped to deal with their symptoms by changing their beliefs, thus leading to less catastrophic symptoms.

Question 4

Aim

Answer 4

-To identify and change patients beliefs which contribute to their symptoms.

Question 5

Process

Answer 5

• The agendas set are generally more flexible than traditional CBT, and the patient generally has between 12 and 20 sessions:
• Make patient aware of the role of cognitions (e.g., beliefs about their experiences) and how they impact on their functioning.
• Question, challenge and try to change patient’s beliefs.
• Test patient’s beliefs against reality.
• Achieved through experimentation, role- play and ‘homework’.
• Allow patient to become aware of irrationality of beliefs.

Question 6

Cognitive element

Answer 6

• Make patients aware of the role of the cognition and that impacts on their functioning
• Question, challenge and change the patients beliefs

Question 7

Behavioural element

Answer 7

• Test patients beliefs against reality
• Achieved through experimentation, role-play
• Allow patients to become aware of irrational beliefs

Question 8

Ellis’s ABC model

Answer 8

• ABC model challenges irrational beliefs, it is a way of organising patients confused thoughts and feelings
• A= activating event
• B= Beliefs
• C= Consequences

-The therapist will get the patient to try and understand the beliefs and why they are illogical

Question 9

Goal setting

Answer 9

Realistic goals for therapy should be discussed early in the therapy with the patient, using the distressing consequences (C) to fuel the motivation for change.
-The goals are revisited both during and at the end of therapy.

Question 10

Normalisation techniques

Answer 10

Weiden uses “normalisation” techniques that may be helpful in the patient’s as well as the physician’s understanding of a patient’s delusions.
Example: He gave an example of a young African-American male patient with schizophrenia whom he treated in New York and who was convinced that the police were following him and targeting him for harassment, simply because of his race.
“we talked about the difference between the police’s being specifically racist against him versus being racist in general. It helped him to know that his delusional fear was actually somewhat founded and normal.”

-not just flatly negating patient’s beliefs; empathising with patient, enabling him to maintain it but in a more realistic form

Question 11

Decatastrophising techniques

Answer 11

A normalising rationale is helpful in decatastrophising psychotic experiences.

• Education regarding that many people can have unusual experiences in a range of different circumstances (stressful events, etc.) reduces anxiety and the sense of isolation.
• the psychotic experiences are placed on a continuum with normal experiences, the patient will often feel less alienated
• the possibility of recovery seems less distant.

Question 12

Development through trust

Answer 12

-The therapist must develop a degree of trust, perhaps using gentle questioning to help the patient appreciate the illogicalness and delusion of their thoughts

Question 13

Effectiveness of CBT

Answer 13

• Reviews by Rector & Beck and Gould et al have found that CBT reduces positive symptoms, but the effects are smaller in proper RCTs rather than pre/post treatment studies.
• Wykes et al found an effect size of 0.4 between CBT and no treatment, but only an effect size of 0.22 in good quality trials.
• Jones et al’s (2012) review of RCTs found that CBT was no more effective than other psychological treatments on any criteria (functioning, relapse, etc).
• This is despite NICE recommending it as the front- line psychological treatment for S. The original enthusiasm for CBT may have been based on inadequate trials, including some with weak blinding, and (in the case of NICE) the relative cost of CBT compared to other psychological treatments.

Question 14

Appropriateness of CBT

Answer 14

• The lower cost and relative speed of CBT make it appropriate for the NHS, where cost to the tax- payer is a consideration.
• The absence of side- effects compared to drug treatments is a major advantage, and it probably has fewer issues of dependence on the therapist compared to other therapies, in which the relationship between patient and therapist is important.