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Schizophrenia > Psychological therapies for SZ > Flashcards

Psychological therapies for SZ Flashcards

1
Q

3 main psychological therapies for SZ

A
  • Cognitive Behavioural Therapy
  • Family therapy
  • Token economy
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2
Q

CBT

A
  • NICE (National Institute for Health and Care Excellence) recommend that all people should be offered CBT (CBTp for psychosis) in the treatment for SZ
  • helps to deal with the symptoms of SZ + improve patient’s functioning
  • at least 16 sessions
  • used to treat residual symptoms of antipsychotic medication
  • helps to treat LT +ve and -ve symptoms
  • taken alongside antipsychotic medication
  • can be group sessions or one to one
  • involved ABC model
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3
Q

process of CBTp

A
  • Assessment
  • Engagement
  • The ABC model
  • Normalisation
  • Critical collaborative analysis
  • Developing alternative explanations
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4
Q

Assessment - CBTp

A
  • patient expresses their thoughts to the therapist
  • realistic goals for therapy are discusses
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5
Q

The ABC model - CBTp

A
  • patient gives their explanation of activating event (A)
  • that appear to cause their emotional behaviour (B) + consequences (C)
  • patient’s own beliefs can then be rationalised, disputed + changed
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6
Q

Normalisation - CBTp

A

conveying to people that many people have unusual experiences e.g. hallucinations + delusions
= reduces anxiety + isolation
= less alienation + stigmatised

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7
Q

Developing alternative explanations - CBTp

A
  • patients develops their own alternative explanations for their previously unhealthy assumptions
  • new ideas constructed w/ therapist through e.g. positive self talk
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8
Q

ads of CBTp

A
  • more effective
  • depends on stage of disorder
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9
Q

disads of CBTp

A
  • lack of availability
  • meta-analysis
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10
Q

more effective - ads of CBTp

A
  • CBTp seems to be more effective in treating SZ compared to standard care (antipsychotic medication alone)
  • a review of treatments for SZ found consistent evidence that CBTp was effective in reducing rehospitalisation rates up to 18 months
  • also reducing the severity of symptoms + improvements in social functioning
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11
Q

depends on the stage of the disorder - ads of CBTp

A
  • the effectiveness of CBTp is dependant on the stage of the disorder
  • group based CBTp seem to be more effective following the stabilisation of the psychotic symptoms w/ medication
    = helps normalise their experience by meeting similar individuals
  • not effective in the initial acute phase of SZ where self reflection is not appropriate
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12
Q

lack fo availability - disads of CBTp

A
  • despite being recommended by NICE as treatment for SZ
  • estimated only 1 in 10 individuals w/ SZ actually have access to CBTp
  • study found that in North West of England, out of 187 SZ patients, only 13 (7%) had been offered CBTp
  • HOWEVER, a significant number either refuse or fail to attend the therapy sessions
    = limiting effectiveness
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13
Q

meta-analysis - disads of CBTp

A
  • there are problems w/ meta-analysis of CBTp as treatment for SZ
  • there is a failure to take into account the quality of the studies
  • e.g. in some studies, they fail to randomly allocate participants to CBTp or control conditions
  • other studies fail to assess the patients subsequent assessment of symptoms + general functioning
    = the methodologically weak trials translated into biased findings about the effectiveness of CBTp
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14
Q

Family therapy

A
  • aim of family therpay is to provide support for carers
    = attempt to make family life less stressful
    = reduce rehospitalisation
  • at least 10 sessions
  • NICE stress that this should be considered a priority where there are persistent symptoms of high risk of relapse
  • offered for a period of 3-12 months
  • aimed at reducing the level of EE (Expressed Emotion), reduce risk of relapse
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15
Q

process of family therapy

A
  • reducing level of EE + stress = reduce risk of relapse
  • psychoeducation
  • forming an alliance w/ relatives
  • reducing emotional climate
  • enhancing relatives’ ability tp anticipate + solve problems
  • reducing expressions of anger + guilt by family members
  • maintaining reasonable expectations among family members for patient performance
  • encouraging relatives to set appropriate limits/ boundaries
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16
Q

procedure - key study on family therapy

A
  • Pharaoh et al reviewed 53 studies to investigate the effectiveness of family intervention
  • studies chosen were conducted in Europe, Asia + North America
  • studies compared the outcomes from family therapy to ‘standard’ care (antipsychotic medication alone)
  • researchers concentrated on studies that are randomised controlled trials (RCTs)
17
Q

findings - key study on family therapy

A
  • mental state = overall impression was mixed, some studies reported improvement + some didn’t
  • compliance w/ medication = use of family therapy meant that patients took medication more
  • social functioning = some improvement on general functioning, nit much effect on outcomes such as living independently or employment
  • reduction in relapse + readmission = there was a reduction in the risk of relapse
    = there was a reduction in hospital admission during treatment + in 24 months after
18
Q

