A03

• What are the strengths of cognitive-behavioural therapy?

  1. Advantages over drug therapy
  2. Effectiveness of CBT
• What are the limitations of cognitive-behavioural therapy?

  1. Dependent on the stage of disorder
  2. Effectiveness may have been overstated
  3. Lack of availability
• Strength = advantages over drug therapy

  • The NICE (2014) review of treatments for schizophrenia found consistent evidence that, when compared with standard care (antipsychotic medication alone), CBTp was effective in reducing rehospitalisation rates up to 18 months
  • CBTp was also found to be more effective in reducing symptom severity and improving social functioning compared to standard care
• Strength = effectiveness of CBT

  • Sensky et al. (2000) found that CBT was effective in treating patients with schizophrenia who hadn’t responded to drug treatment
  • CBT was helpful with both positive and negative symptoms and a continued improvement was seen 9 months after treatment with CBT ended
• Limitation = dependent on the stage of disorder

  • CBTp may not be effective for all stages of the disorder
  • Addington and Addington (2005) - in the initial acute phase of schizophrenia, self-reflection is not particularly appropriate
  • Positive symptoms lead to lack of self-awareness and negative symptoms lead to reluctance to engage, both of which are vital for CBTp
  • It has been found that CBTp is more effective for individuals with more experience of their schizophrenia and a greater realisation of their problems
• Limitation = effectiveness may have been overstated

  • One recent large-scale meta-analysis revealed only a ‘small’ therapeutic effect on the key symptoms of schizophrenia
  • Even these small effects disappeared when symptoms were assessed ‘blind’ (assessors unaware of whether the patient was in therapy or a control condition)
  • This uncertainty regarding the effectiveness of CBTp has resulted in conflicting recommendations even within the UK
  • England and Wales emphasise the use of CBTp, whereas Scotland places more emphasis on antipsychotic medications
• Limitation = lack of availability

  • Despite being recommended by NICE as a treatment for people with schizophrenia, it is estimated that in the UK only one in 10 of those who could benefit get access to this form of therapy
  • Haddock et al. (2013) carried out a survey in North West of England
  • Found that of 187 randomly selected patients diagnosed with schizophrenia, only 13 had been offered CBTp
  • Even those that were offered CBTp, a significant number failed to attend the therapy sessions as they struggled to commit to a large amount of sessions and further limiting its effectiveness