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CBTp for Persistent Symptoms — MRCPsych Paper B MCQ

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ModerateSchizophrenia & PsychosisCBTp for Persistent SymptomsMRCPsych Paper B

A 42-year-old man with schizophrenia continues to experience distressing auditory hallucinations after an adequate-duration clozapine trial, with adherence confirmed and a plasma clozapine concentration of 0.55 mg/L. He agrees to individual cognitive behavioural therapy for psychosis (CBTp). According to NICE CG178, which is the most appropriate therapeutic goal?

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Reveal the answer and explanation

Correct answer: E — Develop alternative coping strategies, reduce associated distress and improve functioning

The correct answer is E. NICE recommends CBTp for people with persisting positive or negative symptoms. Therapy should help the person link thoughts, feelings and actions with target symptoms, re-evaluate relevant perceptions or beliefs, and include components such as developing alternative coping strategies, reducing distress or improving functioning. Complete elimination of hallucinations is not a required or sole outcome, so A is incorrect. CBTp is usually offered alongside antipsychotic treatment rather than automatically replacing clozapine, excluding C. Insight-oriented exploration that does not address current symptoms and hypnotherapy are not the recommended CBTp approach, excluding D and E. NICE specifies individual CBT delivered over at least 16 planned sessions.

Reference: National Institute for Health and Care Excellence. Psychosis and schizophrenia in adults: prevention and management (CG178), recommendations 1.3.7.1 and 1.5.4.1. 2014; last reviewed 29 July 2025. https://www.nice.org.uk/guidance/cg178/chapter/recommendations