psychological treatment for schizophrenia Flashcards
what is CBT?
- CBT is a form of therapy that combines a cognitive approoach (the way a person thinks) with learning theory concepts which aim to change behaviour (such as reinforcement)
- it is commonly used to treat clients with schizophrenia
- it usually takes place in between 5-20 sessions either in groups or indvidually
irrational thoughts - P1, A01
the aim of CBT in general involves helping clients to identify irrational thoughts and try to change them
people with schizophrenia often lack necessary coping skills to manage their symptoms leaving them vulnerable to stress, which can trigger relapse
reducing the stress of the situation by altering the way the person thinkins and feels can help to prevent decompensation (a decline from normal functioning into a psychotic epsiode)
the therapist will build self-awareness by hel;ing the individual to understand more about their condition
this should help them to recognise specific situations which precede decompensation, allowing them to initiate coping strategies, such as stress management techniques
weakness of CBT - P1, A03
one weakness of CBT is that there is mounting evidence to suggest that it does not after all reduce symptoms or prevent relapse
for example, Peter McKenna and David Kingdon (2014) compared CBT with routine treatment or a control non-biological intervention and found that CBT was only superior in two out of nine methodologically rigorous trials
furthermore, in oe of the studies that had a positive result the blinding procedure lapsed as the study unfolded suggesting that the results may not have been valid
therefore, this suggests that CBT may not be as effective as the NICE 2014 report suggests
COUNTER ARGUMENT TO weakness of CBT - P1, A03
however, meta-analyses using only quantitative data overlook the unique experiences of people in therapy, whereas case studies such as Bradshaw (1998), which take an idiographic approch demonstrate that a strog theraputic alliance developed over many months can support the process of personal recovery
therefore, this suggests that CBT can be effective and be valuable to the patients
delusions - P2, A01
people with schizophrenia typically experience delusions and hallucinations, both related to irrational thinking
they can be helped to make sense of how their dellusions and hallucinations impact on their feelings an behaviour
just understanding where symptoms come from can be hugely helpful for some clients
if, for example a client hears voices and believes the voices are demons, they will naturally be very afraid
offering non-biological explanations for the existence of hallucinations and delusions can help to reduce this anxiety
strength of CBT - P2, A03
one strength of CBT is support from the National Institude for Health and Care Excellence (NICE)
NICE (2014) conducted a meta-analysis of high quality studies of CBT (e.g., randomised controlled trials)
the analysis showed that CBT was effective in reducing rehospitalisation rates for up to 18 months for people with schizophrenia and it also reduced time spent in hospital (8.26 days on average)
CBT also reduced symptom severity and improved psychosocial functioning, both at the end of treatment and 12 months later
therefore, this is strong evidence to support the value of CBT as a treatment for schizophrenia
COUNTER ARGUMENT TO strength of CBT - P2, A03
however, CBT as a treatment for schizophrenia is not very practical
CBT requires a number of therapy sessions which last several weeks or months
this therapy is time consuming and could be inconvinient for the patients
due to the length of the process it may lead to patients withdrawing from the therapy and not completing the treatment
therefore, even though CBT can be seen to be valuable to patients with schizophrenia, it is not practical meaning that some patients may drop out and not complete the treatment making it uneffective
behavioural experiments - P3, A01
delusions and hallucinations may be combatted by verbally challenging the client’s percieved reality
one method is using behavioural experiments - a kind of peronal experiment where the client test whether the delusions are real
in many cases it is difficult to talk a client out of their belief so it is better to set up a situation where they can test it
for example, if a client believes someone else is truing to harm them, ask them to keep a record of evidence to support this. so the client might record that a person in the street walked past them deliberately looking away which reflects an intention to harm
ecidence collected in the experiment can then be discussed and used to debunk erroneous beliefs
this should help the individual differentiate between the ‘confirmed reality’ and the ‘percieved reality’
weakness of CBT as a treatment for schizophrenia - P3, A03
one weakness of CBT as a treatment for schizophrenia is that ot can be considered unethical
CBT relies on collaboration between a therapist and their clients
however, challenging a client’s delusions can be distressing for them and needs to be managed gradually and with sensitivity
furthermore, behavioural experiments must also be managed with care in order to acoid further distress
therefore, this means that aspects such as challenging a client’s delusions must be approached with care
behavioural activation - P4, A01
schizophrenia is associated with motivational deficits such as social withdrawal and anhedonia
these may be reduced by rewarding positive behaviors, such as becoming more socially active and expanding the range or pleasurable activities that the person is involved in
the person’s sense of ‘self’ may also be addressed
for example, helping the client to recognise that there are more ways to define themselves than ‘I am schizophrenic’, which could be linked to feelings of marginalisation and stigmatisation
strength of CBT - P4, A03
one strength of CBT as a treatment for schizophrenia is that there is study evidence from patients who have not responded well to medication
Elizabeth Kuipers et al (1997) conducted a randomised controlled trial of CBT for schizophrenia and found that drug-resistant clients improved when given CBT which targeted their delusions and hallucinations
therefore, this is important because many patients with schizophrenia do not respond to antipsychotics so it is useful to have a second line of therapy available to those patients
