The Abcs Of Cognitive
Douglas Turkington, MDPsychiatric Times
This article examines the use of cognitive-behavioral therapy for psychosis, the evidence for its use, and the implications for practicing psychiatrists given the short-comings of pharmacologic therapy.
Cognitive-behavioral therapy in schizophrenia was originally developed to provide additional treatment for residual symptoms, drawing on the principles and intervention strategies previously developed for anxiety and depression. In the 1950s, Aaron Beck1 had already treated a psychotic patient with a cognitive approach, but thereafter the research in this specific area lay dormant for decades. Only after cognitive therapy had been firmly established for depression and anxiety, in the 1990s, did the research into psychological treatments for psychotic conditions gather force-again, with Beck in the forefront.
Pharmacologic therapy can leave as many as 60% of psychotic patients with persistent positive and negative symptoms, even when the patients are compliant with their medication instructions.2 Furthermore, medication compliance remains a major problem despite the introduction of modern atypical antipsychotics. Studies have shown treatment discontinuation in an estimated 74% of patients in both outpatient and inpatient settings.3
Does Cognitive Behavior Therapy For Psychosis Show A Sustainable Effect On Delusions A Meta
- 1Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- 2Department of Health and Social Work, Frankfurt University of Applied Science, Frankfurt, Germany
- 3Department of Psychological Methods and Statistics, University of Hamburg, Hamburg, Germany
- 4Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
What Is Cognitive Behavioral Therapy
In summary, CBT can help you identify and change unhealthy thought patterns that affect both your emotions and behavior. There are three levels of thought that affect your emotions and behavior. They are:
Core beliefs are ways of thinking about yourself, others, the world, and the future. Theyre central to your way of thinking and are formed early in life.
Dysfunctional assumptions follow your core beliefs. They are thoughts that are inflexible and unhealthy . Assumptions also impact your response to experiences and situations.
Negative automatic thoughts are unhealthy thoughts that occur in some situations, without you even realizing it.
Negative Automatic Thoughts
Negative automatic thoughts can make you feel depressed, anxious, or stressed and keep you from doing the things you want to do.
Automatic thoughts often focus on low self-worth, decreased self-confidence, and hopelessness.
You may have thoughts like Im a failure Anything I try fails Im worth nothing People never like me
Your thoughts may increase your depression and lead you to withdraw from social activities or give up on work projects.
Automatic thoughts often minimize coping abilities and magnify risk.
You may have thoughts like, I cant take the chance to call my sister. Ill be too upset or If I join that bicycling club, I know Ill get hurt
What are the Standards for CBT?
Whats in a Typical CBT Program?
How is CBT delivered?
Read Also: Is There Medication For Ptsd
Guidelines On Cbt For Schizophrenia
Finally, in the last decade there has been a great interest in the neurobiological effects of CBT, as increased awareness regarding neuroplasticity and learning has led researchers and clinicians to wonder how this intervention changes the brain.4040 Etkin A, Pittenger C, Polan HJ, Kandel ER. Toward a neurobiology of psychotherapy: basic science and clinical applications. J Neuropsychiatry Clin Neurosci. 2005 17:145-58. http://dx.doi.org/10.1176/jnp.17.2.145,4141 Collerton D. Psychotherapy and brain plasticity. Front Psychol. 2013 4:548. http://dx.doi.org/10.3389/fpsyg.2013.00548 Better understanding of the brain mechanisms which underlie CBT can play a crucial role to further understand the neural correlates of symptom reduction, to improve the efficacy and accuracy of intervention programs and to choose the most effective treatment for each patient. However, evidence regarding the brain mechanisms which support or underlie CBT effectiveness for patients with schizophrenia have been scarcely explored.
