treatment

•  cbtp - main aim is to help patients identify and challenge the irrational and maladaptive thoughts underlying schizophrenia.
• Cognitive behavioural therapy (CBT) is the main psychological treatment for schizophrenia. There are many different forms of CBT, but the main aim is to help patients identify and challenge the irrational and maladaptive thoughts underlying schizophrenia.
• For example, a schizophrenic patient may have delusional thoughts that there is a conspiracy to kill them. These thoughts cause negative emotions (e.g. fear, anxiety) and irrational behaviours (e.g. hiding from or attacking people).
• ✔ Identification of irrational thoughts – Patients learn to recognize and question their delusions and hallucinations.✔ Challenging beliefs – The therapist encourages the patient to consider alternative explanations for their experiences.✔ Developing coping strategies – Patients learn methods such as distraction, reality testing, or relaxation techniques to manage distressing symptoms.✔ Normalizing symptoms – The therapist explains that hearing voices or having unusual beliefs is not uncommon, helping to reduce stigma.
• More effective behaviours are put into place by questioning the reality of the patient’s beliefs and considering other, more reasonable alternatives. For example, beliefs about the Mafia can be rationalised as simply being based upon a single day where an individual was staring at the patient for an extended period of time, perhaps lost in thought.
• One of the main strengths of CBTp is that research evidence supports its effectiveness in reducing schizophrenia symptoms, particularly positive symptoms like delusions and hallucinations. Jauhar et al. (2014) conducted a meta-analysis of 34 studies and found that CBTp had a small but significant effect on positive symptoms. Similarly, Tarrier et al. (2004) found that patients receiving CBTp alongside antipsychotic medication showed greater symptom improvement compared to those receiving medication alone.
• Unlike drug treatments, which focus on symptom reduction, CBTp teaches patients active coping mechanisms to manage their symptoms more independently. Through cognitive restructuring, individuals learn to challenge delusional thoughts, recognize hallucinations as distortions of reality, and develop alternative explanations for their experiences. This encourages a sense of control over their illness, which can improve treatment adherence and overall well-being.
• However, CBTp requires active engagement and self-awareness, which can be difficult for individuals experiencing severe schizophrenia symptoms, such as disorganized thinking or extreme paranoia. This means CBTp may not be suitable for all patients, particularly those in the acute phase of schizophrenia.
• A major limitation of CBTp is that its effectiveness varies between individuals. Some patients respond well, while others show little to no improvement. Kingdon & Kirschen (2006) found that older patients and those with more severe symptoms were less likely to benefit from CBTp. Additionally, research suggests that patients with greater insight into their illness are more likely to benefit, while those with poor insight or rigid delusions may resist the therapy.
• This suggests that CBTp may not be a universally effective treatment, and clinicians should assess individual suitability before recommending it. Other psychological interventions, such as family therapy or supportive counseling, might be more appropriate for some patients.
•  Pharoah identified examples of how family therapy works: It helps family members achieve a balance between caring for the individual and maintaining their own lives, it reduces anger and guilt, it improves their ability to anticipate and solve problems and forms a therapeutic alliance.
• Economic Benefits: Family therapy is highly cost effective because it reduces relapse rates, so the patients are less likely to take up hospital beds and resources. The NICE review of family therapy studies demonstrated that it was associated with significant cost savings when offered to patients alongside the standard care – Relapse rates are also lower which suggests the savings could be even higher.