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Posted: February 27th, 2023
The potential benefits of cognitive behavioural therapy plus standard care as compared to standard care alone in symptom reduction and recovery for patients with schizophrenia.
Cognitive behavioural therapy (CBT) is a type of psychotherapy that helps people with schizophrenia cope with their symptoms and improve their functioning. CBT is based on the idea that the way we think, feel and behave are interconnected and can influence each other. CBT aims to help people identify and challenge unhelpful or distorted thoughts, emotions and behaviours that may contribute to their distress or impair their recovery.
CBT for schizophrenia is usually offered as an adjunct to medication and other forms of psychosocial support, such as family intervention, vocational rehabilitation and peer support. CBT can be delivered individually or in groups, depending on the needs and preferences of the person. CBT typically involves 12 to 16 sessions of one hour each, over a period of 6 to 9 months.
CBT for schizophrenia has been shown to be effective in reducing positive symptoms, such as hallucinations, delusions and paranoia, as well as negative symptoms, such as apathy, social withdrawal and lack of motivation. CBT can also help people cope with the side effects of medication, enhance their self-esteem and quality of life, and prevent relapse.
A typical CBT session for schizophrenia may include the following steps:
– Establishing a collaborative and trusting relationship between the therapist and the person
– Reviewing the goals and progress of the therapy
– Exploring the current difficulties and challenges faced by the person
– Identifying and evaluating the thoughts, feelings and behaviours associated with the difficulties
– Developing alternative or more balanced perspectives on the difficulties
– Practising new skills or strategies to cope with the difficulties
– Assigning homework tasks to reinforce the learning and apply the skills in daily life
– Summarising the main points and feedback of the session
For example, a person who hears voices may work with the therapist to understand the triggers, content and meaning of the voices, and how they affect their mood and behaviour. The therapist may help the person question the validity and authority of the voices, and find ways to reduce their impact or ignore them. The therapist may also help the person develop positive coping strategies, such as relaxation techniques, distraction activities, social support or assertiveness skills.
CBT for schizophrenia is supported by a large body of research evidence from various countries and settings. A meta-analysis of 50 randomized controlled trials found that CBT for schizophrenia was superior to usual care or other psychological interventions in reducing positive and negative symptoms, improving functioning and enhancing well-being (Jauhar et al., 2014). Another meta-analysis of 21 randomized controlled trials found that CBT for schizophrenia was effective in reducing hallucinations, delusions and paranoia, both immediately after treatment and at follow-up (van der Gaag et al., 2014).
CBT for schizophrenia is recommended by several clinical practice guidelines, such as those from the American Psychiatric Association (APA), the National Institute for Health and Care Excellence (NICE) in England, and the Royal Australian and New Zealand College of Psychiatrists (RANZCP). However, CBT for schizophrenia is not widely available or accessible in many countries, due to various barriers such as lack of trained therapists, limited resources or low awareness.
CBT for schizophrenia is not a cure for the condition, nor does it aim to eliminate all symptoms. Rather, it is a helpful tool that can empower people with schizophrenia to manage their symptoms better, improve their functioning and enhance their recovery.
References:
Jauhar S., McKenna P.J., Radua J., Fung E., Salvador R., Laws K.R. (2014). Cognitive-behavioural therapy for the symptoms of schizophrenia: systematic review and meta-analysis with examination of potential bias. British Journal of Psychiatry 204(1):20-29.
van der Gaag M., Valmaggia L.R., Smit F. (2014). The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophrenia Research 156(1):30-37.
APA (2016). Practice guideline for the treatment of patients with schizophrenia. Second edition. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/schizophrenia.pdf
NICE (2014). Psychosis and schizophrenia in adults: prevention and management. Clinical guideline [CG178]. https://www.nice.org.uk/guidance/cg178
RANZCP (2016). Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders. Australian & New Zealand Journal of Psychiatry 50(5):410-472.
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