6 Psychological Treatments

Question 1

Cognitive Behavioural Therapy For Psychosis (CBTp)

Answer 1

Patients are encouraged to evaluate the content of their delusions or voices and test validity of beliefs. They are set behavioural assignments to improve functioning. Distorted thinking and maladaptive beliefs are identified with the help of the therapist, looking for alternative explanations for coping strategies.

Question 2

How Does CBTp work

Answer 2

Assessment: The patient expresses their thoughts and goals are discussed

Engagement: The therapist empathises with the patient and the ABC model is discussed

Normalisation: The patients are reassured that many people have hallucinations and delusions when they are stressed this helps the patient feel less anxious

Critical Collaborative Analysis: The therapist uses gentle questioning to challenge the patients beliefs.

Develop Alternative Explanations: The patient develops their own alternative explanations for previously unhealthy assumptions.

Question 3

Evaluation Point: Advantages of CBTp over standard care

Answer 3

It is found that CBTp is effective in reducing symptoms severity and re-hospitalisation rates up to 18 months after the treatment ends, compared with drug treatment alone. CBTp is generally combined with drug treatment, so its independent effectiveness cannot be assessed.

Question 4

Evaluation Point: Effectiveness is dependent on the stage of the disorder

Answer 4

CBTp is not appropriate in the initial acute phase of psychosis, but when symptoms have been stabilised with drugs, it can be more effective. Group Based CBTp can help to normalise patients experiences. Individuals with more experience and self awareness benefit more from individual CBTp

Question 5

Evaluation Point: Lack of availability of CBTp

Answer 5

Only 1 in 10 patients who could benefit are able to access CBTp in the UK. Availability varies between areas of the country. Many who are offered CBTp refuse treatment or fail to attend.

Question 6

Evaluation Point: Benefits of CBTp may have been overstated

Answer 6

More recent meta analyses of CBTp as a sole treatment show only a small effect on positive symptoms. Theses effects disappeared when symptoms were assessed ‘blind’ This has led to conflicting treatment advice in different regions of the UK.

Question 7

Family Therapy Define:

Answer 7

A range of interventions aimed at the family of someone with a mental disorder.

Question 8

Nature of the family therapy.

Answer 8

At least 10 sessions over 3-12 months aimed to reduce EE and stress in a family, provide information about schizophrenia, resolve practical problems and help families to support the patient in their treatment.

Question 9

How does Family Therapy Work

Answer 9

• Psychoeducation: helping the person and their carers better understand the illness.
• Forming an alliance with relatives who care for the patient
• Reducing Emotional climate in the family.
• Enhancing relatives ability to anticipate and solve problems
• Encouraging relatives to set appropriate limits

Question 10

Pharoah Procedure

Answer 10

Review of 53 randomised controlled trails in Europe, Asia and North America. Compared outcomes from family therapy to treatment involving antipsychotic medication alone.

Question 11

Pharoah Findings

Answer 11

Mixed Results on improvement in mental state of the patient. Increased compliance with medication. Some improvement in general functioning, but no effect on independent living or employment. Reducing in the risk of relapse and hospital admission during family therapy and for 24 months after

Question 12

Evaluation Point:

Why is family therapy effective

Answer 12

It can improve clinical outcomes and social functioning, but the main reason for its effectiveness is the increase in medication compliance

Question 13

Evaluation Point:

Methodological limitations of family therapy studies

Answer 13

In Pharoahs analysis many Chinese’s studies may not have actually used random allocation of participants to treatment conditions. 10 studies did not ‘blind’ raters to the condition and 16 did not mention whether blinding had been used.

Question 14

Evaluation Point:

Economic benefits of family therapy

Answer 14

The Nice review of family therapy studies showed that the extra cost of family therapy is offset by a reduction in costs of hospitalisation because of their lower relapse rates

Question 15

Evaluation point:

Impact on family members

Answer 15

Family Therapy improves outcomes for the individual and also has a positive impact on family members relationships and problem-solving skills. However, many of the studies in this review used poor methodology so the conclusions my not be valid.

Question 16

Evaluation Point:

Is Family Therapy Worthwhile

Answer 16

If a patient has a good standard of care in a family with relatively low EE then family therapy may give no further advantages.

Question 17

Token Economy Define

Answer 17

A form of therapy where desirable behaviours are encouraged by the use of selective reinforcements.
Rewards are given as secondary reinforcers when individuals engage in correct /socially desirable behaviours.
The tokens can then be exchanged for primary reinforcers food or privileges.

Question 18

4 Stages of Token Economy

Answer 18

Assigning value to the tokens:
Tokens are paired with rewarding stimuli and so become secondary reinforcers.

Reinforcing Target Behaviours:
Patients engages in target behaviours or reduces inappropriate ones

The Trade
Patients are given tokens for engaging in theses target behaviours and trades these tokens for access to desirable items or other privileges.

Question 19

Evaluation Points:

Ethical Concerns

Answer 19

Clinicians may control important primary reinforcers like food, privacy or social activities. However all human beings have basic rights that should not be violated regardless of the positive consequences that might result from their manipulation.

Question 20

Evaluation Points:

Research Support

Answer 20

Dickerson reviewed 13 studies of token economy systems used in treating schizophrenia. Eleven reported beneficial effects. However, methodological shortcoming in many of the studies limit the validity of these conclusions .

Question 21

Evaluation Points

Difficulties assessing the success of a token economy

Answer 21

Suggested that programmes are difficulty to assess as all patients on a ward are usually included in the programme. The lack of a control group means improvements are compared with past behaviours and other factors could be confounding.