Psychological treatment of Schizophrenia Cognitive Behavioural Therapy

Why might drugs not work when treating individuals with Schizophrenia?

How does this therapy work? Behavioural? Cognitive? CBT – Focus is on thinking and how emotions follow our thoughts Which means we behave in certain ways and the consequences lead back to our thinking. Changing the thoughts or behaviour can break the cycle

CBT The cognitive approach believes that abnormality stems from faulty cognitions about others, our world and us. This faulty thinking may be through cognitive deficiencies (lack of planning) or cognitive distortions (processing information inaccurately) Beck,1970. Maladaptive thinking maintains emotional distress and behavioural problems Beck claimed that the maladaptive thinking comes from schemas and general beliefs about the world and about oneself CBT acts to focus on these thoughts and schemas to change them

Cognitive elements – challenging thoughts and beliefs How can CBT help? (I) specific coping skills that help the client modify environmental stresses, change perceptions and interpretations of events, reduce physiological arousal (2) focus on the interaction of the illness and the person. Enhancement of the client's ability to cope with stress is essential to prevent relapse Learning to cope with disorder Social causation– i.e. lack of support and feelings of isolation Alleviating cognitive symptoms Difficulties in concentrating and paying attention Problems with working memory Difficulty with executive functioning Cognitive elements – challenging thoughts and beliefs Behavioural elements –putting the skills acquired into practice in real situations in their own lives

Drug therapies do not alleviate all symptoms Shepherd et al. (1989) – fewer than 60% of sufferers achieve full remission Drug therapies do not alleviate all symptoms Biological factors are taken into account but it is assumed that how someone experiences and expresses their psychotic symptoms will be about psychological factors and can be modified by psychological interventions. Reducing stress and distress Working on coping mechanisms Dickerson (2000) Review - 20 clinical trials of CBT for schizophrenia since 1990. The CBT interventions appear to be beneficial in reducing overall symptom levels, especially the severity of delusions.

CBT for schizophrenia Symptoms are focused on rationally, accepting them and their experience of them Focus on the individual One to one sessions (weekly for weeks or longer) Focus on therapist being supportive and non-threatening Cognitive elements and behavioural elements are incorporated into therapy Collaboration between patient and therapist is required

Process of CBT for schizophrenia – following an acute phase What do these phrases mean? Discuss in pairs Belief modification Focusing and reattribution Normalising Cognitive therapy Behavioural experiments(separate word doc. On the learning space) Ensure you have notes on the behavioural elements as well as the cognitive elements i.e. behavioural experiments. Using the resources on the learning space provide an explanation for each of these (pg. 49 and 50) Pair work – using a shared doc.

National Institute for Health and Care Excellence (NICE) NICE has produced guidelines for the care of patients with psychosis schizophrenia https://www.nice.org.uk/Guidance/cg178 Using the link above provide some information regarding these guidelines 1.2.3 Treatment options to prevent psychosis 1.3.4 Treatment options 1.1.2 Race, culture and ethnicity (to link back to cultural issues)

Evaluation task