CBT for schizophrenia

Supporting

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CBT is a person-centred form of talking psychotherapy used to work with the patient to try and overcome the symptoms of schizophrenia – based off of the idea that our thoughts influence our behaviour. It aims to challenge the client’s positive symptoms of the disorder, for example hallucinations and delusions 

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Chadwick found a significant reduction in the power and control that voices (auditory hallucinations) had in 22 patients using group CBT 
Kuipers (1997) found that CBT is effective for those who have been treatment resistant in the past, particularly when targeting hallucinations and delusions. 

CBT provides patients with the skills they need to manage their own condition – allows them more autonomy and control over their treatment  

Conflicting

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There are typically 5-20 sessions, and this can be individual or in a group. The sessions are usually once a week, and one of the first aims is to develop a therapeutic rapport with the client, so that they feel safe and comfortable enough to open up 

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McKenna and Kingdon 2014 compared CBT with other interventions, and found that CBT was only superior in 2/9 trials 

Impact of the Hawthorne Effect rather than the CBT – where the strategies of CBT have little effect, it is instead the presence of someone who cares about them and is observing their behaviours

Opposing

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A client may be asked to identify an ‘activating event’ - something they believe is the trigger for their problems. The client then identifies their ‘beliefs’ about this event, and may be asked to provide evidence for why they believe these beliefs are real. The therapist will then explore the ‘consequences’ of these beliefs, such as how talking back to the voices upsets and frightens other people around them. 

An extra 4^th step of ‘dispute’ can be added, where the therapist challenges the client’s beliefs 

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Drug treatments and antipsychotics have also been found to be an effective treatment of schizophrenia, with the mere existence of an alternative theory suggesting that one complete treatment has not been found. The use of antipsychotics emphasises the role of biological nature over nurture 

drug treatments as easier to take/less time consuming/less emotionally draining. could be useful to use drugs as a precursor to CBT

Usefulness

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CBT gives patients the skills that they need to manage their disorder, for example encouraging them to psycho-educate themselves – learning about their illness and how to recognise triggers. This can also include skills training, which is how to self-manage their symptoms. Strategies such as Coping Strategy Enhancement works by figuring out the triggers for delusions and hallucinations and the coping strategies the client uses

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 Might be the most useful when used in combination with other drug therapies to provide a more holistic approach to treatment 
CBT can be useful in the long term as the aim is to equip patients with the skills they need to manage any future relapses. This allows them to re-enter society and becoming a functioning member of society. This integration into reality has been shown to help reduce incidences of psychosis, or ‘unreality’. 
CBT may not be useful or accessible for everyone – for example there are long waiting lists on the NHS and going private may be expensive 

Testability

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Patient is usually given homework tasks, which could include putting new strategies into action. ‘Reality testing’ is used, in which the therapist and client plan an activity to put a delusional belief to the test. 

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Difficult to test a reduction in symptoms, as typically the clinician is not able to see/hear/experience these, only the patient. Therefore relies on self reporting data, as there is no objective way to measure a reduction in symptoms 

Conclusion

A useful method of treatment for individuals who are anti-drug, or who have ethical issues against the ‘chemical straightjacket’ or socially controlling behaviour through drugs.  
More autonomous process, patient has more control, less dehumanising