đź’— Schizophrenia Therapy- CBT Flashcards
(17 cards)
CBT Overview for Schizophrenia
What is the purpose of CBT for schizophrenia?
Helps organize disordered thoughts rationally.
Challenges delusions/hallucinations (positive symptoms).
Promotes self-reliance by teaching patients to evaluate their beliefs.
Combines cognitive (thought restructuring) + behavioral (skill-building) approaches.
Key Components of CBT (Smith et al., 2003)
Name the 6 key stages of CBT for schizophrenia.
Engagement strategies (build rapport, discuss coping methods).
Psycho-education (normalize symptoms, improve understanding).
Cognitive strategies (ABCDE model to dispute irrational beliefs).
Homework (thought diaries, evidence collection).
Behavioral experiments (test control over symptoms, e.g., voices).
Relapse prevention (identify early warning signs)
ABCDE Model (Ellis)
How does the ABCDE model challenge irrational beliefs?
Activating event → Belief (rational/irrational) → Consequence (emotions).
Dispute beliefs → Effect (rational thinking).
Example: “Voices are real” → “Voices are a symptom; I can ignore them.”
Behavioral Experiments
How do behavioral experiments help with hallucinations?
Patients test strategies (e.g., listening to music) to reduce voice severity.
Rates symptom intensity → proves control is possible
Homework & Thought Diaries
What is the role of homework in CBT?
Record thoughts/behaviors during triggering events.
Challenge beliefs by listing alternative interpretations.
Review with therapist to reframe irrational thinking.
Relapse Prevention
How does CBT prevent relapse?
Identifies early warning signs (e.g., social withdrawal).
Creates action plans (e.g., contact support networks).
Teaches coping strategies (problem-solving, relaxation)
Strengths of CBT
Evaluate 2 strengths of CBT for schizophrenia.
Empowers patients (self-management skills).
Reduces symptom severity (meta-analysis: Jauhar et al., 2014).
Limitations of CBT
What are 2 limitations?
Less effective for severe cases (e.g., catatonia).
Requires patient motivation (hard with avolition).
Exam-Style Application
Q: How might CBT help someone with delusions of persecution?
Use thought diary to log “evidence” of persecution.
Therapist challenges inconsistencies (e.g., “Why would spies target you?”).
Develop alternative explanations (e.g., “Neighbors are just noisy”).
Bonus: Key Study
What did Smith et al. (2003) find about CBT?
Identified 6 core components (e.g., engagement, psycho-education) for effective therapy.
Evaluation: Effectiveness of CBT (Kuipers, 1997)
Q: What did Kuipers et al. (1997) find about CBT’s effectiveness for schizophrenia?
- Study: 60 patients with medication-resistant positive symptoms ; compared CBT+standard care vs. standard care alone.
- Results: After 9 months, 50% improved with CBT vs. 31% with standard care.
- Conclusion: CBT can reduce psychotic symptoms when added to standard care.
Evaluation: Contradictory Evidence
Q: What conflicting evidence exists about CBT’s effectiveness?
- Jauhar et al. (2014): Found only a “small therapeutic effect”.
- Morrison et al. (2014): Reported significant symptom reduction.
- Confounding variable: Patient choice in treatment may influence outcomes (motivation/engagement).
Evaluation: Short-Term vs. Long-Term Effects
Q: How does CBT’s effectiveness change over time?
- Short-term: Effective (e.g., Kuipers’ 9-month improvement).
- Long-term: Tarrier et al. (2004): After 18 months, CBT group had same relapse rate as standard care.
- Limitation: Effects may not be sustained without ongoing therapy.
Evaluation: Ethical Issue – Patient Experience
Q: What ethical concerns exist about CBT for schizophrenia?
- Negative experience: Diagnosis + medication can be frightening, but Kuipers (1997) found patients viewed CBT as appropriate and helpful.
- Access inequality: Only 49% referred for CBT (Kingdon & Kirschen, 2006), possibly due to clinician bias.
Evaluation: Social Implications – Unequal Access
Q: How does access to CBT vary socially?
- NHS audit (2014): CBT offered to 14–67% of patients across Trusts (half not offered any).
- Violates NICE guidelines, creating postcode lotteries in care.
Evaluation: Cost-Effectiveness
Q: Is CBT cost-effective for schizophrenia?
- Kuipers et al. (1998): Higher initial costs but long-term savings (reduced emergency care).
- Barrier: NHS Trusts prioritize short-term budgets over future savings.
Evaluation: CBT’s Limitations
Q: What are CBT’s key limitations for schizophrenia?
- Not a cure: Manages symptoms but doesn’t eliminate schizophrenia.
- Short-lived effects: Relapse rates match standard care long-term (Tarrier, 2004).
- Access issues: Clinician bias and funding disparities limit availability.
