A National Scandal: Psychological Therapies for Psychosis are Helpful, But Unavailable. Peter Kinderman and Anne Cooke.
For years, drugs were it. If you felt paranoid, heard voices or were diagnosed with schizophrenia, the only thing likely to be on offer was ‘antipsychotic’ medication.
Like all drugs, these have a number of different effects on our nervous system. Some of the effects can be helpful, for example calming us down or making our experiences less intense or distressing. Others may be less desirable.
The unwanted effects – euphemistically called ‘side’ effects – of these particular drugs can be seriously distressing. For some people, they can be more disabling than the original problem.
Despite the hype it’s been a fine balance for many people, and worrying evidence is now emerging that some drugs can cause serious and permanent problems such as brain damage if taken long-term.
In view of the downsides of antipsychotics it comes as something of a relief that there is a possible alternative Psychological approaches such as cognitive behaviour therapy (or CBTp, the ‘p’ standing for psychosis) have become increasingly popular.
NICE (the National Institute for Care Excellence) is sufficiently convinced of the effectiveness of these approaches to recommend that they should be offered to everyone with a diagnosis of schizophrenia. Traditionally they have been offered in addition to drugs, but a recent trial suggests that they might also be promising as an alternative.
Last week saw a flurry of debate about this issue. On Wednesday, the Guardian published an article somewhat sceptical of the value of psychological therapies for people experiencing psychosis. The same day, a packed house at London’s famous Institute of Psychiatry debated the motion ‘This House Believes that CBT for Psychosis has been Oversold’. We were there: Peter Kinderman was one of the speakers against the motion.
We heard evidence that CBT can actually lead to changes in the ‘wiring’ of the brain – it’s not just a sticking plaster solution. And unlike drugs, talking therapies are only ever offered to people, not foisted or forced on them.
The influential Schizophrenia Commission recently found that despite CBT for psychosis being recommended by NICE, only one in ten people who could benefit are actually offered it. The other nine presumably get drugs, willingly or in some cases under duress.
The issue is not one of overselling, it’s that psychological therapies are shamefully underprovided.
This article first appeared on the website Discursive of Turnbridge Wells