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Psychology > Schizophrenia L5 - 6 > Flashcards

Schizophrenia L5 - 6 Flashcards

1
Q

What are the 3 main psychological therapies for SZ?

A

1) CBT
2) Family therapy
3) Token economies

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2
Q

What is the key idea of CBT?

A

Beliefs, expectations and cognitive assessment of the self, environment and nature of personal problems affect how individuals perceive themselves and others

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3
Q

Features of CBT: (3)

A
  • Over a period of 5 to 20 sessions in a grp/individually
  • Drawings are used to display links between sufferers’ thoughts
  • Involves understanding root of symptoms
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4
Q

What is one CBT approach and what does this involve? (2)

A
  • Personal therapy
  • Detailed evaluation of problems, their triggers, consequences and strategies to overcome
  • Used to tackle problems faced by schizophrenics discharged from hospital
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5
Q

Give 7 cognitive techniques used in CBT:

A

1) Helping to understand how their irrational cognitions impact their feelings and behaviour
2) Distractions from intrusive thoughts
3) Challenging the meaning of intrusive thoughts
4) Increasing/decreasing social activity to distract from low mood
5) Normalisation –> saying that many people have unusual experiences to avoid stigmatisation
6) Using relaxation techniques
7) Positive self-talk

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6
Q

Strengths and weaknesses of CBT: (+2, -4)

A

+ Research evidence –> Jauhar et al (2014), Pontillo et al (2016)
+ Effectiveness of CBT depends on stage of disorder –> Addington and Addington (2005)
- Lack of availability of CBT –> Haddock et al (2013)
- Patient refusal to attend sessions –> Freeman et al (2013)
- Failure to consider quality of studies –> Juni et al (2001), Wykes et al (2008)
- Wide range of techniques and symptoms included in study –> Thomas (2015)

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7
Q

Jauhar et al (2014):

A
  • Review of 34 studies using CBT w/ SZ
  • Clear evidence for small but significant effects on both positive and negative symptoms
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8
Q

Pontillo et al (2016):

A

Reductions in frequency and severity of auditory hallucinations

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9
Q

What does the national Institute for Healthcare and Excellence say about CBT for SZ?

A

NICE (2019) recommends its use for SZ

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10
Q

Addington and Addington (2005):

A
  • In initial phase of SZ, self reflection is not particularly appropriate
  • Following stabilisation w/ psychotic medication, they can benefit from grp-based CBT
  • Individuals w/ more experience of SZ and greater realisation of problems are most likely to benefit from CBT
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11
Q

Haddock et al (2013):

A
  • In NW of England only 7% had been offered CBT
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12
Q

What fraction of individuals in UK have access to CBT?

A

1/10

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13
Q

Juni et al (2001):

A

Clear evidence that problems associated w/ methodologically weak trials translated into biased findings about effectiveness of CBT

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14
Q

Wykes et al (2008):

A

More rigorous the study, the weaker the effect of CBT

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15
Q

Thomas (2015):

A

Different studies have involved the use of different CBT techniques and people w/ different combinations of positive and negative symptoms

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16
Q

Family therapy:

A

Identified patient takes part in therapy w/ families

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17
Q

What are 3 aims of family therapy?

A

1) Improve quality of communication and interaction between family
2) Increase tolerance levels and decreases criticism between family
3) Decreases feelings of guilt and responsibility for ‘causing’ illness

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18
Q

What amount of time is given for CBT?

A

9 month to 1 yr

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19
Q

Which psychologist identified a range of strategies to be used in CBT and what are they? (2)

A
  • Pharoah et al (2010)
    1) Reduce negative (expressed) emotions
    2) Improves family’s ability to help –> agreeing on aims of therapy
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20
Q

State the 7 phases of Burbach (2018)’s model for working w/ families dealing w/ SZ:

A

1) Sharing basic info and providing emotional and practical support
2) Identifying resources abt what different family members can and can’t offer
3) Encouraging mutual understanding
4) Identifying unhelpful patterns of interactions
5) Skill training
6) Relapse prevention
7) Maintenance for future

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21
Q

Strengths and weaknesses of family therapy: (+3, -1)

A

+ Effective –> McFarlane (2016)
+ Benefits all family members –> Lobban and Barrowclough (2016)
+ Economical benefits to family therapy –> NCCMH (2009)
- Not all family members will want to take part

22
Q

McFarlane (2016):

A
  • FT was one of the most consistently effective treatments available for SZ
  • Relapse rates found to be reduced by abt 50 - 60%
  • Using FT as mental health initially starts to decline is particularly promising
23
Q

Lobban and Barrowclough (2016):

A
  • The effects of FT are important because the family provides most of the care for the person w/ SZ
  • Lessens negative impact and strengths ability of family to support
24
Q

NCCMH (2009):

A
  • NICE review of family therapy studies
  • Demonstrated that family therapy is associated w/ significant cost savings when offered to people w/ SZ
  • Evidence that FT reduce relapse significant period after completing intervention
25
Q

Token economies:

A

Example of behaviour modification using reward systems to manage schizophrenia in hospital settings, especially those w/ maladaptive behaviours after being in hospital for so long

26
Q

What are the 3 institutional behaviours commonly tackled by token economies according to Matson et al (2016)?