Promoting Further Recovery And Resiliency
The earlier discussion focused on the use of CBT for acute or persistent primary symptoms of schizophrenia or targeting co-occurring conditions, such as PTSD or substance use. An additional target for CBT has been to help with the disabilities that arise from peoples experience of demoralization and failure, especially in the area of major role function. Earlier hopes that the newer antipsychotics would not only have fewer side effects but also be more effective in treating negative symptoms and thus enhance the functional capacity of people with schizophrenia have not been realized. Unemployment rates and social isolation of people with schizophrenia remain very high. Despite having also made advancements in the development of vocational approaches more suited to people with severe mental disorders, such as supported employment, many people find themselves unable to fill the hours of the day with any meaningful activity. An Indiana study showed an improvement in vocational outcomes when weekly CBT group and individual sessions were used over standard vocational support in patients with schizophrenia spectrum disorders.38 The individuals receiving CBT worked more weeks and more hours and had better work performance over the 26-week study compared to those receiving standard vocational support.
Summary Of This Month’s Cochrane Review
The review by Jones et al in this month’s Cochrane Corner includes 60 RCTs involving 5992 individuals diagnosed with schizophrenia or related disorders. It compares adding CBT to standard care with standard care alone. The results suggest that the addition of CBT has no effect on long-term risk of relapse, mental state, social functioning and quality of life, although it may have some effect in improving long-term global state and reducing the risk of adverse events. The strength of these conclusions was limited by the poor quality of the available evidence.
BOX 1 Standard care
Standard care is also known as treatment-as-usual , usual care or routine care. Standard care is often used as a control condition in randomised controlled trials to determine whether the addition of a new intervention is a significant improvement on current practice . It can be a useful design to inform policy-making.
However, what standard care involves for a particular condition may vary significantly and is often not well-defined . The quality of standard care may vary, and the treatments themselves may differ depending on the provider. This variation can make it difficult to conclude whether or not a significant result is due to an effective trial intervention or to poor-quality standard care. It can also lead to heterogeneity, i.e. inconsistency, across studies.
How Does Cbt Help People With Schizophrenia
To help a person with schizophrenia minimize and manage their symptoms, CBT employs a variety of treatments and self-help initiatives. It promotes social integration as well as drug adherence.
A person will work with their therapist to develop objectives, learn how to manage with their symptoms, and change self-defeating behaviors during CBT sessions. A therapist will learn about a persons symptoms in order to determine the appropriate treatment option.
CBT assists people in examining their feelings, ideas, and behaviors in relation to symptoms or events. Negative ideas can be learned to detect, challenge, and change.
To assist a client with schizophrenia, the therapist may employ a variety of strategies. These are some of them:
expounding on noises
restoring normalcy to auditory hallucinations
offering coping strategies such as music or exercise
Restructuring of the brain
You May Like: What To Do When You Feel A Panic Attack Starting
Who Can Benefit From Cognitive Remediation
Schizophrenia can affect a wide range of people, across age ranges and demographics, seemingly at random. The cause of this thought disorder remains unknown however, a mixture of genetics, brain chemistry, stress, and psychoactive drug abuse may all contribute to it. While the condition affects the way a person thinks, feels, and behaves, when they develop the condition can play a key role in its overall effectiveness.
While cognitive remediation therapy can benefit patients with schizophrenia, it appears to be more effective in younger patients with higher IQs, symptomatically stable, and intrinsically motivated to improve. Older patients who develop the condition later in life can also benefit from the treatment.
Determining who can benefit the most from this treatment plan requires a comprehensive evaluation of their current cognitive functions. This allows the treatment program to target specific deficits and impairments and set meaningful goals to help improve the chances of success. Some of the categories of patients that can benefit the most include:
Developments In Cbt For Schizophrenia
Ongoing research and practice of CBT have led to emerging evidence of other important factors in schizophrenia, in addition to thought content and thinking styles. These include the role of arousal, emotion, attachment and interpersonal issues,, loss and trauma, self-esteem, and acceptance and self-to-self relating. These processes may potentially have a causal role in the development of the disorder and may contribute to the symptoms experienced in schizophrenia, the way in which these are expressed and the subsequent course of the disorder. The importance of these factors has been demonstrated in recovery approaches to psychosis, where there has been marked value in helping individuals to develop personal meaning and empowerment from their own psychotic experiences, acquire a sense of inner control and self-regulation, and enable emotional and cognitive change facilitating the attainment of goals and recovery. Appreciation of the heterogeneity and complexity of processes operating in schizophrenia beg a broader approach to treatment that incorporates evolving cognitive theory and practice.
