Service user perspectives on individual CBT for psychosis


I have been procrastinating about writing this blog for a while. This is, in part, caused by hesitancy about involving myself in the CBT for psychosis (CBTp) debate.

Regular readers of the Mental Elf will be aware that in recent months Jauhar and colleagues presented results of a meta-analysis that called into question the effectiveness of CBTp (Jauhar et al, 2014).

More recently, the findings of Morrison et al’s study of CBT for un-medicated psychosis were published in The Lancet (Morrison et al, 2014). Morrison and colleagues considered the results to be an endorsement of CBTp, but their conclusions were questioned by members of the Mental Elf team (Tomlin et al, 2014).

I was first trained in CBTp as a trainee clinical psychologist. Since then, I have seen people who seem to have benefitted from CBTp and some whom it does not seem to have helped. As a jobbing clinician, working regularly with people with psychosis, I currently find myself in a bit of a quandary. The evidence for CBTp is contested and debated yet recently updated NICE and SIGN guidelines continue to recommend its use. I had hoped that the paper I have been asked to review might help me to think about this aspect of my clinical practice since it seeks to explore service user perspectives on their experiences of individual CBTp, an extremely important group of stakeholders.

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Having gone through extensive CBT about 3 years ago - I can tell you it did not work out for me so well. I was partially psychotic so obviously it did not work out for me. CBT requires a non psychotic brain, in order for it to work effectively. My current psycholgist told me to read a book on CBT - she understands that CBT on schizophrenics goes so far. If you ask me, all the hype on CBT and how it can help schizophrenia, is really all about finding a way to keep therapists involved and taking on more patients and in turn this helps them gain financially - its all about money.
CBT works on non psychotic depression,anxiety - not so much for schizophrenia or even bipolar



@Wave I would agree with that to a certain extent re therapists pushing non drug therapies.



My current therapist knows that CBT has limited value, when it comes to effectively treating psychotic patients.
CBT is a way for therapists - to lure in more patients into their practice maybe? Bottom line its probably about money and to a certain extent recognition. I think as time passes, the truth that CBT at best is minimally effective for treating psychotic patients will come up to the surface - CBT is more effective for depression and anxiety to a certain degree with some individuals, not everyone will benefit form CBT. If you ask me there is a lot of hype surrounding CBT and how effective it is