psychological therapy for schizophrenia Flashcards
CBT - how it helps
- can help clients make sense of how their irrational cognitions such as delusions impact on their feelings and behaviour
- understanding where symptoms come from can be hugely helpful, eg. if a therapist can convince someone that voices they hear actually come from the malfunctioning speech centre in their brain, it is less frightening and less debilitating
- this doesn’t eliminate symptoms but can make people better able to cope with them, this therefore reduces stress and improves ability to function adequately
- people hearing voices can also be helped by teaching them that this is an extension of the ordinary experience of thinking in words (normalisation)
- delusions can also be challenged eg. through reality testing, examining likelihood that beliefs are true
- if delusions are resistant to reality testing, CBT can still be used to tackle anxiety and depression linked with schizophrenia
CBT - a case example
- Douglas Turkington described an example of of CBT used to challenge where a client’s delusions came from
paranoid client - the mafia are observing me to decide how to kill me
therapist - you are obviously very frightened, there must be a good reason for this
paranoid client - do you think it’s the mafia?
therapist - it’s a possibility but there could be other explanations. how do you know it’s the mafia?
family therapy
- takes place with families as well as identified patient
- aims to improve quality of communication and interaction between family members
- range of approaches to family therapy for schizophrenia
family therapy - how it helps
- Fiona Pharoah identified range of strategies that family therapist use to improve functioning of family with member who has schizophrenia
reduces negative emotions -
- aims to reduce levels of expressed emotion
- ie. reduce level of general emotion but specifically negative emotions that cause stress
- reducing stress is important to reduce likelihood of relapse
improves family’s ability to help -
- therapist encourages family members to form therapeutic alliance where they all agree on aims of therapy
- also tries to improve families’ beliefs about and behaviour towards schizophrenia
- further sim is to ensure that family members achieve balance between caring for individual and maintains their own lives
family therapy - a model of practice
- Frank Burbach proposed model for working with families dealing with schizophrenia
- begins with sharing basic info and providing emotional and practical support
- develops through progressively deeper levels of
- phase 2 involves identifying resources such as what each family member can offer
- phase 3 aims to encourage mutual understanding and creating a safe space for family members to express their feelings
- phase 4 identifies unhelpful patterns of interaction
- phase 5 is about skills training such as stress management techniques
- phase 6 looks at relapse prevention planning
- phase 7 is maintenance for the future
evaluation strength of CBT - evidence of effectiveness
- Jauhar reviewed 34 studies using CHT with schizophrenia
- concluded there is clear evidence for small but significant effects on both positive and negative symptoms
- other studies have focused on symptoms, such as Pontillo finding reductions in frequency and severity of hallucinations
- clinical advice from NICE recommends CBT for schizophrenia
- both research and clinical experience support benefits of CBT
evaluation limitation of CBT - quality of evidence
- CBT techniques and schizophrenia symptoms vary widely between cases
- Neil Thomas noted that different studies have involved use of different CBT techniques and people with different combinations of symptoms
- overall modest benefits of CBT probably conceal wide variety of effects of different CBT techniques on different symptoms
- makes it hard to say how effect CBT will be for a particular person with schizophrenia
evaluation strength of family therapy - evidence of effectiveness
- McFarlane concluded that family therapy was one of the most consistently effective treatments available
- relapse rates found to be reduced by 50-60%
- also concluded that using family therapy as mental health initially starts to decline is promising
- clinical advice from NICE recommends family therapy for everyone with a diagnosis
- family therapy is likely to be of benefit to people with early and ‘full-blown’ schizophrenia
evaluation limitation of family therapy - benefits to whole family
- thwrsot not just for benefit of identified. patient
- reviewing of evidence by Lobban and Barrowclough concluded that these effects are important because families provide bulk of care for people with schizophrenia
- by strengthening functioning of whole family, family therapy lessens negative impact of schizophrenia on other family members, strengthens ability of family to support identified patient
- family therapy has wider benefiTs beyond obvious positive impact on identified patient