Read Also: Do Panic Attacks Make You Sick
Information Sources And Search
Relevant studies were identified by an electronic literature search using five databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, and PsycLIT from 1987 to 21st January 2015 in the English or German languages. Published meta-analyses and reviews were also searched.
We conducted three different searches that were combined later. First, we searched the databases on the terms CBT OR cognitive therapy OR cognitive behavioural therapy OR cognitive behavior therapy OR cognitive behaviour therapy OR cognitive behavior therapy. Second, we searched the databases on psychosis OR psychotic symptoms OR schizophreni* OR paranoi*. Third, we investigated the terms RCT OR randomized controlled trial OR randomised controlled trial. Then, we combined all three searches, using the operator AND, which yielded 1598 studies. Removing duplicates resulted in 816 studies . Of these, 774 could be excluded beyond doubt after reading the title, leaving 42 studies. The search of existing meta-analyses identified three further studies. The remaining 45 studies were read by the first author and a Master’s student of clinical psychology. Of these, 19 studies fulfilled our inclusion criteria and were ultimately included.
Figure 1. Flow chart of selected studies.
Does Cbt Work For All People
CBT can be as effective as medicine in treating some mental health problems.
CBT can be helpful in cases where medicine alone has not worked.
CBT is usually safe and comfortable to undergo.
CBT can be effective for a wide range of mental health problems.
CBT can be helpful for people of all ages.
CBT may be particularly helpful for people who have difficulty accessing or sticking to treatment programs.
CBT may be helpful for people who have difficulty communicating with their doctors or therapists.
Also Check: Can Anxiety Lead To Depression
Cbt: Theory And Techniques
Several leaders in the field of CBT for treatment of schizophrenia have provided summaries of the theorectical background and therapeutic techniques.2123 Tarrier and Haddock21 note the recognition of coping strategies as a buffer against psychotic decompensation and that CBT could enhance these coping strategies already being employed by people with schizophrenia. They describe the following characteristics of coping training:
Specific cognitive and behavioral techniques Tarrier and Haddock21 advocate are attention switching, attention narrowing, increased activity levels, social engagement and disengagement, modification of self-statements, and internal dialogue.
Other types of interventions described by this group are de-arousing techniques, increasing reality or source monitoring, and belief and attribution modification.
Turkington et al23 summarize the main techniques as follows:
Intervention Comparator And Outcome
For the current analysis, unlike our previous review, we considered only studies on cognitive behavioural therapy, compared with any non-pharmacological intervention or control condition. Among the included studies cognitive behavioural therapy was administered usually in addition to standard care, which typically included pharmacological treatment. Studies were included in the analysis if they provided data for overall symptoms and/or positive symptoms measured with validated rating scales.
Don’t Miss: What Is The Phobia Of Dogs Called
Is Cbt Good For Aspergers
There is a lot of debate about whether or not CBT is good for people on the Aspergers and autistic spectrum. Research oes suggest that CBT can help to reduce the symptoms of anxiety within patients on the Aspergers and autistic spectrum.Throughout the CBT process the approach discusses the ways in which the individuals thinking correlates with their behaviour. CBT is a form of counselling that aims to help patients change their negative thoughts and behaviours. It can be very helpful for people who suffer from anxiety and have difficulty regulating their emotions.
Does Cbt Work On Everyone
Therapy is an important part of your health and well-being. However, it isnt always effective for everyone. One reason CBT may not be effective for you is if you dont believe in or have difficulty accepting your feelings and thoughts. This can make it difficult to learn and apply CBT techniques.
