psychological Therapies For SZ

Question 1

What did the national institute for health and care excellence recommend?

Answer 1

NICE recommended that all people should be offered CBT - or for psychotic disorders like SZ CBTp - cognitive behavioural therapy for psychosis. CBTp was originally used to treat residual symptoms that persist despite antipsychotic medication. This doesn’t cure the symptoms, it just helps patients better cope with them

Question 2

What are the phases for CBTp

Answer 2

Assessment
Engagement
ABC Model
Normalisation
Critical collaborative analysis
Developing alternative explanation s

Question 3

What is the assessment stage (1)

Answer 3

The patient expresses his thoughts to the therapist. For example they may describe their delusions, talk about their relationships and lay out their goals from this therapy

Question 4

What is engagement (2)

Answer 4

The therapist wins the trust of the patient, so they can work together.

This requires honesty, patience and unconditional acceptance. The therapist needs to accept that the illusions may seem real to the patient at the time and should be dealt with accordingly

Question 5

THE ABC MODEL (3)

Answer 5

Get the patients to understand what is really happening in their life:
Activating events - what triggers the problem
Behaviour - how do you react to this problem
Consequence - what impact does this behaviour have on others or yourself

I.e. a person may think sharing the fact they have voices may cause them to think that no one will like them, however it can be disputed that some may find it interesting, Whereas some may not

Question 6

Normalisation (3)

Answer 6

Conveying to the patients that it is normal have unusual experiences like hallucinations and delusions reduces anxiety and the sense of isolation. By doing this, the patients feels less alienated and stigmatised and possibility of recovery seems more likely.

Question 7

Critical collaborative analysis (5)

Answer 7

The therapist uses gentle questioning to help patients understand their illogical conclusions. For example ‘if your voices are real, how come no one else can hear them?’. Questing can happen without distress, provided there is trustful atmosphere between therapist and patients.

Question 8

Developing alternative explanations (6)

Answer 8

The patient develops their own alternative explanations to their previously unhealthy assumptions. If the patient is not forthcoming with healthy alternative explanations - then new ideas can be constructed in cooperation with the therapist. E.g. positive self talk - whereby the therapist encourages client to repeat things such as I can do this…

Question 9

What is CBTP normally delivered in and it’s aim

Answer 9

Normally delivered in 1-1 situations, but can be done in groups. And NICE recommends at least 16 sessions. Aims to establish links between thoughts and feelings and their symptoms and general level of functioning and to trace back the origins of their symptoms to get a better idea of how they developed

Question 10

Strengths CBT

Answer 10

CBTp seems to be more effective in treating SZ compared to antipsychotic medication alone - The 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.

CBTp can be tailored to the individual- CBTp appears to be more effective when it is adjusted to the stage the individual is currently at. Addington and Addington (2005) claim that self reflection is not particularly appropriate at early stages. However following stabilisation of the symptoms with medication, patients can benefit from group based CBTp -which can normalise their experience by meeting similar individuals. Thus 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. This means CBT can be tailored to the person

Question 11

Weakness CBT

Answer 11

Lack of availability of CBTp and patients refusal to attend sessions- Despite being recommended by NICE as treatment for sz , it is estimated that in the UK only one in ten individuals with SZ actually have access to CBTp. This figure is even 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.

Studies that investigate the effectiveness of CBTp lack scientific rigour, especially the methodological issues. For example, some studies fail to randomly allocate participants to CBTp or a control condition; other studies fail to assess the patients subsequent assessment of symptom and general functioning after they have been treated with CBTp. Juni et al. (2001) concluded that there was clear evidence that the problems associated with methodologically weak trials translated into biased findings about the effectiveness of CBTp.