Psychological therapies for SZ

Question 1

3 main psychological therapies for SZ

Answer 1

• Cognitive Behavioural Therapy
• Family therapy
• Token economy

Question 2

CBT

Answer 2

• 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

Question 3

process of CBTp

Answer 3

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

Question 4

Assessment - CBTp

Answer 4

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

Question 5

The ABC model - CBTp

Answer 5

• 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

Question 6

Normalisation - CBTp

Answer 6

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

Question 7

Developing alternative explanations - CBTp

Answer 7

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

Question 8

ads of CBTp

Answer 8

• more effective
• depends on stage of disorder

Question 9

disads of CBTp

Answer 9

• lack of availability
• meta-analysis

Question 10

more effective - ads of CBTp

Answer 10

• 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

Question 11

depends on the stage of the disorder - ads of CBTp

Answer 11

• 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

Question 12

lack fo availability - disads of CBTp

Answer 12

• 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

Question 13

meta-analysis - disads of CBTp

Answer 13

• 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

Question 14

Family therapy

Answer 14

• 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

Question 15

process of family therapy

Answer 15

• 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

Question 16

procedure - key study on family therapy

Answer 16

• 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)

Question 17

findings - key study on family therapy

Answer 17

• 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

Question 18

ads of family therapy

Answer 18

• economic benefits
• positive impact

Question 19

disads of family therapy

Answer 19

• medication compliance, effective?
• lack of blinding in method

Question 20

economic benefits - ads of family therapy

Answer 20

• 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

Question 21

positive impact - ads of family therapy

Answer 21

• 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

Question 22

positive impact - ads of family therapy

Answer 22

• 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

Question 23

medication compliance, effective? - disads of family therapy

Answer 23

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

Question 24

lack of blinding in method - disads of family therapy

Answer 24

• 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

Question 25

token economy

Answer 25

- 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..

Question 26

tokens - token economy

Answer 26

- 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

Question 27

rewards - token economy

Answer 27

- 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

Question 28

ad of token economy

Answer 28

- 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

Question 29

disads of token economy

Answer 29

- ethical concerns - lacks ecological validity - do they work?

Question 30

ethical concerns - disads of token economy

Answer 30

- 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

Question 31

lacks ecological validity - disads of token economy

Answer 31

- 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

Question 32

do they work? - disads of token economy

Answer 32

- 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