Psychological Therapies Flashcards
How does CBT work?
Usually takes place between 5 and 20 sessions, either in groups or individually
It aims to help patients identify irrational thoughts and change them - this may involve a discussion about how true a patients beliefs are and a consideration of other, less threatening possibilities
CBT does not get rid of symptoms, what does it do?
Makes patients more able to cope with them - patients can be helped to make sense of their hallucinations and delusions and how they impact on feelings and behaviour - offering psychological explanations can reduce anxiety. Delusions can be changed so that patients are able to see that their beliefs are not based on reality
What does family therapy aim to do?
Improve the quality of interaction an communication in families and to reduce EE
In keeping with the double blind and mother theory, some therapies see the family as a root cause
Modern psychologists more concerned with reducing family stress and reduce family relapses
What strategies did Pharoah et al identify which aims to improve the functioning of the family?
Forming a therapeutic alliance with all family members
Reducing the stress of caring for a relative with Sz
Improving the ability of the family to anticipate and solve problems
Reduce anger and guilt in family members
Help family member achieve a balance between caring for a Sz individual and maintaining their own lives
Improving family beliefs and behaviours about Sz
How do Pharoah’s strategies work?
By reducing stress and EE while increasing patient’s compliance regarding medication. This leads to reduced likelihood of relapse and readmission into hospital
What happens when patients stay in hospitals for long periods of time?
They may suffer from institutionalisation - they may develop poor hygiene and stay in nightwear all day, modifying these habits improvise the patients quality of life in order for them to live outside of the hospital
How do token economies work?
Tokens (coloured disks) are given to the patients when they have carried out a desirable behaviour that has been targeted for reinforcement e.g. making the bed (all related to a patients behavioural issues)
Tokens can be swapped for rewards e.g. sweets, cigarettes or privileges such as outside walk
Why is the immediacy of the reward important?
It prevents ‘delay discounting’ which reduces the impact of the reward
What principle are token economies based on?
Operant conditioning - tokens are secondary reinforcers because they have only have value once the patient has learned they can be used for rewards
What is some evidence for the effectiveness of CBT?
Jauhar et al reviewed the results of 34 studies of CBT and found it had a significant but significant but fairly small impact on positive and negative symptoms????
What is the evidence into the effectiveness of family therapy?
Pharoah et al reviewed the effectiveness of family therapy and found evidence that it reduces hospital readmission over the year and improves quality of life for Sz patients but results in studies were inconsistent with quality for evidence and overall the evidence base for family therapy is weak
What is the evidence into the effectiveness of token economies?
McMonagle and Sultana found only 3 studies where patients had been randomly allocated to conditions- random allocation is important to match patient to control group and only one of the three demonstrated improvement in symptoms
Overall, there is only modest support of psychological treatments, this maybe because Sz remains very difficult to treat
What is the weakness with treatments just improving quality of life?
CBT helps patients make sense of their condition and sometimes challenge symptoms
Family therapy reduces stress for both patients and families
Token economies make behaviour more socially acceptable
They do not cure, as with biological treatments they just reduce severity of symptoms - failure to cure = weakness
What are the ethical issues with token economies and CBT?
Token economies - controversial with the idea that those who receive privileges are the less severe patients as they are more able to comply - this means the most ill patients are discriminated against and some families have challenged it legally which has in turn, reduced the token economies in the psychiatric system
CBT - tries to cure paranoia but at what point does this become a challenge to freedom of thought (this can be demonstrated if patients are paranoid about controlling government)
What is the quality of the evidence for effectiveness?
Small studies have shown that psychological treatments do help, however, in these studies there is often no control group and if there is they are randomly allocated
Where these studies are included in reviews they appear more optimistic - other way to look at it = if not included does this mean pessimistic conclusions are being drawn
