Schizophrenia (CBT) Flashcards
HOW DOES THE COGNITIVE APPROACH EXPLAIN SCHIZOPHRENIA
Sees mental illness as being caused by problems with the internal mental processes
If they are not working and the result is the delusions or maladaptive thinking typical of the illness
CBT aims to alter the disordered thinking
May not be able to prevent a schizophrenic from experiencing delusions but can help them to deal with and cope with the symptoms when they arise
CBT should not be seen as a cure for schizophrenia
Manage the symptoms and lead to a relatively normal life
Must be careful to not fall for the treatment aetiology fallacy
False belief that a medical treatment works, it was a lack of whatever the treatment that caused the disorder
How is CBT used for irrational thinking?
Patients are normally unaware that they are subject to cognitive errors, or that there are problems with their thinking
Therapist will make these maladaptive thoughts conscious and by challenging them, the patient will see that there is no basis for these thoughts
Used mainly to reduce the positive symptoms of schizophrenia
When given the right cognitive skills, the schizophrenic may be empowered to be more independent, and have more confidence
What are the main components of CBT
Takes place weekly or fortnightly for between 5 and 20 sessions
Patients are encouraged to trace back their symptoms in order to gain insight into the way in which they may have developed
Offering a range of psychological explanations may help reduce stress and anxiety
Smith (2005) identified the key components for using CBT for schizophrenia
Engagement strategies - Fully engage with therapist so they stay committed
Psychoeducation - Develop an understanding of their illness so they learn their symptoms can be managed
Decatastrophize the symptoms
Investigates the specific symptoms and their possible triggers
Cognitive strategies
Behaviour Skills Training - Aim to give skills to cope with the symptoms
Relapse Prevention Strategies - Anticipate the signs to relapse, develops a plan
What are the cognitive strategies?
Aim to alter the cognitive errors
The therapist cannot simply tell them that their thinking is wrong, and tell them how to think properly
Develop more productive thinking styles
Socratic Questioning - Series of curiosity driven questions asked by the therapist during therapy sessions
Helps the schizophrenia to identify errors in their thinking
Challenges the patient to find evidence that supports their delusions
The lack of evidence should start to undermine the patients beliefs in the delusion
Dysfunctional Thought Diary - Patient notes down each time they have a thought that may be classed as dysfunctional
Challenged to think differently about the event and are asked to come up with possible alternative outcomes
Behavioural Experiments - May be given a homework task to report back on findings
By testing these beliefs and finding them not to be true, hopefully the schizophrenia will change their maladaptive thinking
Realise their delusions are not based on reality
How does CBT work for patientes who hear voices?
Frith (1992) argues that schizophrenics fail to monitor their own thoughts, misattributing them to the outside world
It is actually their own inner speech being misinterpreted
Schizophrenics who hear voices can be helped to bring the voices under control using CBT
Asking patients to focus on the nature of the thoughts
Whether they’re are male or female
Find external ways of focusing, by drawing pictures
The therapist therefore helps the patient to recognise that the voices are part of who they are
Taught strategies to protect them against the wishes of the voices
This will not eradicate the voices, it may make the manageable
Effectivness Evaluation
Kupiers et al (1997) 50% of patients given CBT benefited in a reduction of symptoms
Benetall et al (1994) CBT may be the most effective for patients experiencing their first episode of schizophrenia
Jauhar et al (2014) found that CBT only gave a small therapeutic effect
Kingdon and Kirschen et al (2006) Many patients were not deemed suitable from CBT because psychiatrists believed they would not fully engaged with the therapy
CBT is rarely used as the sole treatment of schizophrenia, it is used with antipsychotics
It is not suitable for all schizophrenics
Patients who are too severe / Patients in denial
Absence of a placebo group in CBT
Cannot measure effectiveness
Ethical Implications evaluation
Does not have any side effects
Patients give consent
Gives them free will
Are able to withdraw at any point
Without the use of antipsychotics, CBT is ineffective
Have to be able to monitor and change their own thinking
Without antipsychotics, it would not work
Bentall et al (1994) argues that CBT the emphasis is on controlling the thought processes rather than understanding the thoughts behind them
CBT could only be treating the symptoms not the root cause
Focusing on the voices instead of trying to ignore them could be harmful
Could cause them to act on these voices
Social implications Evaluation
Learn effective coping strategies to help them
CBT when combined with antipsychotics may produce a good outcome for patients
While the initial cost of treatment may be costly in the short term, long term there is actually a saving in money as the patients are less likely to need hospitalisation in future
Kulpers (1998)
CBT is not on the NHS
CBT is expensive
