CBTp

Question 1

Describe the aims of CBT for treating schizophrenia

Answer 1

It aims to deal with both the thoughts and behaviour of a person with schizophrenia

Question 2

What is the ABCDE model?

Answer 2

A ctiviating event
B elief - identify delusional belief
C onsequence - how the delusion affects their feelings and actions
D isputing *
E ffect - restricted beliefs, less distressed and better at identifying delusions

Question 3

What are the two types of disputing?

Answer 3

Reality testing -‘what is the likelihood that..?’
Critical collaborative analysis - gentle logical disputing

In disputing they also have to provide an alternative to the patient as they don’t have the insight to see their delusion is irrational (unlike someone with depression)

Question 4

What is normalisation?

Answer 4

telling them how their thoughts (hallucinations) aren’t really weird - makes them less distressed so they don’t isolate so they function adequately

Question 5

What do you add to the end of the ABCDE model

Answer 5

normalisation and behavioural assignments

Question 6

Does CBTp enable patients to be cured of schizophrenia?

Answer 6

No- rather than ‘getting rid’ of schizophrenia, CBTp helps patients to cope better with their symptoms because it reduces distress.

Question 7

Differences between CBT and CBTp

Answer 7

1. The disputing is different. In CBTp they use critical collaborative analysis and reality testing to lead to restructured beliefs (the effect)
   
   2. They also use normalisation which they don’t typically in regular CBT.
   3. The behavioural assignments (homework) are about improving their general functioning (e.g. Showering, socialising)

Question 8

Weakness of CBTp (ethics)

Answer 8

It may have ethical issues: CBTp may involve, for example, challenging a person’s paranoia. At what point does this interfere with an individual’s freedom of thought?

If, for example, CBTp challenged a patient’s beliefs in a highly controlling government, this can easily stray into modifying their politics. This is a weakness of CBTp as a treatment for schizophrenia (appropriateness).

Question 9

Weakness of CBTp (effectiveness)

Answer 9

CBTp may be more effective at certain stages of the disorder. Addington and Addington (2005) claim that self-reflection is not particularly appropriate during the initial acute phase of schizophrenia. Following stabilisation of the psychotic symptoms with antipsychotics, individuals may then benefit more from group-based CBTp.

This can help to normalise their experience by meeting others with similar issues. Research has found that it is those with more experience of their schizophrenia and a greater realisation of their symptoms that benefit more from individual CBTp. This suggests that CBTp is effective, but may be more appropriate in the latter stages of treatment rather than initially.

Question 10

Weakness of CBTp (motivation)

Answer 10

CBTp requires motivation that patients may not have. The length of the therapy means that patients have to be motivated and committed to multiple sessions. The therapy itself also requires self-awareness and a willingness to engage with the process.

However, the positive symptoms of schizophrenia lead to a lack of awareness and the negative symptoms lead to a reluctance or inability to engage. The length of the therapy also leads patients to drop out at times of severe episodes. Overall, this suggests that CBTp may not be an appropriate treatment for all patients with schizophrenia.

Question 11

Strength of CBTp

Answer 11

There is evidence to support the benefits of CBTp for schizophrenia. The NICE review of treatments for schizophrenia found consistent evidence that when compared with antipsychotics alone, CBTp was effective in reduction rehospitalisation rates up to 18 months following the end of treatment. CBTp was also shown to be effective in reducing symptom severity and improving social functioning.

Overall, there seems to be support for the effectiveness of CBTp, and this support suggests that CBTp may be a more effective long-term therapy than drug therapy as it provides patients with strategies that they can use to manage symptoms in the future beyond therapy.