Alison opened her presentation by discussing the understanding of schizophrenia and psychosis and said that this has changed radically over the last two decades. In the past clinicians were discouraged from talking to service users about their psychotic symptoms as this was deemed to be harmful. Now there is consistent evidence that psychological therapies can be beneficial; moreover service users want access to talking treatments. CBT for psychosis (CBTp) follows the fundamental principles of standard CBT for anxiety and depression, but it has been adapted to help people distressed by symptoms of psychosis. The basic premise of all CBT is that how people makes sense of events (their beliefs) impacts upon their emotional and behavioural response.
“Catastrophic interpretation of events: focus on this, therefore reduce the symptoms of psychosis”
When working with hallucinations, therapists explore service users’ beliefs about their voices: how they relate to them. Those who believe their voices have malevolent intent, that their voices are powerful and omniscient are more likely to be distressed than those who believe their voices are benevolent, have little power and cannot take charge. The premise is, it is not the voices themselves that are essentially problematic, but it is the beliefs about the voice that lead to the distress. In therapy, the service user would be helped to explore and often test out the validity of distressing beliefs as a means of feeling more comfortable with their experiences. Similarly, delusions are seen as understandable though often inaccurate attempts to make sense of events in the world. The therapist collaborates with the service user to explore beliefs and find less distressing alternatives.
“Zubin and Spring in 1977 were first to talk of psycho-social understanding of psychosis. 30 years on they have been proved right”
There is now sufficient evidence to show that CBTp is effective at reducing symptoms and has been found to be cost effective. NICE now recommends CBTp for those at risk of developing psychosis, those experiencing a first episode of psychosis and those experiencing further acute episodes or in remission. Despite this it seems that only about 10% of those eligible for CBTp actually get offered this. Also, although there is accumulating data supporting the effectiveness of CBTp, effect sizes within research trials to date are small to moderate. More needs to be done. Further research needs to be conducted to determine who is most likely to benefit from CBTp and which elements of therapy are most therapeutic.
“Catastrophic interpretation of events: focus on this, therefore reduce the symptoms of psychosis”
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