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William Bradshaw (1998) : The Case of Carol (Who was Carol? (a 26-year-old…
William Bradshaw (1998) : The Case of Carol
Who was Carol?
a 26-year-old she came from upper-middle-class family where academic and career success were extremely important. Conservative Christians
She was hospitalised many times and was diagnosed with undifferentiated type schizophrenia.
began to experience auditory hallucinations and delusions in college. She started to withdraw herself from others.
Assessed on Global Assessment of Functioning (GAF) on 30 out of 100
They developed a rapport by talking about Carol hobbies, mostly talked about how Carol really enjoyed playing softball
Results of CBT
Carols 'major cognitive theme' - Bradshaw identified her major cognitive theme as black and white thinking
Goal Attainment
End of treatment : 80.15
Follow-up (One Year) : 80.15
Pretest : 19.85
Psychological Functioning
Pretest : 6
End of treatment : 27
Follow-up (One Year) : 27
Hospitalisation
Before : 60 days
After : 0 Days
Aim : To investigate the effectiveness of CBT in long-term outpatient care of a young woman with schizophrenic
To illustrate how CBT can be adapted to the unique needs of people with schizophrenia.
Phases of CBT
Early Phase
Focus on the inactivity and her difficulty managing stress and anxiety - Takes approx.12 months
A weekly schedule was useful in helping her cope with a loss of structure
Then stress management skills were developed in three ways
Identifying relaxation methods, meditation was used.
She told to identify her personal signs of stress and symptoms of release
Habitual stress situations were defined and meditation was used to cope with anticipated stressful events
Middle Phase
Took approx.16 months
Identified the habitual stressful situations and cognitions and utilisation of cognitive strategies to cope with them
Three major areas emerged : dealing with social situation, the impact of schizophrenia on Carol's sense of self and fear of relapse
Socialisation Phase
Used to develop a therapeutic alliance, helping the client understand the process of CBT and to agree on treatment goals
Takes approx. 2 months
The therapists took on a teaching role, telling the client about schizophrenia and the treatment
ABC Model was used to teach the cognitive view and the process of treatmen
Ending Phase
Takes approx. 3 months
A goal of treatment was dealing with thoughts and feelings regarding ending treatment
Another goal of treatment was developing a plan to maintain treatment gains
Evaluation
Validity
Delivers both qualitative and quantitative data about Carol
Study taken over 4 years, so her actual behaviour was changed - no demand characteristics
Reliability
Very hard to replicate as the rapport that Carol and the therapist built was very strong.
Ethics
Problems with consent as Carol has severe schizophrenia and wouldn't be able to give her fully informed consent
However, at the end of the study Carol still gave informed consent
Generalisability
Hard to generalise as very unique case as she is very young to have schizophrenic and has a rare type of schizophrenia
No mental health illness history and comes from a supportive surgery