CBT and Sensky et al (2000)

aim of sensky

to compare the efficacy of one to one CBT and a befriending intervention for people with schizophrenia

procedure of sensky

randomly allocated to the CBT or befriending group. all participants had been medicated with 3000mg of chlorpromazine daily for six months but still experienced positive symptoms. symptoms were assessed by blind raters. they were assessed before to establish a baseline, post treatment up to 9 months later, and 9 months after treatment ended which was a follow up

what happened in the CBT sessions

therapists worked collaboratively with the patients to understand the development of both positive and negative symptoms and to reduce stress and disability 

what happened in the befriending group 

recieved the same amount of contact time with a therapist, at similarly spaced intervals. therapists were empathetic and non-directive. they talked about hobbies, sports and current affairs

what were the results

participants attended an average of 19 sessions in 9 months. there was no significant difference in the number of sessions attended by the CBT group compared to the befriending group. both groups showed a reduction in post-treatment symptoms but only the CBT group showed continuous improvement at the 9-month follow up. there was no difference in medication use between these two groups

whats the conclusion

CBT was more effective than befriending- patients continued to improve post-treatment to follow up, unlike befriending, where initial improvements were no longer evident at follow up

strengths (2)

all the sessions were audiotaped and a blind rater randomly selected a sample of tapes to assess the quality of the treatment. this improved internal validity as the rater was able to check that the befriending sessions did not contain elements of CBT and the CBT sessions covered all of the expected elements

sample was selected from 5 clinical services in london, newcastle, cleveland and durham. this means generalisations can be made as the sample included people living in a variety of urban and more rural locations

weaknesses (2) 

it is unclear whether CBT would be effective on its own, as in this study it was combined with drug treatment, although initially the participants were not responding to their medications, they were still taking them therefore it is possible that it was the combination of drugs and CBT that was effective

longitudinal design, which meant that some of the participants were excluded due to not completing a sufficient number of therapy sessions as 6 failed to engage at all and 9 dropped out before they had received sufficient therapy. participant drop out can reduce the representativeness of the sample, thus limiting generalisations that can be drawn, for example CBT may only lead to enduring benefits for a certain subset of people with schizophrenia, such as those that have coherent speech

what does CBT involve (3)

exploring events, beliefs and feelings. a therapeutic alliance. stress management

what is characteristic of exploring events, beliefs and feelings

helping their clients to develop self awareness through understanding daily events, physical sensations, thoughts and feelings. focusing on present issues rather than past events, explains how thoughts are interlinked and how they reflect our core beliefs

what happens in a therapeutic alliance

developing a trusting and accepting alliance. this is central to the success, as CBT is a collaborative exercise where therapists and patients work together towards the patients goals. 

what happens in stress management

aims to develop coping skills, including stress management. help the person identify prodromal symptoms (warming symptoms) that may precede decompensation, as proactive initiation of coping strategies and stress reduction can ensure that symptoms do not worsen

strengths of CBT (2)

the client and therapist work collaboratively which reduces the imbalance of power on the client. a therapy that encourages self-efficacy may help to improve the patients self worth

weaknesses of CBT (3) 

some patients may struggle with communication skills for example those experiencing negative symptoms. it is dependent on the effectiveness of therapeutic alliance. additional support may be needed in between sessions for some patients