A
  • Personal care
  • Condition-related behaviours eg apathy
  • Social behaviour
27
Q

What are the 2 major benefits of modifying behaviours, even though it doesn’t cure SZ?

A
  • Improves person’s quality of life w/in hospital setting
  • Normalises behaviour, making it easier for them to integrate after into the community after leaving hospital
28
Q

How do token economies work? (3)

A
  • Tokens eg coloured discs given immediately to patients when they have carried out a desirable behaviour
  • Desirable behaviours vary depending on the individual
  • Tokens can later be exchanged for more tangible rewards
29
Q

Are tokens primary or secondary reinforcers and why?

A
  • Secondary
  • They only have value once a patient has learnt that they can be used for rewards (rewards are the priamry reinforcers)
30
Q

Strengths and weaknesses of token economies:

A

+ Evidence for effectiveness –> Glowacki et al (2016), Dickerson et al (2005)
- Ethical issues
- Lack ecological validity –> Corrigan (1991)
- Existence of more pleasant and ethical alternatives –> Chiang et al (2019)

31
Q

Glowacki et al (2016):

A
  • 7 high quality studies published between 1999 and 2013
  • Examining effectiveness of token economies for ppl w/ chronic mental illnesses
  • Reduction in negative symptoms
  • Decline in frequency of unwanted behaviours
32
Q

Dickerson et al (2005): (+weakness)

A
  • Reviewed 13 studies
  • 11 had reported beneficial effects that were directly attributable to token economies
  • However many of the studies had methodological issues
33
Q

What ethical issues are there in token economies?

A
  • Control is exercised over patients
  • Lose basic human rights
34
Q

Corrigan (1991):

A

In real world, no-one will be able to give them tokens straightaway, which is how they are treated in hospitals, where they receive 24 hr care

35
Q

Chiang et al (2019): (+weakness)

A
  • Art therapy may be a good alternative
  • High gain low risk alternative
  • evidence base is small and has methodological limitations
36
Q

Does NICE recommend art therapy for SZ?

A

Yes

37
Q

What is the interactionist approach otherwise known as?

A

Biosocial approach

38
Q

Interactionist approach:

A

Approach that acknowledges that there are biological, psychological and societal factors in development of SZ

39
Q

What does diathesis mean?

A

Vulnerability

40
Q

Who created diathesis stress model and what does it propose?

A
  • Meehl (1962)
  • SZ was entirely genetic and caused by one specific gene (schizogene)
  • Leads to a schizotypic personality, which is sensitive to stress
  • Because they have the gene, chronic stress especially in the presence of a schizophrenogenic mother can lead to SZ
41
Q

Can stress lead to SZ in someone who doesn’t have the schizogene?

A

No

42
Q

How does the modern view of diathesis differ?

A
  • Many genes increase genetic vulnerability: not just one
  • Psychological trauma according to Ingram and Luxton (2005) also becomes the diathesis rather than the stressor
43
Q

How does the modern view of stress differ?

A

Anything that risks triggering schizophrenia is a stressor

44
Q

Who else proposed a model where psychological trauma affects brain development and what is it?

A
  • Read et al (2001)
  • Neurodevelopmental model where early and severe trauma affects brain development
45
Q

What is the treatment for schizophrenia according to the interactionist model?

A

Combining antipsychotic medication and psychological therapies eg CBT

46
Q

Strengths and weaknesses of interactionist approach:

A

+ Research support for role of vulnerability –> Tienari et al (2004)
+ Support for effectiveness of combining treatments –> Tarrier et al (2004)
- Too simplistic –> Houston et al (2008)
- Lack of understanding of how vulnerability and stress produce symptoms of schizophrenia
- Treatment-causation fallacy –> Turkington et al (2006)

47
Q

Tienari et al (2004)

A
  • Studied children adopted away from schizophrenic mothers
  • Adoptive parents’ parenting styles assessed and compared w/ control grp of adoptees w/ no generic risk
  • Child-rearing style w/ high levels of criticism, conflict and low levels of empathy was implicated in development of SZ but only for kids w/ genetic risk
48
Q

Tarrier et al (2004):

A
  • Randomly allocated 315 patients to:
    1) medication and CBT grp
    2) medication and supportive counselling grp
    3) control grp (medication only)
  • Patients in grp 1 and 2 showed lower symptom levels than grp 3 but no difference in hospital readmission
49
Q

Houston et al (2008):

A
  • Childhood sexual trauma was a diathesis and cannabis use was a trigger
  • Shows old idea of diathesis as biological and stress as psychological has turned out to be overly simple
50
Q

Turkington et al (2006):

A
  • Treatment causation fallacy
  • Just because combined biological and psychological therapies are more effective does not necessarily mean interactionist approach is correct

Psychology (37 decks)

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