psychological treatments for schizophrenia - cbtp and family therapy

Question 1

CBT

Answer 1

Anti-psychotics are usually prescribed to patients first, these will reduce their psychotic thoughts so that CBT can be more effective

CBT sessions are STRUCTURED and TIME-LIMITED: 5 to 20 weekly sessions of about 50 minutes

Early CBT sessions involve IDENTIFYING THE PATIENTS BELIEFS (e.g. the delusions they have & the hallucinations they see)

The therapist then tries to persuade the patient that DISTORTED THINKING or MALADAPTIVE THINKING is causing them to withdraw from many ‘normal’ activities (causing NEGATIVE symptoms of schizophrenia).

This is achieved by using an ‘ABCDEF
CHART’ which involves the patient and therapist searching for links between events, beliefs and their emotional consequences:

Question 2

CBT idea is to

Answer 2

convince the patient the belief causes consequence, not activating event

disputing techniques: logical, empirical, pragmatic

behavioural techniques used to carry out trial experiments e.g. those with violent delusions encouraged to regularly leave house & undertake activities they find uncomfortable

Question 3

family therapy

Answer 3

assumed family dysfunction contributes to development of schizophrenia so, family therapy aims to alter relationships & communication patterns within families
- 9-12 months, minimum of 10 sessions
- 2 family therapists > effective communication skills

Question 4

family therapy involves

Answer 4

getting consent: talk openly about disorder, no details kept confidential

learning about disorder: all members given all relevant information about diagnosis

discussing day-to-day problems within family: encourage discussion about day-to-day problems, and suggest strategies of how best to solve them as a family

learning strategies for better communication: taught strategies to support each other e.g. how to deal with difficult situations in a tolerant way) and be taught how to be effective caregivers

Question 5

aim of family therapy

Answer 5

improve communication within homes (e.g. reduce double binds)

increase tolerance levels between family members

decrease feelings of guilt and responsibility for causing the illness, among family members

involve each family member in the rehabilitation of the schizophrenic

Question 6

CBT strength 1

Answer 6

supporting research evidence from the NICE review 2014

found patients having CBTp spend an average of 8.26 days in hospital, compared to those not receiving CBTp who spend several weeks as CBTp patients demonstrate better attitudes, higher levels of motivation & commitment towards recovery

suggests CBTp effective therapy in treating schizophrenia. as it reduces hospitalisation, increasing credibility of psychological treatments

Question 7

CBT strength 2

Answer 7

further convincing research from Tarrier

found schizophrenics receiving 10 weeks of CBT, coupled with drug therapy showed better improvement in positive symptom reduction, compared to those who just received drug therapy alone

shows CBTp helps greatly reduce positive symptoms & reinforces importance of an interactionist approach when treating schizophrenia (e.g. both biological & psychological factors must be considered to effectively treat schizophrenia)

Question 8

CBT limit

Answer 8

refuting research evidence as effectiveness seems to depend on stage of schizophrenia

e.g. Addington & Addington claim that in the initial acute phase of schizophrenia, self-reflection on symptoms is not appropriate

however, following stabilisation of symptoms with antipsychotic medication, individuals are more likely to benefit from CBTp

this suggests that it is individuals who are in deeper stages of schizophrenia and a greater realisation of their problems that benefit more from CBTp

Question 9

family therapy strength 1

Answer 9

strong supporting research from Pilling

conducted a meta-analysis of 18 studies with 1467 ppts & found patients who had family therapy had smallest number of relapses and lowest number of hospital readmissions

suggests family therapy is effective as it reduces chance of relapse and therefore greatly reduces amount of time patients spend in hospital

Question 10

family therapy strength 2

Answer 10

evidence from McFarlane

found family therapy greatly improved relationships among family members, which led to an increased well-being for patients & fewer psychotic episodes

shows family therapy helps to greatly reduce symptoms of schizophrenia and reinforces importance of good communication within the family, as families provide support network during recovery

Question 11

family therapy limit

Answer 11

environmentally reductionist - therapy unfairly oversimplifies schizophrenia to environmental explanations

e.g. family therapy doesn’t consider other relevant factors, such as genetic or biochemical factors, in the development of schizophrenia as only focuses on disturbed patterns of communication within family, despite there being overwhelming evidence to suggests biological basis for disorder

suggests family therapies don’t offer a holistic treatment to schizophrenia and should be used in conjunction with biological treatments