Family Therapy Flashcards
Goal of family therapy in SZ
Provide support for careers in an attempt to make family life less stressful and so so reduce rehospitalisation.
What does NICE ZRECCOMEND
That family therapy should be offered to everyone with SZ who are still in contact with or live with family members. They also said this kind of intervention is necessary where there are persistent symptoms or a high risk of relapse. Families need to be managed as expressed emotion can increases chance of relapse a lot so this is essential
How long is family therapy offered for
It’s offered for a period of 3-12 months and at least 10 sessions. It aims to reduce the level of expressed emotion as this likely causes relapse. Garety found 25% relapse compared to 50% of just standard care alone
How does family therapy work?
By reducing levels of expressed emotion and increasing the capacity of relatives to solve problems, it helps reduce incidence of relapse. In incorporates a number of strategies like:
a) psycho education - helping the person and their careers to understand and be better able to deal with illness
b) forming an alliance with relatives with care for the person with SZ
c) Reducing emotional climate within the family and the burden of care for family members
d) Enhancing relatives abilities to anticipate and solve problems
e) Reducing expressive emotion
f) maintaining reasonable expectations for patient performance
g) Encouraging relatives to set appropriate limits and maintain some degree of separarion
Proceedure of Pharoah et al
Reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention. The studies chosen were conducted in Europe, Asia and North America. Compared the outcomes of standard care (drugs) to family therapy.
What were the findings of family intervention compared to standard care
Mental state: the overall impression was mixed. Some studies saw improvement whereas some did not.
Compliance with medication: family therapy increased compliance of medication
Social functioning: there was some general improvement but it didn’t have much effect in concrete outcomes like living independently or employment
Relapse: reduction in relapse 24 months after
Strengths of family theory
+ according to pharoahs study - it increases compliance with medication, reduces relapse and does increase social functioning. This implies it’s effectiveness. But since they are encouraged to take medication due to family, is the other positive effects due to this medication? Overall it can be mixed the results
+ economical benefits to family therapy. NICE reviewed family therapy studies and found that family therapy is associated with significant cost savings when offered to people with SZ in addition to standard care. This is because it reduces chance of relapse and rehospitalisation
Impact of this on family members is also beneficial. Lobban et al analysed results of 50 family therapy studies that had an intervention to support relatives. 60% of these studies reported significant positive impact of the intervention on at least one outcome category for relatives.
Weakness FT
There are problems with a lack of blinding in family therapy studies. In pharoahs study, 10 of the 53 studies reported in this meta analysis did not use any form of blinding. The raters were not blinded to which condition the participants had been allocated to. They knew if experimental or control so this would create rater bias. May rate those in FT better. Doesn’t tell us if family therapy is effective
What is token economy used for
Reward systems used to manage the behaviour of SZ patients in a hospital setting - in particular those with maladaptive behaviour. It is common for those who are in hospital for long time to have poor hygiene and stay in their pyjamas all day. Changing these habits doesn’t cure SZ, but improves quality of life inside and out the hospital
What’s the principle of token economy
Based on operant conditioning to encourage good behaviour. I.e. a patient is given a token for exhibiting good and desirable behaviours. Once enough tokens are collected it can be exchanged for a reward. I.e sweets.
What are tokens
coloured disks - given immediately to patients after doing a good behaviour. I.e. making their bed, brushing their teeth. They are given immediately so that the patients can associate the positive behaviour with a reward
What are rewards
Tokens can be later swapped for tangible rewards.
Evaluation token economy
+ Research support Dickerson et al reviews 13 studies using token economies in treating SZ. 11 reported beneficial effects. He claimed these studies prove its effectiveness. However he did recognise that some of these studies did have methodological issues that could have impacted the overall effectiveness of token economy.
- Ethical concerns especially in psychiatric settings: in order to make reinforcement effective, clinicians may exercise control over important primary factors like food, privacy or access to activities that stop patients from being bored. Patients could then exchange token economies for these. However it should be accepted that all people should be entitled to basic rights that should not be violated regardless of the positive outcomes it could achieve.
Lacks validity: Although shown effective in reducing neg symptoms, it only conducted in hospital. Corrigan argues there are problems administering token economy to outpatients who live in the community. Patients have 24hr care and can be given tokens right away but in the community, who will give them their tokens immediately. And what tangible reward can be exchanged. It can’t be used outside hospital.
