Cognitive Behavioural Therapy for Psychosis (CBTp)

• Based on the idea that people have distorted beliefs and these influence feelings and behaviour in maladaptive ways
• Aim

  Help patients to identify irrational thoughts, their origin and how these affect behaviour (symptoms)

  To correct these faulty interpretations and consider alternative ways of explaining the ways they behave and feel

  Does not get rid of the symptoms (drug therapy), but helps patients to cope better with symptoms, reduce stress, and improves functioning
• Usually takes place for 5-20 sessions, with NICE recommending 16 sessions

  Can take place individually or in groups
• Assessment

  The patient expresses their thoughts about their experiences to the therapist

  Realistic goals for therapy are discussed, using the patients current distress as motivation for change
• Engagement

  The therapist empathises with the patients perspective and their feelings of distress, and stresses that explanations for the distress can be developed together
• ABC Model

  The patient gives their explanation of the activating events (A) that appear to cause their emotional and behavioural (B) consequences (C)

  The patients own beliefs, which are usually the cause of the consequences, can then be rationalised, disputed, and changed

  For example, the belief that ‘people wont like me if I tell them about my voices’ might be changed to a more healthy belief e.g ‘Real friends may understand it’
• Normalisation

  Information that many people have unusual experiences such as hallucinations and delusions under many different circumstances (eg situations of extreme stress) reduces anxiety and sense of isolation

  By placing psychotic experiences in a continuum with normal experiences, the patient feels less alienated and stigmatised, and the possibility of recovery seems more likely
• Behavioural assignments

  Tasks patients are set to improve their general level of functioning

  EG, to shower everyday or to go out and socialise before the next session
• Critical collaborative analysis

  The therapist uses gentle questioning to help the patients understand illogical deductions and conclusions

  For example, ‘if your voices are real, why cant other people hear them‘

  Questioning can be carried out without causing distress, provided there is an atmosphere of trust between the patient and the therapist, who remains empathetic and non-judgemental
• Developing alternative explanation

  The patient develops their own alternative explanations for their previously unhealthy assumptions

  These healthier explanations might have been temporarily weakened by their dysfunctional thinking patterns

  If the patient is not forthcoming with alternative explanations, new ideas can be constructed in cooperation with the therapist
• Strength - Supporting evidence - Jauhar et al (2014)

  Reviewed result of 34 studies of CBTp, concluding that it has a significant but fairly small effect on symptoms

  However, this is only modest supporting evidence
• Strength - Supporting evidence

  Many small scale studies where patients are compared before and after psychological treatment have found more positive results

  However, these studies often lack control groups, or if there is one, they’re not often randomly allocated to treatment and control conditions

  Where these studies are included in reviews, conclusions are generally more optimistic than those that strictly control which studies are included
• Eval - Treatments improve QoL but do not cure

  CBT helps to allow a person to make sense and in some cases challenge some of their symptoms

  Drug therapy and biological approaches have a higher chance of reducing the severity of symptoms
• Weakness - Ethical issues

  CBT may involve challenging someone’s paranoia, but at what point does this interfere with someone’s freedom of thought

  Challenging a patients beliefs in a highly controlling government, can easily stray into modifying their politics

  However, no side effects which could accompany drug therapy