CBT

• Cognitive behavioural therapy

  Aims to alter the way a patient thinks and alter behaviour through learning
• Aims of CBT

  - to alter the way patients with SZ think

  - help them manage their disordered thinking

  - challenge maladaptive thoughts
• Steps of CBT

  - assessment

  - engagement

  - ABC model

  - developing alternative explanations

  - critical collaborative analysis

  - normalisation
• Assessment

  The patient expresses their thoughts about their experiences to their therapist and realistic goals are discussed
• Engagement

  The patient has to fully engage with the therapist and commit to the therapy
• ABC model


  Activating event: the event that leads to an emotional response

  Beliefs: negative thought that occurred during the event

  Consequences: the negative feelings and dysfunctional behaviour
• Normalisation

  The patient learns that their behaviour is a symptom that can be managed and decatastrophises the situation
• Critical collaborative analysis

  The therapist uses questioning to help the patient understand illogical conclusions - they may be given homework to test an irrational belief
• Developing alternative explanations

  The patient develops their own explanations for their previous assumptions
• Kuipiers et al


  60 ppts were randomly allocated to 2 conditions: CBT+medication, medication alone

  Just medication: 25% improved, 3 got worse and 1 committed suicide

  CBT+medication: 50% improved, 1 got worse

  - shows that CBT can improve symptoms of SZ
• Why is CBT not suitable for all people?

  Patients who are in denial about their illness won't fully engage in the therapy
• Placebo effect in CBT

  There is no way to conduct a placebo trial so patients in a clinical trial are aware they are receiving the actual treatment - any improvement may be due to the placebo effect
• Strengths of CBT

  - no side effects

  - ppts consent to the treatment