CBTp

CBTp

What does CBTp stand for?

Cognitive behavioural therapy for psychosis

CBTp

How many sessions does it take place in?

5-20

CBTp

What does CBT involve?

Helping patients identify irrational thoughts and try to change them

CBTp
How does CBT help?

• patients are helped to make sense of how their delusions and hallucinations impact on their behaviour

• offering explanations for these symptoms reduces anxiety

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What did NICE find?

CBT was effective in:

• reducing rehospitalisation rates for up to 18 months after the end of treatment

• reducing symptom severity

BUT patients were receiving drugs too

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What does CBTp entail?

1. assessment of patients current emotional state: patient expresses their thoughts about their experiences → set realistic goals for the therapy

2. engagement (therapist empathises w/ patient’s perspective + feelings)

3. ABC model (A - Explanation of activating events, B - Trigger emotional beliefs + behavioural actions, C - consequences of beliefs → beliefs are rationalised, disputed and changed)

4. normalisation: places psychotic experiences on continuum w/ normal experiences → Reduces anxiety, feelings of isolation, + sense of stigmatisation around S (eg: many people have unusual experiences like hallucination)

5. critical collaborative analysis (therapist gently questions patient + evaluates the content of the delusions/voices → tests validity → builds trust, therapist uses unconditional positive regard)

6. developing alternative patterns (alt explanation for previous assumptions → heathier → coping strategies + Patient is set behavioural assignments to improve general functioning)

CBTp

Evaluation: support

NICE's review of S treatments found CBT vs  standard care (antipsychotics) = consistently CBT = more effective in reducing rehospitalisation rates up to 1.5 yrs post treatment + reduce symptom severity → suggests CBT = effective for treating S symptoms → improves quality of life BUT doesn’t ‘cure’

CBTp

Evaluation: doesn’t ‘cure’, but still important

Although cannot directly ‘cure’ S, many find comfort in understanding causes of symptoms, esp. if suffering from upsetting hallucinations/paranoid delusions bcs reassures they are not ‘crazy’ → reducing intrusive effects of symptoms + increasing self-awareness → supported by Turkington et al (2004): CBT could be used to challenge a patient’s paranoid beliefs that was targeted by Mafia → SO although doesn't 'cure', still can improve symptoms/comfort patients

CBTp

Evaluation: counter of support

BUT patients taking antipsychotics ALONGSIDE CBT → difficult assessing effectiveness of CBT independent of meds → don't really know effectiveness of it

CBTp
Evaluation: alternative

Alt = drug therapy (eg: APs = effective treating symptoms → reportedly positive, negative, and cognitive impairment) → suggests drug therapy is important in helping alleviate S symptoms

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Evaluation: practical application

Economic benefits → NICE's review demonstrates CBT = associated w/ sig. cost savings when given to S patients alongside standard care → extra costs of CBT = offset by less relapses for sig. period post treatment → MEANS more likely to function in job roles, boosting economy

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Evaluation: Culture bias

Culture bias → applies effectiveness of CBT in W cultures to non-W cultures → may not be true universally → further research needed → suggests findings can't be generalised bcs not representative of other cultures