5. psychological therapies Flashcards
COGNITIVE BEHAVIOUR THERAPY
Aims to deal with both thoughts and behaviour, taking over a period of 5-20 sessions.
CBT assumes
schizophrenia is the result of dysfunctional thinking, and helps patients identify dysfunctional thoughts and reality testing them to reduce distress.
COGNITIVE BEHAVIOUR THERAPY
1 . RECOGNISING:
examples of dysfunctional or delusional thinking, patients receive help on how to avoid acting on these thoughts.
COGNITIVE BEHAVIOUR THERAPY
2 . EDUCATING
explaining to the patient where their delusions actually come from stops patients believing the voices can hurt them, which stops anxiety.
COGNITIVE BEHAVIOUR THERAPY
3 . NORMALISING
helping the patient realise it is normal to have disrupted thoughts in certain situations, e.g. explaining that voice hearing is an ordinary extension of thinking in words
COGNITIVE BEHAVIOUR THERAPY
4 . REALITY TESTING:
test if the patient’s belief is actually true.
COGNITIVE BEHAVIOUR THERAPY
AO3: strength of CBT
RESEARCH SUPPORT - Jauhar, Portillo
There is evidence for the effectiveness of CBT.
Jauhar et al. reviewed 34 studies of using CBT with schizophrenia, concluding there is clear evidence for a small but significant effect on both positive and negative symptoms. Furthermore, Portillo et al. found reductions in frequency and severity of auditory hallucinations. Clinical evidence from NICE recommends the use of CBT for schizophrenia.
This means that both research and clinical evidence supports the benefits of CBT for schizophrenia.
COGNITIVE BEHAVIOUR THERAPY
AO3: limitation of CBT
poor quality evidence - Thomas
There is a wide range of techniques and symptoms included in the studies.
CBT techniques and schizophrenia symptoms vary widely from one case to another. Thomas points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms.
This is a limitation because it makes it hard to say how effective CBT will be for a particular person with schizophrenia.
FAMILY THERAPY
Takes place with families as well as the identified patient.
Aims to
improve the quality of communication and interaction between family members.
FAMILY THERAPY
Pharoah et al. identified a range of strategies that family therapists use to improve the functioning of a family member with schizophrenia:
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REDUCES NEGATIVE EMOTIONS: family therapy aims to reduce levels of expressed emotion, especially negative emotions such as anger and guilt which create stress. Reducing stress is important to reduce the likelihood of relapse.
· IMPROVES FAMILY’S ABILITY TO HELP: the therapist encourages the family members to form a therapeutic alliance whereby they all agree to the aims of the therapy. The therapist also tries to improve the families’ beliefs about and behaviours towards schizophrenia. A further aim is to ensure that family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.
FAMILY THERAPY
7 STAGES: Burbach proposed a model for working with families who are dealing with schizophrenia:
- Basic information sharing - providing emotional and practical support.
- Identifying resources - of what family members can offer.
- Encourage mutual understanding - creating a safe space for everyone to express their feelings.
- Identify unhelpful patterns of behaviour.
- Skills training - such as stress management techniques
- Relapse prevention training.
- Maintenance for the future.
FAMILY THERAPY
AO3: strength of family therapy
RESEARCH SUPPORT - McFarlane
There is evidence for the effectiveness of family therapies.
A review by McFarlane concluded that family therapy was one of the most consistently effective treatments available for schizophrenia. Specifically, relapse rates were found to be reduced by 50-60%. He also found that using family therapy as mental health initially starts to decline is particularly promising. Clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia.
This means that family therapy is likely to be of benefit to people with both early and full-blown schizophrenia
FAMILY THERAPY
AO3: strength of family therapy
BENEFITS THE WHOLE FAMILY
Family therapy benefits all family members.
Therapy is not just for the benefit of the identified patient, but also for the families that provide the bulk of care. A review concluded that these effects are important because families provide care for people with schizophrenia and by strengthening the functioning of a whole family, family therapy lessens the negative impact of schizophrenia on other family members. It also strengthens the ability of the family to support the person with schizophrenia.
This means that family therapy has wider benefits beyond the obvoius positive impact on the patient.
