schizophrenia - 1.5 Flashcards
Cognitive behaviour therapy and family therapy as used in the treatment of schizophrenia. Token economies as used in the management of schizophrenia.
psychological treatments for SZ
family therapy
CBT
psychological method of managing SZ
token economies
CBT for treating schizophrenia A01
doctors attempt to challenge and dispute delusional beliefs
- explanation - patient explains their symptoms
- normalisation - doctor explains patients’ feelings are normal
- challenging - doctor challenges beliefs and experiences
- alternative explanations- patient is asked to develop alternative explanations for beliefs and experiences
CBT aims to treat the dysfunctional thought processes that the patient is having
CBT challenges and corrects the biases in reasoning that cause the symptoms of schizophrenia
main aim of CBT
to challenge patients’ irrational beliefs and though processes patient is having
4 steps of CBT
explanation
normalisation
challenging
alternative explanations
explanation
patient explains their symptoms
normalisation
doctor explains patients’ feelings are normal
challenging
doctor challenges beliefs and experiences
alternative explanations
patient is asked to develop alternative explanations for beliefs and experiences
strength of CBT study support
study support comes from NICE - conducted a review, patients in studies either given CBT + antipsychotics or just antipsychotics, lab experiments + independent groups design, found that treatments involving CBT were more effective, given CBT less likely to relapse
limitation of CBT - availability and cost
requires lots of expensive sessions which are usually 1:1 and require multiple sessions, limited availability of the treatment
limitation of CBT - study limitation
not all studies in the review used random allocation to assign participants e.g. just did first 20 participants to experimental group, studies couldn’t control participant variables that might have influenced the patients behaviour e.g. patients given CBT might have already had less severe symptoms than the control group, confounding variables make it seem more effective than it is
researchers knew which experimental group the patients had been assigned to, not blind, may have displayed personal bias when assessing symptoms, effectiveness may have been exaggerated, lacked objectively
family therapy
therapy which involves family members of individual with SZ
aim of family therapy
reduce stress and help family members process their thoughts and feelings about the illness
find a practical solution to situation
3 steps of family therapy
- educate family about symptoms of schizophrenia
- teach new coping strategies to manage patients’ symptoms
- change the family’s communication style, reduce expressed emotion
family therapy study support
pharoah et al’s review
aimed to investigate effectiveness of combining family therapy and medication
those who received family therapy were more likely to take medication consistently + less likely to relapse into severe symptoms
however, there was less clear evidence family therapy reduced the number of symptoms or improved the patient’s general mental health
strength of family therapy cost effective
NICE conducted a review of cost of family therapy compared to antipsychotics
less likely to relapse, less likely to go back to hospital
reduces cost of looking after SZ patients
saves NHS money
limitations of family therapy study support
many studies in the review didn’t use random allocation
participant variables weren’t controlled
e.g. patients in group receiving therapy may have already had a less strong stress response to expressed emotion
(confounding variables)
token economy
form of psychological therapy based on operant conditioning, which uses a reward system to encourage desired behaviour
what behaviour do token economies encourage?
positive, adaptive behaviour
what can tokens be exchanged for?
a reward
how do token economies use operant conditioning?
through positive reinforcement
associate actions with token
how do token economies use classical conditioning?
token is a NS at first
CR is developed and token becomes CS
token is associated with a reward
aim of token economies
incentivise SZ patients to behave in ways which are socially acceptable which helps to manage illness
what do tokens act as?
secondary reinforces
why are the tokens secondary reinforces and not primary reinforcers?
it isn’t the tokens themselves that provide the reward, it’s what they can do with the tokens
e.g. primary reinforcement of sweets
primary reinforces in token economies
the reward
not the token
support for token economies
dickerson et al
11/13 studies reported improvements in behaviour after token economy in hospital was implemented
particularly effective when combined with other therapies
limitation of the study support for token economies
there was no control group, used on all patients at same time
decreases validity
can’t establish cause and effect as behaviour may have just improved over time
limitation of token economies application
might not apply outside clinic
if not immediately rewarded, might not form association
to immediately reward, need to monitor behaviour all the time
hard to do outside hospital
e.g. may see therapist once a week
token economies less effective outside hospital setting
limitation of token economies further concerns
some consider them unethical
could make them feel humiliated or distressed, treated like a child
could have negative effects if no longer rewarded outside hospital
may stop producing behaviour
become dependent on reward
