Outline and evaluate Cognitive behaviour therapy used in the treatment of schizophrenia.

Cognitive Behavioural Therapy for psychosis (CBTp)

It assumes that feelings and behaviour are negatively influenced by distorted beliefs. It aims to identify and correct these beliefs. By monitoring thoughts, feelings and behaviours schizophrenics are better able to consider alternative explanations for why they occur. CBTp is usually delivered one to one for at least 16 sessions but it can be delivered in groups.

Phases of CBTp - Phase 1 - Assessment

The therapist discusses the person's current symptoms and their origins. Once these are known, realistic therapeutic goals are set.

Phase 2 - Engagement

The therapist emphasises with the person's distress. Emphasis is placed on how the therapist and person will work together.

Phase 3 - The ABC model

This is used to challenge the person's beliefs. This involves rationalising, disputing and ultimately changing the person's beliefs.

Phase 4 - Normalisation

Placing the person's own psychotic experiences on a continuum with normal experiences. If the person is told their experiences are common, they will feel less alienated and stigmatised.

Phase 5 - Critical Collaborative analysis

Gentle empathetic and non-judgemental questioning helps the person understand their false beliefs. This takes place in an atmosphere of trust.

Phase 6 - Developing alternative explanations

Enables healthier explanations for behaviour. The therapist helps with this if the person has difficulty.

Ao3 - Difficult to assess effectiveness

P - It is difficult to assess how effective CBTp is.

E - NICE's review of research indicates that CBTp is more effective in reducing symptom severity than antipsychotic medication alone.

E - However, CBTp is typically used in conjunction with antipsychotic medication.

L - This means that it is difficult to assess CBTp's effectiveness independent of antipsychotic medication.

Ao3 - Meta-analysis flawed

P - Most meta-analysis studies of CBTp's effectiveness is seriously flawed.

E - For example, studies have typically failed to allocate participants randomly to treatment conditions.

E - However, meta-analyses fail to take an individual study's quality into account.

L - This means that claims about CBTp's effectiveness may be biased by methodologically weak research.

Ao3 - Effectiveness depends on the schizophrenic

P - CBTp's effectiveness appears to depend on the stage of a schizophrenic's disorder.

E - For example, Addington & Addington suggest that CBTp is inappropriate in the initial acute phase of shizophrenia.

E - CBTp is more appropriately used following stabilisation of symptoms with antipsychotic medication.

L - This means that CBTp should be used in conjunction with drug therapy rather than as 'first choice' therapy.

Ao3 - not yet an established therapy

P - CBTp is not yet an established therapy in the treatment of schizophrenia.

E - For example, in the UK, CBTp is only available to 10% of people who could benefit from it.

E - Even when it is available, many who are offered CBTp either refuse it or fail to attend sessions.

L - This means that if CBTp is beneficial, more needs to be done to raise its availability and uptake.