Schizophrenia - Methods Of Modifying Behaviour: CBT For Schizophrenia

Question 1

What are the two components to describe

Answer 1

• Irrational thinking
• Key components of CBT for schizophrenia

Question 2

Describe irrational thinking in relation to CBT

Answer 2

• Schizophrenia involves disordered thinking, which exacerbates symptoms like hallucinations and delusions.
• CBT Aims to challenge and reorganize irrational thoughts by engaging clients in identifying and disputing disordered thinking patterns.
• The goal is to:
  1) Help clients understand the link between their disordered thinking and their illness.
  2) Encourage rational interpretation of experiences (e.g., questioning evidence for hallucinations).
• the outcome is that it addresses positive symptoms (e.g., hallucinations, delusions), promoting self-reliance and active client participation in therapy.
• Emphasises respect and collaboration, referring to individuals as “clients” rather than “patients” to foster empowerment.

Question 3

Describe the key components of CBT for schizophrenia

Answer 3

• Laura smith et al (2003) says that although CBT is used to treat other illnesses like depression, if you are going to use it to treat schizophrenia there are 5 particular elements that you need:
  1) Engagement strategies
  2) Psycho-education
  3) Cognitive strategies
  4) Behavioural skills training
  5) Relapse prevention strategies

Question 4

What are engagement strategies

Answer 4

• Building a strong relationship and good rapport is crucial for trust, especially as clients may have had negative experiences with previous therapists or doctors.
• Initial Sessions Focus on:
  1) Addressing the client’s worries and unique experiences of schizophrenia (acknowledging individual differences in symptoms).
  2) Discussing the client’s existing coping strategies to highlight their role in managing symptoms.
• client involvement is emphasised because this therapy is a collaborative process, requiring active participation rather than passive reliance (as with medication)

Question 5

What is psycho education

Answer 5

• Educates clients about their schizophrenia to achieve three main functions:
  1) Decatastrophizing: Helps normalize psychotic symptoms (e.g., hallucinations) to reduce fear and distress, and discusses alternate explanations for these symptoms.
  2) Understanding Triggers: Encourages clients to identify the contexts or triggers for their symptoms, fostering greater self-awareness.
  3) Clarifying Understanding: Assists clients in assessing and understanding their symptoms, making it easier to challenge and change irrational thoughts.

Question 6

What are cognitive strategies

Answer 6

Examples include
1) Dysfunctional Thought Diaries:
- Clients record negative or irrational thoughts and rate their belief in them (e.g., 1-100%).
- They then consider alternative, rational perspectives and re-rate their belief in the original thought.
- This “reality check” helps reduce irrational beliefs (e.g., decreasing belief in delusions from 80% to 20%).
2) Behavioral Experiments:
- Clients identify and test actions to reduce symptom influence (e.g., focusing on music or conversations to counteract auditory hallucinations).
- These exercises demonstrate clients’ ability to manage symptoms and regain control over their experiences.

Question 7

What is behavioural skills training

Answer 7

1) Relaxation Techniques: Clients are taught strategies like controlled breathing (e.g., inhaling briefly and exhaling slowly) to manage anxiety when experiencing symptoms like hearing voices.
2) Pleasant Activity Scheduling: Encourages clients to plan and engage in daily activities that provide enjoyment or a sense of accomplishment, reducing focus on negative thoughts.
3) Problem-Solving Skills:
A structured 5-step approach to address challenges:
- Identify or define the problem.
- Generate potential solutions.
- Evaluate the alternatives.
- Choose and implement a solution.
- Assess the outcome

Question 8

What are relapse prevention strategies

Answer 8

1) Relapse Definition: Occurs when symptoms reappear after a period of remission.
2) Identifying Early Warning Signs:
- Clients work with the therapist to recognize early indicators of relapse, including:
- Thoughts: Identifying irrational or recurring thoughts signaling relapse.
- Behaviors: Noting avoidant or unusual actions linked to symptom return.
- Feelings: Monitoring emotional changes tied to worsening symptoms.
- Involves assessing feedback from family and friends about changes they observed before previous episodes.
3) Creating a Relapse Plan:
- Develops a personalized plan highlighting:
- Indicators and triggers of relapse.
- Support systems available (e.g., therapy, family).
- Actions to take if symptoms resurface.
- Encourages reflection on cognitive and behavioral changes to prevent relapse.

