Lesson 5 - Psychological Therapies for SZ Flashcards
What are the three main psychological therapies for SZ?
CBT
Family Therapy
Token Economy
Cognitive Behaviour Therapy
This is the main psychological treatment for SZ. Beliefs, expectations and cognitive assessments of self, the environment and the nature of personal problems affect how individuals perceive themselves. Usually takes place over a period of 5-20 sessions in groups or 1-on-1. Focus on the origin of negative thoughts.
Antipsychotic drugs are usually given to reduce thought processes.
One approach is Personal Therapy (PT) involved using detailed evaluations of problems and experiences
Cognitive techniques in PT
Distractions from intrusive thoughts - for example, turn up the volume on the TV when this happens
Challenging the meaning of intrusive thoughts - this can be done with reality testing and questioning
Increasing/decreasing social activity to distract from low mood
Normalisation - conveying to patients that many people have hallucinations and delusions under unusual circumstances reduces anxiety and the sense of isolation. They feel less stigmatised and alone.
Relaxation techniques
Helping them understand how their irrational thoughts impact their feelings and behaviour can help them cope
Strengths of CBT to treat SZ
- One strength is there is supporting evidence. Jauhar et al (2014) reviewed 34 studies reviewed 34 studies of CBT to treat SZ. There is a small but significant effect on both positive and negative symptoms. Pontillo et al (2016) found reductions in the frequency and severity of auditory hallucinations.
- NICE (2019), the National institution for Health and Care Excellence recommends CBT for SZ. Therefore there is clinical experience support for the benefits of CBT.
- The effectiveness of CBT is dependent on the stage of the disorder. CBT appears to be more effective when it is made available at certain stages and when it is adjusted to these stages. For example, it was found by Addington and Addington (2005) that self reflection is unnecessary in the early stages of SZ, but for patients with more experience with the illness who will benefit from this.
Weaknesses of CBT to treat SZ
- Lack of availability of CBT. Only 1/10 individuals with SZ have access to CBT in the UK, and in some areas this is worse. In a survey by Haddock et al (2013), they found that in the North West, 7% were offered CBT.
- A significant number of those who were offered CBT as a treatment refused to attend sessions (Freeman et al, 2013), limiting its effectiveness.
- A problem with meta-analyses in this area is that it fails to take into account the quality of the studies considered. For example, some studies fail to randomly allocate participants to CBT or a control condition. Other studies fail to assess the patients’ subsequent assessment of symptoms and general functioning after CBT. Juni et al (2001) concluded that there was clear evidence that problems in methodically weak trials resulted in biased findings about the effectiveness of CBT.
- Wykes (et al (2008) found that the more rigorous the study conducted, the weaker the effect of CBT is.
- Another problem with CBT to treat SZ is the wide array of techniques and symptoms associated with the studies .Thomas (2015) found that different studies use different CBT techniques and people with different combinations of positive and negative symptoms. Therefore is makes it hard to see how CBT will affect a person as it is difficult to see which techniques work best for what symptoms
What is Family Therapy (FT)?
It takes place with the identified patient and their family. It aims to:
- Improve the quality of communication and interaction in the family
- Increase tolerance levels and decrease criticism levels
- Decrease feelings of guilt and responsibility for causing the illness among family members.
It takes place over 9 months to a year. It keeps in line with psychological theories like the double-bind and schizophrenogenic mother theories.
Pharoah et al (2010)
Identified a range of strategies that family therapists use to improve the function of a family:
Reduce negative emotions - FT aims to reduce levels of expressed emotions like negative emotions like anger and stress. It is important in reducing the likelihood of a relapse
Improve the family’s ability to help - The therapist encourages family members to form a therapeutic alliance where they can all agree on the aims of the therapy. It also aims to try to improve the family’s beliefs towards SZ. Another important factor in FT is attempting to balance the family’s care for the patient but also have their own lives as well.
Burbach (2018)
Proposed a model for working with families with SZ
Phase 1 - Sharing basic information and providing emotional and practical support
Phase 2 - Involves identifying resources, and what the family can and cannot offer.
Phase 3 - Aims to encourage a mutual understanding, creating a safe space for all family members to express their feelings
Phase 4 - This involves identifying unhelpful patterns of interaction such as the negative emotions like anger which could make things difficult for everyone in the family
Phase 5 - Skills training such as stress management techniques
Phase 6 - Relapse prevention
Phase 7 - Maintenance for the future
Strengths of FT to treat SZ (no weaknesses)
One strength of Family Therapy is its effectiveness. McFarlane (2016) concluded that FT was one of the most consistently effective treatments of SZ. 50-60% reduction in relapse rates. Also found was, using FT when mental health initially starts to decline is particularly effective. NICE recommends FT for everyone with a diagnosis of SZ.
Another strength is that while it benefits the patients, it also benefits all family members as well. Lobban and Barrowclough (2016) concluded that these effects are important because the family provide most of the care for the patient. By strengthening the while family, it lessens the burden of SZ.
There are economical benefits. a NICE review of family therapy studies found that it was associated with significant cost savings when offered to people with SZ in addition to standard care. It is also aided by a reduction in hospitalisation costs due to the lower relapse rates.
