CBT

AO1

• overall aim is to reduce symptom severity, improve functioning, and prevent relapse.

• uses Ellis’ ABC model to help patients identify, challenge, and change irrational or maladaptive thoughts that contribute to symptoms such as delusions and hallucinations.

• based on the cognitive approach, which suggests that schizophrenia is partly caused by faulty thinking patterns and irrational beliefs.

• involves regular one-to-one sessions between the therapist and the patient, often lasting 5–20 sessions over several months.

• therapist works collaboratively with the patient to examine the evidence for and against their beliefs, rather than directly challenging them, which helps reduce distress without increasing resistance.

• reality testing - patients are encouraged to evaluate the accuracy of their delusions or hallucinations. For example, if a patient believes voices are giving them commands, the therapist may help them consider alternative explanations, such as the voices being a product of their own thoughts. May be given homework

• also focuses on normalising symptoms - helping patients understand that hallucinations and unusual thoughts are common experiences and do not necessarily mean they are dangerous or uncontrollable. This can reduce anxiety and improve coping strategies

• behavioural strategies - patients are taught coping mechanisms to manage symptoms, such as distraction techniques or stress management, which can reduce the impact of hallucinations.

• often used alongside antipsychotic medication (combination treatments)

Strengths AO3

• P - research to support

• E - Gould et al found in their meta analysis that in all in all 7 studies sz patients’ positive symptoms significantly decreased after CBT treatment.

• T - this suggests that CBT has a meaningful impact on symptom severity & is an effective treatment in treating sz.

• However, a counter-argument is that CBT was delivered alongside antipsychotic medication, meaning it is difficult to determine whether the improvements were due solely to CBT or the combined treatment, reducing the internal validity of the conclusions. It also suggests that CBT is more effective in combined treatments (eg with drugs, family therapy etc). Despite this, the findings still support CBT as an effective adjunct psychological therapy, strengthening its usefulness in real clinical settings where combined treatment is standard practice.

• P - it improves insight and coping strategies, rather than merely masking symptoms.

• E - Unlike antipsychotic medication, which primarily reduces hallucinations and delusions by altering brain chemistry, CBT teaches patients to understand the nature of their thoughts and experiences. Techniques such as reality testing, cognitive restructuring, and normalisation help patients recognise that hallucinations and delusions are products of faulty thinking, rather than objective reality. This insight allows patients to challenge and manage their symptoms more effectively, reducing the distress and anxiety associated with psychotic experiences. Additionally, CBT equips patients with practical coping strategies, such as distraction techniques or stress management skills, which they can apply outside therapy sessions to prevent symptoms from escalating.

• T - By focusing on long-term skill development rather than short-term symptom suppression, CBT empowers patients to take an active role in managing their illness. This makes CBT a particularly valuable treatment, as it addresses not just the presence of symptoms, but also their impact on daily life, supporting sustained improvements in well-being.

Limitations AO3

• P - not suitable for all patients, particularly for those with severe symptoms

• E - CBT relies on the patient having sufficient insight, attention, and cognitive capacity to reflect on their thoughts and engage in techniques such as reality testing and cognitive restructuring. However, many individuals with schizophrenia experience severe thought disorder, paranoia, or firmly held delusions, which can make them unwilling or unable to question their beliefs, as doing so may increase distress or suspicion of the therapist. In addition, patients with prominent negative symptoms, such as avolition and social withdrawal, may lack the motivation to attend sessions consistently or actively participate in therapy. This means CBT is often more effective for stable or mildly symptomatic patients, rather than those in acute phases of the disorder.

• T - limits the generalisability and overall effectiveness of CBT as a treatment for schizophrenia, as it cannot be successfully applied to all individuals suffering from the disorder, reducing its value as a standalone intervention

• P - time-consuming & costly

• E - involves regular one-to-one sessions over several months, often requiring 20 or more sessions delivered by a highly trained specialist therapist. This makes CBT expensive to provide, particularly within public healthcare systems such as the NHS, where resources are limited. As a result, many patients may experience long waiting lists or may not be offered CBT at all, reducing access to the treatment. In contrast, antipsychotic medication is quicker and cheaper to administer and can be prescribed to a large number of patients simultaneously.

• T - factors often result in patients dropping out before completing the full course, which reduces the overall effectiveness of CBT in clinical practice. High attrition rates mean that the promising symptom reductions observed in research studies may not be replicated in real-world settings, as patients who remain in therapy are often those who are more motivated or less severely ill. Consequently, the practical applicability and generalisability of CBT as a widespread treatment for schizophrenia are limited, despite its demonstrated efficacy under ideal conditions.

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