Psychological therapies for Schizophrenia Flashcards
What are the three main psychological therapies for SZ?
Cognitive behaviour therapy, Family therapy, Token economies
What is the main psychological treatment for SZ?
CBT
What is the idea behind using CBT to treat schizophrenia?
That beliefs expectations and cognitive assessments of self, the environment and the nature of personal problems affects how individuals perceive themselves and others, how problems are approached and how successful people are in coping and reaching goals
How is CBT structured as a treatment to schizophrenia?
Takes place over a period of 5-20 sessions either in groups or individually
What is done first before CBT to treat schizophrenia?
They prescribe the patient antipsychotic drugs so that CBT can be more effective
After drugs are prescribed what is the process of using CBT to treat schizophrenia?
CBT is undertaken around once every 10 days for 12 sessions to identify rational thinking. Drawings are often used to display links between sufferers thoughts
What is a type of CBT approach?
Personal Therapy (PT)
What does Personal Therapy involve?
Detailed evaluation of problems and experiences their triggers and consequences and strategies being used to cope with
What are cognitive techniques developed between patients and therapists in treating SZ?
- Understanding their irrational cognitions - Distractions from intrusive thoughts - Challenging the meaning of intrusive thoughts - Increasing/Decreasing social activity - Normalisation - Using relaxation techniques - Positive self talk
Why is the cognitive technique of understanding how their irrational cognitions impact their feelings and behaviour?
Helps them make sense of where their symptoms come from (especially for auditory hallucinations) as it helps them cope
How can the meaning of intrusive thoughts be challenged?
Through reality testing
How is normalisation used as a cognitive technique to treat SZ?
conveying to patients that many people have unusual experiences such as hallucinations and delusions helps to reduce anxiety and any sense of isolation. This reduces alienation stigmatisation and increases hope for recovery
How else is PT used in SZ patients except from treatment?
Helps tackle problems faced by schizophrenics discharged from hospital taking place in small groups or as one to one therapy. Patients are taught to recognise small signs or relapse
What are the strengths of CBT as a psychological treatment for SZ?
Evidence to support its efficiency, Jauhar
What research evidence is there to show the efficiency of CBT in treating SZ?
Jauhar et al (2014), Pontillo et al (2016)
What did Jauhar et al. (2014) find?
In reviewing 34 studies of using CBT with SZ found there is evidence for small but significant effects on positive and negative symptoms
What did Pontillo et al. (2016) find?
Found reductions in frequency and severity of auditory hallucinations
Addington and Addington (2005)
Claims in the initial acute phase of SZ self reflection isn’t appropriate however after stabilisation or psychotic symptoms patients can benefit from group based CBT which can normalise their experience by meeting similar individuals
What are the weaknesses of CBT as a psychological treatment for SZ?
- Lack of availability of CBT and refusal to attend, Haddock
How is there a lack of availability of CBT and refusal to attend sessions?
It is estimated that in the UK only one in ten individuals SZ have access to CBT
Haddock et al (2013)
In a survey they found that in NW England 13/187 patients (7%) had been offered CBT
Freeman et al (2013)
(From Haddock’s survey) a significant number of the 7% offered CBT for schizophrenia refuse or fail to attend the therapy sessions
What are the problems with meta-analysis of CBT in treating SZ?
There is a failure to take into account the quality of the studies leading to unreliable meta analysis conclusions
What is an example of poor quality studies into the use of CBT to treat schizophrenia?
Some studies fail to randomly allocate participants to a control or CBT condition and others may fail to assess the patients subsequent assessment of symptoms and general functioning after treatment
Juni et al (2001)
concluded that there was clear evidence that the problems associated with methodologically weak trials translated into biased findings about the effectiveness of CBT, Wykes et al (2008)
Wykes et al (2008)
Found that the more rigorous the study, the weaker the effect of CBT
Why is it an issue in using CBT to treat SZ that there is a wide range of techniques and symptoms included in the studies?
symptoms and techniques vary widely from one case to another, Thomas (2014)
Thomas (2015)
Points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms so it is difficult to assess which technique works best for which symptom.
