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How can we treat schizophrenia from a psychological perspective? Are there therapies available for schizophrenia? Psychological therapies explore the mental and emotional side of disorders in an attempt to treat mental health issues, delving into a person's past and future experiences to help with current symptoms. One form of therapy is Cognitive Behavioural Therapy (CBT).Developed by Aaron Beck in the 1960s, CBT is…
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Jetzt kostenlos anmeldenHow can we treat schizophrenia from a psychological perspective? Are there therapies available for schizophrenia? Psychological therapies explore the mental and emotional side of disorders in an attempt to treat mental health issues, delving into a person's past and future experiences to help with current symptoms. One form of therapy is Cognitive Behavioural Therapy (CBT).
Developed by Aaron Beck in the 1960s, CBT is a form of psychological therapy that focuses on teaching patients to recognise their dysfunctional thoughts and behaviours, how to rationalise these thoughts using logic, and how to avoid acting on these thoughts. CBT is a lengthy process and varies depending on the patient’s needs. It requires a therapist to work closely with the patient to build trust and a sense of rapport.
Although this will not necessarily cure schizophrenia, it can help patients cope with the symptoms of the disorder. An accredited cognitive-behavioural-therapy trained therapist will help assess patients.
Fig. 1 - Cognitive behavioural therapy (CBT) is a form of psychological treatment for Schizophrenia and other disorders.
As we discussed above, cognitive behavioural therapy is a psychological treatment of mental health disorders. We can define CBT as:
Cognitive behavioural therapy is a psychological talking therapy that explores dysfunctional, maladaptive thoughts and behaviours and employs behavioural learning techniques to combat these issues, usually through analysing cognition and behaviour logically and restructuring these thought processes.
CBT combines cognitive therapy and behavioural therapy.
CBT aims to identify and alter irrational thoughts and behaviours, and when we look at it through the lens of schizophrenia, examples include:
General, irrational beliefs e.g. hearing people who are not there talking about you or hearing a voice narrate your daily life.
Issues with how the patient views themself, such as delusions of grandeur.
Issues with paranoia, in which the patient believes someone is watching them.
When issues with these areas are identified and worked through, a patient with psychosis can then work on clearing up misunderstandings and improving their emotional state.
CBT is not reserved only for schizophrenia. It can also be used to treat other mental health issues, as dysfunctional and maladaptive thoughts are somewhat common symptoms.
Examples of disorders that use cognitive behavioural therapy include:
CBT attempts to instil behaviours that help alleviate symptoms in disorders through talking with an accredited therapist.
CBT has multiple stages to help identify the issues and offer solutions to a patient with schizophrenia. Typically, a patient undergoes anywhere from 5 to 20 sessions over multiple weeks (NHS, 2021).
Normally, CBT undergoes a specific process that addresses dysfunctional and maladaptive thoughts to treat symptoms of a disorder, from a psychological perspective. Patients are first assessed to identify areas of concern. The therapist will then work with the patient to break down maladaptive and dysfunctional thoughts and behaviours.
Essentially, we can boil CBT for schizophrenia down to an Assessment and Engagement phase (Kingdon & Turkington, 2006).
We can summarise the process of CBT as:
A clinician may use the ‘ABC’ method.
The overall goal of CBT is to establish the links between thoughts, feelings, and actions.
Fig. 2 - CBT adopts the ABC method, developed by Ellis and Harper, in some cases.
The ABC model, developed by Ellis and Harper (1961), encourages patients to try and understand what is happening in their lives. It finds the source of the faulty condition and then goes on to work towards providing a process to restructure the irrational beliefs.
Activating event: what is causing the problem? Patients often give their own estimation of what they think activating events are.
Behaviour and beliefs: how does the patient react in these situations? The patient's own beliefs are linked intrinsically to the activating and events and consequences, bridging the missing gaps in the patient's knowledge of their behaviours.
Consequences: what impact does this have on the patient’s life and their relationships with others? What are the emotional and behavioural consequences?
Overall, links between each stage are made and the therapist helps the patient to see these links.
The ABC model was later expanded on to include "DE", but in general, professionals still refer to it as the "ABC model", and for exam purposes, it is only important for you to know the ABC aspects of the model.
We still refer to the model as the ABC model, despite the 'DE' addition.
Socratic questioning is used to move patients through the ABC model, using various scales to monitor the progress of the therapy (such as using a scale of 0 to 10). Patients are encouraged to identify what activating events trigger consequences, and this will ultimately aid them in their daily lives, as they will be able to identify potential triggers outside of a professional environment, and then engage in rationalisation and behavioural restructuring.
Fig. 3 - The ABC model was later expanded on, but typically it is still referred to as the ABC model.
If a patient with schizophrenia has a delusion that someone is trying to hurt them, say, a doctor, they may then believe that the advice/prescriptions given by the doctor are going to kill them. Consequently, they refuse treatment.
