Psychological Therapies for SZ Flashcards
What is CBT?
Main psychological treatment
Assumption behind CBT
Disordered beliefs influence behaviour in maladaptive ways, leading to SZ
Aim of CBT
Help patient identify these faulty/disordered beliefs and correct them
What are patients encouraged to do in CBT?
- Trace origins of symptoms & when first arose
- Evaluate content of delusions/internal voices
- Behavioural assignments
What might patients evaluating the content of delusions/voices lead to?
Consider ways they could test the validity
What might behavioural assignments lead to?
Improved levels of functioning
What is a final stage of CBT?
Therapist lets patient develop own alternatives to maladaptive belief
Looks for alternative explanations/coping strategies already present
What do outcome studies do?
Measure effectiveness of treatments in comparison to accepted, standard form of treatment
What have outcome studies suggested about CBT
Patients recover to far greater extent
What did Dury find regarding outcome studies of CBT
20-25% reduction in recovery time when combined with APs
Reduction in positive symptoms
What did Kuipers find in a subsequent study regarding CBT outcome studies?
Same advantages with lower patient drop out rate and increased satisfaction
What are the AO1 points?
CBT
Outcome Studies
Psychodynamic Therapy
AO2 Research for CBT?
Generally shows CBT has significant effect on improving symptoms
Gould - meta analysis of 8 - statistically significant decrease in positive symptoms post CBT
AO2 Why might CBT benefits not be due to CBT alone?
Majority of students have been conducted whilst patients are undergoing APs treatment
Many CBT studies have taken place while patients are on Aps also. What does this mean?
Difficult to assess CBT as independent treatment
Although it is difficult to assess CBT as an independent treatment, what does it support?
- Success when used with APs
- Supports a bio-psycho interaction
Rather than eliminating them entirely, how does CBT work?
Reducing distressing symptoms of psychotic experiences
Why might negative symptoms be useful?
Safety behaviours - rapid treatment/hospitalisation
What does encouraging reduction of distressing symptoms mean for patients?
Forced to mask rather than experience with any less vigour
What concerns are there for CBT regarding its appropriateness?
Ethical - suffering in silence?
What is an issue with the appropriateness of CBT regarding its approach?
Reductionist as oversimplifies to simply cognitive explanation when there are bio roles
CBT in conjunction with…
APs has widely seen benefits
Does everybody with SZ benefit from CBT?
No
Who benefits from CBT? Study -
142 SZ patients - found CBT may not be suitable as may not fully engage with therapy
Why might some not fully engage with CBT therapy?
- Some may lack intelligence
- May only work with milder forms
Why might CBT only work with milder sZ forms?
Symptoms are too severe, mind too chaotic
What is psychoanalysis based on?
Assumption that individuals are often unaware of the influence of unconscious conflicts on their psychological state
What is the aim of psychoanalysis?
Bring conflicts into the conscious mind so they can be attended to
What does psychoanalysis assume about symptoms?
All are meaningful and product of individuals life history
What happens in psychoanalysis?
- Alliance created by help offered to perceived problems
- Trust of patient won and relationship built by therapist replacing the harsh, punishing conscience with more supportive conscience
Why did Freud oppose techniques such as PA?
SZ patients could not be analysed as could not form a transference (shift of emotions onto analyst)
What resulted from Freud’s pessimism towards PA?
Only a handful practice this technique or variations
Effectiveness of PDA - What did Malmberg/Fenton find?
We cannot draw definite conclusions about effectiveness (subjective)
- Some may argue PDA is harmful
Effectiveness of PDA - What did Meta analysis find?
- MA of 37 studies
- Effective treatment in psychotherapies, amplified when used in conjunction with APs
Contradictory effectiveness of PDA: What was found regarding APs?
- better outcome when PDA/Aps combined
- APS superior compared to PSD alone
- Just AP, not PSD?
Contradictory effectiveness of PDA: What did Karen and VandenBos find?
- Opposite findings
- Patients treated with PDA improved more than APs alone
Why might PDA be appropriate for patients?
- APA recommend supportive interventions alongside APs
- PDA is undoubtedly supportive
What is an argument opposing PDA regarding the cost?
- Expensive
- Treatment required to be undergone long term
What is an argument opposing PDA regarding the cost in relation to APs?
Not worth extra expense, as APs are cheaper and more effective
What is an argument in SUPPORT of PDA over APs regarding cost?
- Overall cost may decrease as less likely to seek inpatient treatment if they get better over time
- Employment?
Overall, what do suggestions into cost and benefits of PDA show?
May be reliant upon individual and their level of functioning
