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.
Relatively little is known about the effects of CBT when compared with other psychological or talking therapies (such as supportive therapy, psycho- education, group, relaxation and family therapy) in helping people with schizophrenia. This review found that research in this area was often small scale and of limited quality. The majority of therapists (65%) met the review’s standard of being qualified (but this was not a complete finding as most studies did not take into account appropriate training and the qualification of therapists).
In the main, no difference in overall effectiveness was found between CBT and other talking therapies. Relapses (people with schizophrenia becoming unwell again) and re-hospitalisation (the need to go back into hospital) were not reduced. CBT was not any better at improving mental state compared to other talking therapies and CBT was no better or worse in managing the symptoms of schizophrenia, both in terms of managing positive symptoms (such as hearing voices or seeing things) and negative symptoms (not feeling emotions, inactivity which leads to weight gain).
No difference was found for leaving the study early or continuing treatment for CBT compared with other therapies, although the overall number of people who left the study early was relatively low compared to drug trials meaning that CBT and other talking therapies may better at retaining and keeping people with schizophrenia in treatment. No advantage for CBT was recorded with regard to death by natural causes or suicide, coping with anxiety, building self-esteem, developing insight or helping with anger or problem behaviours such as violence. Few studies reported the effect CBT had on quality of life and in developing better social or work skills.
The review, however, suggests that there might be some longer term advantage in CBT for dealing with emotions and distressing feelings. Some initial findings indicated that CBT may be of greater benefit to people with depression and managing its symptoms.
This Plain Language Summary was written by a consumer Benjamin Gray, Service User and Service User Expert,
Rethink Mental Illness. Email: firstname.lastname@example.org.