Discuss psychological therapies for schizophrenia. (8+16)

Question 1

2 psychological therapies

Answer 1

Cognitive Behavioural Therapy, Family Intervention

Question 2

Cognitive Behavioural Therapy

Answer 2

Use - to treat schizophrenia, Rationale - CBT is based upon the idea that schizophrenia is caused, or at least maintained, by irrational beliefs that patients have about their experiences, Aim - the aim is to address and change the patient’s beliefs and thought processes which contribute to their symptoms, Process - the patient has between 12 and 20 sessions, Cognitive element, Behavioural element, Goal setting, Normalisation techniques, Decatastrophising techniques, developing trust through being non-judgmental

Question 3

Cognitive element

Answer 3

make patient aware of their cognitions and how they impact ton functioning; question, challenge and try to change the patient’s beliefs

Question 4

Behavioural element

Answer 4

reality testing, role-play, homework

Question 5

Goal setting

Answer 5

realistic goals for therapy should be discussed early in the therapy with the patient, using the distressing consequences to fuel the motivation for change. Therapists job to ensure the goals are measurable, realistic and achievable.

Question 6

Normalisation techniques

Answer 6

Not just flatly negating patient’s beliefs; empathising with patient, enabling him to maintain it but in a more realistic form

Question 7

Decatastrophising techniques

Answer 7

A normalising rationale is helpful in decatastrophising psychotic experiences. Education regarding the fact that many people can have unusual experiences in a range of different circumstances reduces anxiety and the sense of isolation.

Question 8

Developing trust

Answer 8

the therapeutic relationship must have developed a degree of trust. the therapist uses gentle questioning to help the patient appreciate potentially illogical deductions and conclusions

Question 9

Rational Emotive Behavioural Therapy (REBT)

Answer 9

Example - ABC model used by Ellis to challenge irrational beliefs is a popular method used by clinicians today within their CBT sessions. Clinicians would start a session by asking the patient to express his or her own thoughts and feelings about his/her experiences, whilst they listen. The ABC model is used to allow the patient to organise confusing experiences. A = activating event, B = beliefs, C = consequences

Question 10

Startup et al

Answer 10

90 patients with schizophrenia, admitted to hospital suffering from an acute episode of psychosis. Of these 43 were given standard treatment of antipsychotic drugs and nursing care, while the remaining 47 were given in addition to the standard treatment up to 25, 90 minute sessions of CBT. They were assessed for symptoms and social functioning on admission to hospital, then 6 months later, and 1 year after admission - found that CBT group - 60% showed reliable change with fewer positive symptoms - control group - only 40% showed significant improvement

Question 11

Jones

Answer 11

Cochrane review - found no difference in overall effectiveness between CBT and other talking therapies - relapses and re-hospitalisation were not reduced - CBT and other talking therapies are good at retaining patients

Question 12

CBT not a cure

Answer 12

although some studies have shown that CBT can improve certain symptoms of schizophrenia and new cognitive treatments continue to be developed, CBT does not offer a cure but rather a way of ‘normalising’ symptoms

Question 13

CBT ethics

Answer 13

CBT is a collaborative therapy and involves the active cooperation of the client. For this reason it often avoids the criticism made of drug therapy that the client becomes a passive recipient of treatment

Question 14

Family Intervention

Answer 14

Families with high EE had more frequent relapses than people with the same problem who lived in families less expressive with their emotions. This has led to the development of various family intervention programmes, attempting to reduce levels of EE in the home and subsequently reduce relapse rates. In addition the family should develop cooperative and trusting relationships, where contributions of all family members are valued.

Question 15

Procedure of family intervention

Answer 15

the therapist provides information on the cause, course and symptoms of schizophrenia, while family members bring to the group their own experiences of living with the disorder. Family members learn more constructive ways of interaction and communication, reducing the emotional climate within the family. Ways are discussed of expressing feelings of anger or impatience without resorting to high levels of EE. The family and individual are trained to recognise early signs of relapse so they can respond rapidly and reduce its severity

Question 16

Leff et al

Answer 16

A programme was developed that involved: educational sessions, group meetings, family sessions - the effects of the intervention were evaluated during the following 2 years, families who did not take part in the programme acted as a control group. Patients in both groups were taking antipsychotic medication throughout - found that families who had been through the programme showed a significant decrease in the number of critical comments and emotional over-involvement - while 78% of the patients in the control had been readmitted to hospital on at least one occasion during this period, this was true of 14% of the programme group

Question 17

Meta-analysis NCCMH

Answer 17

32 studies, nearly 2500 participants, significant evidence for the effectiveness of family intervention, compared to patients receiving standard care there was a reduction in hospital admissions during treatment and in the severity of symptoms both and up to 24 months following the intervention - the relapse rate in the FI condition was 26% and in the control condition it was 50%

Question 18

Pharaoh et al

Answer 18

A review of 53 studies, cross-cultural, outcomes from FI and ‘standard care’ were compared - FI may reduce the risk of relapse and compared to ‘standard care’, FI increased patients’ compliance with medication, some studies reported an improvement in mental state of the patient, there was some improvement on general social functioning, but not much of an effect on more concrete outcomes such as living independently or employment

Question 19

Methodological limitations of family intervention studies

Answer 19

Problem with randomisation (large number of studies were from the People’s Rebublic of China, where its emerged that random allocation was stated as having been used when it wasn’t), Lack of blinding (there was the possibility of observer bias where raters were not ‘blinded’ to the condition (FI vs standard) to which people were allocated)

Question 20

McCreadie - do relatives want FI?

Answer 20

63 relatives of 52 schizophrenics living at home were offered a package of treatments by professionals working in an everyday NHS setting: educational seminars, relatives’ groups, and family meetings. 32 relatives refused intervention, of the 31 who agreed, 14 attended neither the educational seminars nor the relatives’ groups

Question 21

Economic benefits of FI

Answer 21

Although it would cost NHS more in terms of delivery to patients - the NHS will end up spending less money on antipsychotics, less readmission to hospital, less wastage of drugs