6.5: Cognitive behavioural therapy, family therapy and token economies

Question 1

Briefly outline how cognitive behaviour therapy (CBT) is used to treat schizophrenia and explain one limitation of using CBT to treat schizophrenia (4 marks)

Answer 1

Outline
Possible content:
• Challenging beliefs (including origin of ‘voices’) and reality testing to reducedistress.
• Use of positive self-talk.
• Coping strategy enhancement through education and symptom targeting.
• Cognitive restructuring via ABCDE framework. Identifying activating event (A),
exploring beliefs (B), recognising consequences (C), disputing irrational beliefs (D),
restructured belief (E).
Credit other relevant aspects of cognitive behaviour therapy.

Possible limitations:
• CBT requires self-awareness and willingness to engage with process (positive symptoms
lead to lack of awareness; negative symptoms lead to reluctance/inability to engage).
• Practical issues, eg length of therapy (leading to drop out at times of severeepisodes).
• Not all clients are suited to vigorous confrontation

Question 2

Sally’s schizophrenia has been so severe that she has been hospitalised for a considerable time and there have been problems in getting Sally to interact with staff and other patients and to take her medication regularly. She also does little to take care of herself, has low motivation and cannot pay attention to anything for very long.
With reference to the scenario above, explain how the technique of token economy could be used to improve Sally’s behaviour (4 marks)

Answer 2

Token economy is a behaviourist technique that seeks to positively modify the behaviour of schizophrenics through operant conditioning, by the use of
reinforcements.
Therefore, Sally would be offered ‘tokens’ as a form of positive reinforcement for doing such things as interacting more with clinical staff and fellow patients and taking more care of herself

Question 3

Sally’s schizophrenia has been so severe that she has been hospitalised for a considerable time and there have been problems in getting Sally to interact with staff and other patients and to take her medication regularly. She also does little to take care of herself, has low motivation and cannot pay attention to anything for very long.
With reference to the scenario above, explain how the technique of token economy could be used to improve Sally’s behaviour (4 marks).
Token economy is a behaviourist technique that seeks to positively modify the behaviour of schizophrenics through operant conditioning, by the use of
reinforcements.
Therefore, Sally would be offered ‘tokens’ as a form of positive reinforcement for doing such things as interacting more with clinical staff and fellow patients and taking more care of herself.

Answer 3

The tokens are exchangeable for desirable goods.
The use of such tokens to reward Sally’s positive behaviours should increase the chances of her acting in these ways again