Psychological Treatments - family therapy, CBTp and TES Flashcards
Treatment 1 - 6 steps of family therapy
1 - takes place in persons home with 2 therapists
2 - lasts between 3-12 months, sessions every 2-4 weeks and a minimum of 10 sessions recommended
3 - relatives are made more aware of the psychosis and are encouraged to ask questions
4 - provides whole family with practical coping skills to manage everyday difficulties
5 - family members learn more constructive ways of communicating and are encouraged to focus on positives
6 - finally the patient and family are trained to recognise early signs of relapse so they can respond quickly and reduce severity
EVALUATION of family therapy in treating SZ
STRENGTH - research support for effectiveness - NCCMH 2009 meta analysis of 32 studies, 2500 patients compared standard drug therapy to family therapy. - found lower relapse rate (26% for FT and 50% for DT) - therefore family therapy more effective and is even found after 8 years (67% for FT and 88% for DT) - however methodological differences and ususally both are taken together
WEAKNESS - issues comparing family and drug therapy - most undergo drug anf family therapy together hence comparison not valid - problem as which is the effctive one - it could be the medication allows the patient to access family therapy - the only way to eliminate this would be to have a third group of just FT but it would be unethical to deny drug treatment
WEAKNESS - treatment helps the family not the patient - study of 103 SZ patients who lived in HEE - 25% who had FT relapsed after 2 years compared to 62% on medication only - therefore FT does help to reduce the relapse rate but does not treat the cause as otherwise the family would prevent the child developing Sz in the first place - furthermore more expensive as it takes a long time but cheaper in the long run
Treatment 2 - CBTp - 6 steps of how it works
1 - Assessment - patient expresses their thoughts about their experiences to the therapist
2 - Engagement - therapist empathises with the patients perspective and explanations for their stress can be developed together
3 - ABC Model - patient gives account of their ABC which can then be rationalised, disputed and changed
4 - Normalisation - informed that many people experience the same thing to reduce feeling isolated
5 - Critical Collaborative Analysis - therapist uses gentle questioning to help the patient understand illogical conclusions
6 - Developing alternate explanations - patient develops own alternate explanations for their previously unhealthy assumptions
EVALUATION of CBTp in treating SZ
STRENGTH - research support for effectiveness - NICE compared drug therapy to CBTp and found it is better at reducing hospitalisation and symptom severity up to 18 months after treatment - therefore more effective and no side effects - however less effective for people in first stages of diagnosis
WEAKNESS - the effectiveness may be overstated - meta analysis examined many CBTp programmes and found a small therapeutic effect but when double blind, there was no effect of CBTp on SZ - therefore investigator bias as it was the time and effort spent on their own patients - however maybe the methodologies used were not taken account of eg double blind, random allocation, competence
WEAKNESS - lack of availability in the UK - estimated only 1/10 can access CBTp in the UK - therefore more funding needed for mental health services as many people end up without help and support - therefore sz is not seen by majority as a disorder worthy of support
Treatment 3 - Token Economy Systems
TES are based on operant and classical conditioning and are used to manage behaviour. Patients are given tokens (NS) for doing adaptive behaviours. These are the secondary reinforcer and can be exchanged for primary reinforcers (rewards). Behaviour shaping is used to provide tokens for increasingly complex behaviours and tokens can also be taken away for bizarre behaviours
EVALUATION of TES in treating schizophrenia
STRENGTH - Research support for effectiveness - meta analysis of 13 studies found 11/13 reported beneficial effects - shows it is useful and increases adptive behaviours - however lacked a control group and different methodologies used so TES implemented in different ways therefore varying degrees of consistency
WEAKNESS - issues with effectiveness in reducing symptoms long term - TES has been shown only to work in hospital settings - therefore difficulty in implementing a TES in the community where there is no 24hr supervision - therefore unlikely that it makes permanent behaviour changes as it is management not treatment
WEAKNESS - ethical concerns - tokens are taken away for bizarre behaviours like having hallucinations or delusions which are things they cant control - this could increase stigma and make things worse for the patient - there must be a biological component as everyone has different symptoms.