It is then up to the clinician and the patient to challenge and dispute these irrational beliefs using logic: why would a doctor try to kill them when they are there to help them? They have no reason to kill the patient. Once a patient can see this, they then will restructure the consequences and ultimately their behaviour and beliefs, and the goal will be to resume treatment.
When disputing the beliefs of a schizophrenic patient, it can be done through goal setting, reality testing, normalisation, critical collaborative analysis and the development of alternative explanations (Kingdon & Turkington, 2006).
Goal setting involves identifying goals early in therapy. Alternative explanations are developed towards the end of therapy which allows patients to develop their own alternatives to dysfunctional thoughts and behaviours.
Reality testing helps a patient identify irrational or illogical events. If patients struggle to differentiate between their internal reality (such as hearing voices and hallucinating), and external reality (what is actually occurring), they may engage in beliefs and behaviours that do not reflect reality and hurt themselves and others around them.
Reality testing is where a patient is encouraged to evaluate and recognise that their irrational thoughts are not real.
If a patient hears voices telling them a family member is breaking into their house and stealing items (activation event), they may lose trust and begin displaying distressing emotions (beliefs and behaviours) and delusions as a result. They no longer trust their family, and may even isolate themselves (consequences).
A clinician would then show the patient that the family member is not doing this by either finding the ‘stolen’ items, disputing and establishing reality by identifying the whereabouts of family members during these times or encouraging them to discuss other reasons for the missing items, such as they are misplaced somewhere in the house (disputing irrational beliefs). Then, trust is regained and the consequences are dismantled (effect restructuring).
Normalisation establishes that events can occur on a scale or continuum, rather than being a catastrophic psychotic experience that only occurs in disorders such as schizophrenia.
Normalisation is when a clinician works towards helping a patient understand that negative thoughts are normal in certain, appropriate situations.
Everyone can at times feel paranoid, for example, if they misinterpret a friend’s actions. The experiences of patients are explained to be on a continuum with normal human experiences, this way the patient feels less stigmatised.
Some patients struggle with normalising their behaviours and thoughts. Their internal thought processes are demonised by their self-persecution, worsened by delusions. A clinician will dispute the ideas and help a patient accept them. The patient will then understand there is no need to feel stress or shame, and reduce feelings of isolation and distress.
Stigma is reduced.
Critical collaborative analysis bridges conversations between patient and therapist so they can explore illogical beliefs together, and identify logical conclusions.
A clinician and patient should work together, logically discussing ideas that the patient has, why they are wrong, and why they came about.
Systems are put in place so the patient can recognise these negative thoughts and implement their own tests for these faulty beliefs. Reality testing is used throughout to continually establish the irrational parts of a patient's thinking, and the therapist remains empathetic and non-judgemental as they coach patients through critical analysis.
Ideally, the patient can eventually independently challenge and rethink their faulty beliefs. The patient can then develop their own alternative explanations by using these coping strategies, rather than resorting to delusional thinking.
When using CBT to treat schizophrenia, it’s important to understand whether it’s effective and appropriate, and why this may be the case. The advantages and disadvantages of using CBT are detailed below.
Let's explore the strengths of CBT.
Let's explore the weaknesses of CBT.
The impact factor or score refers to how many research articles cite the content published in a journal within the last year. Impact factors are valuable scores to consider for researchers identifying where to publish their content.
Scopus produces an impact score, and Cognitive Behaviour Therapy currently has an impact factor score of 3.928 (2021), and 5.672 over a five-year period leading up to 2021 (Journal Metrics for Cognitive Behaviour Therapy, n.d.).
An example of cognitive behavioural therapy (CBT) can be seen in how it is used to help treat schizophrenia. CBT helps identify irrational, dysfunctional thoughts and behaviours, and establish ways to deal with and combat these issues.
Cognitive behavioural therapy is a psychological talking therapy that explores dysfunctional, maladaptive thoughts and behaviours and employs behavioural learning techniques to combat these issues, usually through analysing cognition and behaviour logically and restructuring these thought processes.
The three main components of cognitive behavioural therapy are identifying the problematic or dysfunctional thought processes and behaviours, recognising they are dysfunctional and problematic, and employing techniques the patient can use to manage these issues (disputing irrational beliefs, for instance). The ABC model by Ellis and Harper (1961) is a good example of how CBT is used as a therapy.
It involves a therapist sitting with a patient and working through their issues and dysfunctional thoughts, disputing these irrational beliefs, and developing plans for the patient to restructure their thought processes.
It can be used for a multitude of disorders, such as depression, schizophrenia, anxiety, and many more. It helps treat symptoms of these disorders.
Cognitive behavioural therapy (CBT) has shown promising results in the treatment of schizophrenia where research is concerned. When combined with biological treatments, such as antipsychotics, the combination of therapies is even more promising. Rector and Beck (2012) found large clinical effects in the use of CBT to treat positive and negative symptoms of schizophrenia.
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