Introduction
Because of diagnosis loss and accompanying fees, psychotic diseases cost numerous health agencies around the world a large amount of money. The economic burden is likewise present around the world. For example, it costs the United Kingdom (U.K.) £105 billion per year to care for and treat citizens with psychotic disorders in England. However, due to the analysis of Cognitive Behavioural Therapy (CBT), which has proven to be cost effective and has several benefits in the treatment of the condition, the pharmaceutical framework has significantly reduced the economic burden of psychotic disorders. It has helped those suffering from psychotic disorders to receive better care at a lower cost. The treatment approach has well-informed management strategies that could assist the therapists and patients to make an appropriate clinical decision for early intercession, prevention, and recovery from the psychological disorder (Freeman et al., 2014).
Various studies have further demonstrated how CBT can be effective in the treatment of psychotic disorders that have symptoms which resist could medications and can also reduce the duration that the patient would be required to stay in the health facility as compared to other therapies. However, CBT can be ineffective in reducing the negative symptoms of schizophrenia and against relapse (Beck, 2011).
There are also some arguments that the strengths of CBT as a treatment for psychotic disorder depends on the evidence that is derived from reliable models, but such evidence hinder the scope of development and application of new therapeutic interventions. Therefore, utilization of CBT as a response to psychotic illnesses has strengths and weaknesses.
Strengths
The highly structured approach nature of CBT can be utilized to treat psychotic disorders of the patients effectively. The approach encompasses the client and therapist cooperating on the goals of treatment (Kurniawan, 2013).The goals are typically realistic, achievable, specific, and measurable and have a time frame that is set. In the processes of treatment, a therapist would encourage the clients to break down their feelings, thoughts, and behaviours that have made them be stuck in the negative cognitive cycle (Padesky and Mooney, 2012). Further, the therapists would install learning skills and techniques that the patient can apply in their daily life to assist them to improve their mental health situation.
CBT has strategies that are based on rational approaches which have made it emerge as an effective response to the treatment of psychotic disorders. The theory and techniques that used in CBT treatment processes are based on the rational thinking; which means that the interventions are focus on identifying the problems that the patient is suffering from and it using facts. For instance, an inductive approach of CBT would encourage the patients to examine their personal beliefs and perceptions to determine if they are indeed realistic (Rathod, 2010). Further, the CBT treatment process is based on the assumptions that most of the behavioural and emotional reactions are things that the psychotic disorder patient acquires from the environment. In many occasions, the therapists utilizing CBT model would assist patients to understand that the underlying assumptions and hypotheses that they have been holding for a long time in their life would appear to be partially untrue, and it could be causing them unnecessary torments and miseries (Simmons et al., 2009). The characteristics of rational method have made CBT to be chosen as an effective treatment for psychotic disorders patients.
The law of impermanence and entropy are another strength of CBT that greatly helps to treat psychotic illnesses effectively. CBT is based on the scientific assumptions that are governed by the law of entropy that is an essential feature which states that 'in case you do not utilize it, you lose it.' The assumptions indicate that individuals always have privileges to change how they feel because their feelings are derived from their mental state processes which are constantly evolving (Minde et al., 2010). The breaking of the mental chemical reaction generates thought patterns which would automatically make the brains of individuals to adjust for the better (Hays, 2009). The use of MRI scans has revealed that human brains establish and sustains neural synapses between frequent emotions and thoughts, and if individuals could practice thinking positively, their brain will facilitate them to start feeling more relieved in the future.
Accepting painful or unpleasant emotions that are based on CBT framework has proven to be effective in the relieving the sufferings of psychotic disorder conditions. In the treatment process, the therapists would assist the patient to acquire social skills of how to be calm and express their views or opinions in the case where they are facing undesirable circumstances (McLeod, 2015). It is crucial that the patient learns how to accept undesirable emotions or thoughts as part of their life to help them prevent the vicious cycle of irrational thinking from forming itself. People often get upset from their worst feelings and even more when accompanied with suffering that they are subjected. CBT interventions would make the patients be prepared to embrace their problems without being judgemental to ensure that the undesirable situation is not worsening (Lynch et al., 2010). It happens when the patient is guided by therapists to avoid self-blaming, frustrations, anger, disappointments or sadness that already exists in their negative feelings.
CBT works more efficiently in relieving the pain of psychotic disorder by allowing the therapists to ask questions and the individual patients to express their negative emotions. The asking of questions would assist the patient to acquire a new perspective, see the situations more clearly and to create a realistic image concerning that situation (Silverman et al., 2008). The strategy would help the patients to uncover their irrational feelings which can easily be transformed into rational ones with much ease to help them recover from the psychotic disorder. The strategy of asking questions and expressing inner feelings has helped patients to feel much easier after therapy sessions.
