CBT as treatment for schizophrenia

How CBT works

• 6/12 50 min sessions

• First focused on setting expectations and addressing concerns of confidentiality + privacy

• Each session agenda is set where patient chooses issue they’d like to raise

• Client talks about themselves so therapist can understand their frame of reference

• Therapists summarises what they’ve heard to check they understand

• Then uses CBT tools

CBT strategies to challenge and modify delusions

• Identify delusions

• Challenge evidence that they’re based on

• Design ‘experiments’ to test the reality of this evidence

Time requirement

• 50 min sessions of 12 or 6 weeks

• Consistency requires motivation + resilience

  • Difficult with symptoms of apathy

• Includes tasks and homework to be completed outside of sessions

• iCBT still takes time but more accessible

Effectivness

Chadwick + Lowe 1993:

• CBT was effective in reducing delusions

• Not as effective for negative symptoms

Kingdon + Turkington 1996:

• CBT effective for 70% of patients

• Risk of symptoms worsening in remaining 30%

• Should be combined with antipsychotics (short term effectiveness)

• Not intended to be a cure but to help patients live with their symptoms

Acceptability - yes

• Emphasises autonomy, freedom and control as patient centred approach

• Treatment designed around patient - considering triggers

Acceptability - no

• Not suitable for patients with speech / thought disorders, or social withdrawal

• Patients with apathy would struggle to attend

• Aggressive tendencies rule out group therapy

• Cultural reservations about opening up - won’t be effective

Relapse

• High relapse rate when used alone (same for antipsychotics) but lowered when used together

• Taught coping skills help with hallucinations and managing stress caused by them

Side effects

No physical side effects

Can be mentally distressing

• Result in drop out