psychological therapies for schizophrenia

Question 1

what is CBT?

Answer 1

• uses cognitive & behavioural techniques
• commonly used
• 5-20 sessions
• group / individual
• identifies irrational thoughts and try to change them
  
  • via argument & discussion

Question 2

how CBT works?

Answer 2

• patients are helped to make sense of how delusions & hallucinations affect their feelings and behaviour ( where symptoms come from)
• gives psychological explanation for symptoms
  
  • can reduce anxiety
• delusions can be challenges so they learn that the thoughts aren’t real

Question 3

CBT: example - Turkington et al (2004)

Answer 3

• challenging paranoid delusions
  
  • (p): mafia are observing me to decide how to kill me
  • (t): you are obviously frightened… there must be a good reason for this.
  • (p): do you think it’s the mafia?
  • (t): it’s a possibility but there could be other explanations. how do you know that it’s mafia?

Question 4

what is family therapy?

Answer 4

• takes place with families
• aims to improve quality of communication & interaction in families
• more about reducing stress now in the family to reduce relapse
  
  • aims to reduce levels of expressed emotion

Question 5

how family therapy works?

Answer 5

• Pharoah et al (2010): identified a range of strategies
  
  • forming therapeutic alliance with all family members
  • reducing stress of caring for schizophrenic relative
  • improved ability of a family to anticipate and solve problems
  • reducing anger and guilt
  • helping family members have a balance between caring for the patient and maintaining own life
  • improves family beliefs about & behaviour towards schizophrenia
• Pharoah suggests that they work by reducing stressed & expressed emotion
  
  • while increase chances of patient taking medication
• combination results in less chances of relapse and readmission

Question 6

family therapy: model of practice - phase 1-3

Answer 6

• Frank Burbach - proposed model for working with families
  
  • phase 1: basic levels of information & moving to deeper levels
  • phase 2: identifies resources family can & cannot offer
  • phase 3: encourages mutual understanding & safe enviroment for feeling expression

Question 7

family therapy: model of practice - phase 4-7

Answer 7

• phase 4 : identifies unhelpful patterns of interaction
• phase 5: skills training ( stress management)
• phase 6 : relapse prevention
• phase 7 : maintenance of healthy patterns for the future

Question 8

AO3 - evidence for effectiveness of the therapies (s)

Answer 8

• Jauher et al: reviewed the results of 34 studies on CBT & concluded that it has small significant effect on positive and negative symptoms
• Pharoah et al: reviewed evidence on family therapy
  
  • found moderate evidence that family therapy significantly reduces hospital readmission over a year & improves quality of life
• other studies have been inconsistent & it’s concluded that evidence for family is weak
• National Institute for Health & Care Excellence (NICE) - recommends CBT for schizophrenia

Question 9

AO3 - CBT improves quality of life but doesn’t provide a cure (W)

Answer 9

• therapies only aim to make the condition more manageable
• CBT aims to help understand the thoughts & family therapy tries to reduce stress & token economies try to help people to fit into society better
• helpful but don’t provide a cure for symptoms
• biological therapies reduce severity of symptoms

Question 10

AO3 - quality of evidence for effectiveness (W)

Answer 10

• wide range of techniques and symptoms included in studies
• different CBT techniques have been used for varied symptoms of schizophrenia
• makes it hard to judge the overall effectiveness of CBT

Question 11

AO3 - evidence for family therapy (S)

Answer 11

• review of studies by Mc Farlane concluded family therapy was one of the most effective treatments
• relapse rates reduced by 50%-60%
• effective for early and fullblown

Question 12

AO3 - benefits whole family (S)

Answer 12

• not intended just for patients but effective for families as well
  
  • that provide majority of care
  • strengthens functioning of the whole family
  • family therapy strengthens negative impact of schizophrenia on others and gives support skills to the family

Question 13

AO3 - economic benefits (S)

Answer 13

• family therapy reduces relapse rates & decreases admission of patients to hospital & attending clinic check up’s
• saves funds