1. Psychological Therapies Schizophrenia

2. Introduction Although the use of drugs is crucial in the treatment of schizophrenia, many people do not experience the effects and still experience distressing symptoms. There are many forms of psychotherapy which can be successful in treating schizophrenia.

3. Cognitive Behavioural Therapy Assumption – People suffering from schizophrenia often have distorted beliefs which influence their behaviour in maladaptive ways. They may feel someone controls their behaviour. These delusions are thought to result from faulty interpretations of events. Cognitive therapy is used to help the patient to identify and correct these faulty thoughts.

4. CBT Techniques In CBT, patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how the symptoms may have developed. They are also encouraged to evaluate the content of their delusions or of any internal voices they hear, and to consider the validity of their faulty beliefs.

5. CBT Techniques Patients might also be set behavioural assignments with the aim of improving their general level of functioning. The learning of maladaptive responses to life’s problems is often the result of distorted thinking by the schizophrenic, or mistakes in assessing cause or effect (e.g. assuming that something terrible happened because they wished it).

6. CBT Techniques During CBT, the therapist lets the patient develop their own alternatives to these previous maladaptive beliefs, by looking for alternative explanations that are already in the patients mind. They learn to change their initial negative interpretations.

7. Outcome Studies Outcome studies measure how well a patient does after a particular treatment. These studies suggest that patients who receive cognitive therapy experience fewer hallucinations and delusions and recover their functioning to greater extent than those who receive antipsychotic medication alone.

8. Outcome Studies Drury et al (1996) – Found benefits in terms of a reduction of positive symptoms and a 25-50% reduction in recovery time for patients given a combination of antipsychotic medication and CBT Kuipers et al (1997) – Found lower patient drop out rates and greater patient satisfaction when CBT was used in addition to antipsychotic medication.

9. Effectiveness Supporting Research Several studies have shown that CBT can be effective in treating schizophrenia. Gould et al found that all seven studies in their meta- analysis reported a statistically significant decrease in the positive symptoms of schizophrenia after treatment.

10. Effectiveness CBT Alone Most studies on effectiveness of CBT have been conducted with patients treated at the same time with antipsychotics. It is therefore difficult to assess the effectiveness of CBT independent of antipsychotic medication.

11. Effectiveness Lone Term Benefits Jones et al (2000) found CBT reduced both the frequency and the intensity of hallucinations. It was less effective with delusions but it did seem to reduce the accompanying distress. Drury et al (2000) found that CBT had immediate and short term gains but in a five year follow up study the treatment showed no long term advantage.

12. Appropriateness Who Benefits? The use of CBT in conjunction with other therapies seems to have benefits but it is commonly believed that not everyone will benefit. Kingdon and Kirschen (2006) - found that many patients are not suitable for CBT as they would not cooperate with it. It was also seemed more appropriate with younger people.

13. Appropriateness Not a cure Although some studies have shown that CBT can improve certain symptoms of schizophrenia, CBT does not offer a cure.

14. Appropriateness Ethics CBT is a collaborative therapy and involves the active cooperation of the patient. This avoids the criticism of made of drug therapy where the patient passively receives drugs.