Psychological therapies for schizophrenia

Question 1

CBT

Answer 1

• this is a quite commonly used treatment for schizophrenia
• it takes between 5-20 sessions, either one-on-one or in groups
• this therapy helps patients identify their irrational thoughts and how they can change them
• this may involve argument concerning how likely the beliefs of the patients are to be and considering other less threatening possibilities
• this does not get rid of schizophrenia but helps the patients cope with it
• psychological explanations for the existence of delusions and hallucinations can help reduce anxiety that may come from their presence

Question 2

5 stages of CBT

Answer 2

A B C D and E
A - activating event
B - irrational beliefs
C - consequences of these beliefs
D - dispute of beliefs from therapist
E - effect that challenging the beliefs has

Question 3

Turkington et al. (2004) case study example of CBT

Answer 3

Patient: the mafia are observing me to decide how to kill me
Therapist: that must be very frightening, there must be a good reason for this
Patient: do you think its the mafia
Therapist: it’s a possibility, but there could be other explanations. How do you know that it’s the mafia?

Question 4

Family Therapy

Answer 4

• this type of therapy involves the family, not just the individual with schizophrenia
• it aims to improve the quality of communication and interaction between members of the family
• there are a wide range of approaches to family therapy for schizophrenia
• some therapists will see the family as the root of the condition, like the double bind theory and schizophrenogenic mother
• more commonly therapists will aim to reduce stress within the family which may contribute to a risk of schizophrenia relapse
• the aim is to reduce levels of expressed emotion

Question 5

Family Therapy - Pharaoh et al. (2010)

Answer 5

• recognised a number of strategies by which family therapists aim to improve functioning of a family with a schizophrenic member

These include:

• forming 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
• reducing the anger and guilt in the family
• helping family members achieve a balance of caring for the patient and continuing with their own lives
• improving the families beliefs about and behaviour towards schizophrenia
• these strategies reduce stress levels and expressed emotion, as well as reducing the likelihood of relapse and re-admission to hospital

Question 6

Token economy

Answer 6

• this is a rewards system used to manage the behaviour of patients with schizophrenia
• particularly those who have developed patterns of maladaptive behaviour due to spending long periods in psychiatric hospitals
• commonly institutionalised patients develop bad hygiene or remain in pyjamas all day
• altering bad habits doesn’t cure schizophrenia but it does improve the quality of life for the patient
• it makes it more likely that they can live outside of hospital
• tokens are given to the patient immediately after they carry out a desired behaviour which has been specifically targeted for reinforcement
• delay discounting is prevented by giving the reward straight away, reducing the effect of a delayed reward
• this type of therapy is based on operant conditioning

Question 7

(-) EVAL - evidence for effectiveness

Answer 7

• there is some evidence to support the idea that psychological therapy is beneficial for schizophrenia sufferers
• Jauhur et al. (2014) looked at the result of 34 CBT schizophrenia studies and concluded that it has a small but significant effect on both positive and negative schizophrenia symptoms
• Pharaoh also found evidence for the effectiveness of family therapy on families with schizophrenics
• however, it was also noted that the results from some studies were inconsistent
• there was also a problem with the quality of some evidence
• this means that the evidence for family therapy is quite weak
• McMonagle and Sultana (2009) reviewed evidence for token economies and found that there were only 3 studies in which patients had been randomly allocated
• this technique for sorting patients is important in matching patients to treatment and control group
• of these three studies, only one showed improvements in symptoms and non of them provided useful information about behaviour change
• there is therefore little support for the effectiveness of psychological treatments for schizophrenia

Question 8

(-) EVAL - treatments improve quality of life but dont cure

Answer 8

• all psychological treatments aim to make schizophrenia more manageable and improve the quality of life for the patients
• CBT helps patients make sense of and challenge some of their symptoms, family therapy helps to reduce stress of living with schizophrenia and token economies make the patients behaviour more socially acceptable
• however, none of these therapies cure schizophrenia, which is a weakness

Question 9

(-) EVAL - ethical issues

Answer 9

• psychological treatment for schizophrenia do not have the serious side effects or medical risks of drug therapy, but they can raise ethical issues
• token economies have proven controversial, with the main issue being that services and privileges become more available to patients with moderate symptoms and less so for patients with more serious symptoms, which prevents them from complying with desired behaviours
• seriously ill patients therefore suffer discrimination and this has been legally challenged by some families of patients
• this has in turn reduced the use of token economies in psychiatry
• CBT may also have ethical issues since by challenging the paranoia of the patient they may intrude on their individual’s freedom of thought

Question 10

(+) EVAL - alternative psychological treatments

Answer 10

• there are other psychological treatments which may be helpful for some people with schizophrenia
• however, these are less well known and less available
• one of these is art therapy, recommended by the National Institute for Health and Clinical Excellence (NICE)
• this is provided by an art therapist who has experience working with schizophrenics
• this wide range of treatments is a strength due to individual differences