pshycoical treatments for schizophrenia eval apply it Flashcards
Does CBT cure?
CBT may improve the quality of life for people with schizophrenia but not actually ‘cure’ them. As schizophrenia appears to be largely a biological condition we would expect that a psychological therapy like CBT just benefits people by improving their ability to live with schizophrenia. For example CBT may enhance the ability of an individual to ignore auditory hallucinations and so experience less anxiety, but this is not the same as eliminating those symptoms.
On the other hand studies report significant reductions in the severity of both positive and negative symptoms. This suggests that CBT does more than enhance coping. For example a number of studies have reported that the frequency and intensity of hallucinations can be reduced by CBT as well as the anxiety associated with them.
On balance then it may well be that CBT does more than teach coping skills and may be a partial cure for schizophrenia.
Which matters most?
Because family therapy reduces relapse rates and makes families better able to provide the bulk of care it has huge economic benefits. The State does not need to pay so much for hospital care, benefits etc. It is always important to consider economic benefits of a treatment because they influence the case for funding it. If family therapy is cost-effective because it reduces future care costs for the identified patient and perhaps other family members it is cost-effective and should be funded.
On the other hand family therapy also has very significant therapeutic benefits for people with schizophrenia and their families. It is important to remember the importance of the recovery and future quality of life for the person with schizophrenia as well as wider economic benefits.
This suggests that everyone wins, ultimately the therapy should be for the benefit of the individual with schizophrenia and then for their family, and any economic gain is a bonus.
Evidence of effectiveness CBT
One strength of CBT for schizophrenia is the evidence for its effectiveness.
Sameer Jauhar et al. (2014) reviewed 34 studies of using CBT with schizophrenia, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Other studies have focused on symptoms, for example Maria Pontillo et al. (2016) found reductions in frequency and severity of auditory hallucinations. Clinical advice from NICE
(2019), the National Institutg for Health and Care Excellence, recommends CBT for schizophrenia.
This means that both research and clinical experience support the benefits of CBT for schizonhrenia.
Quality of evidence
One limitation of CBT for schizophrenia is the wide range of techniques and symptoms included in studies.
CBT techniques and schizophrenia symptoms vary widely from one case to another.
Neil Thomas (2015) points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. The overall modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms.
This makes it hard to say how effective CBT will be for a particular person with schizophrenia.
Evidence of effectiveness Family therapy
One strength of family therapy for schizophrenia is evidence of its effectiveness.
A review of studies by William McFarlane (2016) concluded that family therapy was one of the most consistently effective treatments available for schizophrenia. In particular relapse rates were found to be reduced, typically by 50-60%. A/cFarlane also concluded that using family therapy as mental health initially starts to decline is particularly promising. Clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia.
This means that family therapy is likely to be of benefit to people with both early and ‘full-blown’ schizophrenia.
Benefits to whole family
A further strength of family therapy for schizophrenia is the benefits for all family members.
Therapy is not just for the benefit of the identified patient but also for the families that provide the bulk of care. A review of evidence by Fiona Lobban and Christine Barrowclough
(2016) concluded that these effects are important because families provide the bulk of care for pennle with srhiznphrenia Ry strongthening the functinning of a whole family, family therapy lessens the negative impact of schizophrenia on other family members and strengthens the. ability of the family to support the person with schizophrenia.
This means that family therapy has wider benefits beyond the obvious positive impact on the identified patient
