Lesson 5 - Psychological Treatments for Schizophrenia

Question 1

What are the main three psychological therapies used for schizophrenia?

Answer 1

Cognitive Behaviour Therapy (CBT)
Family Therapy
Token Economies

Question 2

What are the 6 stages used in CBT?

Answer 2

Assessment
Engagement
The ABC model
Normalisation
Critical Collaborative Analysis
Developing Alternative Explanations

Question 3

What is Assessment (CBT)?

Answer 3

This is where the patient expresses their thoughts to the therapist, and realistic goals for the therapy are discussed.

Question 4

What is Engagement (CBT)?

Answer 4

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.

Question 5

What is The ABC Model (CBT)?

Answer 5

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.

Question 6

What is Normalisation (CBT)?

Answer 6

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.

Question 7

What is Critical Collaborative Analysis (CBT)?

Answer 7

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.

Question 8

What is Developing Alternative Explanations (CBT)?

Answer 8

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.

Question 9

How many sessions of CBT are recommended to treat schizophrenia?

Answer 9

16

Question 10

What must be combined with CBT in order for it to be successful?

Answer 10

Drug Therapy

Question 11

Evaluation of CBTp - It is more effective than drugs alone

Answer 11

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.

Question 12

Evaluation of CBTp - It is more effective depending on the stage of schizophrenia

Answer 12

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.

Question 13

Evaluation of CBTp - CBTp is hard to access, and patients may refuse

Answer 13

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.

Question 14

Evaluation of CBTp - Problems with meta analysis in this area

Answer 14

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.

Question 15

What is family therapy?

Answer 15

Family therapy is essentially just intervention done with the family, in order to make them better at dealing with the schizophrenic family member.

Question 16

How long is family therapy usually done for?

Answer 16

3-12 months, and at least ten sessions overall.

Question 17

What is the point of family therapy?

Answer 17

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.

Question 18

What are the strategies used in family therapy?

Answer 18

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.

Question 19

What is psychoeducation (Family therapy)?

Answer 19

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.

Question 20

What is reducing the emotional climate (Family Therapy)?

Answer 20

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.

Question 21

What is Enhancing The Ability To Anticipate and Solve Problems (Family Therapy)?

Answer 21

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.

Question 22

What is Reducing Expressions Of Guilt (Family Therapy)?

Answer 22

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.

Question 23

Evaluation of Family Therapy - Pharoah’s mixed results

Answer 23

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.

Question 24

What was the procedure of Pharaoh’s study?

Answer 24

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.

Question 25

What were the findings of Pharaoh’s study?

Answer 25

Pharaoh found that:
There was mixed results on whether the mental state improved or not.
Patients were more compliant with taking their drugs.
Social functioning was not really affected.
There was a reduction in the risk of relapse and rehospitalisation for up to 2 years after the treatment.

Question 26

Evaluation of family therapy - Researcher Bias

Answer 26

There is large researcher bias when it comes to family therapy studies. In Pharaoh’s study, 10/53 of the studies mentioned had no blinding involved. This then leaves the issue of rater bias, as it is known which family is in which condition, and thus ultimately the results on how effective family therapy is cannot be trusted.

Question 27

Evaluation of Family Therapy - Economic Benefits

Answer 27

Schizophrenics that have family therapy have significantly lower relapse and rehospitalisation rates. This lack of relapse offsets the amount of money needed to implement family therapy, and actually makes a saving for the hospitals. This shows that family therapy actually saves money.

Question 28

Evaluation of Family Therapy - Actual benefits

Answer 28

Lobban (2013) analysed the results of 50 family therapy studies, and found that 60% of these studies reported a significant positive impact of the intervention. This shows that family therapy works.

Question 29

What is a token economy?

Answer 29

A token economy is a form of behaviour shaping, and it is used to manage the behaviour of patients with schizophrenia in hospital settings.

Question 30

What principles are a token economy based upon?

Answer 30

It is based on operant conditioning, and positive reinforcement.

Question 31

How do the tokens work?

Answer 31

Tokens are essentially coloured discs. These are given to patients when the patients have carried out a desirable behaviour. Tokens are given to patients immediately after a good task to ensure that the positive behaviour is linked with the action.

Question 32

What are the rewards given?

Answer 32

The tokens have no value in themselves. The tokens are secondary reinforcers, because they can be traded for rewards. These rewards may be sweets, cigarettes or even a walk outside the hospital.

Question 33

Evaluation of token economies - Research Support

Answer 33

Dickerson (2005) reviewed 13 studies which use token economies. 11 of these studies show beneficial effects from token economies. This shows that token economies are quite effective in increasing desirable behaviours.

Question 34

Evaluation of token economies - Ethical Issues

Answer 34

Clinicians may have to exert control over specific primary reinforcers to ensure that the rewards are actual incentives. This could potentially infringe on basic rights that the schizophrenia patients may need such as the ability to do something fun and not be bored. This could create a potentially dangerous power dynamic.

Question 35

Evaluation of Token Economies - Ecological Validity

Answer 35

It does not apply in scenarios where the patients are not in a hospital receiving 24 hour care. Who will instantly give patients tokens at home. Thus token economies lack ecological validity as they cannot be used in a real life scenario.

Question 36

Evaluation of Token Economies - Questionable results on if they work

Answer 36

There is no real conclusive evidence that token economies actually work. There are very few randomised trials that have been carried out concerning this topic. This lack of research support makes it questionable as a strategy, but ultimately it is a control method rather than a treatment method.