psychological therapies for schizophrenia Flashcards
what are the 3 types of psychological therapies for schizophrenia
- CBT
- Family therapy
- token economy
how many sessions of CBT and group size
usually 5-20 sessions
groups or individual
what’s the aim of CBT for schiz
helping patients identify irrational thoughts n trying to change them.
may involve discussion how likely patients bleifies r to be true and consideration of less threatening possibilities.
does CBT get rid of SChiz
no helps patients better able to cope with symptoms
how does CBT help delusions n hallucinations
helps make sense of delusions n halluncinations, impacts on feelings n behaviour. understanding where symptoms come from hugely helpful.
e.g. hears voices-thinks demon=afriad. this can help reduce this anxiety.
delusions challenged so patient comes to learn beliefs not based on reality.
who gave a case example of CBT
Tarkington et al 2004
what was the case study example for CBT
paranoid patient: the mafia r observing me to decide how to kill me
therapist: you r obviously very frightened.. there must be a reason for this.
paranoid patient: do u think its the mafia?
therapist: its a possibility, but there could be other explanations. How do u know its the mafia?
what’s family therapies aim?
improve quality of communication between family members.
double-bind and schizogenic mother some psychologist see as root cause.
now more concerned w reducing stress (expressed emotion)
what are Pharaoh et al 2010 range of strategies family therapy uses to improve
-forming a therapeutic alliance with all family members
-reducing stress of caring for relatives w schiz.
-improving abilities to anticipate and solve problems.
-reducing anger n guilt in family members
-helping families achieve balance between caring for the individual with schiz and maintaining their own lives.
-improving families beliefs abt and behaviour towards schiz
how do these stratergies work according to Pharaoh
reducing levels of stress and expressed emotion, whilst increasing chances of patient complying with medication.
combination of benefits result in reduced likelihood of relapse and re-admission to hospital.
what is a token economies
reward system used to manage beh of patients w schiz, in particular those w maladaptive beh.
token economy- what’s maladaptive behaviour involve
spend long periods of time in institutions (psychiatric hospitals)
under these conditions often-bad hygiene, remianing in pyjammers all day.
modifying this beh doesn’t cure but improves quality of life, more likely to live outside hospital.
what an example of token
example- coloured disks immediately given to patients after carrying out desirable behaviour targeted for reinforcement.
may be getting dressed in the morning, making the bed, according to particular patient beh issues.
token- why is the immediacy of rewards important
it prevents ‘delay discounting’= reduced effect of delayed reward.
what can tokens be swapped for
tangible rewards
e.g. sweets, cigarettes or magazines or forms of service-having room cleaned or privileges like walk outside the hospital
token economies is based on what
operant conditioning, tokens are secondary reinforcers.
^because they have more value once patient learns they can be used to obtain rewards
evaluation of psychological therapies for schizophrenia
-evidence for effectiveness
-treatments improve quality of life but do not cure
-ethical issues
what evidence for effectiveness is there
Jauhar et al 2014-CBT
Pharaoh et al-family therapy
McMonagle and Sultana 2009-token economy
what was Jauher et al research
reviewed results of 34 studies of CBT for schiz.
concluded: CBT has significant but fairly small effect on both positive and negative symptoms.
what was Pharoah et al research
reviewed evidence for effectiveness of family therapy for schiz sufferers. concluded-there is moderate evidence to show that fam therapy significantly reduces hospital readmission over course of YR. n improves quality of life for patients n family.
However results of different studies were inconsistent + problems w quality of evidence.
overall research family therapy weak
what was McMonagle and sultana research into token economy
reviewed evidence for token economy.
found only 3 studies where patients had been randomly allocated to conditions. total of 110 patients.
random allocation is important in matching patients to treatment and control groups.
only 1 of 3 studies showed improvements in symptoms + none had useful infomationabt beh change.
what’s the overall point to evidence for effectiveness
there is only modest support for the effectiveness of psychological treatments and schiz remains one of the harder mental health problems to treat.
limitation of psychological treatments.
treatments improve quality of life but do not cure
all psychological treatments are a way to make schiz more manageable n improve quality of life.
-CBT
-family therapy
-token economy
but all don’t cure. failure to cue is weakness
ethical problems - token economy
token economy- privileges services. become more available to mild symptom patients, those more severe less-this prevents them complying with desirable behaviour.
means-most severely ill face discrimination, some families of patients challenged legality of this. in turn reduced use of token economy in psychiatric system.
