Psychological therapies for Sz

Question 1

what is the main aim of CBT

Answer 1

to challenge patients irrational belifs and thought processes

Question 2

what is the steps of CBT for schizophrenia

Answer 2

explanation: patient describes experiences and beliefs
normalisation: doctor normalises patients experiences
challenge: doctor challenges beliefs and experiences
alternative explanations: the patient is asked to develop alternative explanations for beliefs and experiences

Question 3

what does CBT do

Answer 3

corrects the biases in reasoning that the patient displays such as jumping to conclusions bias and persecution bias. This helps reduce symptoms of schizophrenia, such as delusional beliefs

Question 4

Laurie has experienced the symptoms of schizophrenia since he was $16,$ and has recently started CBT to ease his symptoms. In his next session, Laurie’s therapist asks Laurie for more logical explanations for his delusions. For example, asking Laurie to explain why, if he works for the government, he doesn’t get paid. Also, if his medication is poisoned, why is he not getting poorly. This requires Laurie to think in a less biased way.
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Question $3.$ Which step of CBT is being described here?

Answer 4

challenge
The third step of CBT is where the therapist challenges the patient’s irrational cognitions, so that they start to think in a less biased way.

Question 5

Laurie has experienced the symptoms of schizophrenia since he was $16,$ and has recently started CBT to ease his symptoms.
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Question $5.$ Identify and explain the fourth step of CBT. Use Laurie as an example of how this step would occur in therapy

Answer 5

The fourth step of CBT is suggesting alternative explanations for the patient’s experiences. This is when the patient is asked to develop alternative explanations for their beliefs and experiences. For Laurie, this might involve him realising and accepting that the medication from the doctor has effective drugs in it, and not poison. Also that when he is sitting at his desk writing, that it is not for the government, but for himself.

Question 6

support for the use of CBT in schizophrenia

Answer 6

NICE conduced a review comparing the use of CBT combined with medical drugs to medical drugs alone
Treatments with CBT were found to be more effective at reducing symptoms and at reducing the likelihood of a patient relapsing

Question 7

limitations for the study support for the use of CBT in schizophrenia

Answer 7

• many studies failed to use blinding or random allocation
• studies may have suffered from confounding variables
• researchers may have lacked objectivity
  the consequence of these issues is that the effectiveness of CBT may have been overexaggerated

Question 8

limitation of CBT

Answer 8

it requires lots of expensive sessions, which are usually one to one with therapists
studies are not well designed
high cost limits availability of cost

Question 9

Question $3.$ Explain what the NICE review found, and what conclusion they were able to make.

Answer 9

NICE found that treatments that included CBT were more effective at reducing symptoms of schizophrenia, compared to drugs alone. When patients were given CBT, they were also less likely to display a severe relapse of symptoms, and have to go back into hospital. This indicates that combining medication with CBT is more effective than just taking standard medication.

Question 10

Question $6.$ Why is a lack of random allocation a problem in the NICE research?

Answer 10

This is a problem because it means that the studies couldn’t control participant variables that might have influenced the patient’s behaviour. For example, it’s possible that the patients given CBT and medication already had less severe symptoms than the group given medication. This means that there might have been confounding variables that influenced the results of the study, making CBT seem more effective than it really is.

Question 11

what are three steps to family therapy

Answer 11

educating families
teaching coping strategies
changing communication styles

Question 12

what is family therapy

Answer 12

psychological therapies involving both the schizophrenic patient and their families.
aims reduce family conflict or expressed emotions

Question 13

what is the study support for family therapy

Answer 13

• a review conducted by Pharoah et al found that patients that took medication alongside family therapy were more likley to take medication consistently, and less likely to experience a relapse but only looked at studies that had random allocation and control groups
• NICE also found that its cost effective as it reduces the likelihood of relapse

Question 14

even though pharaoh et al is study support for family therapy what are limitations

Answer 14

• many studies didnt use random allocation which they had already claimed
• many studies didnt control for participant variables
• some studies may have lacked objectivity
• some studies may lack reliability and objectivity

Question 15

Pharoah et al. originally claimed to have only included studies that used random allocation or a control group in their review, when this was later found out to not be the case. Explain why this is an issue.

Answer 15

As Pharoah et al. did not exclusively use studies that had random allocation or a control group, this means that many of the studies did not control for participant variables. Individual differences may have created different outcomes after family therapy, acting as an extraneous or confounding variable to those studies. This lack of randomisation could also have lead to researcher bias, and a lack of objectivity, because some studies had researchers that were not blind to how participants were allocated to the experimental group. Also, this means that some studies may lack reliability or validity.

