Cognitive behaviour therapy

• What is cognitive behaviour therapy?
• Does CBT help people with psychosis?
• How do you know it works?
• Who are the therapists?
• Can everyone with psychosis access CBT?

What is cognitive behaviour therapy?

Cognitive behaviour therapy (CBT) is a type of talking therapy that aims to help someone find solutions to their problems by looking at the way they think, how their thoughts affect their actions and vice versa.

The therapy can help people change how they think and what they do to make them feel better about themselves. CBT focuses on today’s problems and difficulties, rather than looking backwards into the past as some other forms of therapy do.

CBT can be adapted to help people with specific mental health problems. Different versions of CBT have been developed for people with depression, anxiety, obsessive compulsive disorder and post traumatic stress disorder, for example. CBT can also help people who have physical health problems.

CBT can be done individually or in groups. There are also self-help versions available for some problems, and computer programmes – Beating the Blues, for example, is available in some NHS services for people with mild to moderate depression.

A course of CBT can last from six weeks to six months, depending on the type of problems.

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Does CBT help people with psychosis?

Researchers at the Institute of Psychiatry and health professionals working at South London and Maudsley NHS Foundation Trust were among those who pioneered CBT for psychosis some years ago. The research they carried out showed that the talking therapy, given in addition to medication, could help people who have psychosis to cope better with some of the symptoms.

Therapists help people to try to understand their hallucinations, delusions and distressing thoughts, and discuss new ways of thinking about them, and dealing with them. CBT doesn’t necessarily get rid of the symptoms or unpleasant experiences, but it does help with the distress, and impact on functioning those symptoms can cause.

CBT can also help with depression, anxiety, lack of motivation and low self-esteem often experienced by people with schizophrenia.

CBT for psychosis focuses on the priorities of each individual. People with psychosis come to the sessions with a list of problems that they and the therapist can then work on together.

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How do you know it works?

A lot of research has been carried out to test the effectiveness of CBT for psychosis.

In the last 15 years, research from the UK, Europe, the USA and Canada has shown that CBT can help reduce the symptoms of psychosis and depression. The research has shown that it works best for people who are relatively stable on medication, but who have ongoing residual distressing symptoms.

However, therapy does not help everybody. Only people who want therapy (as opposed to those who may need therapy) can be helped. Therapy cannot be imposed on people, and the person has to be motivated to come.

Research carried out with the help of people with bipolar disorder has shown that CBT can help speed recovery from depression and help prevent relapse.

New forms of CBT are being developed to help people deal with specific symptoms of psychosis, such as ‘command’ voices – voices that tell people to carry out harmful actions  – and to help people cope with early symptoms of psychosis. These types of CBT are being tested and evaluated.

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Who are the therapists?

Cognitive behaviour therapists are usually mental health professionals who have had special training. These include clinical and counselling psychologists, psychiatrists, psychiatric nurses, social workers and psychology graduates. Sometimes, therapists follow manuals that have been developed in research studies and are designed for specific problems.

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Can everyone with psychosis access CBT?

The National Institute for Health and Clinical Excellence (NICE) Guideline on Schizophrenia says mental health professionals should offer CBT to people to help with both the positive and negative symptoms of schizophrenia. People should be given CBT on an individual basis for at least 16 planned sessions.

The NICE Guideline on Bipolar Disorder says CBT in addition to medication should be considered as part of a long-term treatment package.

However, CBT for psychosis is still not available in all parts of the country. Your GP or the mental health team supporting your relative should be able to tell you if it is offered in your area.