Psychological treatment

Question 1

What are the psychological treatments of schizophrenia?

Answer 1

Cognitive behaviour therapy
Family therapy

Question 2

What is cognitive behaviour therapy?

Answer 2

Usually 5-20 sessions, in groups or as an individual. Helps patients to identify irrational thoughts and try to change them. May involve argument or discussion of how likely the beliefs are to be true

Question 3

How does CBT help?

Answer 3

Helps to make sense of how delusions and hallucinations impact their feelings and behaviour. Helping understand where symptoms come from can be helpful E.g. believing voices are demons – helped to understand the existence of hallucinations can help to reduce anxiety

Question 4

Process of CBT

Answer 4

• Patients are asked to trace the origins of their symptoms to understand how they developed.
• They need to evaluate the content and consider ways to test the validity of these faulty beliefs.
• Psychiatrist sets behavioural assignments to improve the patients functioning.
• The therapist lets the patient develop and learn their own alternative beliefs to the previously learnt maladaptive beliefs. The development of alternative explanations and coping strategies will reduce the symptoms of sz being presented, e.g. hearing voices.

Question 5

Give a case example of CBT

Answer 5

Turkington et al (2004) describe an example of CBT used to challenge paranoid delusions.
Patient: The mafia are observing me to decide how to kill me.
Therapist: You are obviously very frightened…there must be good reason for this.
Patient: 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?

Question 6

What does family therapy aim to do?

Answer 6

The hope is to hopefully reduce the high level of EE within the household which is causing the relapse.

Question 7

Explain the process of family therapy

Answer 7

• Family therapy usually takes place within the people’s homes and typically two family therapists will work with the relatives and patient.
• It lasts between 3-12 months with sessions every 2-4 weeks. A minimum of 10 sessions are recommended by NICE.
• The therapists work with the family and the patient to develop strategies to cope better with the mental disorder and its symptoms.
• This hopefully leads to a more supportive and warm atmosphere which helps the patient make better progress and the relatives to feel more positive about, and more effective in, their supporting roles.

Question 8

How does family therapy work?

Answer 8

• The relatives are made more aware of the information regarding psychosis and the particular diagnosis their relative has been given.
• The therapist encourages the relatives to ask questions and learn more about the disorder so they can properly understand the difficulties the patient faces.
• The patient will also be asked to discuss their symptoms with the family as they are the expert in this situation!
• The goal is also to provide the whole family with practical coping skills which enables them to manage the everyday difficulties arising from having Sz in the family.

Question 9

What does Pharoah do?

Answer 9

Pharoah et al (2010) suggests a range of strategies used by family therapists

Question 10

Name the strategies Pharoah suggests for family therapy?

Answer 10

• Forming a therapeutic alliance with all family members
• Reducing the stress of caring for a relative with sz
• Improving the ability of the family to anticipate and solve problems
• Reduction of anger and guilt
• Help family to achieve a balance of caring for family member and own life
• Improving families’ beliefs and behaviours towards sz

Question 11

How do these strategies work?

Answer 11

These strategies work by reducing stress and increasing compliance with medication and tend to result in reduced risk of relapse and hospital readmission.

Question 12

How is schizophrenia managed?

Answer 12

Token economies

Question 13

What are token economies?

Answer 13

Reward systems to manage behaviour, in particular those who have developed maladaptive behaviour after spending long periods in psychiatric hospitals e.g. it is common to develop bad hygiene.

Question 14

What are tokens?

Answer 14

Tokens are coloured disks are given to patients when they carry out desirable behaviour. For example, Getting dressed, making a bed etc.

Question 15

Explain token economy

Answer 15

Tokens can be swapped for rewards. Based on operant conditioning. Tokens are secondary reinforcers as they only have value once the patient has learned they can be used to obtain rewards eg food, sweets.