Lesson 5 - Psychological Treatments for Schizophrenia Flashcards
What are the main three psychological therapies used for schizophrenia?
Cognitive Behaviour Therapy (CBT)
Family Therapy
Token Economies
What are the 6 stages used in CBT?
Assessment
Engagement
The ABC model
Normalisation
Critical Collaborative Analysis
Developing Alternative Explanations
What is Assessment (CBT)?
This is where the patient expresses their thoughts to the therapist, and realistic goals for the therapy are discussed.
What is Engagement (CBT)?
This is where the therapist empathises with the patient’s perspective and their feelings of distress, and then explains that they can develop an understanding for this distress together.
What is The ABC Model (CBT)?
The patient must give an explanation of activating events through the ABC method.
A) Appears to cause the
B) Behavioural and emotional
C) Consequences.
This helps the patient rationalise their own beliefs, and understand what is going on in their head.
What is Normalisation (CBT)?
This is when the therapist attempts to convince the patient that many people have unusual experiences, such as hallucinations and delusions. This helps the patient feel less alienated and will boost the chances of recovery in the future.
What is Critical Collaborative Analysis (CBT)?
The therapist would use gentle questioning to help the patient understand their illogical delusions and conclusions. For example, ‘If you can hear the voices, why can’t other people hear them?’. This would need to be done without causing distress, and the therapist must have a bond built with the patient for this to happen.
What is Developing Alternative Explanations (CBT)?
This is when the patient develops their own alternative explanations for their previously unhealthy assumptions. The therapist can help construct these new ideas if need be.
How many sessions of CBT are recommended to treat schizophrenia?
16
What must be combined with CBT in order for it to be successful?
Drug Therapy
Evaluation of CBTp - It is more effective than drugs alone
The NICE (National Institute for Health and Care Excellence) review in 2014 for the treatment of SZ found consistent evidence that CBTp + drugs was better than just drugs alone. CBTp also helped reduce rehospitalisation and was effective in reducing the severity of symptoms.
Evaluation of CBTp - It is more effective depending on the stage of schizophrenia
CBTp is found to be more effective at certain stages of schizophrenia. Addington and Addington (2005) claim that, self reflection is not relevant in the early stages of SZ. However, once the patient is more used to the symptoms, and is stabilised with drugs, this is when CBTp becomes extremely effective.
Evaluation of CBTp - CBTp is hard to access, and patients may refuse
Only one in ten individuals in the UK actually have access to CBTp. This figure is lower depending on where it is. However, many schizophrenics that are offered CBTp also just deny it, or fail to attend the sessions, which limits it’s effectiveness even more.
Evaluation of CBTp - Problems with meta analysis in this area
The issue with the meta analysis of CBTp is that it does not take into account the quality of the studies involved. Many CBTp studies are unreliable, as they do not allocate patients properly, or just generally do not measure the success well. June (2001) found clear evidence that the problems associated with methodologically weak trials translated into biased findings about CBTp.
What is family therapy?
Family therapy is essentially just intervention done with the family, in order to make them better at dealing with the schizophrenic family member.
How long is family therapy usually done for?
3-12 months, and at least ten sessions overall.
What is the point of family therapy?
It is essential that the home becomes a safe environment for the schizophrenic. This is to ensure that they do not feel stressed, and are able to live comfortably, which greatly decreases the rate of rehospitalisation.
What are the strategies used in family therapy?
Psychoeducation;
Forming an alliance
Reducing the emotional climate;
Enhancing relatives’ ability to anticipate and solve problems;
Reducing expressions of guilt;
Maintaining reasonable expectations
Encouraging relatives
You only need to know 4 of these at max, so pick the ones with a semi colon at the end.
What is psychoeducation (Family therapy)?
Psychoeducation is essentially helping the people in the family and the carers understand SZ to a higher degree, so that they can deal with the illness more efficiently.
What is reducing the emotional climate (Family Therapy)?
This is trying to make the family home less emotional and less stressful and try to reduce the emotional burden on the family that comes from looking after a schizophrenic.
What is Enhancing The Ability To Anticipate and Solve Problems (Family Therapy)?
This is essentially making sure that the surrounding family understand the schizophrenic, and the typical issues that may arise. They can then see these issues occurring in the future and act proactively, or just act appropriately when they rise.
What is Reducing Expressions Of Guilt (Family Therapy)?
This is essentially training the family to show less expressions of anger and guilt, in order to create a safer and less stressful environment for the schizophrenic.
Evaluation of Family Therapy - Pharoah’s mixed results
On one hand, Pharaoh found that family therapy increases patient compliance with medication, and leads to improvements in mental state and social functioning.
However, Pharaoh also mentions that it is hard to tell whether the drugs or the family are having a bigger impact on the schizophrenia symptoms, and thus this makes for mixed results.
What was the procedure of Pharaoh’s study?
Reviewed 53 studies between 2002 and 2010.
Studies were from NA, EU, and Asia.
It compared the effectiveness of family therapy with just drug therapy.
