Description of the intervention
Medication is the mainstay of treatment for schizophrenia but 5% to 25% of people continue to experience symptoms in spite of medication (Christison 1991; Davis 1977; Meltzer 1992) and may experience side effects that are unwanted and unpleasant.
Talking therapies may also be used in addition to medication. In cognitive behaviour therapy (CBT), links are made between the person's feelings and patterns of thinking which underpin their distress. The participant is encouraged to take an active part by using the following techniques.
1. Challenging the habitual patterns of thinking.
2. Examining the evidence for and against the distressing beliefs.
3. Using reasoning abilities and personal experience to develop rational and personally acceptable alternative explanations and interpretations (Alford 1994) and to test these alternative explanations in real world situations. Tarrier 1993 has stressed the beneficial effects of enhancing coping strategies and general problem-solving skills. At present, a variety of interventions have been labelled as CBT and it is difficult to provide a single, unambiguous definition. In recognition, the review authors have constructed criteria that are felt to be both workable and to capture the elements of good practice in CBT.
Cognitive behavioural therapy is becoming increasingly available for people with schizophrenia, with recent recommendations of national treatment guidelines suggesting that CBT should be more widely available for people with schizophrenia (NICE 2009). This 2009 update of NICE 2002 is more directive in its support of the use of CBT for people with schizophrenia than the earlier version.
In addition, many of the trials of CBT for psychosis have incorporated additional active therapeutic elements (e.g., psychoeducation and relapse prevention, etc) that would be considered adjunctive to techniques which are specifically targeted at eliciting belief change (e.g., guided discovery or behavioural experiments).