Cognitive behaviour therapy (CBT) aims to help people change patterns of thinking or behaviour that are causing problems. Changing how you think and behave also changes how you feel.
(DH, 2001 a, p. 8)
Mental health problems, according to this approach, can be alleviated by people learning different behaviours and responses to events and situations that cause distress. During CBT people follow a structured approach to learning new behaviours and changing their ways of thinking, feeling and responding.
The approach involves identifying a goal and then breaking it down into smaller, achievable stages. Each person has an individual plan which includes detailed instructions and tasks for them to undertake between therapy sessions.
For example, Martin finds it very difficult to go outside. With his community psychiatric nurse (CPN) he has talked about what he would like to be able to do and the feelings he has when he goes outside.
They have agreed a goal for the therapy - that Martin will go fishing again, something he has not been able to do for several years. Martin and the CPN then discuss and set specific tasks which will lead up to this goal.
Tasks range from gaining the confidence to stand at his door, to going into the garden, and so on until Martin can go fishing. At each stage the CPN teaches Martin techniques to help manage his anxiety and he practises them between sessions. Managing his anxiety helps Martin to change his thought patterns and his problematic ways of thinking, feeling and responding.
CBT has been found to be helpful for people who experience problems with anxiety and depression (DH, 2001b) and may also be effective for people who have received a diagnosis of schizophrenia (NICE, 2002).
The British Psychological Society (2000) has found that psychological interventions, including CBT, offer a 50% decrease in relapse rates for people with what they term psychotic experiences. Such evidence has led to a major interest in training professionals to offer more CBT interventions to people using mental health services. CBT is cost-effective in terms of speed of delivery and provides easily measurable outcomes as the desired changes are identified as the objective at the beginning of therapy (Rowland and Goss, 2000).
There are many views about the use of CBT among service users/survivors and practitioners. Mike Smith, a mental health nurse, sees it as one therapeutic tool among many. However, he is concerned that when working with people hearing voices CBT may be used to correct, rather than explore, meanings:
CBT tends to understand people's experiences and reactions as abnormal or maladaptive
For example, someone may be saying that their voices are spiritual. But the CBT therapist will say this is abnormal, and it is a form of inner speech.
But my view is that if someone believes in spirits, work with it, don't put a negative value on it.
(Quoted in James, 2003, p. 12)
John Williams, a service user and treasurer of the Hearing Voices Network, welcomes the use of CBT as he feels it helps people to communicate about hearing voices:
In the past, nurses might have tried to ignore people's voices and instead tried to get them to play Scrabble or chess
But now they might sit down with someone and listen and challenge their ideas.
(Quoted in James, 2003, p. 13)
British Psychological Society (2000) Recent Advances in Understanding Mental Illness and Psychotic Experiences, Leicester, BPS.
Department of Health (2001a) Choosing Talking Therapies?, London, DH.
James, A. (2003) 'CBT - liberation or limitation?' Openmind, Vol. 124, Nov/Dec, pp. 12-13.
National Institute for Clinical Excellence (2002) Clinical Guideline I: Schizophrenia. Core Interventions in the Treatment and Management of Schizophrenia in Primary and Secondary Care, London, NICE.
Rowland, N. and Goss, S. (2000) Evidence-based Counselling and Psychological Therapies: Research and Applications, London, Routledge.