CBT Schizophrenia

• Cognitive Behavioural Therapy (CBT) is commonly used to treat people with schizophrenia. It usually takes place over a period of 5-20 sessions either in groups or on an individual basis.
• CBT aims to deal with both thoughts (cognitions) and behaviour.
• Cognitive Behavioural Therapy (CBT) involves both cognitive and behavioural elements.
• The cognitive element of CBT aims to identify irrational and negative thoughts and replace these negative thoughts with more positive ones.
• The behavioural element of CBT encourages patients to test their beliefs through behavioural experiments and homework.
• As schizophrenia is associated with cognitive problems such as attention, memory and perception, CBT can be a useful therapy
• With CBT for schizophrenia it is believed that patients can be helped to see logical ways for dealing with their hallucinations and delusions.
• CBT starts with an initial assessment, in which the patient and therapist identify the patient’s problems. Thereafter, the patient and therapist agree on a set of goals, and plan of action to achieve these goals.
• If CBT is using Beck’s cognitive triad, the therapist will help the patient to identify negative thoughts in relation to themselves, their world and their future.
• In CBT the patient and therapist will work together to challenge the irrational thoughts, by discussing evidence for and against them.
• In CBT the patient will be encouraged to test the validity of their negative thoughts and may be set homework, to challenge and test their negative thoughts.
• The ABC model of treatment was first created by Ellis (1957) mainly for people suffering from depression. However it has since being applied to people with schizophrenia.
• When the ABC model is used in CBT there are six main stages; assessment, engagement, ABC model, goal setting, normalising and critical collaborative analysis.
• In Ellis’s CBT during the assessment patients express their thoughts and feelings about their experience with schizophrenia whilst the therapist listens actively.
• During the engagement stage of CBT the use of Socratic questioning and empathy helps build a rapport between the patient and the therapist.
• In Ellis’s approach to CBT therapists will work though the ABC model and include D (dispute) and E (effect). Like Beck, the main idea is to challenge irrational thoughts, however, with Ellis’s theory this is achieved through ‘dispute’ (argument).
• In CBT there are different types of dispute which can be used. Logical dispute is where the therapist questions the logic of a person’s thoughts and empirical dispute where the therapists seeks evidence for a person’s thoughts.
• In CBT an example of logical dispute is where the therapist may ask the patient, ‘does the way you think about that situation make any sense?’.
• In CBT an example of empirical dispute is where the therapist may ask the patient, ‘where is the evidence that your beliefs are true?’.
• During the goal setting stage of CBT patients work with the therapist to set realistic goals which are measurable and achievable.
• In CBT, the therapist will help the patient normalise their psychotic experiences. This is done through discussion and dispute.
• In CBT once trust is formed, gentle questioning is used to help the patient appreciate their maladaptive beliefs. This is the critical collaborative analysis stage.
• In CBT following a session, the therapist may set their patient homework to do at home, with the idea that the patient is encouraged to identify their own irrational beliefs and find alternative ways to stop or change them.
• Sensky et al (2000) compared CBT with nonspecific befriending interventions. They used a group of 97 patients in the UK who were nonresponsive to medication. After an average of 19 sessions patient showed improvements in both positive and negative symptoms.
• Sensky et al (2000) found that CBT has significant and lasting benefits even after nine months, for both positive and negative symptoms of schizophrenia.
• Coping strategy enhancement (CSE) is a technique which aims to help schizophrenics find the best strategies to deal with their symptoms.
• In a recent form of CBT patients create an avatar to represent the voices they hear in their mind. In this avatar therapy patients practise strategies for challenging and overcoming the threats made by negative voices.
• Bradshaw (1998) followed a single patient over four years. Over the period of treatment her symptoms improved dramatically, and it was suggested that CBT contributed to this.
• Turkington et al (2004) demonstrated how CBT can be used to challenge positive symptoms of schizophrenia such as paranoid delusions.
• Jauhar et al (2014) reviewed 34 studies of using CBT with schizophrenia, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms.
• Pontillo et al (2016) found reductions in frequency and severity of auditory hallucinations when using CBT.
• Clinical evidence from NICE (2019) which is the National Institute for Health and Care Excellence, recommends CBT as a beneficial treatment for schizophrenia.
• CBT works in combination with drug therapy and is more effective than either treatment on its own. NICE guidelines recommend the combination of CBT and drug therapy for patients with schizophrenia.
• CBT requires a skilled therapist who is trained to work with patients with psychosis.
• CBT is a very time consuming process and several sessions are required before a patient sees any improvement in their symptoms.
• CBT is not suitable for all patients. People with extreme agitation or anxiety may not be able to rationalise or empathise with a therapist.
• CBT is not suitable for acutely psychotic patients who are too ill to engage with the demanding therapy.
• Trower et al (2004) suggest that CBT provides strategies for dealing with schizophrenia rather than treating the symptoms.
• CBT may improve the quality of life for people with schizophrenia but may not actually cure them.
• CBT as a treatment fails to consider the biological nature of schizophrenia. It does not reduce excessive dopamine levels.