Some specific techniques and agendas are utilized in the CBT treatment process which makes the intervention become a more suitable form of treating patients suffering from psychotic disorders. The response consists of a series of sessions where each contains a particular objective, technique, or concept that is applied (Davis et al., 2014). It makes the sessions appear much simpler for both the therapists and the client, as it allows them to speak openly without having a hidden agenda. It is contrary to what typically happens in some other forms of therapy. The CBT sessions would provide opportunities where the clients could learn skills of how to handle undesirable thoughts and feelings by practicing specific strategies that they might later apply in their life when they are much needed (Minde et al., 2010). Therefore, having specific agendas and techniques in CBT has helped in discovering the causes of psychotic disorders and making the application of appropriate strategies for dealing with the negative feelings much possible.
CBT can be applied in the cross-cultural context as compared to other psychotherapy interventions that have models which are aimed at treating psychological disorders that emerge in a monoculture setting. CBT treatment process is based on the assumptions that human behaviors are derived from the universal laws which have enabled the intervention to be effective in cross-cultural settings such as learning institutions (Seligman and Ollendick, 2011). The effectiveness in a cross-cultural setting is enhanced by focusing on the goals of the patients, rather than the therapists attempting to impose their wishes on the patients. It has made it possible to reframe irrational thinking of the patients into positive thoughts to relieve them from the painful worries.
In the treatment of psychosis, CBT would target to address emotional problems that are faced by the psychotic disorder patients. CBT has proven to be useful in solving some of the emotional challenges such as anxiety, self-evaluative thinking, depressed mood, hallucinations, and delusions (Hazell et al., 2016). They are symptoms that cause resistance to antipsychotic medications such as antidepressants. Based on results of previous studies, CBT has firmly demonstrated effectiveness in the treatment of psychosis which has led to major international health organizations such as National Institute of Clinical Excellence in the U.K (NICE) to prove CBT as a necessary form of therapy for the patients who have schizophrenia.
Limitations
Utilization of CBT in the treatment of psychotic disorder causes confusion on the symptoms of depression due to its cognitive causes. The example of negative cognition includes self-blame, low self-esteem, negative predictions, erroneous interpretations of experiences, and unpleasant memories (Thomas, 2015). Further, there is dichotomous thinking, making an immediate conclusion and the exaggeration of the negative experiences. The examples allow the individual patients to have an internal conversation concerning their self-evaluation, expectations, attributions, recall, and inferences. All these examples form part of the symptoms, and they are not cognitive causes of why the patients would be required to engage themselves in exaggeration of negative experiences, self-blame, and other irrational things that they might have.
The other limitation that CBT has on the treatment for psychotic illness is its emphasis on examining the relationship between mental dysfunctions and negative thoughts. It is because the intervention does not reply to the question of why people would decide to focus their attention on negative attributes that might be present rather than evaluating the positive of oneself to acquire more accurate insights (Jauhar et al., 2014). Further, the cognitive model that is applied in CBT interventions does not reconcile self-serving bias and self-blame bias findings. Various studies have revealed that people would be significantly motivated to see their positivity while avoiding any self-concepts that might be negative in their lives (Suveg et al., 2009). It is a form of demonstrating a self-serving bias as it involves appreciating success while blaming failures on the prevailing conditions.
CBT model also applies terminologies such as irrational belief about the self, dysfunctional self-concepts, negative self-concepts, and biased cognitions concerning the self as if they are synonymous and they can replace one another (Bhaumik et al., 2011). In fact, these terminologies have different meanings that are not recognized in the CBT intervention framework. Many studies have shown that the valence of either being positive or negative is independent and can be differentiated from the evaluation's accuracy (Kuyken et al., 2008). In numerous situations, the reports and appraisals of the clients are usually on their distressful or negative experiences which are quite realistic, rational and accurate. For instance, the physical abuses or sexual experiences of the clients often leave significant pain in their lives regarding their tragedies or of their loved ones. In such situations, the CBT interventions usually engage in cognitive-restricting exercises with the focus of reframing the reality rather than initiating a changing process. It is a process that does not solve the true problem that is affecting the patient.
The other limitation of CBT intervention for treating psychological disorders is its emphasis on applying the negative self-assessment of the problems that the patients might be suffering. Various research has indicated that positive self-evaluation may be maladaptive and dysfunctional (R Subramaniam, 2013). The studies further revealed that negative self-evaluation approaches are usually featured with inaccuracies and biases, especially in the social settings such as a workplace, health, and education (Hurley, 2008). Therefore, it is clear that CBT treatment might not be well effective to deal with the psychological problems that emerge in the learning institutions and other social-related environments.
