CBT

• Basic assumption of CBT is that people often have distorted beliefs, which influence their feelings and behaviours in maladaptive ways
• Delusions are thought to result from faulty interpretations of events and CBT is used to help the patient identify and correct these faulty interpretations
• CBT can be delivered in groups but it is more usual that it is delivered on a one-to-one basis.

  NICE recommend at lease 16 sessions for SZ
• Phases of CBT:

  • Assessment
  • Engagement
  • ABC model
  • Normalisation
  • Critical collaborative analysis
  • Developing alternative explanations
• Assessment - 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 their distress can be developed together
• The ABC model -

  (A) patient gives their explanation of activating events

  (B) these events cause behaviour and emotional consequences (C)

  The patients own beliefs can then be rationalised, disputed and changed
• Normalisation - information that many people have unusual experiences such as hallucinations and delusions under many different circumstances reduces anxiety and the sense of isolation.

  By placing psychotic experiences on a continuum with normal experiences, the patient feels less alienated and stigmatised
• Critical collaborative analysis - the therapist uses gentle questioning to help the patient understand illogical deductions and conclusions
• Developing alternative explanations - 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
• AO3 - advantages

  The NICE review of treatments found consistent evidence that, when compared with antipsychotics, CBT was effective in reducing rehospitalisation rates up to 18 months following the end of treatment.

  CBT was also shown to be effective in reducing symptom severity comparing to patients receiving standard care, there was some evidence for improvements in social functioning
• AO3

  Most of the studies in effectiveness of CBT have been conducted with patients treated at the same time with antipsychotic medication. Its difficult, to assess effectiveness of CBT independent of antipsychotic medication
• AO3 - dependant on stage of the disorder

  CBT appears to be more effective when it is made available at specific stages of the disorder and when the delivery of the treatment is adjusted to the stage that the individual is currently at.
• AO3 - addington and addington

  Claims that in the initial acute phase of schizophrenia, self reflection is not particulalry appropriate. Following stabilisation of the psychotic symptoms with antipsychotic medication, however individuals can benefit more from group based CBT
• AO3

  Research has shown that individuals with more experience of their schizophrenia and a greater realisation of their problems benefit more from individual CBT
• AO3 - benefits of CBT may be overstated

  A meta analysis of effectiveness of CBT as a sole treatment suggests its effectiveness may be low

  One analysis revealed only a small therapeutic effect on the key symptoms of SZ. However these small effects disappeared when symptoms were assessed blind