cognitive treatments

• Cognitive behavioural therapy:

  • Commonly used to treat schizophrenia - 5-20 sessions
  • Need to identify and manage hallucinations and delusions
  • Patient is encouraged to develop rational interpretations or alternative perceptions - e.g- viewing hearing voices as interesting rather that threatening - normalisation 
  • Delusions can be reality tested and challenged - jointly examining the likelihood that beliefs are true 
• Coping strategy enhancement - type of cbtp:

  • Tarrier devised a specific form of CBTp for people with schizophrenia - involves building upon the existing coping strategies
  • Identifying triggers for schizophrenic episodes 
  • Aim is to develop and apply coping strategies for the psychotic symptoms and the accompanying stress they produce 
  • Cognitive strategies such as distraction, concentrating on a specific task and positive self talk 
• Main elements:

  1. Develop a rapport (validating experiences) with the client and identity the triggers of psychotic symptoms, plus review existing coping strategies and develop new ones 
  2. Target specific symptoms and find strategies to deal with them 

  • Participants have homework assignments to consolidate their learning between sessions
  • Overall aim - 2 strategies for each symptom
• Supportive evidence:

  • Jauhr - meta-analysis - small but significant effects on positive and negative symptoms 
  • NICE review - found consistent evidence that CBTp is effective in reducing rehospitalisation up to 18 months post-therapy 
  • Therapy can be adapted to the individual and their symptoms to better treat them
• Opposing evidence:

  • Different studies use different variations of CBTp so meta-analysis can be difficult to compare 
  • Dependent on the stage of the disorder- Addington & Addington found CBTp requires stability of the patient first - may have to take drugs
• limitations

  • Dropout rates can be high due to the length of therapy, difficulty with confrontation 
  • Also shortage of therapists who can provide CBTp as it is a complex training process