SCHIZOPHRENIA - CBTp as a psychological treatment for schizophrenia

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  • CBTp as a psychological treatment for schizophrenia
    • General
      • treatment informed by approach
      • basic assumption is that people have distorted beliefs that influence thoughts and behav
      • delusions come from faulty interpretations of events
      • CBTp helps patient to identify and correct faulty interpretations
      • aims to reduce stress and increase functioning
      • patients encouraged to trace back to origin of symptoms and get a better idea of how they developed
      • patient encouraged to developed their own alternatives to bad thoughts
    • How does it work?
      • follows main flow of CBT
      • patient identifies their ABC (Ellis) to therapist
      • NORMALISATION - making the patient aware that what they are feeling is normal for their condition then reduces anxiety and sense of isolation
      • CRITICAL COLLABORATIVE ANALYSIS - gentle questioning by the therapist helps the patient understand illogical conclusions
      • DEVELOPING ALT EXPLANATIONS - patient develops their own alt explanations for previous assumptions. If patient can't give an alt exp, they can be helped by the therapist
    • Evaluation (A03)
      • NICE review of treatment found CBT was effective compared to antipsychotic medication alone
        • however, patients used were using combination of CBT and medication, so effectiveness of CBT alone is diff to assess
      • CBT is more effective when used at different stages of the disorder (Addington)
      • lack of availability - in UK, only 1 in 10 that could benefit from treatment receive it. This figure is lower in other parts of the country
        • FREEMAN - of the people who are offered CBTp, many refuse of fail to show up
        • HADDOCK survey: in the NW of Eng, only 13 (6.9%) of 187 patients with sch received CBTp.
      • metas don't take into account study quality. Some studies don't randomly allocate PPs.
        • JUNI - clear evidence that problems with methodologically weak trials have biased findings about effectiveness of CBTp
      • benefits may be overstated - JAUHAR - only 'small' effect on key symptoms of sch (delusions and hallucinations)
      • in Eng and Wales, NICE emphasise non-drug therapies such as CBTp, but Soctland, SIGN emphasise antipsychotic meds
    • Research
      • ADDINGTON - found reflection was not effective is acute stages of sch

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