psychological treatments for sz

Question 1

what are the 3 psychological treatments for SZ?

Answer 1

• CBT
• family therapy
• token economies

Question 2

what is CBT?

Answer 2

the main psychological treatment for SZ, there are many different forms
- based on both cognitive and behavioural techniques

Question 3

what is the main aim of CBT?

Answer 3

the main aim is to help patients identify and challenge irrational thoughts underlying SZ

Question 4

what are the 3 ways CBT helps?

Answer 4

• emphasises the importance of understanding, although it cannot directly cure SZ, it offers a psychological explanation for hallucinations/delusions, to lower anxiety
• delusions can be challenged if patient knows beliefs aren’t based on reality
• make sense of how delusions and hallucination impact feelings/behaviours

Question 5

is CBT used to treat positive symptoms or negative symptoms

Answer 5

CBT is primarily used to treat positive symptoms

Question 6

what is CBT often used in combination with?

Answer 6

drug therapy

Question 7

how long would a typical course for CBT last?

Answer 7

12 sessions, spaced 10 days apart

Question 8

what is family therapy?

Answer 8

a treatment for SZ based on the family dysfunction explanation

Question 9

what is family therapy’s focus?

Answer 9

it aims to address family dysfunction rather than focusing on the SZ patient

Question 10

how does family therapy help the family function?

Answer 10

• improves communication patterns with family
• increases tolerance and understanding
• reduces feelings of guilt and anger
• improved levels of expressed emotion

Question 11

how does family therapy help the SZ patient?

Answer 11

the stress upon the SZ lessens, reducing the likelihood of relapse and hospital admission, as they are more likely to be cooperative with medical advice

Question 12

how long would a typical course of family therapy last?

Answer 12

may consist of weekly sessions for a year, after which the family members will have developed skills that they can use after therapy has ended

Question 13

what are token economies?

Answer 13

a behaviourist approach to SZ, based on operant conditioning
- patients are awarded tokens (that can be exchanged for rewards) in return for desirable behaviour

Question 14

where are token economies frequently used?

Answer 14

psychiatric wards

Question 15

how are token economies used to treat negative symptoms?

Answer 15

negative symptoms, such as avolition, may mean that the patient has little motivation to carry out tasks such as
- getting out of bed
- washing
-socialising
token economies provide an incentive for these tasks, changing their behaviour

Question 16

what are tokens/rewards

Answer 16

tokens can be specific to each person
- cigarettes
- extra TV time
- exercise outside hospital grounds
- favourite magazine
etc.

Question 17

evaluation family therapy: supporting evidence

Answer 17

ID: there is a range of evidence supporting the efficacy of family therapy
Q: several studies have demonstrated lower rates of schizophrenia relapse among patients receiving family therapy
EV: for example, McFarlane et al. reviewed available evidence and found that family therapy results in reduced relapse rates, symptom reduction in patients and improved relationships among family members. which leads to an increased well-being for patients
AN: this suggests that family therapy is an effective treatment, with an indication that better family relationships are a key element in the development of SZ

Question 18

evaluation: none provide a treatment/ cure

Answer 18

ID: none of the three psychological therapies above actually treat the patient and ‘cure’ their
schizophrenia
Q: instead, these therapies simply improve their quality of life by making the symptoms more manageable
EV: for example, token economies increase the likelihood that the patients act accordantly with hospital rules and break disruptive patterns of behaviour, whilst family therapies reduce stress within a schizophrenic family and so increase the likelihood of the patient complying with their medical advice, whereas CBT improves the patient’s understanding of their symptoms
AN: this suggests that an interactionist approach towards treatment is best adopted:
biological therapies can treat the distal causes of SZ, whilst psychological therapies can treat the
proximal symptoms.

Question 19

evaluation token economies + CBT: ethical issues

Answer 19

ID: there are serious ethical issues associated with the use of psychological therapies, specifically concerning token economies
Q: some may argue that the ‘privileges’ that patients receive
upon displaying appropriate behaviours are actually rights
EV: for example, preventing patients from calling home or exercising outside may increase their stress and so aggravate their condition further. in addition, patients with the most severe SZ may find it nearly impossible to comply with these rules, and so will bear the most negative consequences. similarly, CBT raises ethical issues because the therapist essentially has control over the patient’s views.
AN: therefore, psychological treatment can be seen as subjective and may discriminate against the most severely ill patients, which isn’t beneficial