Schizophrenia: Cognitive behavioural therapy Flashcards
What do The National Institute for Health and Care Excellence (NICE) recommend for SZ patients?
All SZ patients should be offered CBTp (CBT for psychosis).
Outline the principle of (define) CBTp.
Combination of cognitive therapy - changing maladaptive thoughts/beliefs - and behavioural therapy - changing behaviour in response to these thoughts and beliefs.
What are the 6 stages of CBT?
Assessment
Engagement
ABC model
Normalisation
Critical collaborative analysis
Developing alternative explanations.
What occurs during the assessment stage?
Patient expresses thoughts, feelings and experiences.
Realistic goals for therapy set, using patient’s current distress as motivation for change.
What is involved in the engagement stage?
Therapist empathises with patient and stresses that explanations for their distress can be developed.
Outline the ABC model stage.
A - activation events
B - behaviours and emotions
C - consequences of B
Derived from patient’s description. The patient’s beliefs can then be rationalised, disputed and changed.
What is involved in the normalisation stage and what does it look to achieve?
Therapist gives information explaining that bizarre experiences (hallucinations during stress) are normal.
Patient feels less alienated/isolated, chance of recovery seems more likely.
What is involved in the critical collaborative analysis stage?
Gentle questioning to help patient understand illogical thoughts.
Asked without causing distress - trust is important.
In the developing alternative explanations stage, what happens if the patient is not forthcoming with their own alternative explanations for previously unhealthy assumptions
New ideas can be constructed in cooperation with the therapist - gentle guidance.
AO3: CBT
+Advantage of CBT over standard care
+Another advantage of CBT over standard care
-Issue with using CBT in the real world
-CBT dependency
(+AO3) What is the biggest advantage of CBTp over standard care?
NICE found that CBT is better at reducing relapse rates and severity of symptoms. Some evidence for more improvement in social functioning.
BUT most CBT patients also receive standard care so comparisons are difficult.
(+AO3) What is another key advantage of using CBTp rather than standard care?
CBTp has no side effects. Antipsychotics have extrapyramidal side effects: Parkinson’s disease symptoms in >50% of SZ patients. Also less chance of addiction.
(-AO3) What is the issue with attempting to use CBTp regularly in the real world?
Despite being recommended by NICE for all patients to be offered CBTp, only 1 in 10 in the UK receive it.
Combination of lack of availability and refusal to turn up.
Reduces credibility of funding for institutions and therapists.
Also reduces overall effectiveness of treatment.
(-AO3) What is CBTp dependent on?
The stage of the disorder.
Most effective once initial psychotic symptoms have stabilised (antipsychotics). Less effective in starting phase.
Can be adapted to suit stage - e.g. group CBTp.
Research shown patients more experienced with their SZ benefit more from individual CBTp.
