CBT or drugs for treatment of Schizophrenia?

Matt Kenyon 1411

Cognitive Behavioural Therapy (CBT) involves identifying, challenging and modifying delusionary beliefs. The therapy is mainly talk-based and allows the person to actively alter the thought processes which cause their symptoms. In the cognitive aspect they are taught that their delusions are acceptable and normal for 1% of the population. The behavioural aspect involves the formation of hypotheses to challenge beliefs. Evidence is gathered outside of sessions to show the patient that their beliefs are unrealistic, allowing more realistic alternatives to subsequently be generated.

Drug therapy involves typical and/or atypical antipsychotic drugs. These regulate the abnormal levels of Dopamine (DA) at neurons during neural transmission which cause symptoms. Typical antipsychotics release  a substance which binds tightly to receptor sites, preventing excessive levels of DA from binding. Atypical produce a substance to bind more loosely and for a shorter period of time, causing less severe side effects.

Time– On the basis of time, CBT is superior to drugs, because CBT typically takes about 8-12 weekly sessions to complete a programme, whereas drugs take between 6 to 8 weeks just to begin affect. This makes the actual treatment of schizophrenia shorter to take place with CBT. However, drugs could be said to be better because they take virtually no time to take, whereas CBT is a number of hour-long sessions which may not be desirable for people with busy work or school schedules.

Effectiveness – Hollon found that the two therapies have roughly the same effectiveness, though CBT’s lasts for longer. A combination of the two has also been seen to have a higher effectiveness that any one alone. Individual studies have found high effectiveness for drugs (60%-Barlow and Durand) and for CBt (70%-Kingdon and Turkington).

Acceptability – CBT is a lot more acceptable for patients than drugs because they play an active role in tackling the underlying cause of their delusions, whereas the use of drugs makes patients passive and helpless without independence from drugs; Davis et al found that during his study of the effectiveness of drugs, patients begged not to take medication due to the undesirable side effects. Children and young teenagers may be better suited to CBT as drugs alter the neurochemistry and other processes due to their side effects.

Side effects – One huge strength of CBT over drugs is that they have no side effects. Drugs have many, and some quite severe effects, however: these range from excessive sweating and nausea to irreversible, Parkison’s-like tremors. This leads to further problems on top of schizophrenia. Though atypical antipsychotics have fewer and less severe side effects because binding is looser, the effects still exist but in CBT do not.

Conclusion? –  Each case is different and the treatment which is best for that individual, given their past history and lifestyle, would be most desirable. However, as a whole it can be seen that CBT is the clear winner, with no side effects and high effectiveness and acceptability. The time taken for therapy sessions is worth it for the control that the patient gains over their condition, empowering and useful for the long-term. Despite this, as CBT tackles the brain’s software and drugs the brain’s hardware, a combination would be the best thing to do for the greatest effectiveness.