Clinical - Treating S1 with CBT

How is CBT performed?

1 to 1 between a therapist and patient with S1

Why is CBT 1 to 1?

Because it needs to be tailored to individual needs and experiences

How long does CBT treatment for S1 take?

Many years (long term)

What is usually discussed during the first meeting of CBT?

Rapport is established, the reasoning for the therapy is discussed and the therapist and patient will identify treatment goals

What do sessions during CBT include?

They use the ABC model (identifying Activating events, Behaviour in response, Consequences of said behaviour or actions). During these sessions the therapist will talk through unhelpful beliefs that the patient associates with events and emotions

What is the prodromal phase?

The warning signs/symptoms a person with S1 might experience before a full relapse/psychotic episode

What can CBT help with?

- Improve self awareness by helping individuals identify when they are in the prodromal phase

- Teach adaptive coping mechanisms for stress which reduces probability of relapses

- Combat hallucinations and delusions through the use of reality testing etc

- Encouraging the patient to test their beliefs by collecting evidence (if evidence doesn't exist, the patient can conclude it was not real)

- To educate the patient about their condition

- To encourage patients to develop skills and interact in activities leading them to live a more independent life e.g. have a job, live alone etc (very good for -ve symptoms)

- Destigmatise their experience and help them recognise they are more than their disease

What did Addington and Addington find?

They found there was very little success of CBT when patients are in a psychotic episode (acute stage) due to their poor self awareness and lack of insight

What are some strengths of CBT as a treatment of S1?

- More holistic approach

- Carol study

- Study found that CBT and drugs reduced hospitalisations more than drugs alone

- Treatment has no side effects like drugs do - ethical

- CBT gives people a long term solution which combats both types of symptoms

- CBT gives patients more autonomy as they work WITH the therapist whereas drugs are just given by the doctor who is in control (patient usually doesn't know what exactly the drugs do etc) - more ethical

What are some weaknesses of CBT as a treatment of S1?

- It doesn't work on everyone

- It can only help if patients have the stability and insight into their illness and reasons for treatment

- Challenges patients which can be distressing

- Patients may only report evidence that supports their beliefs rather than looking objectively at their experiences and paranoia (this means patients may have a support person with them in the treatment to ensure the discussions are accurate and not only focused on the negative evidence etc)

- Patients are encouraged to confront delusional beliefs and this can sometimes occur in real life such as challenging someone they believe is following them on the street (this puts both people at risk)

- Weaknesses of Carol study

- Research of Addinton and Addington

- Many studies performed have lack of control groups, small samples etc

- Most people on CBT are also having medication so we cannot be sure improvements are due to the CBT alone