psychological therapies for schizophrenia Flashcards
what are the three types of psychological therapies
- cognitive behavioural therapy
- family therapy
- token economies
what is the aim of CBT
delivery of techniques such as hypothesis testing or diary keeping in order to identify and manage intrusive or delusional thoughts
how is CBT conducted
patient is encouraged to develop ration interpretations or alternative perceptions changing the faulty cognitions eg viewing voices as interesting rather than threatening
- identify, challenge and change
how does CBT help
patients can be helped to make sense of how their delusions and hallucinations impact their feelings and behaviour
- understanding where symptoms come from can be helpful for some patients and they can learn their beliefs arent based on reality
what does CBT promote
- increase in social activity and use of relaxation strategies
how can behavioural homework assignments help
patient could be asked to initiate social contact which could enable them to improve their general level of functioning and negative symptoms
how many sessions of CBT are needed `
5-20 sessions weekly or fortnightly
whats family therapy based on
- double bind and schizophrenogenic mother
- belief that the family is the root cause
whats the aim of family therapy
reducing levels of expressed emotion and reducing stress which could otherwise contribute to a relapse
how does family therapy help
- forming a therapeutic alliance with all family members
- reducing the stress of caring for a relative with schizophrenia
- improving the ability of the family to anticipate and solve problems
- reduction of anger and guilt in family members
- helping family members achieve a balance between caring for themselves and caring for the individual with schizophrenia
- improving family beliefs and behaviour towards schizophrenia
how is family therapy conducted
- therapist meets family members and patient for open, productive discussion
- educates family members about the disorder and what to expect
a strength of cbt and family therapy is that we have evidence for its effectiveness
- there is some support for the benefits of psychological treatment for schizophrenia
- jauhar reviewed results of 34 studies of CBT for schizophrenia
- concluded that CBT has a significant but fairly small effect on both positive and negative symptoms
- paroah reviewed the evidence for the effectiveness of family therapy for families of schizophrenia sufferers
- they concluded that there is 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
- this is important because it shows that the therapy is effective and manages schizophrenic behaviour
- so the therapy has a degree of validity as it achieves what it set out to
a strength of the treatments are that they improve the quality of life of the patient
- all the psychological treatments for schizophrenia discussed aim to make schizophrenia more manageable and in some way improve the patients quality of life
- CBT helps 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 patient themselves and other family members
- these things do not cure schizophrenia but they do reduce the severity of symptoms
- this is a strength as theres economic benefits as schizophrenic sufferers returning to work
- meaning they can pay taxes and contribute to the economy
- this is a strength as the treatment has economic benefits for society
a limitation of the psychological treatment sis that the evidence for effectiveness is limited in scope and the quality of this evidence can be questioned
- many small scale studies in which mental health professionals have compared patients before and after psychological treatment have found more positive results than those described above
- however these studies have problems there is often a lack of control group or if there is one then patients are not randomly allocated to treatment and control conditions
- where these studies are included in reviews conclusions are generally more optimistic than those that strictly control which studies are included
- the studies lack scientific rigour and therefore internal validity
what is token economy used for
its used for promoting socially desirable behaviours rather than alleviating symptoms
outline token economy
- reward systems based on the principles of operant conditioning
- used for schizophrenics who have developed maladaptive behaviour through long periods in psychiatric hospitals
- tokens are used as a secondary reinforcer and are given to patients when they carry out a desirable behaviour
- tokens are exchanged for rewards such as cigarettes
a strength of token economies as a management technique is that we have evidence for their effectiveness
- glowacki identified 7 high quality studies between 1999-2013 that examined the effectiveness of token economies on patients with schizophrenia and other chronic mental health issues
- all studies demonstrated a reduction in negative symptoms
- as a result token economies help by making patients behaviour more socially acceptable so that they can reintegrate into society
- this is a strength as the research shows the treatment as effective at helping schizophrenics return to functional society
a limitation of the psychological treatments is that they are ethically questionable
- although psychological treatments do not have serious side effects or medical risks like drug treatments they can raise ethical issues
- token economy systems have proved controversial as privileges become more available to patients with mild symptoms and less so for those with more severe symptoms that prevent them from complying with desirable behaviours
- meaning that severely ill patients suffer discrimination in addition to other symptoms and some families of patients have challenged the legality of this
- which has reduced the use of token economy in the psychiatric system
- this is a weakness of token economy as a management strategy for schizophrenia as theres other therapies that are less well known such as art therapy which has also proved effective but without the ethical issues
