CBTp 10

• ABC model

  Patient describes Activating event that is the cause of their irrational Beliefs / Behaviour, as well as the Consequences.

  These beliefs can then be challenged or disputed and changed. To challenge their beliefs they are asked for evidence of their belief.
• Dysfunctional thought diary

  Asked to keep a record of how they felt, what they did & what they thought about a particular event.

  Client writes down their automatic negative thoughts associated with these events.

  Client then challenged to think differently about the event & asked to record different views on the event & provide evidence that their way of thinking is appropriate.

  Client & therapist discuss entries.
• Behavioural experiments

  May be used particularly to challenge hallucinations.

  Client asked to identify situations / actions they could take to lessen the voices they hear.

  These situations & actions could be listen to music, garden, etc.

  The client will rate the severity of the voices they hear & this allows them to realise they can control the voices they hear.
• Behavioural skills training

  Behavioural strategies like relaxation, pleasant activity scheduling, problem solving are taught.

  These strategies can be employed to cope with the residual symptoms, symptoms that aren’t managed by medication & symptoms such as anxiety & depression.
• Relapse prevention strategies

  Therapist & client identify early warning indicators of relapse (thoughts, feelings, behaviours).

  Client & therapist make plan for when they notice these indicators (Telling family / friends, support options, strategies).
• Phases of CBTp

  Engagement & befriending

  Assessment of experiences

  Formulation development

  Application of intervention & skill building

  Consolidation of skills
• Engagement & Befriending

  Relationship built between therapist & client.

  Builds trust which is important as client may have paranoia or negative experiences.

  Create a problem list and goals.
• Assessment of experiences

  Allows the therapist to tailor the therapy to the client.
• Formulation Development

  Helps therapist & client gain a better understanding of the links between the client‘s early experiences and their thinking patterns / symptoms.

  Highlights changes that need to be made to challenge symptoms.
• Application of intervention & skill building

  Interventions developed.

  Coping strategies.
• Consolidation of Skills

  Requires active participation of client.

  Client tests skills discussed in session in the real world & provides feedback on their effectiveness.
• Aims of CBTp

  To alter the way in which the patient thinks, helping them to manage disordered thinking.

  Promotes the management and understanding of symptoms but does not eradicate them.
• Kuipers et al

  60 individuals with SZ who were seen to be medication resistant were randomly allocated to one of two conditions:

  CBT plus standard care (medication & supportive counselling).

  Standard care only.

  50% of those who received CBT improved compared to 31% of those who didn’t.
• Jauhar et al


  Meta-analysis of 50 CBT studies over a 20 year period found CBT only has a small therapeutic effect hallucinations & delusions.
• Ethical strengths of CBTp

  Client has more control over therapy as they have more input.

  Ownership over improvement of symptoms could boost self esteem.

  No side effects in comparison to other therapies such as antipsychotics.
• Ethical weaknesses of CBTp

  Patient blame.

  Psychiatric prejudice - psychiatrists may decide that CBTp isn’t suitable for someone without giving them a chance. They may prescribe antipsychotics because it’s easier.

  Pressure placed on the patient to recovery in limited sessions if they cannot afford private.
• Positive social implications of CBTp

  Gives patient coping strategies to allow them to live a normal life. Makes SZ less intrusive to daily life.
• Negative social implications of CBTp

  Attending the therapy may not suit their daily routine.

  Costly therapy.

  Often used alongside antipsychotics and has a high drop out rate - is it worth the cost?

  Not everyone can access it - not all NHS trusts offer it, costly, long waiting lists.