ads of family therapy

A
  • economic benefits
  • positive impact
19
Q

disads of family therapy

A
  • medication compliance, effective?
  • lack of blinding in method
20
Q

economic benefits - ads of family therapy

A
  • there are economical benefits to family therapy
  • NICE review of family studies demonstrated that family therapy is associated w/ significant cost savings when offered to people w/ SZ
  • the extra cost of family therapy is offset by a reduction in costs of hospitalisation = lower relapse rates
  • also evidence that family therapy reduces relapse rates for significant period after intervention
    = costs savings would be even higher
21
Q

positive impact - ads of family therapy

A
  • the impact of family therapy on family members is also advantageous
  • a study analysed the results of 50 family therapy studied
    = 60% if these studies reported a significant positive impact of the intervention

(-ve) ALTHOUGH the methodological quality of most of these studies was poor
= making it difficult to distinguish the effective from ineffective intervention

22
Q

positive impact - ads of family therapy

A
  • the impact of family therapy on family members is also advantageous
  • a study analysed the results of 50 family therapy studied
    = 60% if these studies reported a significant positive impact of the intervention

(-ve) ALTHOUGH the methodological quality of most of these studies was poor
= making it difficult to distinguish the effective from ineffective intervention

23
Q

medication compliance, effective? - disads of family therapy

A

is family therapy effective?
- according to Pharaoh’s study, it increased patient compliance w/ medication –> improvements in their mental state + social functioning
- but does it mean that family therapy improved patients symptoms or medication?
- overall the evidence for family therapy is mixed

24
Q

lack of blinding in method - disads of family therapy

A
  • there is an overall problem w/ a lack of blinding in family therapy studies
  • in Pharoah’s study, 10/52 studies reported in the meta-analysis didn’t use any form of blinding
    = raters knew whether parts were attached to the experimental or control conditions
    = creates rater bias, may rate the parts allocated to family therapy conditions as showing an improvement
    = creates problems as it doesn’t really tell us whether family therapy is really effective
25
Q

token economy

A
  • token economies are reward systems used to manage the behaviour of patients w/ SZ in hospital settings
  • for patients who’ve developed maladaptive behaviours through spending too long in a hospital
  • e.g. bad hygiene - not showering, remaining in pjs all day
    = improved patient’s quality of life
  • based on principles of operant conditioning
  • patient is given a token (reward) for carrying out a goo behaviour (positive reinforcement)
  • then encourages them to repeat that behaviour in the hopes of another token
  • tokens are then accumulated + swapped for a tangible reward e.g. sweets, cigarettes etc..
26
Q

tokens - token economy

A
  • tokens (coloured disks) are given immediately to patients when they’ve carried out a desirable behaviour
    = positive reinforcement
    = so they can associate the positive behaviour w/ a reward as opposed to delayed rewards
27
Q

rewards - token economy

A
  • although tokens have no value, they can be swapped later for more tangible rewards
  • tokens are secondary reinforced = only have value once the patient has learned that they can be used to obtain rewards
28
Q

ad of token economy

A
  • research support for token economies
  • psych reviewed 13 studies in the use of token economies in treating SZ
  • 11 of these studies had reported beneficial effects of increasing the adaptive behaviours of patients w/ SZ
  • HOWEVER psych did caution that many of these studies had methodological issues that affected the overall impact of token economies
29
Q

disads of token economy

A
  • ethical concerns
  • lacks ecological validity
  • do they work?
30
Q

ethical concerns - disads of token economy

A
  • there are ethical concerning the use of token economy programmes
  • e.g. in order to make reinforcement effective, cliniciand may be forced to exercise control over important impact over important primary reinforcers e..g food, privacy etc..
  • patients would then have to display the target behaviours
  • HOWEVER all humans have bear human right + these should not be violated regardless of the positive consequences
31
Q

lacks ecological validity - disads of token economy

A
  • token economy programmes lack ecological validit
  • it has only been shown to work in hospital settings
  • there are problems administering the token economy method w/ outpatients
  • in a hopsital, patients receive 24 hour care + can be given token straight away
  • in the real world, who will give them the tokens straight away + how will they exchange them for a tangible item?
  • lack ecological validity as they can’t be used in the real world
32
Q

do they work? - disads of token economy

A
  • there is no real evidence to suggest that token economy programmes really work
  • there are very few randomised trials
  • token economy programmes are not really used in the developed world + but would be very prominent if randomised trials were used
  • HOWEVER, critics would argue that token economies ar only used in hospitals to MANAGE + CONTROL SZ patients rather than to ‘treat’ them

Schizophrenia (6 decks)

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