Cognitive Behavioural Therapy for Schizophrenia

Outline the dysfunctional thoughts a person with schizophrenia may have?

• Metarepresentation

• Central control

What is the aim of CBT treatment for Schizophrenia?

Identifying and changing maladaptive and irrational thinking in order to stop positive symptoms such as delusions and hallucinations

Explain how CBT could be used to challenge auditory hallucinations

Therapist helps patient challenge auditory hallucinations by helping patients understand the “origin of the voices”

• This will not eliminate the symptoms of schizophrenia, but it can make patients better equipped at coping with them

Patients can also be taught to “tune out” auditory hallucinations

• This will reduce patient distress and improves their ability to function adequately

Explain how CBT could be used to challenge the delusions (faulty beliefs)

1. Faulty thoughts/delusions are identified

2. Delsions can be challenged by a process of reality testing (where patient acts as scientist)

3. Therapists and patient examine evidence and look for alternative reasons for thoughts

What is meant by ‘patient as a scientist’?

1. Patients tests the reality of there delusions

2. By recording experiences that prove their delusions down in a diary

How does Tarrier support the effectiveness of CBT as a treatment for schizophrenia?

Reviewed:

• 20 controlled trials of CBT

• 739 schizophrenia patients

Findings:

• Persistent evidence of reduced symptoms (especially positive symptoms)

• Lower relapse rates

• Speedier recovery time

What is the main strength of CBT compared to drug therapy?

Fewer side effects than drug treatment

Outline Tarrier’s research supporting the interactionist approach

Patients randomly allocated into 3 groups:

1. CBT and medication

2. Counselling and medication

3. Medication only (control)

Findings:

• Group 1 and 2 showed lower symptom levels

• Supports benefits of the interactionist approach to treatment

Why is it difficult to assess the effectiveness of CBT independently of drug treatment?

• Cannot ethically take schizophrenia patients off drug treatment

• Therefore don’t know if CBT will be effective on its own

Why is it difficult to know the reason/s why CBT is effective?

• It may not be the specific techniques that cause improvement in symptoms of Schizophrenia

• For example counselling may be just as effective (Tarrier et al. 2004 found counselling + medication had a similar symptom improvement to CBT + medication)

• So just having someone to talk to could actually be what is improving Schizophrenia symptoms and not the CBT treatment itself

Why is CBT not a cure for schizophrenia? However why is it still useful?

• CBT does not treat underlying cause of cognitive problems

• However it improves quality of life for schizophrenia patient