psychological therapies for schizophrenia Flashcards
outline CBT as a therapy of schz.
Cognitive behavioural therapy usually takes place between five and 20 sessions, either in groups or on an individual basis.
the aim of CBT in general involves helping patients identify irrational thoughts and trying to change them. This may involve argument or discussion of how likely the patients beliefs are to be true, and a consideration of other less don’t impossibilities.
This does not get rid of the symptoms of schizophrenia but can make patients better able to cope with them.
how does CBT help?
Patients can be helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour.
Just understanding why symptoms come from can be hugely helpful to some patients.
For example if a patient has voices and believes the voices are demons, they will be afraid. Technological explanations for the existence of hallucinations and delusions can help reduce this anxiety.
Delusions can also be challenged so that a patient can come to learn that their beliefs are not based on reality.
outline family therapy for schz.
Family therapy takes place with families rather than individual patients, aiming to improve the quality of communication and interaction between family members.
There is a range of approaches to family therapy for schizophrenia. in keeping with the psychological explanations like the double bind and the schizophrenic mother, some therapists see the family as the root cause of the condition.
Nowadays however, most families therapists are more concerned with reducing stress within the family that might contribute to a patient’s risk of relapse. In particular it aims to reduce levels of expressed emotion.
how does family therapy help?
Pharoah et al (2010) Identified a range of strategies by which family therapists aim to improve the functioning of a family with a member suffering from schizophrenia:
Forming a therapeutic alliance with all family members.
Reducing the stress of caring for a relative of schizophrenia.
Improving the ability of a family to anticipate and solve problems.
Reduction of anger and guilt in family members.
Helping family members achieve a balance between caring for the individual schizophrenia and maintaining their own lives.
Improving family’s beliefs about and behaviour towards schizophrenia.
These strategies work by reducing levels of stress and expressed emotion, whilst increasing the chances of patients complying with medication. This combination of benefits tends to result in a reduced likelihood of relapse and readmission to hospital.
Outline token economies as a therapy for schizophrenia.
Token economies a reward systems 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.
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 patient’s quality of life and makes it more likely that they can live outside a hospital setting.
How do you token economies help?
The idea is that tokens, for example in the form of coloured desks, are given immediately to patients when they have carried out a desirable behaviour that has been targeted for reinforcement. This may be getting dressed in the morning, making a bed.
This immediacy of reward is important because it prevents delayed discounting, the reduced effect of a delayed reward.
The tokens have no value in themselves so they can be swapped later on for more tangible rewards.
Token economies are a kind of behavioural therapy based on operant conditioning. tokens are secondary reinforcers because they only have value once the patient has learned that they can be used to obtain rewards.
These rewards might be in the form of materials such as sweets, or rather in the form of services such as having a room cleaned or privileged such as the walk outside the hospital.
Discuss evidence for effectiveness of CBT as a strength of psychological therapies for schizophrenia.
One strength of psychological therapy is that there is support for the benefits of CBT for schizophrenia.
Researchers reviewed the results of thirty four studies of CBT for schizophrenia and concluded that CBT has a significant but fairly small effect on both positive and negative symptoms.
this supports the effectiveness of CBT as a psych therapy for schz.
Discuss evidence for effectiveness of family therapy as a strength of psychological therapies for schizophrenia.
a strength is research support for the effectiveness of family therapies.
Researchers reviewed the evidence for the effectiveness of family therapy for families of schizophrenic sufferers.
Concluded that there is a 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 - suggesting family therapy is at least partly effective as a therapy for schz.
HOWEVER -
they also noted that results of different studies were inconsistent and that there were problems with the quality of some evidence.
Overall, the evidence base for family therapy is fairly weak limiting our confidence in the effectiveness of family therapy.
Discuss evidence for effectiveness of token economies as a strength of psychological therapies for schizophrenia.
a strength is that there is evidence from research support to show the effectiveness of token economies.
For example - Paul and Lentz (1977) found that token economies led to better overall patient functioning and less behavioural disturbance, and were more cost-effective than other forms of therapy.
therefore this provides support for TEs as a therapy for schz.
HOWEVER -
A review of the evidence for token economies 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 control groups and eliminating extraneous variables.
only one of the three studies showed improvement in symptoms and none yielded useful information about behavioural 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.
Discuss treatments improve quality of life but not cure as a limitation of psychological therapies.
All the psychological treatments for schizophrenia aim to make schizophrenia more manageable and in some way improve patients qualities of life.
CBT helped 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 patients themselves and other family members. Token economies help by making patients’ behaviour more socially acceptable so that they can better reintegrate into society.
These things are all worth doing, but should not be confused with curing schizophrenia.
This failure secure schizophrenia is a weakness of psychological treatments.
Discuss ethical issues as a limitation of psychological therapy to schizophrenia.
Although psychological treatments for schizophrenia do not have the serious side effects or medical risks of drug treatments, it can raise ethical issues.
Token economy systems have proved controversial. The major issue is that privileges become more available to patients with mild symptoms and less so for those with more severe 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 and patients have challenged their legality of this.
This has in turn reduced the use of token economies in the psychiatric system.
Ethical issues like this are a weakness of psychological treatments of schizophrenia.
