CBT

• what are the stages of CBT?

  assessment (expresses thoughts about experiences and goals set)

  engagement (empathy with the patient)

  ABC model (activating events, beliefs, consequences)

  Normalisation (informing them that many people experience SZ can help reduce anxiety)

  Critical collaborative analysis (use of gentle questioning to help the patient understand illogical conclusions eg if the voices are real why can't others hear them)

  Developing alternative explanations (develops healthier explanations to previous assumptions)
• what are the aims of CBT for SZ?


  to trace back the origins of their symptoms to get an idea of how they might have developed
• what tasks might be set for patients with SZ in CBT?


  • evaluate the validity of their faulty beliefs and test them
  • set behavioural assignments to improve functioning
  • develop alternatives to maladaptive beliefs
  • develop coping strategies
• advantages of CBT over antipsychotics

  NICE found that CBT was effective in reducing rehospitalisation rates up to 18 months following the end of treatment,

  • CBT was also found to be effective in reducing symptom severity and when compared with patients on antipsychotics alone, there was evidence of improved social functioning

  HOWEVER

  • most of the studies of CBT have been conducted when patients are also being treated with antipsychotics, therefore it is hard to assess the effectiveness of CBT alone
• a disadvantage that affects the effectiveness of CBT


  effectiveness is dependent on the stage of the disorder

  • it seems more efficient in the initial acute phase, self reflection like CBT is not appropriate (Addington and Addington)
  • but in later stages when symptoms have stabilised with antipsychotics, individuals can greatly benefit

  overall, the more experience with SZ (longer had) and more aware they are of the disorder = the more effective CBT is
• problems with the availability of CBT

  its estimated only 1 in 10 in the UK could get access to CBT

  eg Haddock found (in a survey) that out of 187 patients in the north west, only 13 had been offered CBT
• problems with CBT's claimed benefits


  they may have been overstated

  more recent meta analysis and studies suggest its effectiveness is lower than thought

  • Jauhar et al, revealed only a small effect on the key symptoms of SZ such as hallucinations and delusions. these small effects even disappeared when symptoms were assessed blind (assessors didn't know if patient had SZ or was a control)
  • this has led to confusion about whether to prescribe it as a treatment or even recommend it as people may find it no help