Psychological treatments

• Cognitive-behavioral therapy (CBT)


  A type of therapy where therapists and clients work together towards the client's goals
• CBT therapists


  • Develop a trusting and accepting relationship called a therapeutic alliance
  • This is central to the success of the therapy as CBT is a collaborative exercise
• CBT therapy


  1. Therapists and clients work together

  2. Towards the client's goals
• Length and number of sessions

  Depend on the client's needs
• Therapists


  Help their clients to develop self-awareness through understanding the links between daily events, physical sensations, thoughts and feelings
• Therapy


  • Focuses very much on present issues, as opposed to past life events
  • Helps the person to explore how thoughts are interlinked and how they reflect our core beliefs about the world and our place within it
• This in itself can be empowering as it allows people to begin to take control of their thoughts and feelings rather than being controlled by them
• Exploring events, beliefs and feelings
• Relapse


  The return of symptoms that had previously improved
• Remission


  A reduction in symptoms to the point where the person no longer meets the threshold for diagnosis
• Decompensation


  Breakdown in an individual's defense mechanisms resulting in progressive loss of functioning or worsening of psychiatric symptoms
• These terms are often used when discussing the efficacy of the therapies, such as CBT
• The symptoms of schizophrenia can be extremely distressing
• Symptoms of schizophrenia


  Can lead to a build-up of stress
• Build-up of stress


  Can exacerbate symptoms and lead to further decompensation or loss of functioning
• CBT therapy


  Aims to develop coping skills, including stress management
• Key treatment goal


  • To help the person to identify early warning signs (prodromal symptoms) that precede decompensation
• Preventing relapse through stress management

  1. Proactive initiation of coping strategies

  2. Stress reduction

  3. Ensure symptoms do not worsen
• CBT involves


  1. Educating the person (and their family) about schizophrenia (e.g. that voice-hearing can result from misattribution of the inner voice)

  2. How it can be affected by stress

  3. Strengthening their sense of self and combating feelings of stigmatisation that can result from a diagnostic process
• CBT Strength


  • The therapist and client work collaboratively, removing the imbalance of power which is a feature of biological treatments
  • With both ECT and drug treatments, the client's role in their recovery is minimal, but with CBT they are responsible for their own progress
  • Helps to rebuild the person's self-worth by developing self-efficacy
• CBT weakness


  • Relies on the quality of the therapeutic alliance
  • Some patients may lack the necessary communication skills to connect with the therapist
• People with low levels of literacy, organisational skills and/or motivation may be unable to complete homework exercises (e.g. keeping diaries) between sessions
• CBT may only be effective for some clients and others may require additional support between sessions for it to be as effective for them
• Strengths


  • All treatment sessions were audiotaped
  • A blind rater randomly selected a sample of the tapes to assess the quality
  • Improved internal validity as the rater was able to check that the befriending sessions did not contain elements of CBT and that the CBT sessions covered all of the expected elements
  • The sample was selected from 5 clinical services in London, Newcastle, Cleveland and Durham, UK
  • Generalizations can be made as the sample included people living in a variety of urban and more rural locations
• Aim


  To compare the efficacy of one-to-one CBT and a befriending intervention for people with schizophrenia
• CBT may only lead to enduring benefits for a certain subset of people with schizophrenia, such as those that have coherent speech