Friday, 15 June 2012

Cognitive behaviour therapy versus other psychosocial treatments for schizophrenia

Cognitive behavioural therapy (CBT) is a talking therapy first mentioned in 1952 but only became recommended as a routine treatment in 2002. CBT encourages people to openly discuss their beliefs, emotions and experiences with a therapist (individually or in a group), as well as participate in assessing their symptoms, emotional distress and behaviour. Such discussion is thought to help develop ways of challenging, coping and managing unhelpful thoughts and problem behaviour. People with schizophrenia may have difficulties with concentration, attention and motivation. The capacity to think, feel pleasure, talk openly and act also may be reduced. All of which can mean making friends, living independently and finding employment are sometimes hard. The idea of CBT is to help with these problems by coming up with ‘real world’ coping strategies and problem solving skills.  

Read more and find the full summary here:

Perhaps the most important issue from the service user perspective (SUPER) is that waiting times of more than one year are commonplace to get into CBT.  The ratio of people with schizophrenia needing or wanting CBT to available therapists (and the cost of these therapists to health services) may limit the uptake and impact of CBT. 

Uptake of CBT by people with less severe mental health problems (such as depression, which the review found might benefit more from CBT) may also limit access for people with more severe mental health issues such as schizophrenia.  CBT and other talking therapies may be more of an obstacle for people with schizophrenia, because hearing voices, seeing things, having strange beliefs and thoughts may impede the ability to talk and communicate. 

Research also did not take into account CBT and other talking therapies with regard to race, gender and age.  These are very important and should be considered.  In terms of race, for example, therapists and mental health professionals may not share the same culture, first language, values and religious beliefs of service users, leading to cultural misreading or misunderstanding.  Both the content and meaning of people’s experiences may be ‘lost in translation’ by therapists.  This could be rectified by appropriate and racially sensitive training.

From a more critical perspective, talking therapies could become a controlling or confessional exercise, where people with mental health problems may feel obliged or pressured into revealing their personal lives and emotional distress.  Talking therapy must tread carefully so as not to tell people with mental health problems what to think, feel and do, as this would create all kinds of problems, not least unequal relationships between therapists and service users and subsequent mistrust.  Establishing trust and dialogue with service users, appropriate training (perhaps training by service user advocates and experts) and the regular supervision of therapists would counteract this potential problem.   

Finally, CBT is new and evolving, having only become popular and a routine treatment in the last 10 years.  More research and development of CBT is therefore warranted. 

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