psychological therapies for schizophrenia

Question 1

what are the 3 psychological therapies for schizophrenia?

Answer 1

• CBT
• family therapy
• token therapies

Question 2

what is the aim of CBT?

Answer 2

in general, CBT aims to identify and challenge/change irrational thoughts which may involve argument or discussion of how likely a patient’s beliefs are to be true

Question 3

explain how CBT helps patients to understand their symptoms

Answer 3

• it can help patients to make sense of how their delusions and hallucinations impact their feelings and behaviour
• e.g. if patient hears voices and believes the voices are demons, they will very naturally be afraid
• offering psychological explanations for the existence of these symptoms can reduce this anxiety and help the patients realise their thoughts are not based on reality

Question 4

what is the aim of family therapies?

Answer 4

aim to reduce stress and expressed emotion in the family

Question 5

how does family therapy work?

Answer 5

• takes place with families as opposed to individual patients aiming to reduce quality of communication and interaction between family members
• most family therapies are concerned with reducing stress within the family which might contribute to the patient’s risk of relapse

Question 6

Pharaoh et al identified a range of strategies family therapists can use- what are some examples?

Answer 6

1- reducing the stress of caring for a relative with schizophrenia
2- improving the ability of the family to anticipate and solve problems
3- improving families’ beliefs about and behaviour towards schizophrenia

Question 7

the strategies that family therapists can utilise which Pharaoh identified help to do what?

Answer 7

reduce the likelihood of relapse and readmission to hospital of schizophrenic patient

Question 8

what are token economies?

Answer 8

reward systems based upon operant conditioning used to manage the behaviour of patients with schizophrenia who spend long periods in psychiatric hospitals

Question 9

how do token economies work?

Answer 9

• tokens are given to patients who carry out desirable behaviours such as getting dressed in morning, making their bed etc
• this reward reinforces the behaviour and because it is given immediately, prevents DELAY DISCOUNTING
• tokens themselves have no value, but they can be swapped for tangible rewards

Question 10

why are tokens referred to as secondary reinforces?

Answer 10

they only have value once the patient has learned they can be used to obtain rewards such as sweets, magazines or a walk outside

Question 11

what are the evaluation points for psychological therapies?

Answer 11

• psychological therapies appear to help, but not cure schizophrenia
• ethical issues associated with token economies and CBT
• issues regarding the quality of some evidence used to support psychological therapies
• alternative psychological therapies are under-researched

Question 12

explain how psychological therapies appear to help, but not cure schizophrenia

Answer 12

• all the psychological therapies for schizophrenia aim to make it more manageable and improve quality of life
• CBT helps patients to make sense of their symtpoms
• family therapies reduce the stress of living with schizophrenia
• token economies help to make patients’ behaviour more socially acceptable
• these things are all worth doing, but should not be confused with attempting to cure schizophrenia
• biological therapies do not cure schizophrenia either but they do reduce the severity of the symptoms and thus may be desirable over psychological therapies

Question 13

explain how there are ethical issues associated with token economies and CBT

Answer 13

• token economies in particular have been controversial
• this is because privileges become more available to patients with mild symptoms compared to those with more severe symptoms who are less able to comply with desirable behaviours= most severely ill patients suffer discrimination
• CBT also raises ethical issues- the therapy may involve challenging a person’s paranoia, but at what point does that interfere with an individual’s freedom of thought?
• if for example, CBT challenged a patient’s beliefs in a highly controlling government, this can easily stray into modifying their politics
• ethical issues like these make psychological therapies of schizophrenia controversial

Question 14

explain how there are issues regarding the quality of some evidence used to support psychological therapies

Answer 14

• many small-scale studies in which mental health professionals have compared patients before and after psychological therapies have found positive results
• however these studies often have a lack of a CONTROL GROUP and patients are rarely randomly allocated to treatment and control conditions if they have been used, yet these studies which consequently have internal validity issues are included in reviews and conclusions
• this may mean the effectiveness of psychological therapies is overestimate by the supposed evidence

Question 15

explain how alternative psychological therapies are under-researched

Answer 15

• The National Institute of Clinical evidence (NICE) recommends art therapy, providing a qualified art therapist who has experience working with schizophrenia patients
• however these less well-known therapies are not well researched so it is unclear how effective these therapies are
• as such, this questions whether under-researched therapies should be investigated further and made available to patients as they may have reduced controversial ethical associations unlike token economies and CBT