Psychological therapy for schizophrenia Flashcards
Cognitive behaviour therapy
CBT aims to deal with both thoughts and behaviour. From the cognitive viewpoint the therapy aims to deal with thinking such as challenging negative thoughts.
How CBT helps
CBT can help a client make sense of how their irrational cognitions (such as delusions and hallucinations) impact on their feelings and behaviour. This will not eliminate the symptoms of schizophrenia but it can make people better able to cope with them. This in turn reduces their distress and improves their ability to function adequately. Delusions can be through CBT, by a process where the person with schizophrenia and their therapist jointly examine the likelihood that the beliefs are true.
Evaluation of cognitive behaviour therapy (brief)
:) evidence support, Jauhar
:( not for all patients
strength of CBT
evidence for its effectiveness. Jauhar et al (2014) reviewed 34 studies of using CBT with schizophrenia, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Other studies have focused on symptoms and found reductions in frequency and severity of auditory hallucinations. Clinical advice from NICE recommends CBT for schizophrenia. This shows that both research and clinical experience support the benefits of CBT for schizophrenia.
weakness of CBT
there is a wide range of techniques and symptoms included in studies. CBT techniques and schizophrenia symptoms vary widely from one case to another. Thomas (2015) points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. Research by Kingdom and Kirschen (2006) found that CBT is not suitable for all patients, especially those who are too thought disorientated or agitated, those who refuse medication or those who are too paranoid to form trusting alliances with therapists. Therefore this suggests that CBT may not be a valid therapy for all patients with schizophrenia.
Family therapy
A psychological therapy carried out with all or some members of a family with the aim of improving the communications within the family and reducing the stress of living as a family.
How family therapy helps
Pharoah et al (2010) identified a range of strategies that family therapists use to try to improve functioning of a family that has a member with schizophrenia.
Reduces negative emotions – family therapy aims to reduce levels of expressed emotion. This in turn will reduce stress and reducing stress is important to reduce the likelihood of relapse
Improves the family’s ability to help – encourages family members to form a therapeutic alliance whereby they all agree on the aims of therapy. Therapist tries to improve families’ beliefs about and behaviour towards schizophrenia. A further aim is to ensure that family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.
Key components of family therapy
Psychoeducation – teach families about schizophrenia
Communication skills training – reducing criticism, hostility and over-involvement
Problem-solving sessions – addressing family conflicts to reduce stress
Relapse prevention – teach early signs of relapse and effective responses
Evaluation of family therapy (brief)
:) evidence support, McFarlane
:) benefits whole family
strengths of family therapy
there is evidence of effectiveness. A review of studies by McFarlane (2016) concluded that family therapy was one of the most consistently effective treatments available for schizophrenia. In particular relapse rates were found to be reduced, typically by 50-60%. Clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia. This means that family therapy is likely to be of benefit to people with early and ‘full-blown’ schizophrenia.
benefits the whole family. Therapy is not just for the benefit of the patient with schizophrenia but also for the families that provide the bulk of care. A review of evidence by Lobban and Barrowclough (2016) concluded that these effects are important because families provide the bulk of care for people with schizophrenia. By strengthening the functioning of a whole family, family therapy lessens negative impact of schizophrenia on other family members and strengthens the ability of the family to support the person with schizophrenia. This means that family therapy has wider benefits beyond the obvious positive impact on the patient with schizophrenia.
