Psychological Therapies Flashcards
How many psychological therapies are there for SZ?
2
What are the 2 psychological therapies for SZ?
1) Cognitive-behavioural therapy (CBT)
2) Family intervention
Give an example of a delusional belief and how it comes about
Event: see a man outside the house
Interpretation: he is following me
Feeling: scared and paranoid
Behaviour: take evasive action and avoid going out
Outline CBT for SZ
Basic assumption is that people often have distorted beliefs which influence their behaviour in maladaptive ways like someone with SZ may believe their behaviour is being controlled by someone or something else - delusions thought to result from faulty interpretations of events and CBT is used to help patient identify and correct these
Explain the 5 techniques of CBT for SZ
1) Patients encouraged to trace back origins of symptoms to get a better idea of how they might have developed
2) Encouraged evaluate content of delusions or of any internal voices - they hear and consider ways in which they might test the validity of their faulty beliefs
3) Might be set behavioural assignments with aim of improving their general level of functioning
4) Learning of maladaptive responses to problems is often the result of disordered thinking by SZ of mistakes in assessing cause and effect
5) During CBT, therapist lets the patient develop own alternatives to these previous maladaptive beliefs, ideally by looking for alternative explanations and coping strategies that are already present in patient’s mind
What are outcome studies?
Measure of how well a patient does after a particular treatment compared with an accepted form of treatment for that condition
What do outcome studies suggest for CBT?
Patients experience fewer hallucinations and delusions and recover their functioning to a greater extent than those who receive antipsychotic drugs alone
Name 2 outcome studies for CBT for SZ
1) Drury (96)
2) Kuipers (97)
Outline Drury (96)
Found benefits of CBT in terms of reduced negative symptoms and a 25-50% reduction in recovery time for patients given combination of antipsychotic drugs and CBT
Outline Kuipers (97)
Confirmed these advantages but also noted there were lower patient drop-out rates and greater patient satisfaction when CBT used in addition to antipsychotic drugs
Outline family intervention for SZ
Research has discovered family environment has potential role in influencing course of SZ - main aim is to attempt to make family life less stressful and so decreasing re-hospitalisation
What is the main study regarding the origins of family intervention for SZ?
Brown (72)
Outline Brown (72)
SZs in families that expressed high levels of hostility, criticism or over involvement had more frequent relapses than people with the same problems who lived in families that were less expressive in their emotions
Name the 7 strategies of family intervention for SZ
1) By reducing levels of EE and stress, and by increasing the capacity of relatives to solve related problems, FI attempts to reduce incidence of relapse
2) Forming an alliance with relatives who care for SZ
3) Reducing emotional climate within family and burden of care for family members
4) Enhancing relatives’ ability to anticipate and solve problems
5) Reducing expressions of anger and guilt by family members
6) Maintaining reasonable expectations among family members for patient behaviour
7) Encouraging relatives to set appropriate limits whilst maintaining some degree of separation when needed
Name 2 positive points about CBT for SZ
1) Supporting research - found has a significant effect
2) Appropriateness in terms of negative symptoms
Name a study supporting the significance of CBT for SZ
Gould (01)
Outline Gould (01)
Found all 7 studies in a meta-analysis reported statistically significant reduction in positive symptoms after CBT treatment
Name 2 negative points about CBT for SZ
1) How much is due to the effects of CBT alone - often antipsychotic at the same time so difficult to assess
2) Appropriateness in terms of who benefits?
Outline the appropriateness of CBT for SZ in terms of negative symptoms
CBT works by trying to generate less distressing explanations for psychotic experiences rather than trying to eliminate them completely - negative symptoms may serve useful function for person and so can be understood as ‘safety behaviours’ - e.g. within psychiatric setting, strong expression of emotions might lead to increase in medication or hospital admission - similarly inactivity and withdrawal might be seen as a way of avoiding making positive symptoms worse - therefore CBT offers some hope of alleviating these maladaptive thought processes
Outline the appropriateness of CBT for SZ in terms of who benefits
Use CBT in conjunction with medication seems to have benefits but believed not everyone with SZ may benefit from CBT - study of 142 SZs and Kingdon & Kirschen (06) found many patients not deemed suitable for CBT because thought they would not fully engage with therapy - in particular, found older patients deemed less suitable than younger
What is the main study looking into the effectiveness of FI for SZ?
Pharoah (12)
Outline Pharoah (12)
Reviewed 53 studies 2002-10 investigating effectiveness of FI - conducted in Europe, Asia & North America - compared outcomes from FI to ‘standard’ care alone
What did Pharoah (12) find?
1) Mental state - mixed overall - some reported improvement compared to standard care and others not
2) Compliance with medication - compared to standard, the use of FI increases patients’ compliance with medication
3) Social functioning - although appearing to show some improvement in general functioning, did not appear to have an effect on more concrete outcomes like living independently or employment
What does Pharoah (12) suggest?
FI effective in improving clinical outcomes like mental state and social functioning but suggest due to increased medication compliance, patients are more likely to reap benefits of medication as more likely to comply with their medication regime
Name 2 negative points about FI for SZ
1) Methodological limitations
2) Cultural limitations
Outline the methodological limitations of FI
Pharoah (12) also identified methodological issues with studies randomisation and lack of blinding
Outline the problem with randomisation for FI
All 53 studies claimed randomly allocated ppts to treatment conditions, but researchers note that a large number of these studies are from the People’s Republic of China - there is evidence in many Chinese studies, randomisation had been stated as having been used, yet was not
Outline the problem of lack of blinding for FI
There is possible observer bias where raters were not blinded to condition in which ppts allocated - 10 studies reported no form of blinding used and 16 did not mention whether blinding had been used
Name 2 positive points about FI for SZ
1) Supporting evidence - NICE (09)
2) Economic benefits
Outline NICE (09)
Meta-analysis of 32 studies and nearly 2500 patients - found significant evidence for effectiveness of FI - when compared with patients receiving standard care alone, was a reduction in hospital admissions during treatment and in severity of symptoms during and up to 24 months following - relapse rate in FI 26% and control 50%
Outline the economic benefits of FI for SZ
NICE (09) demonstrated FI associated with significant cost savings when offered to SZs in addition to standard care - the extra cost of FI is offset by the reduced costs of hospitalisation as reduced relapse rates - also evidence FI reduces relapse rates for significant period after completion - means cost savings of FI are even higher
Outline the cultural limitations of FI
Evidence has begun to show effectiveness of FI as an addition to antipsychotic drugs but most of this comes from studies conducted outside UK, principally China - NICE (09) expressed view that hospitalisation levels may differ significantly across countries depending on clinical practise within countries, therefore data on hospitalisation rates from non-UK countries might not be applicable to the UK setting
Outline ethical issues regarding research into these psychological therapies in general
Research must be carried out in a way that does not place any vulnerable individuals at risk - BPs advise when take part in psychological investigation, there should not be an increased probability that they would come to any harm - possibility for harm is heightened when dealing with vulnerable groups - potential for harm include those associated with medication discontinuation, use of placebo conditions and capacity for informed consent
