Cognitive behavioural therapy Flashcards
(38 cards)
When and who was CBT developed by?
Developed by Ellis and Beck in the 1950s
What was the original success of CBT?
Used successfully for the treatment of depression and due to success the therapists began to explore the possibility of using the principles of CBT to treat psychotic disorders e.g schizophrenia
Aim of CBT
-challenge maladaptive thoughts and replace them with constructive thinking that will lead to healthy behaviour
-CBT is used to help an individual suffering with schizophrenia to think about and organise their disorganised thoughts.
Purpose of CBT
Make the individual aware of the connections between their disorganised thinking and their illness. The therapist will try and make these maladaptive thoughts conscious and then by challenging them the client will see that there is no basis for them.
How often does CBT take place?
takes place weekly or fortnightly for about 5-20 sessions
What does CBT involve?
identifying the problem the individual has such as auditory or visual hallucinations and what triggers them and then implementing strategies to help deal with those triggers.
Who identified the key strategies?
Laura Smith et al
Name the all Laura Smith’s key strategies
- Cognitive Strategies
- Engagement Strategies
- Behavioural Strategies
- Relapse Prevention Strategies
Cognitive strategies
-REBT is an example of CBT where strategies such as disputing and thought diaries are used
-Ellis added D and E to ABC model (used to identify irrational thoughts) for therapy i.e disputing and its effects. REBT includes homework activities such as recording feelings, activities and views which are then challenged in therapy.
-Clients are given experiments to complete where they challenge beliefs e.g listening to music or gardening to control voices.
Engagement strategies
Preliminary sessions used to provide opportunities to talk at length about potential worries and any symptoms that are particular concerns to the client with schizophrenia. During this stage therapist will try and build a rapport with client in case client has negative experiences with other therapists.
Behavioural Strategies
A range of effective strategies can be taught such as relaxation, activity scheduling, distraction and problem solving. Behavioural strategies are useful not only in coping with residual symptoms managed by medications but also secondary symptoms of anxiety and depression.
Describe the 5 steps of problem solving
-requires clients to work systematically through a series of steps
1. Identify problem
2. Generate potential solutions
3. Evaluate alternatives
4. Decide on solution
5. Evaluate outcome
Relapse Prevention Strategies
Therapist and client identify early signs of a relapse e.g thoughts and feelings they’ve had before becoming unwell as well as relationships with others and what others notice about them before they are unwell. Plans are developed to employ when these signs appear in order to try and help themselves.
How does CBT help with irrational thoughts?
useful for dealing with disordered thinking which is typical for schizophrenia. CBT helps an individual organise their thoughts in a rational way. It makes clients aware of how their disordered thinking is linked to their illness and encourages them to challenge the way they interpret events by discussing evidence.
How does CBT help with hearing voices?
-a person hearing voices is them misinterpreting their own inner speech
-part of CBT is getting client to recognise these voices as being part of their own mind
What strategies are given to people with schizophrenia to help deal with voices?
Some practitioners believe that schizophrenics who hear voices can be helped to bring the voices under control by asking client to focus on nature of voices
-e.g think about tone and gender of the voice, find external ways of focusing by drawing pictures of different voices.
-therapist therefore helps client to recognises that the voices represent part of who they are
-clients are also taught strategies to protect them against wishes of their voices e.g choosing to listen to the voices only at particular times of the day or relaxation techniques.
Why is CBT effective in treating schizophrenia
-effective for reducing positive symptoms
-effective for reducing relapse
-When schizophrenia is diagnosed early it is also useful for enhancing recovery
What evidence did NICE find about CBT?
CBT can reduce hospitalisation compared with standard care. A meta-analysis of randomised trials reported a 24% relative reduction in hospitalisation at follow up (up to 18 month post treatment) Duration of hospital was reduced by an average of 8 days.
What supporting evidence was found in the year 2000 about CBT that shows the effectiveness of CBT?
Chadwick et al 2000
Showed patients involved in CBT experienced a significant reduction in negative beliefs about the power of the voices and how much they were controlled by them.
What supporting evidence was found in the year 1997 about CBT that shows the effectiveness of CBT?
Kuipers et al 1997
-60 schizophrenic patients who had not responded to medication randomly allocated to CBT and standard care or standard care alone
-after 9 months 50% of CBT group showed improvements and 1 person become worse
-in standard care alone group, 31% improved, 3 got worse, 1 commit suicide
-shows CBT helps more people with schizophrenia than standard care alone.
What did Drury find in 1996?
A reduction in positive symptoms and a 25-50% reduction in recovery time with patients given a combination of antipsychotic medication and CBT.
What did Tarrier et al find in 2004
Found that 18 months after clients had received CBT they had the same relapse rate as those who had standard care. However, they did notice that the CBT group were less negatively affected by their symptoms suggesting there were long-term benefits making their symptoms more manageable.
What 2 pieces of evidence contradicts the effectiveness of CBT
-Jauhar et al found only a small therapeutic effect from using CBT for schizophrenia
-Lomas (2009) found CBT is not an effective treatment for people with schizophrenia in preventing relapses or reducing symptoms.
What is one issue with assessing the effectiveness of CBT? (CBT and APs)
- CBT is conducted alongside anti-psychotic drugs. May be because medication is allowing clients to think more coherently allowing them to access full benefits of CBT. Therefore it is difficult to assess CBT alone.
