Psychological therapy for SZ

Question 1

What is cognitive behavioural therapy?

Answer 1

• a method of treating based on both cognitive & behavioural techniques for treatment of SZ usually takes place over a period of 5-20 sessions> aims to deal with dysfunctional thinking

Question 2

How may CBT help clients make sense of their irrational thoughts?

Answer 2

• help clients make sense of how their irrational cognitions (e.g. delusions & hallucinations) impact on their feelings & behaviour
• understanding where the symptoms come from helps those with auditory hallucinations
• CBT involves convincing clients that the voices come from the malfunctioning speech centre in their own brain > which cannot hurt them if they ignore it
• Makes people with SZ cope with symptoms better > reducing their distress & improving their ability to function adequately

Question 3

How does CBT work?

Answer 3

• delusions may be challenge by reality testing
• patient & therapist jointly examine the likelihood that beliefs are true
• delusions may not be able to be tackled in all cases > but CBT can still be used to tackle depression and anxiety

Question 4

Give an example of how CBT may be able to challenge paranoid delusions

Answer 4

• Turkington et al CBT example
  paranoid client: the mafia ear observing me top decide how to kill me, do you think its the mafia?
• therapist: must be a good reason for this, is there a possibility that their could be other explanations > How do you know it is the mafia?

Question 5

What is a strength of CBT as a therapy for SZ?

Answer 5

• evidence for its effectiveness
• Jauhar et al reviewed 34 studies of using CBT with SZ > finding clear evidence for significant effects on both negative & positive symptoms
• other studies have focused on specific symptoms e.g. Pontillo et al found reduction in frequency & severity of auditory hallucinations while NICE recommend CBT for SZ
• both research & clinical experience support the benefits of CBT for SZ

Question 6

What is a limitation of CBT as therapy for SZ?

Answer 6

• CBT does not actually ‘cure’ people with SZ, but may improve the quality of life
• SZ appears to be largely a biological condition thus we would expect that a psychological therapy like CBT just benefits people by improving their ability to live with SZ
• For example, as forementioned, CBT may enhance the ability of an individual to ignore auditory hallucinations and so experience less anxiety, but this is not the same as eliminating those symptoms > thus it may be better to use drug therapy alongside CBT

Question 7

What is family therapy?

Answer 7

• a psychological therapy involving all members of a family including the identified patient (one member of a dysfunctional family who expresses the family’s conflicts)
• its aim to improve the communications within a family & reduce the stress of living as a family

Question 8

What is the first strategy Pharoah et al identified that family therapists use to try improve the functioning of a family that has a member with SZ?

Answer 8

• reducing negative emotions > aims to reduce level of expressed emotion especially negative emotions such as anger & guilt which creates stress > reducing stress is important to reduce the likelihood of relapse

Question 9

What is the second strategy Pharoah et al identified that family therapists use to try improve the functioning of a family that has a member with SZ?

Answer 9

• improving the family’s ability to help > therapist encourages member to from a therapeutic alliance whereby they all agree on the aims of the therapy
• the therapist also tries to improve families belief about & behaviour towards SZ
• and ensure that family members achieve a balance between caring for the individual with SZ & maintaining their own lives

Question 10

What is Burbach proposed model for working with families dealing with SZ?

Answer 10

• Phase 1 > sharing basic information & providing emotional & practical support
• Phase 2 > identifying resources including what different family members can & cannot offer
• Phase 3 > encourage mutual understanding, creating a safe space for all family members to express their feelings
• Phase 4 > identifying unhelpful patterns of interaction#
• Phase 5 > skills training such as learning stress management techniques
• Phase 6 > relapse prevention planning
• Phase 6 > maintenance for the future

Question 11

What is a strength of family therapy for SZ?

Answer 11

• evidence for its effectiveness
• a review of studies by McFarlane concluded that family therapy was one of the most consistently effective treatments available for SZ
• relapse rates were found to be reduced by 50-60%
• clinical advice by NICE recommends family therapy for everyone with a diagnosis of SZ
• this means family therapy IS likely to be a benefit to people with both early & full blow SZ

Question 12

What is another strength family therapy?

Answer 12

• it can benefit the economy
• Because family therapy reduces relapse rates & makes families better able to provide the bulk of care it has huge economic benefits
• the state does not need to pay so much for hospital care, benefits etc.
• If family therapy is cost-effective because it reduces future care costs for the identified patient and perhaps other family members it is cost-effective & should be funded
• suggests that everyone wins, ultimately the therapy is a benefit for the individual with SZ & the family > any economic gain is a bonus.