SZ- MOM CBT Flashcards
How can CBTp (psychosis) help SZ?
Alters the way patients think managing disordered thinking
-Can’t prevent delusions and hallucinations but can help the patient understand episodes (understanding points)
-Can help underpin delusions by challenging false beliefs
-Can increase confidence tackling neg symptoms
What are the 4 components of CBTp?
Assessment
Engagement
Psychoeducation/normalisation
Cognitive strategies
Component- what is the assessment?
Client will meet therapist
Client then explains experiences and symptoms to therapist
Goals and expectations of therapy established
CBT- what is engagement?
Client has opportunity to talk about worries and symptoms
Rapport built by therapist empathising with patients perspective and feelings
Client and therapist will then discuss coping strategies currently using
CBT- Psychoeducation/normalisation?
Therapists normalises the experience of psychotic symptoms offering an alternative explanations of symptoms (less stigma)
This helps increase clients understanding of the context in which symptoms occur
Helping therapist assess SZ understanding of symptom
CBT- what are the 5 cognitive strategies?
-Relapse prevention
-Dysfunctional thought diary
-The ABC model
-Skills training
-Behavioural experiments
Cog strategies- relapse prevention?
Therapist and client identify indicators of relapse e.g. thoughts and feelings
-SZ assesses how well they got on with others and what they notice about themselves before they relapse
-Client and therapist develop a plan taking into account indicators, what to say to peers and support strategies
Cog strategies- dysfunctional thought diary?
-Client may keep a record of how they felt about and event or thought
-Client will then write down automatic negative thought associated with events
-Client challenged to think differently regarding event and then asked to record different views of event and provide evidence that they use these appropriately
Cog strategies- the ABC model?
Patients describe ACTIVATING events thats the cause of irrational BELIFES/BEHAVIOURS as well as CONSEQUENCE
Belief is then challenged and disputed and changed to challenge belief they are asked for evidence of belief
e.g. people wont like me if i tell them about the voices turns into someone will like me
Cog strategies- skills training?
Pleasant activity scheduling, problem solving and relaxing thought
Employed to cope with residual symptoms (thoughts not managed via medication) occurring via SZ, anxiety and depression
By problem solving SZ systemically goes through steps to identify problem, generating solution, evaluation alternative, decide on solution then evaluation
Cognitive strategies- behaviour experiments?
Challenge hallucinations
Client identify situations or activity to resent voice in head
Situations can be listening to music etc
Client rates severity of voices heard and this allows them to realise they can control voices heard
Evaluation- who is our research support?
Kuipers et al
EVAL- Kuipers et al research support?
60 SZ patients experiencing positive and distressing symptoms that those were medialy resistant were allocated to CBT and standard care condition or standard care only
After 9 moths researchers found change in psychotic symptoms experienced in CBT standard care and condition
50% of patients considered to have become better vs 1 individual becoming worse and another committing suicide
Showing us CBT may be better at treating SZ than standard care
EVAL- contradiction of Kuipers et al researcher?
Not everyone in the CTB and standard care benefited
Only if patients are willing to change
EVAL- contradictory evidence?
Jauhar et al
EVAL- Jauhar et al?
Weakness CBT
Only a small therapeutic effect from using CBT with clients with SZ
Eval- who contradicts Jahur et als research?
Morrison et al
CBT significantly reduces psychiatric symptoms in individuals with SZ
Suggesting that Jauhar didn’t give his patients choice in treatment plan which can be critical when looking at success of CBT
EVAL- short term effectiveness- psychologist?
Weakness due to the lack of significant results shown in long term effectives studies
Tarrier et al
EVAL- short term effectiveness- Tarrier et al?
Individuals receive CBT shortly after diagnosis or received standard care
18 months later the CBT groups had same relapse rates as clients with standard care so short-lived
EVAL- short term effectiveness- counter argument?
Tarrier noted individuals in CBT conditions were less negatively effected by symptoms than those with standard care
So long term benefits depends on how much benefits affected in terms of relapse and symptoms reduced
Ethics- positive?
Client has more control over therapy and therefore more input over symptom, this boosts self esteem
(no power imbalance between client and therapist)
No side effect
Ethics- negatives?
-Therapist tells patient that the way they think is wrong can create patient blame
-Psychiatric prejudice, psychiatrist may judge that the person isn’t suitable for CBT without being given a chance (just prescribing antipsychotics)
Social implications- positives?
-Gives patients coping strategies to allow them to live normal lives w/o stress inducing daily lives
-Return to work, not reliant to state contributing to society
Social implication- negatives?
-Attending CBT could be more intrusive to SZ patients (attend therapy and do homework) so may not suit daily routine
-CBT is often used in conjunction with antipsychotics, this means its more costly on a whole
-Not all NHS trust offers CBT, rates vary from 67% to 14% of the county
-Issues with accessibly (long waiting list) meaning that symptoms may become worse
