Cognitive Behavioural Therapy

Aim of CBT

• Help patients identify faulty, delusionary beliefs and to reduce stress from SZ symptoms

• Can help develop more rational ways of thinking, coping and functioning, managing the illness

Integrated Psychological Therapy

• Aims to identify specific cognitive deficits and remedy them in a non-confrontational matter. e.g. taught to recognise and respond appropriately to social cues and understand and evaluate verbal statements

• This may take place in a group exercise emphasising repetitive training to allow SZ patients to refine behavioural tactics

Coping Strategy Enhancement

• Teaches patients to manage the severity and frequency of psychotic symptoms to reduce distress and their impact on normal functioning

• It teaches coping skills, based on a thorough analysis of each symptom and to assess any coping strategy already employed

• Coping strategies include distractive thoughts and positive self talk, whereas behavioural strategies could include relaxation techniques

Research support (+)

• Startup et al - investigated CBT’s effect on 90 patients who had been admitted to hospital with a SZ episode, with 43 given standard care (antipsychotics, nursing care) and 47 receiving standard care plus 25 × 90 min sessions of CBT

• 60% of CBT group showed improvement compared to 40% of the control group, with these benefits remaining for 6 and 12 month follow ups, compared to just 17% in the control group

Effectiveness (+)

• Garrett (2008) described successfully using CBT to change a patient’s mind about taking the antipsychotic drugs she was prescribed and therefore reducing her SZ symptoms

• It is therefore an appropriate mechanism to encourage SZ patients to take their medication

Lack of therapeutic benefit (-)

• e.g. many delusionary patients may not accept they are ill and need help in the first place

• Klingdon & Kirschen: Clinicians significantly judged older SZ patients as being far less suitable/appropriate than younger patients to benefit from CBT

Appropriateness (-)

• Zimmerman et al: There does seem to be a place for CBT helping with the auditory and visual hallucinations that sufferers experience, particularly helping with the emotional distress and negative emotions experienced by individuals who suffer those hallucinations

• However, it may be less helpful in treating some of the negative symptoms of sz, like avolition and flat affect.