Sc - Cognitive behavioural therapy Flashcards
Cognitive behavioural therapy
A combination of cognitive therapy (a way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs).
What is cognitive behavioural therapy referred to as?
CBTp
What does CBTp stand for?
Cognitive behavioural therapy for psychosis.
Why was CBTp in SZ originally developed?
To provide treatment for residual symptoms that persist despite the use of antipsychotic medication.
What are the 6 phases of CBTp?
- Assessment
- Engagement
- The ABC model
- Normalisation
- Critical collaborative analysis
- Developing alternative explanations
Describe the assessment phase of CBTp
The patient expresses his or her thoughts about their experiences to the therapist. Realistic goals for therapy are discussed, using the patient’s current distress as motivation for change.
Describe the engagement phase of CBTp
The therapist empathises with the patient’s perspective and their feelings of distress, and stresses that explanations for their distress can be developed together.
Describe the ABC model phase of CBTp
The patient give their explanation of the activating events (A) that appear to cause their emotional and behavioural (B) consequences (C). The patient’s own beliefs, which are actually the cause of C, can then be rationalised, disputed and changed.
For example, the belief that ‘People won’t like me if I tell them about my voices’ might be changed to a more healthy belief, e.g. ‘Some may, some may not. Friends may find it interesting.’
Describe the normalisation phase of CBTp
Information that many people have unusual experiences such as hallucinations and delusions under many different circumstances (e.g. in situations of extreme stress) reduces anxiety and the sense of isolation. By placing psychotic experiences on a continuum with normal experiences, the patient feels less alienated and stigmatised, and the possibility of recovery seems more likely.
Describe the critical collaborative analysis phase of CBTp
The therapist uses gentle questioning to help the patient understand illogical deductions and conclusions. For example, ‘If your voices are real, why can’t other people hear them?’ Questioning can be carried out without causing distress, provided that there is an atmosphere of trust between the patient and the therapist, who remains empathetic and non-judgemental.
Describe the developing alternative explanations phase of CBTp
The patient develops their own alternative explanations for their previously unhealthy assumptions. These healthier explanations might have been temporarily weakened by their dysfunctional thinking patterns. If the patient is not forthcoming with alternative explanations, new ideas can be constructed in cooperation with the therapist.
What is the basic assumption of CBTp?
That people often have distorted beliefs, which influence their feelings and behaviours in maladaptive ways.
What are delusions thought to result from and how can CBTp be used to help patients who experience delusions?
Delusions are thought to result from faulty interpretations of events, and CBTp is used to help the patient identify and correct these faulty interpretations.
How can CBTp be delivered?
In groups, but it is more usual that it is delivered on a one-to-one basis.
How many sessions of CBTp do NICE recommend?
At least 16 sessions when used in the treatment of SZ.
