Psychological treatments of schizophrenia Flashcards
Psychological treatments
- CBT
- Family therapy
- Token economies
CBT
- aims to help patients see that their hallucinations/delusions are irrational
- antipsychotics are usually given first to reduce psychotic thought processes so that CBT can be more effective
- cognitive techniques are developed: challenging the meanings of intrusive thoughts, increasing social activity to distract from low moods and using relaxation strategies
- therapist helps individual to understand why they are experiencing symptoms such as hallucinations and hearing voices
- hearing voices in particular is explained as an extension of the ordinary experience of thinking in words- normalisation
- two types of CBT - Rational emotive therapy + Personal therapy
Evaluation of CBT
- Not appropriate for those who lack motivation
- May not be effective if theres a mismatch between patient + therapist personalities
+ CBT can be effective when combined with medication
Not appropriate for those who lack motivation
CBT is not suitable for all people especially those too paranoid to form trusting relationships with practitioners. Attending therapy sessions requires motivation and discipline. Therefore, CBT may not be an appropriate method for everyone, especially those who lack motivation and effort.
However to address this, they are done online
May not be effective if theres a mismatch between patient + therapist personalities
For CBT to be effective, training therapists is very important. Successful treatment is dependent on respect, unconditional positive regard and developing empathy.
Rathod et al (2005) found that non-Afro Carribean therapists had less success using CBT with Afro Carribean patients than white ethnic patients as such empathy between therapists and patients was much harder to establish. Therefore, CBT is less effective as it requires reciprocal relationship.
CBT can be effective when combined with medication
Evidence suggests that CBT plus antipsychotic drugs is useful in treating schizophrenia and more effective than drugs or CBT alone, supporting the case for combined treatment. Therefore using CBT with medication increases its success rate.
Family therapy
- therapists meets regularly with patient + family members, who are encouraged to talk openly about the patients symptoms, progress with their treatment and how the patients illness affects them
- family members are taught to support each other, with each person given a specific role in the recovery of the patient
- aims to reduce levels of expressed emotion + stress
- identifies helpful and unhelpful patterns of interaction
Evaluation of family therapy
- Highly sensitive
+ Cost effective
+ Low relapse rates
Highly sensitive
There can be an issue with family members being reluctant to share sensitive information, as it may cause or reopen family tensions. Some family members may also be reluctant to talk about or even admit their problems, lowering the effectiveness of the treatment. Therefore its less effective ad its not applicable to all people.
Cost effective
As well as lowering the need for hospitalsation, family therapy can educate family members to help manage a patients medication regime, decreasing the need for professionals to do this, thus making the treatment more cost effective.
It has huge economic benefits for the state. Therefore family therapy is appropriate as it reduces the need for the NHS.
Low relapse rates
Relapse rates are found to be reduced by 50-60%. This shows that family therapy is effective in reducing symptoms for schizophrenia and shows that therapy does work as it reduces levels of expressed emotion in families.
Token economies
- Behaviourist theraputic approach
- used mainly with long term hospitalised patients because people often develop bad habits when hospitalised for a long time
- aims to tackle personal care, condition related behaviours and social behaviour
- tokems are given for desirable behaviour. Based on operant conditioning. Tokens are secondary reinforcers, rewards are primary reinforcers
- mainly aims to change negative symptoms e.g. avolition, poor attention + social withdrawal
Evaluation of token economies
+ Appropriate for patients to gain motivation and reduces costs
- Opposing evidence from Glowacki et al (2016)
- High re-admittance rates
- Unethical
Appropriate for patients to gain motivation and reduces costs
Token economies help patients to become more independent, active and more motivated. Additionally, the use of token economies facillitates a safer and more stable theraputic environment. Staff and patient injuries reduce, thus decreasing staff absenteesism and emergency incident levels.
This suggests that token economies are appropriare as they increase a patients motivation to get better and also doesnt require specialist training so its costs are appropriate.
Opposing evidence from Glowacki et al (2016)
Identified 7 research studies to support the effectiveness of token economies. All showed a reduction in unwanted behaviours.
However, 7 studies are not a large enough sample size + this study presents a file drawer problem. Theres a chance that those studies that do not support the effectiveness are filed away. This questions the true effectiveness of this method of schizophrenia.
High re-admittance rates
Problem with token economies is that desirable behaviour becomes dependent on being reinforced. Upon release in the community, reinforcements stop which leads to high readmittance rates. The benefits of this strategy do not generalise to real life. This suggests that the method is not effective when patients are discharged from hospital as it stops working.
Unethical
Professionals use token behaviours to control behaviour. They impose their rules or the institutions rules. What if some people generally like to wake up late or like to look messy. Their personal freedoms are restricted. Therefore, the treatment may not be appropriate for all people as some people may not like routines.
