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 people manage their problems by looking at the way they think, how their thoughts affect their actions, and how their actions affect their thoughts.

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 self-help versions available for some problems, and also computer programmes – Beating the Blues, for example, is offered by some NHS services to people who have mild to moderate depression.

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

Back to top

Does CBT help people with psychosis?

Cognitive behavior therapy, given in addition to medication, can help people who have psychosis to cope better with some of their distressing experiences. The therapy focuses on the priorities of each individual. People come to the sessions with a list of problems that they and the therapist can then work on together.

Therapists help people try to understand their hallucinations and any upsetting and worrying thoughts and beliefs, 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 people live more easily with them and lessen the distress that some symptoms can cause.

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

However, cognitive behaviour therapy does not help everybody who has psychosis. Generally, only people who want therapy (as opposed to those who may need therapy) are likely to be helped. Therapy cannot be imposed on people, and an individual has to be motivated to meet with a therapist.

Back to top

How do you know it works?

A lot of research has been carried out to test the effectiveness of CBT for 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 and carried out a series of studies that showed the talking therapy made a positive difference.

In the last 15 years, research from the UK, Europe, the USA and Canada has continued to illustrate that CBT can help reduce the symptoms of psychosis and depression experienced by people with schizophrenia. The research shows that it works best for people who are relatively stable and taking medication, but who have ongoing distressing symptoms.

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 new types of CBT are being tested and evaluated.

Research has also been carried out to see if cognitive behaviour therapy can help people with schizophrenia who are not taking antipsychotic medication. A very small study carried out in Manchester has shown that CBT for psychosis did help people who had not been taking medication for at least six months. However, more research among a larger number of people is needed to find out what difference CBT alone can make.

Back to top

Who are the therapists?

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

Back to top

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 who want therapy should be given CBT on an individual basis for at least 16 planned sessions over a period of six months or more.

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.