CBT – schizophrenia

Report
5 Minutes for 5 Things
• What can you tell me about the cognitive
explanation of schizophrenia?
Describe and Evaluate the
Cognitive Treatment for Schizophrenia
Cognitive Behavioural Therapy (CBT)
Map to Spec – Page 59
3 Content
g) For schizophrenia describe and
evaluate two treatments. Students
must select one treatment each from
two different approaches studied
from the five in Units 1 and 2.
Map to Spec – Page 60
• Describe and evaluate one treatment/therapy from
each of the following approaches:
i. the Social Approach: either Family Therapy or Care in
the Community programmes
ii. the Cognitive Approach: either Cognitive Behaviour
Therapy or Rational Emotive Therapy
iii. the Psychodynamic Approach: either free association
or dream analysis
iv. the Biological Approach: either the use of drugs
(chemotherapy) or electro-convulsive therapy (ECT)
v. the Learning Approach: either the Token Economy
Programme or Systematic Desensitisation.
What is CBT?
• Therapy which aims to help the patient to
identify disordered and delusional thinking
• Attempt to replace these with thought
processes that are more constructive and
more in line with reality
• Behavioural element – develop coping
strategies
CBT
The aims of this therapy are as follows:
• To help the patient to identify delusions
• To challenge delusory beliefs
• To challenge those delusions by looking
at evidence
• To help the patient to begin to test the
reality of the evidence
An example of a delusional belief
Event
• Overhearing someone saying “I know what’s on your
mind”
Interpretation
• Everyone can read my thoughts
Feeling
• Paranoid, scared and believing that others will attack
me for my thoughts
Behaviour
• Take evasive action – avoiding situations that will bring
me into contact with others
CBT Techniques
• Patients are encouraged to
trace back to the origins of
their symptoms in order to
get a better idea of how
they may have developed.
• Try to help the patient
come up with rational
alternatives
Long-term Help
• The therapist encourages
patient to come up with their
own coping strategies for
when they experience any
symptoms
• They may then receive help
and advice about how they
can avoid acting on
delusional thoughts.
CBT course
• Most people will require between 8 to 20
sessions of CBT over the space of 6 to 12
months. CBT sessions usually last for about
an hour.
Your Task
• In pairs, assign yourself as either the patient
or the therapist.
• If you are the patient – explain your delusion
• If you are the therapist – use the processes of
CBT to attempt to rationalise their belief.
• After you’ve had a go at using one example of
a delusion, swap your roles around.
This type of treatment has been shown to be
effective for reducing the positive symptoms of
schizophrenia, for reducing relapse and for
enhancing recovery when schizophrenia is
diagnosed early.
Sensky et al (2000)
• Studying the effectiveness of CBT
• Put the statements in an order that you think
represents the study
• Use APRC to help you decide on the order
Cognitive Treatment
Sensky et al. (2000)
Aim
• To compare cognitive behavioural therapy (CBT) with non-specific
befriending interventions for patients with schizophrenia
Design
• A randomized controlled design.
• Patients were allocated to one of two groups:
– a cognitive behavioural therapy group.
– a non-specific befriending control group.
Participants
• 90 patients.
– 57 from clinics in Newcastle, Cleveland and Durham and 33 from
London. They had diagnoses of schizophrenia that had not responded
to medication.
– Aged 16–60 years.
Procedure
•
•
•
Patients were allocated to one of two groups.
Both interventions were delivered by two experienced nurses who received
regular supervision.
Patients were assessed by blind raters
– at baseline.
– after treatment (lasting up to 9 months).
– at a 9-month follow-up evaluation.
•
•
•
They were assessed on measures including the Comprehensive Psychiatric Rating
Scale, the Scale for Assessment of Negative Symptoms, plus a depression rating
scale.
Patients continued to receive routine care throughout the study.
The patients received a mean of 19 individual treatment sessions over 9 months.
Cognitive behavioural
therapy condition
• A normal routine of CBT was used:
–
–
–
–
–
–
initially engaging with patient
psycho education
developing a reason for the behaviour
Cognitive and behavioural interventions
treatment of other disorders such as depression
Reducing relapse by planning ahead
CBT Strategies Used
• Specific techniques for positive symptoms of schizophrenia
were used:
– critical analysis of beliefs about auditory hallucinations.
– patients were helped to change their beliefs.
– patients taught coping strategies to deal with the voices.
• Delusions and thought disorders were also addressed using
cognitive strategies.
Befriending condition
• The patients had the same time allocation at the
same intervals as patients in the CBT condition.
• The therapists were empathic and non-directive.
• There was no attempt at therapy:
– The sessions focused on hobbies, sports and current
affairs.
Findings
• Both interventions resulted in significant reductions in
positive and negative symptoms and depression.
• After treatment there was no significant difference
between the two groups.
• At the nine-month follow-up evaluation, patients who
had received cognitive therapy showed greater
improvements on all measures.
– They had improved, while the befriending group had lost
some of the benefits.
Conclusions
• Cognitive behavioural therapy is effective in treating negative as well as
positive symptoms in schizophrenia resistant to standard antipsychotic
drugs.
• Its efficacy is sustained for at least nine months – effective in teaching
patients strategies to cope with symptoms
Evaluation of CBT
• Complete the card sort activity, deciding
between strengths and weaknesses
Evaluation of CBT
for Schizophrenia
 Shown to be incredibly effective, e.g. Kuipers et al. (1997) found that when combined
with antipsychotic drugs there was a lower drop out rate and greater patient satisfaction.
 Can be used in conjunction with other therapies and other forms of treatments (i.e. drug
treatment)
 Improves symptoms, recovery and relapse rates
 No side effects
 CBT puts patients in charge of their own treatment by teaching self help strategies. Fewer
ethical issues than drugs and other treatments




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Not very rational to teach patients to see life through rose coloured glasses
Doesn’t work for everybody i.e. not suitable when the patient are deluding as they
cannot fully engage with the therapy
Expensive and time consuming
CBT works by generating less distressing explanations for negative experiences rather
than by eliminating them completely.
Patients can become dependent on their therapist
Read the Case study and answer the
questions on the worksheet
Extension
Apply your knowledge:
• You have a friend who has recently been diagnosed with
schizophrenia. She is unsure which treatment to go with –
drug, or therapy. How can you help her make the choice?
( note: you need to describe how the treatments work as well as evaluate them)

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