Psychological therapies for Sz Flashcards
(29 cards)
what is the main aim of CBT
to challenge patients irrational belifs and thought processes
what is the steps of CBT for schizophrenia
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
what does CBT do
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
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?
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.
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
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.
support for the use of CBT in schizophrenia
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
limitations for the study support for the use of CBT in schizophrenia
- 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
limitation of CBT
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 $3.$ Explain what the NICE review found, and what conclusion they were able to make.
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 $6.$ Why is a lack of random allocation a problem in the NICE research?
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.
what are three steps to family therapy
educating families
teaching coping strategies
changing communication styles
what is family therapy
psychological therapies involving both the schizophrenic patient and their families.
aims reduce family conflict or expressed emotions
what is the study support for family therapy
- 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
even though pharaoh et al is study support for family therapy what are limitations
- 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
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.
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.
evaluation of family dysfunction
- 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
list of how family therapy works
- 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
what are token economies
- encourage positive behaviour by associating it with a reward
- they use operant conditioning to encourage positive behaviour
how are token economies used to manage patient behaviour in the hospital
- 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
how does the patient learn through classical conditioning
- 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
what is the purpose of using a token economy
to manage patients behaviour
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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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.
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.
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
what is Dickersons et al review on token economies
- review of 13 studies
- 11 of the studies reported improvements in the patients behaviour
- token economies were especially used in combination with other therapies