How is family therapy conducted to treat SZ?
Takes place with families and the identified patient
identified patient
A term used in family therapy which describes one member of the dysfunctional family who expresses the family’s conflicts
What does family therapy aim to do?
- improve quality of communication - Increase tolerance levels whilst decreasing criticism - decrease feelings of guilt and responsibility
How much time is given to family therapy?
Between 9 months and a year with a range of approaches (double bind, ee)
Pharoah et al (2010)
Identified a range of strategies that family therapists use to improve functioning
What strategies did Pharoah et al (2010) identify for FT?
- Reducing negative emotions (expressed emotions) to prevent stress and therefore relapse - Improves families ability to help through creating a therapeutic alliance
What did Burbach (2018) propose?
A model for working with families dealing with schizophrenia including 7 phases
What is the first phase of family therapy identified by Burbach (2018)?
Sharing basic information and providing emotional and practical support
What is the second phase of family therapy identified by Burbach (2018)?
involves identifying resources including what different family members can and cannot offer
What is the third phase of family therapy identified by Burbach (2018)?
encourages mutual understanding creating a safe space for all family members to express feelings
What is the fourth phase of family therapy identified by Burbach (2018)?
identifying unhelpful patterns of interaction such as negative emotions like anger
What is the fifth phase of family therapy identified by Burbach (2018)?
About skills training such as learning stress management techniques
What is the sixth phase of family therapy identified by Burbach (2018)?
Focuses on relapse prevention
What is the seventh phase of family therapy identified by Burbach (2018)?
is about maintenance for the future
What are the advantages of Family therapy in treating SZ?
- Research support for its efficiency, McFarlane (2016)
What did McFarlane (2016) find from reviewing studies?
That FT was of the most consistently effective treatments available for SZ as relapse rates were reduced by 50-60%
What did Lobban and Barrowclough (2016) conclude from their reviews?
The efficiency of FT on everyone in the family is important as the family provide most of the care for the person with SZ so by strengthening this function the negative impact on others can be reduced
What economic benefits did NICE find in their review of family therapy studies NCCMH (2009)?
Cost saving when offered in addition to standard care the extra cost is often offset by a reduction in costs of hospitalisation because of the lower relapse rates
What are token economies?
Reward systems used to manage the behaviour of patients with SZ in hospital settings especially those who developed maladaptive behaviours through spending too long in hospital
Which maladaptive behaviours can people with SZ develop after being institutionalised?
Developing bad hygiene or remaining in pyjamas all day
Mateson et al (2016)
identified three categories of institutional behaviour commonly tackled by means of token economies: personal care condition related behaviours and social behaviour
What are the two major benefits of modifying Mateson’s (2016) three categories of institutional behaviour?
Improves quality of life, Normalises behaviour so they can adapt back into life in the community
How are tokens used to manage SZ behaviours?
(secondary reinforcers) they are immediately given when a desirable behaviour is carried out to associate it with positive behaviour and then they are swapped as a reward (primary reinforcers)
What are token economies an example of?
behaviour modification - a behavioural therapy based on operant conditioning
What are the advantages of Token economies?
- Evidence for their effectiveness - Glowacki et al (2016) - Research support
Glowacki et al (2016)
identified 7 high quality studies published between 1999 and 2013 which examined effectiveness of TEs for people with chronic mental health issues. all showed reduction in negative symptoms and frequency of unwanted behaviours
Dickerson et al (2005)
11/13 studies reported positive effects of token economy effective in increasing adaptive behaviours
What are the weaknesses of Token economies?
- Ethical concerns - Lack ecological validity - Corrigan (1991) - more ethical alternatives
What are the ethical concerns of using token economies?
Clinicians exercise control over important primary reinforcers and this may violate certain basic human rights
Corrigan (1991)
there are problems administrating the token economy method with outpatients
Chiang et al (2019)
art therapy may be a good alternative and the evidence base for this may be small yet it is a high-gain and low-risk approach to managing SZ
