PAPER 3 - SCHIZOPHRENIA - CBTp and family therapy as treatments of schizophrenia

Question 1

what are the 2 aims of family therapy?

Answer 1

• to reduce negative emotions by reducing high expressed emotion (e.g. anger/guilt)
• improve family’s ability to help by encouraging members to agree on the aims of the therapy and the beliefs about behaviour towards SZ (also encouraged to keep balance between caring for SZ individual and maintain own lives)

Question 2

what is family therapy?

Answer 2

• used to reduce expressed emotion
• reduces relapse rates of individual
• involves diagnosed individual to reduce suspicion
• family members encouraged to learn about SZ, to listen to each other and discuss issues together

Question 3

what is Frank Burbach’s model of family therapy? (phases)

Answer 3

1. sharing basic info. & providing practical & emotional support
2. identifying resources that members cannot offer
3. encourage mutual understanding by identifying the safe space for members to express feelings
4. identify unhelpful patterns of interaction
5. skills training (e.g. stress management techniques)
6. relapse prevention planning
7. maintenance for the future

Question 4

what was the procedure of the study by Pharoah?

Answer 4

reviewed 53 studies from Europe, Asia & North America compared outcomes for family therapy vs standard care (antipsychotics only)

Question 5

what were the findings of the study by Pharoah?

Answer 5

• mental state of patient was mixed findings
• compliance with medication was increased y family therapy
• social functioning showed some improvements on general functioning but no difference in more concrete outcomes such as living independently
• relapse was reduced in therapy families & also reduction in hospital admission and in the 24 months after

Question 6

what conclusions can be made from the Pharoah study?

Answer 6

• family therapy can be effective when using a range of strategies
• forming a therapeutic alliance between family members reduces stress of carers
• helps members anticipate and resolve problems (guilt & anger)
• maintains balance between caring and continuing own life

Question 7

what are the criticisms of Pharoah’s study?

Answer 7

• improvements could simply be the fact that family therapy increased medicinal compliance so its the drugs that are working
• in 10 of the 53 studies, the raters were not blinded so they knew which type of treatment the participants had received - risks rater bias

Question 8

is family therapy for economic or therapeutic benefit? (EVALUATION)

Answer 8

reducing relapse is economical for the health service so clearly a good reason for its recommendation - but the therapeutic benefits are also clear

Question 9

how is “whole family benefits” an evaluation point for family therapy?

Answer 9

• strengthening the functioning of the whole family reduces the stress for the members too as the negative impacts of schizophrenia are lessened for everyone
• this means there are wider benefits than just the diagnosed individual

Question 10

what is the evidence for effectiveness within family therapy?

Answer 10

relapse found to be reduced by 50-60% (McFarlene)
- he concluded that not only is it the most consistently effective treatment, but is especially effective if as soon as mental health begins to decline

Question 11

what is CBT?

Answer 11

• aims to help with cognition (thoughts) and behaviour
• helps people cope with their symptoms e.g. convincing them that the voices do not come from demons
• this helps them feel much less frightened, more able to cope and more able to function

Question 12

what is “reality testing”?

Answer 12

therapists use it as a strategy where the individual is encourages to examine the likelihood of the belief being true - this is not always effective but can still be used to help anxiety and depression that comes with SZ

Question 13

what are each of the phases of CBT?

Answer 13

1. assessment
2. engagement
3. ABC model (Ellis)
4. Normalisation
5. critical collaborative analysis
6. development of alternative explanations
   (dont need to recite strictly in this order, only asked for general understanding)

Question 14

what is involved in “1. assessment”?

Answer 14

expression of thoughts and realistic goals

Question 15

what is involved in “2. engagement”?

Answer 15

• therapists empathy is very important and reassurance of explanations
• therapist validates thoughts, builds trust

Question 16

what is involved in “3. ABC model (Ellis)”?

Answer 16

A - activating event
B - belief about that event
C - consequence of that belief
- therapist identifies and addresses abnormal thoughts

Question 17

what is involved in “4. normalisation”?

Answer 17

reassurance that it happens to many people in different circumstances - this is to relieve stress

Question 18

what is involved in “5. critical collaborative analysis”?

Answer 18

Q & A to help patient to see irrationalities e.g. why can no one else hear the voices

Question 19

what is involved in “6. development of alternative explanations”?

Answer 19

patient encouraged to consider healthier explanations

Question 20

does CBT provide a cure? (EVALUATION)

Answer 20

• no, only improves quality of life by helping/allowing patients to make sense and challenge their symptoms
• doesnt get rid of symptoms but can make patients better able to cope with them
• however some studies have shown significant improvement of positive and negative symptoms

Question 21

is there evidence that CBT is effective? (EVALUATION)

Answer 21

• a researcher reviewed 34 studies of CBT for SZ, concluded that CBT has significant, but fairly small effect on positive and negative symptoms
• evidence also suggests CBT is more/less effective at different stages in development of SZ - more effective later on
• reduces relapse rates - hard to entangle whether CBT or drug therapy is effective

Question 22

what are the ethical issues of CBT?

Answer 22

• privileges, services etc. become more available patients with milder symptoms and less for those with more severe symptoms of SZ that prevent them from complying with desirable behaviours
• means severely ill patients suffer with discrimination, reducing use of token economies
• CBT may involve challenging someone’s paranoia