**L5 - Psychological Therapies for SZ

Question 1

what are the 3 main psychological therapies for schizophrenia?

Answer 1

1) cognitive behavioural therapy (CBT)
2) family therapy
3) token economies

Question 2

what is COGNITIVE BEHAVIOUR THERAPY?

Answer 2

Cognitive behavioural therapy, formally referred to as Cognitive behavioural therapy for PSYCHOSIS (CBTp) works through 6 DIFFERENT STAGES.

1) ASSESSMENT
2) ENGAGEMENT
3) THE ABC MODEL
4) NORMALISATION
5) CRITICAL COLLABORATIVE ANALYSIS
6) DEVELOPING ALTERNATIVE EXPLANATIONS

Question 3

what is ASSESSMENT? (CBTp)

Answer 3

Assessment is when the patient EXPRESSES THEIR THOUGHTS to the therapist, REALISTIC GOALS ARE SET for the programme

Question 4

What is the ENGAGEMENT STAGE? (CBTp)

Answer 4

Engagement is when the therapist EMPATHISES with the PATIENTS PERSPECTIVE so that explanations for their feelings can be developed

Question 5

What is the ABC MODEL STAGE? (CBT for psychosis)

Answer 5

This is when the patient gives their explanation of the (A) ACTIVATING EVENTS, (B) BELIEFS about the event and (C) CONSEQUENCES.

Once the therapist understands these elements, they can begin to DISPUTE THEM to make the patient think in a MORE POSITIVE WAY

Question 6

what is the NORMALISATION STAGE?

Answer 6

NORMALISATION is conveying to patients that MANY PEOPLE HAVE UNUSUAL EXPERIENCES such as HALLUCINATIONS AND DELUSIONS which REDUCES ANXIETY and the SENSE OF ISOLATION.

By doing this the patient feels MORE AT EASE and the POSSIBILITY OF RECOVERY IS HIGHER.

Question 7

what is CRITICAL COLLABORATIVE ANALYSIS? (Cognitive behavioural therapy for psychosis)

Answer 7

This is when the therapist USES GENTLE QUESTIONING to HELP THE PATIENT UNDERSTAND ILLOGICAL THOUGHTS THEY MAY HAVE.

Questioning can be carried out WITHOUT CAUSING DISTRESS, the aim is to make the patient RECONSIDER THEIR FAULTY THINKING AND SCHEMAS so that their thought processes become MORE HEALTHY.

Question 8

What is DEVELOPING ALTERNATIVE EXPLANATIONS? (CBTp)

Answer 8

Finally, the patient DEVELOPS THEIR OWN ALTERNATIVE EXPLANATIONS for their PREVIOUSLY UNHEALTHY ASSUMPTIONS.

Question 9

How is CBT delivered?

Answer 9

CBT can be DELIVERED IN GROUPS but it’s typically delivered on a ONE TO ONE BASIS.

It’s recommended that AT LEAST 16 SESSIONS SHOULD BE CONDUCTED WHEN TREATING SZ.

CBTp is great for tracing back to the root of the issue and trying to reconstruct these beliefs that tend to have caused the illness.

Throughout CBT the onus is on the patient to comply with the therapist and try hard to reevaluate their thinking

Question 10

+ more effective than just drugs (CBT)

Answer 10

+ CBTp seems to be more effective than treating SZ with JUST ANTIPSYCHOTICS ALONE. Research shows that CBTp was EFFECTIVE IN REDUCING HOSPITALISATION RATES UP TO 18 MONTHS AFTER the end of treatment.

CBTp was also shown to be effective in REDUCING SEVERITY OF SYMPTOMS as well as IMPROVING SOCIAL FUNCTIONING

Question 11

• LACK OF AVAILABILITY OF CBTp (CBTp)

Answer 11

• despite being recommended as treatment for SZ, it’s estimated that in the UK only ONE IN TEN individuals with SZ ACTUALLY HAVE ACCESS TO CBTp.

In a survey by HADDOCK ET AL they found that in the NORTH WEST OF ENGLAND, out of 187 SZ PATIENTS, only 13 had been OFFERED CBTp.

However, of those who are actually offered CBTp, a significant number either REFUSE OR FAIL TO ATTEND THE THERAPY SESSIONS - limiting its effectiveness even more

Question 12

• problems with meta analysis (CBTp)

Answer 12

• there are problems with meta analysis of the studies in this area which has resulted in UNRELIABLE CONCLUSIONS about CBTp.

Some studies FAIL TO RANDOMLY ALLOCATE PPs to conditions, other studies FAIL TO ASSESS THE PATIENTS PROPERLY AFTER THEY HAVE BEEN TREATED WITH CBTp.

JUNI ET AL concluded that there was CLEAR EVIDENCE that the problems associated with METHODOLOGICALLY WEAK TRIALS TRANSLATED INTO BIASED FINDINGS ABOUT THE EFFECTIVENESS OF CBTp - thus suggesting that CBTp might actually be less effective than we originally thought

Question 13

what is family therapy?

Answer 13

Families play an IMPORTANT ROLE IN HELPING A PERSON WITH SZ to RECOVER and STAY WELL. Family therapy aims to make life LESS STRESSFUL FOR CARERS, in hope of REDUCING RELAPSE RATES, and HOSPITALISATION RATES.

Question 14

what is involved in family therapy?

