CBTp

• what does CBTp aim to do?

  a form of cognitive therapy (way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs) in order to identify and correct faulty interpretations of events
• what does CBTp assume about schizophrenics?

  • people have distorted beliefs that influence their feelings and behaviours
  • delusions result from faulty interpretations of events
• how many sessions do NICE recommend for CBTp?

  16
• how does CBTp help a schizophrenic patient

  • helps people establish links between thoughts, feelings and actions and symptoms, and a general level of functioning
  • therefore consider alternative ways to explain why they feel and behave the way that they do
  • reduces stress and therefore improves functioning
• Describe the nature of CBTp

  • can be delivered in groups, but usually done on a one to one basis
  • patients trace back the origins of their symptoms to get an idea of how they might have developed
  • evaluate the content of their delusions/any voices
  • consider the ways they might test their faulty beliefs
  • set behavioural assignments to improve their general level of functioning
  • therapist allows the patient to develop their own alternatives to these maladaptive beliefs, ideally looking for alternative coping strategies and explanations present in the patient's mind
• why do schizophrenics learn maladaptive responses to life's problems?

  • distorted thinking by the schizophrenic
  • mistakes in assessing cause and effect (eg- assuming that something terrible has happened because they wished it)
• state the 6 stages of CBTp

  • assesment
  • engagement
  • ABC model
  • normalisation
  • critical collaborative analysis
  • developing alternative explanations

  Abby

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• what is involved in assessment?

  patient expresses his/her thoughts about their experiences. realistic goals are discussed, using patient's current distress as motivation for change
• what is involved in engagement?

  therapist empathises with the patient's perspective and feelings of distress. emphasises explanations for distress can be developed together
• what is involved in the ABC model?

  patient explains their activating events, beliefs and consequences of said beliefs. Beliefs can then be rationalised, disputed and changed
• what is involved in normalisation?

  placing psychotic experiences on a continuum with normal experiences, patient feels less alienated and stigmatised, and the possibility of recovery seems more likely eg- many people experience hallucinations or delusions in moments of stress
• state what's involved in critical collaborative analysis

  gentle questioning to help the patient understand illogical conclusions. Can be carried out without causing distress if there's trust between patient and therapist, and no judgement
• what is meant by developing alternative explanations?

  patient develops their own alternative explanations for previously unhealthy assumptions, these healthier explanations might have been weakened by their dysfunctional thinking patterns
• advantages and disadvantages of CBTp?

  • 😊- CBTp over standard care - NICE review of treatments for CBTp compared to standard care, CBTp is effective in reducing rehospitalisation rates up to 18 mths after treatment. However most CBTp treatments used alongside antipsychotics- difficult to determine an independent effect
  • 😊- allows patient to take responsibility for own treatment- enhances effectiveness in other areas of life in developing functional skills
  • ☹️ - CBTp isn't available to everyone- 1/10 people who could benefit from CBTp in UK get access to it. Significant amount of people also refuse CBTp or fail to attend sessions- limits effectiveness
  • ☹️- problems with methodology- study quality - failure to randomly allocate pps to CBTp or control condition, or failure to mask treatment conditions for interviewers carrying out assessments. Such studies are grouped into meta-analyses and decrease accuracy of findings