Psychological therapies for schizophrenia Flashcards
Psychological therapies for schizophrenia
parts
CBT- cognitive behaviour therapy
Family therapy
Token economies
What CBT is
└a method of treating mental disorders based on both cognitive and behavioural techniques
└cognitive- thinking, challenging negative thoughts
└5-20 sessions
└groups or individual
└aim: help patients identify irrational thoughts and try to change them
└argument/discussion of why patients beliefs may not be true
└consideration of less threatening possibilities
└wont get rid of symptoms
└makes patients better able to cope with them
How CBT Helps
└patients can be helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour
└psychological explanations for existence of hallucinations and delusions can help reduce anxiety
└delusions can be challenged so the patient can come to learn the beliefs are not based on reality
CBT: Case example
└Turkington et al (2004)
└describe an example of CBT used to challenge where a paranoid patients delusions come from
└paranoid patient: the mafia are observing me to decide how to kill me
└therapist: you are obviously frightened…there must be a good reason for this
└paranoid patient: do you think it’s the mafia?
└therapist: it’s a possibility, but there could be other explanations. How do you know it’s the mafia?
Family therapy
definition
a psychological therapy carried out with all or some members of a family with the aim of improving their communication and reducing the stress of living as a family
What family therapy is
└takes place with families rather than individual patients
└aims to improved quality of communication and interaction between family members
└some therapists see family as root cause for the condition
└double bind, schizophrenogenic mother theories
└modern: most family therapies concerned with reducing stress within a family that might contribute to patients relapse
└reduced levels of expressed emotion (EE)
How family therapy helps
└Fiona Pharaoh et al (2010)
└identified a range of strategies for family therapists 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 with schizophrenia
└improving the ability of family to anticipate and solve problems
└reducing anger and guilt in family members
└helping family members achieve a balance between caring and having own lives
└improving families belies about behaviour towards schizophrenia
└strategies work by reducing levels of stress and expressed emotion
└increases chances of patient complying with medication
└results in reduced likelihood of relapse and re-admission to hospital
Token economies
└a form of behavioural therapy where desirable behaviours are encouraged by the use of selective reinforcement
└patients given rewards (tokens) as secondary reinforcers when they engage in correct/socially desirable behaviours
└tokens the exchanged for primary reinforcers- privileges
Tokens
└tokens are given immediately to patients when they have carried out a desirable behaviour that has been targeted for reinforcement
└can be swapped later for rewards
└immediate= prevents ‘delay discounting’ (the reduced effect of a delayed reward)
└secondary reinforcers- only have value once the patient has learnt they can be used to obtain rewards
Rewards
└tokens are swapped for rewards at a later time └may be in the form of materials └e.g. sweets, magazines └may be in the form of services └e.g. having room cleaned, privileges └primary reinforcers
Psychological therapies for schizophrenia
strengths
summary
Evidence for effectiveness
└Sameer Jauhar et al (2014)
└Pharoah et al
└McMonagle and Sultana (2009)
Psychological therapies for schizophrenia
strengths
Evidence for effectiveness
Sameer Jauhar et al (2014)
└reviewed 34 studies of CBT for schizophrenia
└concluded CBT has a significant but small effect on positive and negative symptoms
Psychological therapies for schizophrenia
strengths
Evidence for effectiveness
Pharoah et al
└reviewed evidence for effectiveness of family therapy for families of schizophrenia sufferers
└moderate evidence to show it reduces hospital readmission over a year/improves quality of life for patients and families
└however inconsistent results across different studies
└and problems with quality of some evidence
Psychological therapies for schizophrenia
strengths
Evidence for effectiveness
McMonagle and Sultana (2009)
└reviewed evidence for token economies
└found only 3 studies where patients had been randomly allocated to conditions (treatment/control groups)
└total of only 110 patients
└only 1 of 3 studies showed improvement in symptoms
└none provided useful information about behaviour change
Psychological therapies for schizophrenia
evaluation
Alternative psychological treatments
└alternative therapies
└e.g. National institute for health and clinical excellence (NICE) recommends art therapy
Psychological therapies for schizophrenia
limitations
summary
Treatments improve quality of life but don’t cure
Ethical issues
Psychological therapies for schizophrenia
limitations
Treatments improve quality of life but don’t cure
└the treatment aim to make a patient’s life more manageable/improve the patients quality of life
└CBT helps by enabling patients to understand/challenge their symptoms
└Family therapy helps by reducing stress of living as a family, for family and patient
└Token economy helps by making patients behaviour more socially acceptable so they can better re-integrate into society
└doesn’t cure or reduce symptoms
Psychological therapies for schizophrenia
limitations
Ethical issues
└ no serious side effects/medical risks like drug treatments
└but have ethical issues
└token economy systems= controversial
└issue that rewards are more available to patients with mild symptoms than severe symptoms
└severe symptoms may prevent them from complying with desirable behaviours
└suffer discrimination as well as other symptoms- families of patients challenge legality
└=reduced use of token economy in psychiatric system
└CBT= issues
└may challenge persons paranoia- may interfere with persons freedom of thought
└e.g. if patients beliefs were of a highly controlling government, could be seen as modifying their politics
