Quality standard

Quality statement 2: Cognitive behavioural therapy

Quality statement 2: Cognitive behavioural therapy

Quality statement

Adults with psychosis or schizophrenia are offered cognitive behavioural therapy for psychosis (CBTp).

Rationale

CBTp in conjunction with antipsychotic medication, or on its own if medication is declined, can improve outcomes such as psychotic symptoms. It should form part of a broad‑based approach that combines different treatment options tailored to the needs of individual service users.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements to ensure that CBTp is available to adults with psychosis or schizophrenia.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example care protocols.

Process

a) Proportion of adults with psychosis who receive CBTp.

Numerator – the number in the denominator who receive CBTp.

Denominator – the number of adults with psychosis.

Data source: Data can be collected using the Royal College of Psychiatrists' National audit of schizophrenia: Audit of practice tool, questions 42 and 44.

b) Proportion of adults with schizophrenia who receive CBTp.

Numerator – the number in the denominator who receive CBTp.

Denominator – the number of adults with schizophrenia.

Data source: Data can be collected using the Royal College of Psychiatrists' National audit of schizophrenia: Audit of practice tool, questions 42 and 44.

Outcome

Relapse rates of psychosis and schizophrenia in adults.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

What the quality statement means for different audiences

Service providers (such as GPs, community health services and mental health services) ensure that systems are in place for adults with psychosis or schizophrenia to be offered CBTp. They should ensure that practitioners have appropriate competencies to deliver CBTp and have access to training.

Healthcare professionals ensure that they offer CBTp to adults with psychosis or schizophrenia.

Commissioners commission CBTp services and ensure that referral pathways are in place for adults with psychosis or schizophrenia to be referred to these services.

Adults with psychosis or schizophrenia are offered a psychological therapy called 'cognitive behavioural therapy for psychosis' (sometimes shortened to CBTp). This involves meeting a healthcare professional on their own to talk about their feelings and thoughts, which can help them to find ways to cope with their symptoms.

Source guidance

Psychosis and schizophrenia in adults: prevention and management. NICE guideline CG178 (2014), recommendations 1.3.9.1, 1.4.2.1 and 1.4.4.1

Definitions of terms used in this quality statement

Cognitive behavioural therapy for psychosis (CBTp)

CBTp should be delivered over at least 16 planned sessions and:

  • follow a treatment manual so that:

    • people can establish links between their thoughts, feelings or actions and their current or past symptoms and functioning

    • the re‑evaluation of people's perceptions, beliefs or reasoning relates to the target symptoms

  • also include at least 1 of the following components:

    • people monitoring their own thoughts, feelings or behaviours about their symptoms or recurrence of symptoms

    • promoting alternative ways of coping with the target symptom

    • reducing distress

    • improving functioning.

[Adapted from NICE's guideline on psychosis and schizophrenia in adults, recommendation 1.3.7.1]

Equality and diversity considerations

For adults with psychosis or schizophrenia who have a learning disability or cognitive impairment, methods of delivering treatment and treatment duration should be adjusted if necessary to take account of the disability or impairment, with consideration given to consulting a relevant specialist.