The patients who have mental disorders would only be able to benefit from the CBT interventions if they are committed to the treatment process. The patient's cooperation forms the fundamental pillar in CBT treatment process as the therapist can only be able to assist and advice, but cannot eliminate the problems of an individual. According to the Wild and Gur (2008), the role of CBT is not to solve the psychological disorder, but it requires the therapists to play the role of a personal trainer where they advise and encourages, and the patients do the implementations. For example, in a situation where the patients are feeling depressed, it would be difficult for them to be focused and get motivated (Morrison and Barratt, 2009). Thus, the patient would be required to be committed to CBT and perform their essential part in the recovery process such as full participation in each therapy and completing their assigned homework for them to recover from psychological disorders such as depression. However, it is not the case with other treatments.
There is also another limitation with the structured nature of CBT treatment process. The constraints make it difficult for the intervention to be appropriate for the treatment of patients that might be suffering from complex learning difficulties or mental health conditions such as Trauma (Tolin, 2010). CBT also has the limitation of treating a particular group of patients that are having treatment-resistant depression and also those that are having both personality and depression disorder. It has made CBT not to be appropriate in the treatment of some severe psychotic disorders.
CBT intervention only addresses the present psychological disorder challenges and concentrated on the particular issue that is affecting the patient, but the treatment does not deal with the underlying reasons for mental health illness such as the angry childhood (Clark, 2009). Diagnostic Scan under hypnosis is the hypo-psychotherapy intervention that could be applied rather than treating the causes of cognitive disease. Therefore, it makes CBT not effective in preventing people from attracting psychological disorders, unlike hypo-psychotherapy that deals with the causative factors.
The intervention is usually designed to solely focus on the capacity of an individual to transform themselves, and it does not solve the magnitude of problems within the family or the systems that normally have an enormous impact on the health and well-being of an individual (Mitchell et al., 2012). For example, CBT treatment process would require the patients to be able to change their negative thoughts, feelings, and behaviors and replace them with rational thinking for them to recover from the psychological illness.
The CBT intervention process might take longer as compared to other mental disorder treatment mechanisms. The traditional cognitive therapy might not be effective because it would require much time (Andersson and Titov, 2014). However, there is a modality and the opportunity that is available for close contact between the therapists and patients. It requires therapists to conduct numerous counseling sessions with the patients and also some extra ones outside the usual treatment routines to outline the practices and principles of CBT to the patient before the treatment process can commence. Therefore, it makes CBT time-consuming.
CBT cannot be universally used to treat all patients suffering from psychological disorders. The treatment process would not be successful for a particular group of clients as some of them might have prejudice towards the intervention (Nordentoft and Austin, 2014). For instance, it would be impossible for a patient that has distorted or inappropriate attributes or judgmental thinking in their humanity to recover successfully through cognitive-behavioral approaches. Further, CBT interventions might be confused by a patient that has a moral model as they believe that negative things are happening to them due to bad individuals that possess irrational feelings and thoughts. Therefore, it makes the effectiveness of CBT limited to a particular group of patients where it can be effective.
There is continued uncertainty concerning the effectiveness of various psychotherapies as opposed to their efficacy. CBT is known to be working well in higher learning institutions such as colleges and university based on the clinical trials, with the participants that have been selected from the advertisement (Roes, 2011). However, there is less firm evidence on the effectiveness of the intervention in the real world of clinical practice. For instance, couple therapy performed better as compared to antidepressants in the London depression trials in the treatment of severe depression patients that were living with their partners, but CBT did not perform as expected in early trials. It is because CBT has ineffective compliance with particular psychological challenges for a group of patients.
There is still much to discover about the impact of CBT concerning the psychiatric disorder's long-term course. For example, there are some cases where the depressed patients that are suffering from chronic diseases such as Kidney stone are relapsing immediately after undergoing the entire CBT treatment process (Yanos et al., 2011). It means that additional comparative follow-up research is required to determine the durable impacts of CBT on depressed patients. Therefore, CBT is not effective in the treatment of severe depression as its long-term impact on the patient would not be felt.
Conclusion
The application of CBT as a response to psychotic disorders has some strengths and weaknesses. CBT interventions can work in a situation where there is resistance to psychotic disorder medications and can the treatment period be completed in a short time. The interventions also have a highly structured approach that can be offered in various formats, and it helps the patient to acquire practical strategies that can be utilized in the future if the same illness recurs. Further, the collaborative nature of CBT motivates therapists and patients to be committed to the treatment process, which enhances quick recovery. Despite the strengths of CBT as a treatment of psychotic disorders, some weakness has reduced its consistent effectiveness. The response might take longer than expected, it cannot be suitable for patients suffering from more complex mental health disorders such as Trauma, and it compels patients to confront their negative emotions and anxieties that might torment them further. CBT also ignores some critical problems in the systems that might be having significant impacts on the health and well-being of an individual patient. Therefore, CBT is just like other Psychotherapies which have strengths and limitations as well.
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