Answer 14

Family therapy is offered for a PERIOD OF 3-12 MONTHS and AT LEAST TEN SESSIONS,

Family based interventions are aimed at REDUCING LEVELS OF EXPRESSED EMOTION within the family - as expressed emotion has been demonstrated to INCREASE THE LIKELIHOOD OF RELAPSE.

Family therapy typically involves providing family members with INFORMATION ABOUT SZ, finding WAYS OF SUPPORTING an individual with SZ, and RESOLVING ANY PRACTICAL ISSUES

Question 15

how does family therapy actually work?

Answer 15

By REDUCING LEVELS OF EXPRESSED EMOTIONS AND STRESS, and by INCREASING THE CAPACITY OF RELATIVES to SOLVE RELATED PROBLEMS, family therapy helps to reduce relapse chances for the person with SZ.

It makes use of a number of strategies to do this:

1) PSYCHOEDUCATION - helping the family to better understand the illness
2) forming ALLIANCE with caters
3) REDUCING EMOTIONAL CLIMATE
4) ENHANCING RELATIVES ABILITY TO SOLVE PROBLEMS
5) REDUCING EXPRESSED EMOTION
6) MAINTAINING REASONABLE RECOVERY EXPECTATIONS
7) encouraging relatives to take time for themselves when needed

Question 16

how is family therapy applied as treatment?

Answer 16

FAMILY THERAPY forms part of an OVERALL TREATMENT PACKAGE and is commonly USED IN CONJUNCTION WITH DRUG THERAPY.

Question 17

Side benefits of family therapy?

Answer 17

Research has shown that family therapy is also synonymous with a few other benefits:

• slight improvements in MENTAL STATE
• COMPLIANCE WITH MEDICATION, use of family therapy increased patients compliance with medication
• SOCIAL FUNCTIONING improved slightly
• relapse rates and hospitalisation rates decrease for up to 24 months after treatment

Question 18

• LACK OF BLINDING (family therapy)

Answer 18

• there is a LACK OF BLINDING IN FAMILY THERAPY STUDIES. A lack of blinding of the RATERS means the raters knew which condition the pp was attached to, creating RATER BIAS.

This is a problem because it doesn’t really tell us whether family therapy is really effective or the research was just completely biased.

Question 19

+ economical benefits (family therapy)

Answer 19

+ there are ECONOMICAL BENEFITS to family therapy .

Family therapy leads to SIGNIFICANT COST SAVINGS because relapse rates and more importantly HOSPITALISATION RATES ARE REDUCED, this means that less money is spent by hospitals due to this intervention which is a great strength of family therapy

Question 20

+ impact on family members is good (family therapy)

Answer 20

+ the impact of family therapy on family members is ADVANTAGEOUS.

E.g LOBBAN ET AL analysed the results of 50 FAMILY THERAPY STUDIES that had included an intervention to support relatives.

60% OF THESE STUDIES REPORTED A SIGNIFICANT POSITIVE IMPACT of the intervention for relatives

Question 21

what is TOKEN ECONOMY?

Answer 21

Token economies are REWARD SYSTEMS based on the principles of OPERANT CONDITIONING that are used to MANAGE THE BEHAVIOUR OF PATIENTS WITH SZ in HOSPITAL SETTINGS.

For patients who have spent are INSTITUTIONALISED (spent too long in hospital) they tend to develop bad behaviours and token economy is implemented to TRAIN THEM TO IMPROVE THRDR BEHAVIOURS.

Question 22

How does token economy work?

Answer 22

Patients are rewarded for good behaviours by being given a TOKEN (reward) and this acts as a SECONDARY REINFORCER. The token can then be exchanged for a TANGIBLE REWARD like ACCESS TO SWEETS which acts as the PRIMARY REINFORCER.

Carrying out good behaviours and then receiving REWARDS for doing this good behaviour POSITIVELY REINFORCES the good behaviour and makes the patients MORE LIKELY TO BEHAVE WELL IN THE FUTURE.

Each patient has token economy goals and targets based on the behaviours that they need to improve upon and this makes it more effective.

Question 23

+ research support (token economies)

Answer 23

+ there’s research support for token economies.

E.g DICKERSON ET AL reviewed 13 STUDIES investigating the use of token economies in treating SZ.

11 OF THESE STUDIES REPORTED BENEFICIAL EFFECTS that were directly attributable to the use of TOKEN ECONOMIES.

DICKERSON ET AL concluded that these studies provide evidence of the TOKEN ECONOMY’s EFFECTIVENESS in improving the behaviours of schizophrenic patients.

Question 24

• ethical concerns (token economy)

Answer 24

• revoking certain ‘privileges’ like being able to smoke, or walk around can actually lead to NEGATIVE IMPACTS FOR THE PATIENT as they should be basic rights for them but withholding them can make them distressed and affect their mental health even more

Question 25

• lack ecological validity (token economy)

Answer 25

• token economy programmes LACK ECOLOGICAL VALIDITY. Although the token economy programme has proven to be effective in HOSPITAL SETTINGS, it doesn’t really work outside of this.

CORRIGAN argues that there are PROBLEMS ADMINISTERING TOKEN ECONOMY to patients who have left the hospital, in a hospital the tokens can be given STRAIGHT AWAY as the patients receive 24 HOUR CARE. But once they leave the hospital this can’t happen because these systems AREN’T IN PLACE outside of INSTITUTIONAL SETTINGS and thus cannot be used in the real world - LACKING ECOLOGICAL VALIDITY