Describe and Evaluate the
Cognitive Treatment for Schizophrenia
What is CBT?
• Cognitive behavioural therapy (CBT) is based on the idea that most unwanted
thinking patterns, and emotional and behavioural reactions are learnt over a long
period of time.
The CBT approach to treatment of schizophrenia
differs slightly from conventional CBT methods.
The aims of this therapy are as follows:
•
• To challenge and modify delusory beliefs
• To help the patient to identify delusions
• 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
For example, you may be taught to recognize
examples of delusional thinking in yourself.
eg – thinking that people what to kill you.
You may then receive help and advice about
how you can avoid acting on these thoughts.
eg – Rationalizing that people have no reason to want to hurt you. Encouraging you to
engage with people in meaningful ways. Allowing opportunities to practice these new skills
and share your experiences and reflect on how it felt to engage in positive social
interactions.
• Most people will require between eight to 20
sessions of CBT over the space of six to 12
months. CBT sessions usually last for about an
hour.
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.
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.
Evaluate the research:
1.
2.
3.
4.
Evaluation of CBT
for Schizophrenia
 Shown to be incredibly effective
 Allows people to function more normally with symptoms, preventing
Learned symptoms from developing.
 Can be used in conjunction with other therapies
 Improves symptoms, recovery and relapse rates
 No side effects
 Not very rational to teach patients to see life through rose coloured
spectacles
 Doesn’t work for everybody
 Expensive and time consuming
Read the Case study and answer the
questions on the worksheet
Extension
Apply your knowledge:
• You have a friend that you believe has schizophrenia. You have been asked
to explain to them why they might have schizophrenia. They also ask you
about which treatments you would recommend. Which explanations /
treatments would you share with them? Are there any that you would
leave out?