The Cognitive Treatment for Schizophrenia (Clinical Psychology) Flashcards
What is the Cognitive Treatment for Schizophrenia?
Cognitive Behavioural Therapy
What is Maladaptive Thinking, and how does CBT aim to change it?
Maladaptive thinking is thinking that is not helpful in the situation and is not suitable (it doesn’t help someone to function, or adapt to the situation). It maintains emotional distress and behavioural problems Maladaptive thinking comes from schemas and general beliefs about the world and oneself and about the future. CBT acts to focus on these thoughts and schemas, to change them so that the emotions and behaviours that arise from the maladaptive thoughts also change. CBT tends to take the view that disorders and distress are down to cognitive factors.
What does CBT for Schizophrenia focus on?
CBT for schizophrenia, consistent with CBT in general, focuses on the way someone structures their world cognitively and challenges the difference between psychosis and normality It is assumed that normal cognitive processing is involved in the maintenance of some psychotic symptoms. Normal cognitive mechanisms are thought to be helpful for someone coping with the symptoms of schizophrenia. CBT is an individual therapy to strengthen coping, and focusing on the persons life at the time. CBT also targets psychotic symptoms
What is the Process of CBT for Schizophrenia?
CBT focuses on the individual, with one-to-one sessions weekly over a number of weeks or longer.
Why is collaboration and the relationship between the patient/therapist important for CBT for Schizophrenia?
The therapist has to be nonthreatening and supportive to keep the pace and relaxed. They work together to discuss specific symptoms. There is focus on the subjective experience and then specific symptoms and problem areas are targeted to work on them. The patient’s symptoms are focused on rationally, accepting them and the patients experience of them
What 3 things does CBT for Schizophrenia include?
Reattribution + Focusing Normalising Belief Modification (RNB)
What is meant by Focussing + Reattribution?
It looks at auditory hallucinations; to reduce the frequency of the voices, and the distress they bring The therapist first looks at physical attributes (number, volume, tone, gender, etc) They then look at the content of what is being said: The patient writes it down for homework The first focus is on the patient’s beliefs and thoughts about the voices The aim is to show that the voices are self generated; and they’re to be accepted, not feared
What is meant by Normalising?
It involves de-stigmatising the psychotic experience They examine the evidence, looking for alternative explanations and challenging faulty thinking Relaxation techniques and activity planning may also be used They look at psychotic symptoms is more normal and less of a catastrophe; to reduce the fear and distress related to them
What is meant by Belief Modification?
It’s where delusional thinking is challenged directly and there is testing against reality Evidence for the delusional belief is challenged and exploration of the delusional belief being only one version of the events is carried out
What are the four different procedures of cognitive therapy following an acute phase?
Cognitive therapy to challenge and test key beliefs, with a supportive and non-threatening relationship between the patient and the therapist Group therapy, where members of the group are encouraged to see the irrationalities and inconsistencies of the other group members. Coping strategies are encouraged in the group The third approach involves sessions with family so that patients do not become absorbed in their psychotic symptoms The fourth part involves structured activities
What does the National Institute for Health and Care (NICE) recommend about CBT for Schizophrenia?
The NICE produces guidelines under the heading ‘preventing psychosis’: The first recommendation is that individual CBT is offered, with or without family intervention The second recommendation is to offer interventions for the present and anxiety disorders and/or related disorders For the first episode, medication is recommended and it is for subsequent acute episodes that CBT is mentioned again, as well as family intervention this time The guideline also contains recommendations about cultural and ethnic differences. It also indicates that CBT is recommended as a treatment for schizophrenia, as is medication
What Research evidence Supports CBT as an effective Treatment of Schizophrenia?
Kingdon + Turkington Drury et al
How does Kingdon + Turkington show the Effectiveness of CBT for Schizophrenia?
Research evidence by Kingdon and Turkington (1991) found that 35 out of 65 patients with schizophrenia (54%) in a five-year follow-up were free of symptoms when normalising and standard CBT techniques were used. This evidence shows that more than 50% of patients were eventually free of symptoms, which indicates that CBT is useful in treating patients with schizophrenia. Therefore this supports the use of CBT as a form oftreatment for schizophrenia
How does Drury et al show the Effectiveness of CBT for Schizophrenia?
Research evidence by Drury et al. (1996a and 1996b) looked at CBT in an acute phase and found that CBT patients showed fewer psychotic symptoms at week 7 of a 12-week intervention than those in a comparison group. The CBT group average (median) stay in hospital was 49 days compared with 108 days for the comparison group which had another therapy involving activities and informal support. This is strong evidence to support the use of CBT as a form of treatment for schizophrenia as it has been proven to show improvements in patients with schizophrenia in a short amount of time.
What are the Advantages of using CBT for Schizophrenia?
CBT can be useful for more than just treatment for schizophrenia, in the sense that it need not only focus on schizophrenia but also on any stress, distress, depression and anxiety that the patient is experiencing alongside schizophrenia. The therapy is used for many different disorders and as someone with schizophrenia is likely to be experiencing at least distress, it is useful to use one therapy for more than on their symptoms. This supports the use of CBT as a treatment for schizophrenia as it proves to be an effective method in tackling more than one symptom experienced by a schizophrenic patient. Therapists and patients work collaboratively on issues of concern to the individual and the relationship between them is non-threatening and supportive. This gives power to the patient, perhaps more than when drug therapy is involved. This is a strength for ethical reasons as the patient themselves have more control over what happens to them and they are involved in their therapy more directly. It could be argued that it will be more tailored to their needs, and therefore more likely to be successful. This supports the use of CBT as form of treatment for schizophrenia.
