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