Question 9

When evaluating this therapy, what do you talk about

Answer 9

• ethical implications
• social implications
• effectiveness

Question 10

When evaluating the ethical implications what can you talk about

Answer 10

:)
- no side effects
- informed consent and free will

:(
- negative experience for clients
- potential harmful overemphasis on personal responsibility

Question 11

Evaluate the ethical implication of no side effects

Answer 11

P: A major strength of CBT is that it avoids the physical side effects associated with pharmacological treatments.
E: Antipsychotic medications, such as those evaluated in the CATIE trial (Lieberman et al., 2005), were found to cause significant side effects, including metabolic issues and neurological symptoms. In contrast, CBT uses non-invasive psychological techniques to manage symptoms.
T: therefore this is a strength because it reduces the ethical concern of exposing clients to physical harm, aligning with the principle of non-maleficence.
COUNTER: However, CBT may still cause psychological distress if clients are asked to confront challenging thoughts or past traumas, which could indirectly harm their well-being.

Question 12

Evaluate the ethical implication of informed consent and free will

Answer 12

P: Clients undergoing CBT have the autonomy to give informed consent and retain the right to withdraw at any time.
E: Research by Tarrier et al. (2000) demonstrates that clients involved in CBT showed a greater sense of involvement in their treatment compared to those receiving routine care, indicating that CBT encourages collaboration and informed decision-making.
T: This is a strength as it respects ethical principles of autonomy, and it also empowers the individual to manage with relapse in the future.
COUNTER: On the other hand, individuals with severe schizophrenia may struggle to provide fully informed consent due to cognitive impairments or delusions, raising concerns about whether their autonomy can truly be upheld.

Question 13

Evaluate the ethical implication of CBT potentially being a negative experience for clients

Answer 13

P: CBT can be emotionally challenging, as it requires clients to confront distressing symptoms or thought patterns.
E: Morrison et al. (2004) noted that while CBT significantly reduced symptoms in clients with schizophrenia, some participants reported initial discomfort when discussing their delusions or hallucinations.
T: This is a weakness because it could unintentionally emotionally harm the client, raising concerns that this form of treatment might worsen symptoms and leave clients worse off
Counter Argument: Elizabeth Kuipers et al. (1997) found that clients were generally satisfied with their experience of CBT, suggesting that the perceived benefits may outweigh the emotional challenges in most cases.

Question 14

Evaluate the ethical implication of an overemphasis on personal responsibility

Answer 14

P: CBT emphasizes personal responsibility for managing symptoms, which might be ethically problematic for individuals whose condition limits their capacity for control.
E: Bentall (2009) argued that placing too much responsibility on clients for managing symptoms could exacerbate feelings of guilt or inadequacy if they fail to improve.
T: Therefore this is an ethical concern as it risks violating the principle of beneficence, potentially causing emotional harm rather than alleviating it.
COUNTER: A skilled therapist can frame CBT techniques as empowering rather than burdensome, emphasizing small, achievable goals rather than overwhelming self-management.

Question 15

When evaluating the social implications, what do you talk about

Answer 15

:)
- cost effective
- allows individuals to contribute to society

:(
- over-medicalisation of social issues

Question 16

Evaluate the social implication of CBT being cost effective

Answer 16

P: CBT is cost-effective when combined with antipsychotic medication as it reduces the need for future emergency psychiatric care.
E: Kuipers et al. (1998) demonstrated that while the initial cost of delivering CBT might be high, it is offset by long-term savings due to reduced hospitalization and emergency service utilization.
T: This is a positive social implication because it suggests that CBT can alleviate strain on healthcare systems in the long run, allowing resources to be redirected to other critical areas.
COUNTER: However, healthcare budgets often prioritize immediate care requirements over long-term planning, making it difficult to allocate funds to CBT in the short term.

