1. Psychological treatments for schizophrenia
Pages of Year 2 book
CBT for Schizophrenia

2. Psychological Therapies for Schizophrenia
Describe and evaluate CBT as used to treat schizophrenia.
Starter: What do you already know about cognitive behavioural therapy?
Write down your ideas on a post it and feedback.
EXT: Spec check!

3. Cognitive Therapies Between 5 - 20 sessions (AO3???)
Identify and assess irrational thoughts and delusions
Challenge the evidence on which delusions are based
Design ‘experiments’ or arguments to test reality of this evidence
Patient as the scientist - educate patient on the research based, psychological explanations for their symptoms
Also referred to a ‘normalising’ - de-catastophising psychotic experiences.

4. 1. Coping strategy Enhancement
A form of CBT for Schizophrenia
Tarrier devised a specific form of CBT for schizophrenia known as Coping Strategy Enhancement which focused on building on schizophrenics’ existing coping strategies.
Tarrier noted that patients were able to identify triggers for schizophrenic episodes and had devised their own coping strategies.
Examples of triggers would be things like:
Certain people (e.g. a parent)
Being on their own
Being put under stress

5. There are two types of coping strategies that are developed in the therapy:
Cognitive strategies, such as distraction, concentrate on a specific task; positive self talk
Behavioural strategies such as relaxation techniques (e.g. breathing exercises), social withdrawal/ increasing social contact; loud music to drown out voices, behavioural experiments

6. How CSE works There are two parts to the therapy:
Develop a rapport with the patient and identify triggers of psychotic symptoms as well as reviewing existing and developing new coping strategies.
(ii) Target specific symptoms and find strategies to deal with them.
Participants have homework assignments to consolidate their learning of strategies between sessions.

7. The overall aim of CSE is to have two effective strategies for each distressing symptom.
Support for the effectiveness of CSE comes from Chadwick (1992) who worked with a schizophrenic who had the delusion that his thinking could influence the future.
However, he failed to predict what would happen in 50 video clips shown to him which helped provide him with evidence to show that his delusional beliefs were false.

8. Complete worksheet 8.11

9. 2. Cognitive Behavioural Therapy
The focus: Belief Modification
In your own words
“What is meant by….”
Irrational thoughts
Delusional beliefs
Challenging perceptions
Substituting irrational interpretations with rational
The problem…
The solution…
Over to you….A paranoid schizophrenic believes that the worker in her local supermarket is a secret agent spy who is keeping tabs on her.
How might belief modification be used to treat this patient?

10. CBT - AO1 - how it works
Normalising strategies where patient is taught to understand the nature of schiz. Symptoms
Challenge ‘catastrophising’ beliefs about schizophrenia
Help patient feel that symptoms are understandable and ‘normal’
For each of the dysfunctional thoughts on the next slides. How might a psychologist challenge and modify these thoughts? How might normalising strategies be applied?

11. What’s going on inside the ‘black box’?
People are laughing on the bus
There’s something wrong with me

12. What’s going on inside the ‘black box’?
My papers are not where I left them
People are trying to sabotage my career

13. What’s going on inside the ‘black box’?
I can’t hear what people are saying
My family is plotting against me

14. How might you challenge these perceptions?
Identify the irrational thinking and delusional beliefs.
How might you challenge and replace these irrational thoughts? How might you apply normalising strategies?
Mr X believed that other people could read his thoughts through telepathy. This belief started when a woman looked at him in a supermarket and said to her companion ‘I can read his thoughts’. Mr X was convinced that other people had this power but would not admit to it. He was afraid that people would attack him because of what he was thinking, and tended to avoid situations that would bring him into contact with others (Kuipers et al, 1996).
A patient complained that communists were flying over his house in planes, shooting him with invisible rays that caused abdominal churning, tension and heart palpitations (Turkington & Kingdon, 1996).

15. Complete worksheet 8.12 Using CBT for Schizophrenia

16. AO3: Evaluating effectiveness
To evaluate the effectiveness of a treatment, researchers use the clinically significant improvements (CSI). They will also assess the longevity of the positive results.
Evaluation of CBT (and other psychotherapies):
Not all clients are suited to vigorous confrontation. Some Ps are so agitated and unable to rationalise that they cannot emphasise with the therapist.

17. Exam question
Two years ago Jenny was diagnosed with schizophrenia. She has been taking a typical antipsychotic drug and there have been improvements in her positive symptoms. However she still suffers negative symptoms and side effects. Her psychiatrist wants to change her medication from typical antipsychotics to one of
the atypical antipsychotics and has also suggested cognitive behavioural therapy.
With reference to the item above, explain how the cognitive behaviour therapy could be used to help Jenny with the positive symptoms of schizophrenia (4 marks)

18. Ext: Exam Question
Briefly outline how cognitive behaviour therapy (CBT) is used to treat schizophrenia and explain one limitation of using CBT to treat schizophrenia. [4 marks]