Download cognitive behavioural therapy treatment for

LO: To be able to describe and evaluate
the
Cognitive Treatment for Schizophrenia
CBT
• Psychological treatments, such as cognitive
behavioural therapy (CBT), can help people
with schizophrenia to cope better with the
symptoms of hallucinations or delusions.
• Psychological treatments can also help to
treat some of the negative symptoms of
schizophrenia, such as apathy or a lack of
volition, motivation and enjoyment in life.
• It is not a cure for Sz – it does help improve
quality of life though.
We need to ask
1. is it an appropriate therapy?
2. is it an effective therapy?
What is CBT?
• Cognitive behavioural therapy (CBT) is based on the idea that most unwanted
thinking patterns, and emotional and behavioural reactions are learnt over a long
period of time.
The CBT approach to treatment of schizophrenia
differs slightly from conventional CBT methods.
The aims of this therapy are as follows:
• To challenge and modify delusory beliefs
• To help the patient to identify delusions
• To challenge those delusions by looking at evidence
• To help the patient to begin to test the reality of the evidence
An example of a delusional belief
Event
• Overhearing someone saying “I know what’s on your
mind”
Interpretation
• Everyone can read my thoughts
Feeling
• Paranoid, scared and believing that others will attack
me for my thoughts
Behaviour
• Take evasive action – avoiding situations that will bring
me into contact with others
CBT TECHNIQUES
• Patients are
encouraged to trace
back to the origins of
their symptoms in order
to get a better idea of
how they may have
developed.
• Try to help the patient
come up with rational
alternatives
LONG-TERM HELP
• The therapist encourages
patient to come up with their
own coping strategies for when
they experience any symptoms
• They may then receive help
and advice about how they
can avoid acting on delusional
thoughts.
• Patients come up with their
own solutions using their own
thoughts –i.e. alternative
explanations already present in
their own mind
For example, you may be taught to recognize
examples of delusional thinking in yourself.
e.g. – thinking that people what to kill you.
You may then receive help and advice about
how you can avoid acting on these thoughts.
e.g. – Rationalizing that people have no reason to want to hurt
you. Encouraging you to engage with people in meaningful
ways. Allowing opportunities to practice these new skills and
share your experiences and reflect on how it felt to engage in
positive social interactions.
• Normalizing strategies can be used where the patient is taught to
understand the nature of schizophrenic symptoms
• Challenge ‘catastrophizing’ beliefs about schizophrenia
Help patient feel that symptoms are understandable and ‘normal’
CBT Course
• Most people will require between 8 to 20
sessions of CBT over the space of 6 to 12
months. CBT sessions usually last for about an
hour.
This type of treatment has been shown to be
effective for reducing the positive symptoms of
schizophrenia, for reducing relapse and for
enhancing recovery when schizophrenia is
diagnosed early.
Cognitive Treatment
Sensky et al. (2000)
Aim
To compare cognitive behavioural therapy (CBT) with non-specific
befriending interventions for patients with schizophrenia
Design
A randomized controlled design.
Patients were allocated to one of two groups:
– a cognitive behavioural therapy group.
– a non-specific befriending control group.
Participants
90 patients.
 57 from clinics in Newcastle, Cleveland and Durham and 33 from
London. They had diagnoses of schizophrenia that had not responded
to medication.
 Aged 16–60 years.
Procedure
Patients were allocated to one of two groups.
Both interventions were delivered by two experienced nurses who received regular supervision.
Patients were assessed by blind raters



at baseline.
after treatment (lasting up to 9 months).
at a 9-month follow-up evaluation.
They were assessed on measures including the Comprehensive Psychiatric Rating Scale, the Scale for Assessment
of Negative Symptoms, plus a depression rating scale.
Patients continued to receive routine care throughout the study.
The patients received a mean of 19 individual treatment sessions over 9 months.
Cognitive behavioural
therapy condition
A normal routine of CBT was used:
initially engaging with patient
psycho education
developing a reason for the behaviour
Cognitive and behavioural interventions
treatment of other disorders such as depression
Reducing relapse by planning ahead
CBT Strategies Used
Specific techniques for positive symptoms of schizophrenia were
used:
– critical analysis of beliefs about auditory hallucinations.
– patients were helped to change their beliefs.
– patients taught coping strategies to deal with the voices.
Delusions and thought disorders were also addressed using
cognitive strategies.
Befriending condition
• The patients had the same time allocation at the
same intervals as patients in the CBT condition.
• The therapists were empathic and non-directive.
• There was no attempt at therapy:
The sessions focused on hobbies, sports and current
affairs.
Findings
• Both interventions resulted in significant reductions in
positive and negative symptoms and depression.
• After treatment there was no significant difference
between the two groups.
• At the nine-month follow-up evaluation, patients who
had received CBT therapy showed greater
improvements on all measures.
– They had improved, while the befriending group had lost
some of the benefits.
Conclusions
• Cognitive behavioural therapy is effective in treating negative as well as
positive symptoms in schizophrenia resistant to standard antipsychotic
drugs.
• Its efficacy is sustained for at least nine months.
Evaluate the research:
Evaluation of CBT
for Schizophrenia
 Shown to be effective for some patients
 Allows people to function more normally with symptoms, preventing
learned symptoms from developing.
 Can be used in conjunction with other therapies
 Improves symptoms, recovery and relapse rates
 No side effects
Chadwick & Lowe (1993) – found CBT led to significant reductions in
delusions in 10 out of 12 patients
 Doesn’t work for everybody
 Expensive and time consuming
 Helps 70% of patients although other 30% may deteriorate (Kingdon &
Turkington, 1996)
Bradshaw’s – ‘Carol’
Read the Case study and answer the
questions on the worksheet
Extension
Apply your knowledge:
• You have a friend that you believe has schizophrenia. You have been asked
to explain to them why they might have schizophrenia. They also ask you
about which treatments you would recommend. Which explanations /
treatments would you share with them? Are there any that you would
leave out?