CBTp

Question 1

aim of CBTp

Answer 1

• help patients identify irrational thoughts and challenge them and reality testing them to reduce distress
• by establishing links between thoughts, feelings, actions and their symptoms and general level of functioning so symptoms can be monitored/coped with effectively to reduce distress and improve functioning

Question 2

how long is CBTp

Answer 2

• 5-20 sessions
• NICE recommends at least 16 sessions

Question 3

ABCDE model

Answer 3

challenges delusions
- Activating events
- Beliefs
- consequences
- dispute
- effect

Question 4

Activating events

Answer 4

• CBTp involves identifying activating events

Question 5

Beliefs

Answer 5

• the resulting beliefs from the activating events
• that appear to cause their emotional and behavioural consequences

Question 6

consequences

Answer 6

• emotional and behavioural consequences caused by beliefs

Question 7

Dispute

Answer 7

• beliefs can be rationalised , disputed and changed through critical collaborative analysis and reality testing

Question 8

effect

Answer 8

• effect from critical collaborative analysis and reality testing is that patient develops alternative explanation for previously unhealthy thoughts
• so beliefs are restructured and are more rational

Question 9

does CBTp get rid of schizophrenia?

Answer 9

• rather than getting rid of it, it helps patients cope better with their symptoms because it reduces distress
• e.g. therapist tried to convince patient that voices come from malfunctioning speech centre in their own brain and it cannot hurt them if they ignore it
• so this is much less frightening

Question 10

CBTp normalisation

Answer 10

• treats hallucinations
• therapist shares that many people have unusual experiences like hallucinations/delusions in many different circumstances e.g. extreme stress
• reassure patient that auditory hallucinations is an extension of ordinary experiences of thinking in words
• reduces anxiety/distress and sense of isolation by making patient feel less alienated and stigmatised
• makes possibility of recovery seem more likely and improves ability to function adequately

Question 11

CBTp behavioural assignments

Answer 11

• may be set behavioural assignments to improve general level of functioning
• e.g. shower every day, go out, socialise with friends once between now and next session
• may include relaxation techniques

Question 12

evaluation points for CBTp

Answer 12

• weakness of effectiveness from not curing schizophrenia
• weakness of appropriateness from motivation
• weakness of appropriateness from ethical issues
• supporting evidence for effectiveness from NICE review

Question 13

weakness of effectiveness of CBTp from not curing schizophrenia

Answer 13

• CBTp focuses on managing schizophrenia rather than curing it.
• It helps patients understand and challenge their symptoms through critical, collaborative analysis.
• This can improve quality of life, making symptoms more manageable.
• However, these benefits should not be mistaken for a cure.
• CBTp provides coping strategies for current and future symptoms, but does not eliminate the disorder.

Question 14

weakness of appropriateness of CBTp from motivation

Answer 14

• CBTp requires high levels of motivation and commitment, as it involves multiple long-term sessions.
• Patients must be self-aware and willing to engage, which can be difficult for many with schizophrenia.
• Positive symptoms (e.g., delusions) can reduce insight, making engagement harder.
• Negative symptoms (e.g., apathy, withdrawal) can limit motivation and ability to participate.
• The long duration of therapy increases the risk of dropout, especially during severe episodes.
• Therefore, CBTp may not be suitable for all patients, limiting its appropriateness as a universal treatment.

Question 15

weakness of appropriateness of CBTp from ethical issues

Answer 15

• CBTp can raise ethical concerns, especially when challenging a patient’s paranoid beliefs.
• Intervening in these beliefs may risk infringing on a person’s freedom of thought.
• Challenging certain delusions (e.g., beliefs about government control) can blur the line between treating symptoms and influencing personal or political views.
• This creates a risk of therapists unintentionally modifying a patient’s beliefs beyond clinical aims.
• Therefore, these ethical issues weaken the appropriateness of CBTp as a treatment for schizophrenia.

Question 16

supporting evidence for effectiveness of CBTp from NICE review

Answer 16

• found that CBTp, compared with antipsychotics alone, reduced rehospitalisation rates for up to 18 months after treatment.
• CBTp also reduced symptom severity and improved social functioning
• Overall, evidence suggests modest but reliable effectiveness, indicating that CBTp may offer better long-term benefits than drug therapy.
• This is because CBTp equips patients with coping strategies they can continue using after therapy ends.

Question 17

critical collaborative analysis

Answer 17

• where therapist uses gentle questioning to help patient understand/challenge illogical delusions e.g. ‘if your voices are real, why can no one else hear them?’
• so patient develops alternative explanations for previously unhealthy assumptions
• so beliefs are restructured and are more rational
• patient becomes better at identifying delusional thoughts

Question 18

reality testing

Answer 18

• patient and therapist jointly examine likelihood that beliefs are true
• so patient develops alternative, more rational explanations for previously unhealthy assumptions
• therefore effect is restructured beliefs