Psychological therapies Flashcards
What is cognitive behaviour therapy?
- cognitive behavioural therapy can be conducted in groups or individually
- it helps identify irrational beliefs and cope with schizophrenia
- helps reduce anxiety as the patients learn that their beliefs are not based on reality
What is a case study example of CBT?
- Turkington et al describe an example of CBT used to challenge where a paranoid patient’s delusions come from
- paranoid patient: the mafia are observing me to decide how to kill me
- Therapist: you are obviously very frightened… there must be a good reason. For this
- paranoid patient: do you think it’s the mafia?
- therapist: its a possibility, but there could be other explanations, how do you know that it’s the mafia?
What is family therapy?
- takes place with the family rather than just the individual
- aims to reduce quality of communication and interactions between family members to reduce anxiety which helps reduce anger and guilt so they can better care for the patient
- family therapy reduces stress in the family which reduces replace rates
What are token economics?
- a reward system used to manage the behaviour of patients with schizophrenia in particular those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals referee to as institutionalised
- under these circumstances it is common for patients to develop bad hygiene or perhaps to remain in pyjamas all day
- modifying these bad habits does not cure schizophrenia but it improves the patients quality of life and makes it more likely that they can live outside a hospital setting
What are the evaluation points of psychological therapies?
- evidence for family therapy is weak and inconsistent, individual differences act as a confounding variable
- treatments improve quality of life but are not a cure
- ethical issues of the token economy system leads to discrimination
- economic implications as a combination of psychological therapies and drug therapies are most effective but is not always available
How is evidence for effectiveness a weakness of psychological therapies?
- there is some support for the benefits of psychological treatment for schizophrenia
- Jauhar et al reviewed the results of 34 studies of CBT for schizophrenia
- they concluded that CBT has a significant but fairly small effect on both positive and negative symptoms
- Pharaoh et al reviewed the evidence for the effectiveness of family therapy for families of schizophrenia sufferers
- they concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year and improves quality of life for patients and their families
- however. They also noted that results of different studies were inconsistent and that there were problems with the quality of some evidence
- overall then the evidence base of family therapy is fairly weak
- a review of the evidence for token economics found only three studies where patients had been randomly allocated to conditions, with a total of only 110 patients
- random allocation is important in matching patients to treatment and none yielded useful information about behaviour change
- overall there is only modest support for the effectiveness of psychological treatments and schizophrenia remains one of the harder mental health problems to treat
- this is a limitation of psychological treatments
How is the fact that treatments improve quality of life but do not cure a weakness of psychological therapies?
-all the psychological treatments for schizophrenia discussed here aim to make a
Schizophrenia more manageable and in some way improve patients’ quality of life
-CBT helps by allowing patients to make sense of and in some cases challenge some of their symptoms
-family therapy helps by reducing the stress of living with schizophrenia in a family, both for the patient themselves and other family members
-token economics help by making patients behaviour more socially acceptable so that they can better re-integrate into society
-these things are all worth doing, but should be confused with curing schizophrenia either but they do reduce the severity of some symptoms
-this failure to cure schizophrenia is a weakness of psychological treatments
How are ethical issues a weakness of psychological therapies?
- although psychological treatments for schizophrenia do not have the serious side effects or medical risks of drug treatments, they can raise ethical issues
- in particular token economy systems have proved controversial
- the major issue is that privileges, services etc., become more available to patients with mild symptoms and less so for those with more servers symptoms of schizophrenia that prevent them complying with desirable behaviours
- this means that the most severely ill patients suffer discrimination in addition to other symptoms and some families of patients have challenged the legality of this
- this has in turn reduced the use of token economies in the psychiatric system
- other psychological therapies can raise additional issues
- CBT may involve, for example, challenging a person’s paranoia, but at what point does this interfere with an individual’s freedom of thought?
- if, for example, CBT challenged a patient’s beliefs in a highly controlling government, this can easily stray into modifying their politics
- ethical issues like this are a weakness of psychological treatments for schizophrenia
Economic implications are a weakness of psychological therapies?
- you may not be able to get a combination of both therapies which means that they will not be as effective
- psychological therapies are only useful if drugs are given however psychological therwapies are expensive so are not available to all patients
