CBTp

• CBTp Central idea - patients' problems area based on incorrect beliefs and expectations
• CBTp recognises examples of dysfunctional or delusional thinking, and provides help on how to avoid acting on these thoughts. This does not get rid of symptoms, but helps patients cope with them
• CBTp helps a patient experiencing delusions and hallucinations to change the way they think about and respond to these experiences. The goal is to make them less distressing and less impairing
• CBTp's goal is not to make the patient question the reality of the delusions and hallucinations, but to reduce the damage that they can do
• CBTp Process:

  Cognitive restructuring

  Reality Testing

  Coping strategies
• CBTp Cognitive restructuring - identifying and challenging irrational or distorted thoughts related to delusions or hallucinations
• CBTp Reality testing - helping the patient differentiate between what is real and what is not, particularly for hallucinations
• CBTp coping strategies - teaching patients techniques to manage distressing symptoms EG ignoring auditory hallucinations
• CBTp role of the therapist - works collaboratively with the patient, establishing trust and encouraging the patient to question the validity of their experiences
• There are advantages of using CBTp over standard care. A NICE review in 2014 found that CBTp was effective in reducing rehospitalisation rates for up to 18 months, compared to standard care of antipsychotic medication alone. CBTp was also found to be effective in reducing symptom severity and evidence for improvements in social functioning compared to standard care alone. However studies are done on people who have received CBTp alongside antipsychotic medication - so it is difficult to know the effectiveness of CBTp alone. 
• The effectiveness of CBTp is dependent on the stage of the disorder. Addington and Addington claim that the self reflection stage is not appropriate at the initial acute phase of Sz, and when there is stabilisation of psychotic symptoms after antipsychotic use then there is benefit from group based CBTp which normalises their experiences by meeting other individuals with the same issues. Research has shown that individuals with more experience of their sz and a greater realisation of their problems benefit more from individual CBTp. 
• A limitation of CBTp is the lack of availability. It is estimated that only 1 in 10 people that could benefit from the therapy get access to it, despite it being recommended by NICE as the treatment for patients with SZ. This figure is even lower in some areas. This means that although CBTp is effective, it is not available to all SZ patients. 
• There are problems with meta analyses of CBTp. They are often unreliable conclusions as they fail to take into account the study quality. Some studies don’t randomly allocate ppts. Juni concluded that there was clear evidence that the problems in methodologically weak trials affected the findings about the effectiveness of CBTp