Question 16

evaluation of family dysfunction

Answer 16

• high expressed emotion amongst families could be symptoms rather than cause
• research support from Berger, schizophrenics recorded a higher recall of double bind from mothers than none Sz
• implies families are responsible for childrens problems

Question 17

list of how family therapy works

Answer 17

• helping patient and family to understand and be better able to deal with the illness
• reducing the stress of caring for a relative with schizophrenia and emotional climate within family
• improving ability of family to anticipate and solve problems
• reduction of anger and guilt in the family members
• improving family member knowledge beliefs and behaviour towards Sz
• maintain reasonable expectations among family members for patient performance

Question 18

what are token economies

Answer 18

• encourage positive behaviour by associating it with a reward
• they use operant conditioning to encourage positive behaviour

Question 19

how are token economies used to manage patient behaviour in the hospital

Answer 19

• patients are given reward tokens when they engage in positive adaptive behaviour
• tokens can be exchanged for rewards
• the patient learns to repeat positive, adaptive behaviours through positive reinforcement

Question 20

how does the patient learn through classical conditioning

Answer 20

• at first token is a neutral stimulus
• through repeated association with the reward, the token becomes a conditioned stimulus
• the patient develops a conditioned response to the token

Question 21

what is the purpose of using a token economy

Answer 21

to manage patients behaviour

Question 22

Dr. Barcoe recently implemented a token economy on her psychiatric ward, and began trialling it with one patient, named Ricky, who had schizophrenia.
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Ricky often experienced avolition, and it was difficult for staff to get him to focus on tasks. Dr. Barcoe gave Ricky a token every time he engaged in a new, positive behaviour, for example dressing himself and getting out of bed. Ricky then traded the tokens in at the end of the day for a reward. As he received more tokens, Ricky began to associate the token with the reward, motivating him to behave better.
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Answer 22

The token is reinforcing Ricky’s behaviour, as it is a tool being used to make Ricky perform adaptive behaviours more often. The token is also a conditioned stimulus, because Ricky is learning to make an association between the token and receiving a treat.

Question 23

Dr. Barcoe recently implemented a token economy on her psychiatric ward, and began trialling it with one patient, named Ricky, who had schizophrenia.
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Ricky often experienced avolition, and it was difficult for staff to get him to focus on tasks. Dr. Barcoe gave Ricky a token every time he engaged in a new, positive behaviour, for example dressing himself and getting out of bed. Ricky then traded the tokens in at the end of the day for a reward. As he received more tokens, Ricky began to associate the token with the reward, motivating him to behave better.
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Question $4.$ With reference to the scenario, explain how classical conditioning is involved in token economies.

Answer 23

Token economies use classical conditioning through the association of the token with the reward. The token is initially a neutral stimulus, however through repeated association with the reward, the token becomes a conditioned stimulus. This then elicits a conditioned response from the patient, in order to receive the reward. For example, Ricky developed a conditioned response to the token, because he associated the token with a good reward

Question 24

what is Dickersons et al review on token economies

Answer 24

• review of 13 studies
• 11 of the studies reported improvements in the patients behaviour
• token economies were especially used in combination with other therapies

Question 25

one limitation of very studies investigating token economies and its effectiveness

Answer 25

• they often lack a control group

- we cant be sure that there is a cause and effect relationship

Question 26

limitation of token economy

Answer 26

• they have limited use outside of the hospital
• outside of the hospital, it is harder to monitor patient behaviour and provide an immediate reward for positive behaviour
• they are less likely to form and association between their positive behaviour and the reward
• token economies might encourage patients to become overdependent on being rewarded for their behaviour

Question 27

why are token economies considered unethical

Answer 27

patients are treated like small children which might be humiliating and cause distress

Question 28

Harry has been in a hospital for several months. His doctor is using a token economy to reduce his schizophrenia symptoms. The nurses are ready to discharge him, but they are concerned that his symptoms will reappear once he leaves the hospital.
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Question $4.$ In relation to token economy, explain why Harry’s behaviour may change outside the hospita

Answer 28

The token economy successfully managed Harry’s behaviour, because he was rewarded for his positive behaviour as soon as it happened. However, outside of the hospital, Harry cannot be constantly monitored for his behaviour. For example, his family may work and his therapist may see him infrequently. This means that his positive behaviour of not showing symptoms cannot be immediately rewarded, so the token economy may be less effective outside the hospital.

Question 29

evaluation of token economy

Answer 29

• reducing symptom, not a cure
  + helpful for reintegration of person in society (learned behaviour)
• ethical issues