CBT and Family Therapy

• Cognitive Behavioural Therapy 


  Method for treating mental disorders based on cognitive and behavioural techniques. May deal with thinking such as challenging negative thoughts
• Family Therapy


  A psychological therapy carried out with all or some of the family members of a family with the aim of improving communication within the family and reducing stress
• CBT explained

  • Commonly used for people with schizo
  • May take between 5-20 sessions either in groups or individually
  • CBT aims to deal with thoughts and behaviours
• How does CBT help?

  • CBT can help patients make sense of how their irrational thoughts such as delusions and hallucinations impact their feelings and behaviour
  • Understanding the symptoms can help reduced the effects it has on the patient
  • It does not get rid of symptoms but helps them cope and improves their ability to function
• How may CBT help someone with hallucinations?

  • If someone is hearing voices they may be told that this is the extension of the ordinary experience of thinking in words
  • This then makes the patient less worried about their symptoms and can help them cope more
• How may CBT help someone with delusions?

  • Delusions can be challenged
  • Reality testing can be used where the patient and therapist examine the likelihood of their delusions being true
  • When delusions are resistant to reality CBT can be used to tackle anxiety and depression
• AO3 CBT: Evidence for effectiveness

  • The NICE review of treatments for schizophrenia also found consistent evidence to show CBT was most effective when combined with antipsychotic medication
  • It was effective in reducing rehospitalisation rates up to 18 months following the end of treatment
  • Also reduced symptom severity compared to patients receiving only antipsychotics
• AO3 CBT: Lack of availability

  • As little as 1 in 10 actually get access to this form of therapy
  • Out of 187 randomly selected schizophrenics only 13 had been offered the therapy and of those who were offered many failed to attend or refused
  • Therapy also requires a trained professional to deliver the sessions over a number of months making it incredibly costly and time consuming
  • Patients may struggle to open up with a therapist and the effectiveness of the therapy is influenced by the skill of the practitioner
  • CBT may be inappropriate for most people
• AO3 CBT: Quality of evidence

  • There is a wide range of techniques and symptoms included in studies
  • CBT techniques and schizo symptoms vary from one case to another
  • Different positive and negative symptoms require different techniques
  • This makes it hard to say how effective CBT will be for a specific person with schizo
• AO3 CBT: May not be useful for all patients

  • CBT may in truth only be effective with people with milder forms of schizophrenia
  • They must have enough level of insight and awareness into their own thinking to actually address this
  • Not all patients will be able to use CBT as they may lack the intelligence, insight or their symptoms are too severe to control
  • Some studies have found that age may well be a factor with CBT being less effective for older patients as they may not engage as well
• How does family therapy helps?

  • Reduce negative emotions- reducing stress is important to reduce the likelihood of relapse
  • Forming a therapeutic alliance with the family
  • Ensure the family achieves a balance of caring for the patient and still maintaining their own lives
  • Improving families beliefs towards schizo
  • Can take between 3 months to a year
• Model of practice for family therapy

  • Phase 1 is sharing basic information and providing emotional and practical support
  • Phase 2 is identifying resources including what each family member can and cannot offer with Phase 3 encouraging mutual understanding and a safe space for family members to express their feelings
  • It ends with finding stress management techniques, relapse prevention and then maintaining this for the future
• AO3 Family Therapy: Evidence of effectiveness

  • Family Therapy is one of the most consistently effective treatments that are offered for schizophrenics
  • Relapse rates are reduced by 50-60%
  • NICE also recommends showing its effectiveness
• AO3 Family Therapy: Putting burden on family

  • Family therapy puts significant burden on the family members who may be ill equipped to cope with the needs of schizophrenic sufferers
  • Specialist care may be better suited by staff that better understand the symptoms
  • Use of family members may not be appropriate as this could then impact on their lives causing great stress as they cope to manage another person’s problems as well as their own
  • The family environment may offering lower relapse rates but may be masking the symptoms of the sufferer
• AO3 Family Therapy: Benefits whole family

  • Therapy is not just for the benefit of the identified patient but also for the families that provide the bulk of the care
  • By strengthening the functioning of a whole family, family therapy lessens the negative impact of schizo on other family members and strengthens family ability to support the schizophrenic person
• AO3 Family Therapy: Not helpful for all families

  • The focus on being “open” could cause problems for family members who may be reluctant to share personal information as this may increase family tensions within the home environment
  • The reluctance to talk or acknowledge problems may hinder the effectiveness of the therapy
  • If this could be overcome family therapy may be useful for patients who lack insight into their own illnesses or are unable to talk about it
  • Family members may have a greater awareness of the patient’s behaviour and raise these on their behalf