Psychological Therapies

Question 1

Cognitive - behavioural therapy (CBT)

Answer 1

trace origins of symptoms to understand how they might develop, evaluate content of delusions/hallucinations and test validity
patient allowed to develop own alternatives to maladaptive beliefs

Question 2

CBT - outcome studies

Answer 2

measure how well patient does often treatment compared to accepted form
show fewer hallucinations/delusions, recover functioning to greater extent

Question 3

CBT - assumptions

Answer 3

people have distorted beliefs which influence behaviour

delusions thought to result from faulty interpretations of events

Question 4

Outcome studies - Kuipers et al (1997)

Answer 4

drop-out rates lower and greater patient satisfaction when CBT + medication used

Question 5

Family intervention - assumption

Answer 5

stressful family environment can increase risk of relapse

Question 6

Family intervention - aim

Answer 6

make family life less stressful and reduce re-hospitalisation

Question 7

Family intervention - strategies

Answer 7

form an alliance with relatives who care for patient, reducing EE and increasing capacity of relatives to solve problems
commonly used with drug treatments and clinical care

Question 8

Effectiveness of CBT - Gould et al. (2001)

Answer 8

meta-analysis, 7 studies, reported significant decrease in positive symptoms

Question 9

How much due to CBT?

Answer 9

most studies conducted with patients treated with medication, difficult to assess effectiveness of CBT
don’t fully understand

Question 10

Appropriateness of CBT - who benefits

Answer 10

Kingdom and Kirschen (2006): 142 SZ patients, Hampshire, patients not deemed suitable, they would not fully engage
older patients deemed less suitable

Question 11

Appropriateness of CBT - raise self-esteem

Answer 11

involves realisation delusions and hallucinations can occur in healthy individuals
improve mental state

Question 12

Effectiveness of family intervention - meta-analysis

Answer 12

32 studies (2500 ps.), significant evidence for effectiveness

Question 13

Effectiveness of family intervention - supporting research

Answer 13

compared with patients receiving standard care, reduction in hospital admissions and severity of symptoms
relapse rates 26%, in control 50%

Question 14

Effectiveness of family intervention - limited

Answer 14

not a cure

usually require drug therapy and social adjustment is lower than healthy individuals

Question 15

Appropriateness of family intervention - economic benefits

Answer 15

NICE review: associated with cost savings when offered in addition to standard care
cost offset by reduction in costs of hospitalisation - lower relapse rates

Question 16

Appropriateness of family intervention - cultural limitations

Answer 16

most evidence from studies outside UK

NICE study: hospitalisation level may differ across countries, data from other countries might not be applicable

Question 17

Meta-analysis of family intervention studies

Answer 17

Pharoah et al: 53 studies in Europe, Asia, N. America
mental state - mixed
compliance with medication - increase
social functioning - not much effect on living independently, employment etc.

Question 18

Methodological limitations of family intervention studies

Answer 18

randomisation - not always used in studies from China

lack of blinding - Pharoah et al study, 10 studies reported no blinding, 16 did not say

Question 19

Ethical issues in research

Answer 19

BPS advise that possibility of harm should not increase

harm in outcome studies: medication discontinuation, use of placebo, capacity for informed consent