CBTp

who recommends this treatment

NICE

what are the stages of CBTp and describe them

1. assessment= This is where they talk through there symptoms and come up realistic goals and how to achieve them

2. Engagement= The therapist empathises with there perspective and feelings of distress and shows how explanations for there stress can be developed together

3. ABC model

4. Normalisation= In Cognitive Behavioural Therapy for psychosis (CBTp), normalisation means helping a person see that their unusual thoughts, beliefs, or perceptions can be understood as part of common human experiences, rather than something strange, dangerous, or unique to them.

5. Critical collaborative analysis = is a technique used in CBTp where the It is called “critical” because it involves thoughtful questioning and evaluationing there beliefs and experiences and “collaborative” because it is done jointly, not in a confrontational way — the therapist does not tell the client they are wrong, but helps them explore alternative explanations in a respectful, supportive manner.

6. Developing alternative explanations= This step involves working with the person to generate alternative, less distressing, and more realistic explanations for their unusual experiences or beliefs (such as voices, paranoia, or delusions).

explain the ABC model in depth with an example like schizophrenia 

what does the ABCDE model stand for

A=active event eg drug treatment causes side

B=beliefs eg effects hospital staff trying to kill me

C=consequences eg refusing treatment

D=disputing eg The staff have no reason to kill them

E=restructured beliefs eg The drugs are necessary

 

 

explain normalisation and how its implemented in therapy 

Normalisation= In Cognitive Behavioural Therapy for psychosis (CBTp), normalisation means helping a person see that their unusual thoughts, beliefs, or perceptions can be understood as part of common human experiences, rather than something strange, dangerous, or unique to them.

The goal is to reduce stigma, distress, and hopelessness by showing that many people have odd thoughts or perceptions, especially under stress, and that these experiences don’t automatically mean someone is “mad” or “broken.”

🔹 How it’s used in therapy:

• The therapist might explain that hallucinations and delusional thoughts can occur in anyone under certain conditions (e.g., lack of sleep, extreme stress, drug use).

• They encourage the client to see their symptoms as understandable reactions rather than as signs of personal failure.

• This helps reduce shame and self-stigma, which makes it easier for the person to engage in therapy and explore coping strategies.

what type of symptoms does it target and treat

CBTp that specifically aims to treat positive symptoms such as hallucinations and delusions by helping identify disorganised and distorted beliefs and faulty interpretations

CBTp can also be used to treat negative symptoms such as avolition and and social withdrawal by encouraging behavioural activation and goal setting

what is behavioural activation

In CBTp for schizophrenia, behavioural activation involves encouraging and supporting the person to re-engage in meaningful, structured, and rewarding daily activities that they may have reduced or avoided due to negative symptoms (like low motivation, social withdrawal, or lack of pleasure).

🔹 Purpose:

• To increase activity levels and reconnect the person with enjoyable or valued experiences.

• To counteract the negative symptoms of schizophrenia (such as apathy, social isolation, and reduced goal-directed behaviour).

• To improve mood, motivation, and self-esteem by increasing contact with positive reinforcement.

strengths of CBTp evidence in support 

There is strong evidence in support of the effectiveness of CBTp. NICE in 2014 found that CBTp when combined with standard care significantly reduced symptom severity and  a reduction in rehospitalisation rates up to 18 months after treatment. Not only that but Sensky et al showed that patients who had resisted drug treatments had a reduction in positive & negative symptoms when treated by 19 sessions of CBTp. This shows that it provides a key treatment plan for those who drug treatment isn’t an option. 

limitation  related to real world application

P= A major limitation of CBTp is its restricted availability and it varying levels of effectiveness depending on the stage of schizophrenia. 

E= As mentioned before the NICE recommend that it is used as a treatment for all patients yet Haddock et al found that only 6.5 % of patients in the north west had been offered it. Furthermore Addington and Addington in 2005 noted that CBTp was less effective during the acute phase when self reflection is difficult  

E= this suggest that whilst CBTp can be beneficial  however its practical impact can be limited by both systematic barriers and the readiness of the patients readiness for therapy. It may not be suitable for all individuals especially those on early or sever stages of the psychosis

L= Therefore although CBTp targets both positive and negative symptoms its real world applications is constrained reducing its overall effectiveness as a universal treatment.    

One more limitation

P= The evidence based for both CBTp and family therapy is weakened by methodological flaws in research studies

E=Juni et al highlighted that many studies suffer from poor design such as lack of random allocation or blinding. Wykes et al in 2008 found that more rigorous the studies the smaller effects of CBTp . A lack of random allocation in CBTp trials means that participants may not be evenly matched across treatment and control groups. For example, individuals with milder symptoms, higher motivation, or stronger support networks may be more likely—intentionally or unintentionally—to end up in the CBTp group. This creates selection bias, making CBTp appear more effective than it actually is because improvements could be due to pre-existing differences rather than the therapy itself. Similarly, the absence of blinding increases the risk of observer and participant bias. If participants know they are receiving CBTp, they may expect to improve and consequently report fewer symptoms, regardless of genuine change as well If researchers or clinicians know who is receiving CBTp, they may (consciously or unconsciously) rate symptom improvements more favourably. In schizophrenia research, where symptom assessment relies heavily on subjective clinical judgement, this is especially problematic. This may cause exaggerated increase in the results. They may not actually be as effective as they appear.