Cognitive Behavioural Therapy for Schizophrenia
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What are the assumptions of CBT?
- Disturbed or distorted beliefs influence behaviour in maladaptive ways
- People with mental disorders have irrational or unrealistic ways of thinking
- In schizophrenic patients, there is often the belief that behaviour is being controlled by someone or something else
- This means that the delusions are the results of faulty interpretations of events
What are the aims of CBT?
- To adjust thinking patterns and alter inappropriate beliefs
- To help patients identify their delusions and correct this faulty way of thinking
What are the steps of CBT?
- 1: Trace back the origins of the symptoms to bet a better idea of how they developed
- 2: Evaluate the content of the delusions or internal voices, considering ways to test the validity of these voices and delusions
- 3: Develop alternatives to the faulty beliefs by looking for more rational explanations
- 4: Teach the patient coping strategies to counter the delusional beliefs and hallucinations, encouraging them to challenge the initial negative interpretations and change them to more rational positive interpretations
What effects does CBT have?
It does not completely eliminate the symptoms but equips the patients to cope with them more effectively and allows them to understand where they come from
What did Tarrier et al find in 1993?
- 49 patients randomly allocated into either a control group in which they received just drug treatment or a group that received 10, 1 hour CBT sessions along with the drug treatment
- The CBT groups reported a 50% improvement in positive symptoms and a significant improvement in coping skills
What does Tarrier's study suggest?
CBT combined with drug therapy is more effective than just drug therapy in treating schizophrenic patients
What did Haddock find in 1998?
- CBT did not affect the frequency of positive symptoms but reduced the anxiety or stress associated with them
- This leads to patients feeling more in control over their conditions which reduces the risk of relapse
What did Drury et al find in 1996?
There was a reduction in positive symptoms and a 25-50% reduction to recovery time for patients given a combination of drugs and CBT
How can the methodology of studies into the effectiveness of CBT be criticised?
- Most research is carried out on patients who are already receiving drug therapy
- This makes it hard to determine cause and effect as it could be the drugs that are leading to an improvement in symptoms
How can CBT be said to be a Panacea?
- It can improve some of the symptoms associated with schizophrenia by allowing patients to cope with them, but cannot offer a cure
- This might lead to patients lacking motivation as they do not feel it will have any real impact
Why isn't CTB appropriate for all patients?
- Some do not fully engage with the therapy as insight is necessary
- Chronically psychotic patients often lack this insight meaning they cannot doubt the validity of their hallucinations
- A great deal of commitment and effort is required on the part of the patient, a side effect of anti psychotics is often lethargy meaning many patients lack the necessary motivation
What did Turkington find ion 2002?
- CBT is good at increasing the insight of patients into their disorder
- This increases their awareness of the importance of sticking to a medication routine, reducing relapse due to medication neglect
What other issues can arise as a result of CBT?
- The insight into the severity of their disorder could lead to patients experiencing high levels of anxiety and distress
- This could also increase suicide risk
How is CBT seen as ethically sound?
- It is democratic and shows respect to clients, offering them choice and involving collaberation
- This gives patients a sense of control and the ability to shape their own future
- The participant must be lucid and consenting for this to work, however
How does CBT differ from cognitive therapies in terms of ethics and approach?
- It attempts to target the route cause of the symptoms and allow the patient to help themselves rather than just dealing with the symptoms
- The patients are given an active role in their treatment
How can CBT be considered reductionist?
- Schizophrenia is reduced down to only its cognitive symptoms, ignoring the other emotional, behavioural and biological factors that are involved
- This is an overly simplistic perception of the disorder
How can CBT be seen as deterministic?
The patient is determined by their faulty cognitions and schizophrenia is the fault of their mind
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