Psychological Therapies Flashcards
What are the aims of CBT?
To help patients identify irrational thought and try to change them. This may involve discussion of how likely a patient’s beliefs are to be true, and consideration of less threatening possibilities.
How does CBT help patients to understand their symptoms?
Patients are helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour. For example, a patient may hear voices and believe they are demons so will be very afraid. Offering explanations for these symptoms reduces anxiety and helps the patient realise their beliefs are not based on reality.
How does family therapy reduce expressed emotion?
Family therapy is with families rather than individual patients, aiming to improve communication and interaction in the family. Family therapists try to reduce stress within the family that may contribute to patient’s risk of relapse (reduce levels of EE).
How does family therapy try to improve family function?
Pharoah et al identified a range of strategies family therapists use to reduce the likelihood of relapse and readmission to hospital. For example:
- Reduce stress of caring for a relative with schizophrenia.
- Improve ability of family to anticipate and solve problems.
- Reduce guilt and anger in family members.
- Improve beliefs about behaviour toward schizophrenia.
How are token economies used to reinforce desirable behaviours?
Token economies are reward systems (operant conditioning) used to manage the behaviour of patients with schizophrenia who spend long periods of psychiatric hospitals. Tokens (e.g. Coloured discs) are given to patients who carry out desirable behaviours (e.g. Getting dressed, making a bed etc.) This reward reinforces the desirable behaviour and because it is given immediately prevents ‘delay discounting’ reduced effect of a delayed reward.
How are tokens secondary reinforcers?
Tokens have no value in themselves but can be swapped later for tangible rewards (e.g. Sweets, a walk outside etc.). They are secondary reinforcers because they only have a value due to the learned association (classical conditioning) with innate primary reinforcers.
Limitation of psychological therapies: research shows limited benefits.
Jauhar et al found CBT had a significant but small effect on positive and negative symptoms. McMonagle and Sultana found one of three studies of token economies that used random allocation showed improvement. Pharaoh et al reviewed effectiveness of family therapy and found moderate evidence for the reduction of hospital readmissions over one year and some improvement to quality of life - but the evidence was inconsistent. Overall there is only modest support for the effectiveness of psychological therapies.
Limitation: psychological therapies can help but not cure.
CBT helps patients to make sense of their symptoms. Family therapy reduces the stress of living with schizophrenia. Token economies help to make patient’s behaviour more socially acceptable. These things are all worth doing, but should not be confused with curing schizophrenia. Biological therapies do not cure schizophrenia either but they do reduce the severity of the symptoms and thus may be more desirable.
Limitation: relates to ethical issues.
Token economy systems are controversial because severely ill patients cannot get privileges because they are less able to comply with desirable behaviours than moderately ill patients - so severely ill patients suffer discrimination. Also, CBT may challenge a person’s paranoia - but might interfere with their freedom of thought. If, for example, CBT challenges a patient’s beliefs in a controlling government, that could stray into modifying their politics. Ethical issues like these make psychological therapies for schizophrenia controversial.
Limitation: quality of some evidence.
Small-scale studies that compare patients before and after psychological therapies have found positive effects. But these studies lack a control group or random allocation to conditions - but they are included in reviews. This may mean that the effectiveness of psychological therapies is overestimated by the evidence.
Limitation: alternative psychological therapies are under-researched.
For example, NICE recommends art therapy, if a qualified art therapist is available who had experience working with schizophrenia patients. However, these therapies are not well researched so is unclear how effective they are. This questions whether under-researched therapies should be made available to patients.