Question 17

Evaluate the social implication of CBT allowing individuals to contribute to society

Answer 17

P: CBT helps individuals with schizophrenia improve their social skills and re-engage with society, reducing stigma and social isolation.
E: A study by Turkington et al. (2006) found that CBT improved not only symptom management but also social functioning, enabling individuals to build relationships and participate in community activities.
Therefore: This is a positive social implication as it reduces the broader societal burden of isolation and stigmatization associated with schizophrenia, helping individuals become active, contributing members of society.
COUNTER: Some critics argue that while CBT may improve individual functioning, societal stigma surrounding schizophrenia remains a significant barrier, requiring broader public education campaigns alongside therapeutic interventions in order for this to happen.

Question 18

Evaluate the social implication of CBT being an over-medicalisation of social issues

Answer 18

P: The increasing use of CBT for schizophrenia risks framing what are sometimes societal or systemic issues (e.g., poverty, trauma, lack of social support) as purely individual mental health problems. Such as discrimination being a responsible factor in schizophrenia as identified by Harrison et al. 1988.
E: Boyle (2011) critiqued the medical model for overlooking social determinants of mental health, arguing that interventions like CBT might inadvertently shift the focus away from addressing structural inequalities.
T: This is a negative social implication because it can divert attention and resources from broader social reforms that could prevent mental health issues in the first place. Therefore, the societal issues that may be causing schizophrenia goes unaddressed
COUNTER: While structural issues need to be addressed, CBT can still play a critical role in equipping individuals with coping mechanisms to navigate the challenges of their environment.

Question 19

When evaluating CBT’s effectiveness, what do you talk about

Answer 19

:)
- supporting research
- longevity

:(
- treats symptoms not cause
- not appropriate for all patients

Question 20

Evaluate the effectiveness of CBT for having supporting research

Answer 20

P: Research evidence supports the effectiveness of CBT in improving recovery rates for individuals with schizophrenia.
E: Kuipers et al. (1997) randomly allocated 60 individuals with schizophrenia to either CBT + standard care or standard care alone for 9 months. They found that 50% of those in the CBT group recovered, compared to only 30% in the standard care group.
T: This is a strength because it demonstrates that CBT provides a significant improvement in outcomes when used alongside standard care, making it an evidence-based and effective intervention.
COUNTER: However, these results may not generalize to all settings or populations, as the study was conducted within a controlled environment and may not account for real-world variability in care delivery.

Question 21

Evaluate the effectiveness of CBT due to its longevity

Answer 21

P: CBT offers long-term benefits by equipping individuals with strategies to manage symptoms, potentially reducing relapse rates.
E: Morrison et al. (2014) found that CBT not only reduced immediate symptoms but also helped individuals maintain improvements over an extended period by fostering coping mechanisms and resilience.
T: This is a strength because it provides patients with tools for long-term self-management, which can reduce dependence on emergency services and hospitalizations.
COUNTERt: The effectiveness of CBT in maintaining long-term improvements may depend on factors such as the patient’s commitment to therapy and ongoing access to supportive resources, which are not guaranteed.

Question 22

Evaluate the effectiveness of CBT for it only addressing symptoms and not cause

Answer 22

P: CBT focuses on managing symptoms rather than addressing the underlying biological causes of schizophrenia.
E: Schizophrenia is often linked to neurochemical imbalances, such as dopamine dysregulation (as suggested by Howes & Kapur, 2009), which CBT does not directly address.
T: This is a weakness because while CBT may reduce the distress caused by symptoms, it does not target the biological mechanisms, potentially limiting its overall efficacy as a standalone treatment.
COUNTER: Despite this limitation, CBT can still complement biological treatments, such as antipsychotic medication, to provide a holistic approach to managing schizophrenia.

Question 23

Evaluate the effectiveness of CBT for it not being appropriate for all patients

Answer 23

P: CBT may not be effective or suitable for all individuals with schizophrenia, particularly those with severe symptoms or cognitive impairments.
E: Kingdon and Turkington (1994) highlighted that some individuals with severe psychosis struggle to engage with the cognitive processes required in CBT, limiting its applicability.
T: This is a weakness because it suggests that CBT cannot be a universal solution for all cases of schizophrenia, requiring careful assessment of individual suitability.
COUNTER: Adaptations to CBT, such as simplified techniques or family involvement, can make it more accessible for patients with severe symptoms, broadening its applicability.