However, you can work with your therapist to make CBT as effective as possible. This starts by being an active participant in your therapy. You should be involved in making decisions about your treatment and should be able to talk about your thoughts and feelings openly. Additionally, you can try to maintain a positive outlook and focus on the things you can control. If you take these steps, you can help CBT be a success for you.
Recommended Reading: How To Help Someone With Anxiety Attack Over Text
What Are The Implications
In this group of people with longstanding schizophrenia and continued symptoms despite the use of clozapine, CBT was an ineffective addition to usual care. This trial does not support the widespread use of CBT in this group of people
People who had received CBT within the previous year were excluded from the trial, and it is unclear how many of the participants had ever been offered or engaged with CBT or other psychological therapy. Therefore it is difficult to know whether there is a subgroup who would benefit more. There may also be a timing issue of starting therapy when a person is ready to do so, rather than in the confines of a trial.
Though the results are disappointing, it highlights the need for alternative options to be developed. It should also not preclude CBT from being offered on an individual basis.
Antipsychotic Dose Reduction As An Outcome
The trials did not provide information on antipsychotic drug dosage and there was therefore no outcome that considered whether the addition of CBT may have allowed for a reduction in antipsychotic medication. Given the significant side-effect burden of long-term antipsychotic medication, a reduced dose or overall lower absolute dose of antipsychotic could be a very meaningful outcome for patients.
Recommended Reading: Are Panic Attacks Normal During Pregnancy
Performance And Detection Bias
In terms of masking , all trials were considered to have a high risk of performance bias since it is not possible to mask participants to treatment condition when they are required to actively engage in the therapy and it is clearly very different from standard care. This means that there may unavoidably be some expectancy effects on the behalf of participants. Nevertheless, it is possible to mask the trialist collecting outcome data to treatment condition, thus avoiding detection bias. Of the 60 studies, 22 did not address whether outcome assessors were masked, leading to an unclear risk of bias. Three studies stated that the outcome assessors were not masked, leading to a high risk of detection bias.
Cbt For Schizophrenia: A Critical Viewpoint
Published online by Cambridge University Press: 13 February 2019
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- K. R. Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
- P. J. McKenna
- FIDMAG Research Foundation, Barcelona and CIBERSAM, Spain
You May Like: Can Paxil Cause Panic Attacks
What Is The Most Effective Sleep Restriction Method
Sleep restriction therapy, also known as sleep restriction therapy with sleep onset latency restriction , is a non-pharmacological technique that can be used to improve sleep over time. Sleep restriction therapy involves gradually reducing the amount of sleep that a person is allowed to get each night. Sleep restriction therapy with sleep onset latency restriction s the most effective form of sleep restriction therapy.
The goal of sleep restriction therapy is to help a person get to bed earlier and sleep more hours. Sleep restriction therapy with sleep onset latency restriction s the most effective form of sleep restriction therapy because it helps to improve sleep onset latency and sleep quality.Sleep restriction therapy with sleep onset latency restriction lso helps to reduce the number of awakenings during the night.
Sleep restriction therapy with sleep onset latency restriction s usually offered as part of a Cognitive Behavioural Therapy for insomnia rogramme. CBTi is a type of treatment that helps people understand and manage their sleep problems. CBTi usually includes weekly sessions with a CBT therapist and a sleep diary. The sleep diary helps to track how well a person sleeps and how often they have awakenings.
Sleep restriction therapy with sleep onset latency restriction s a safe and effective technique that can help people improve their sleep over time.
How Long Does Cognitive Behavioral Therapy Last
CBT is a psychotherapy that helps people change the way they think and feel. It usually requires weekly sessions, and each session lasts around 30 to 60 minutes. CBT can help people learn how their thoughts and beliefs can affect their feelings and behavior. This can help people feel better and manage their life better.
Recommended Reading: Is Ptsd A Disability Uk