Schizophrenia - Psychological Therapies Flashcards
Relationship between psychological and biological therapies?
Although the use of antipsychotic drugs is crucial in the treatment of SZ, additional psychological treatments are needed to sustain improvement
Types of psychological therapies?
CBT and family intervention
Assumption of CBT?
People have distorted beliefs which maladaptively influence behaviour, e.g. delusions result from faulty interpretations of events
CBT recommendations in NICE 2014 guidelines?
For 1st and subsequent acute episodes, delivered on a one-to-one basis over at least 16 planned sessions
Researcher on CBT?
Drury et al
Drury et al?
Benefits of CBT in terms of a reduction of positive symptoms and a 25-50% reduction in recovery time for patients given a combination of CBT and medication
How many stages in CBT?
4
1st stage of CBT?
ABC model is used to help patients organise confusing experiences
Example of using ABC model?
Rating intensity of distress in experiences on a scale of 1-10 and identifying what activating events seemed to cause the consequences
2nd stage of CBT?
Therapist uses methods to encourage the client to test the validity of their beliefs
Examples of methods used to test validity of beliefs?
Empirical disputing, logical disputing, pragmatic disputing and evaluating the content of their delusions/internal voices
Example of logical disputing?
“Does it make sense that the voices come from the radiator? In general do radiators talk?”
Example of empirical disputing?
“Can you think of any events that have happened which give you evidence that the shop keeper wants to kidnap you?”
Example of pragmatic disputing?
“How has believing that if you tell people about your visions that they will no longer speak to you helped you?”
3rd stage of CBT?
Develop own alternatives to maladaptive beliefs, looking for alternative explanations and coping strategies already present in mind, and setting goals
4th stage of CBT?
Replaces disordered or delusional thinking with rational thought processes
Strengths of effectiveness of CBT?
Reduces positive symptoms
Lots of benefits
Weaknesses of effectiveness of CBT?
Methodological
CBT reducing positive symptoms?
Gould et al
Gould et al?
Statistically significant decrease in positive symptoms of SZ after CBT (meta-analysis of 7 studies)
Research on benefits of CBT?
Tarrier et al
Tarrier et al?
Persistent evidence of reduced symptoms (especially positive), lower relapse rates and speedier recovery of acutely ill patients (20 trials)
Methodological problems with CBT?
NICE guidelines recommend CBT in combination with anti-psychoitcs, so its unsure whether effects are actually due to CBT
Strengths of appropriateness of CBT?
Lower drop out rates than drugs
Weaknesses of appropriateness of CBT?
Individual differences
Research on drop out rates in CBT?
Kuipers et al
Kuipers et al?
Lower drop out rates and greater satisfaction when CBT was used in addition to antipsychotics (instead of just antipsychotics)
Individual differences with CBT?
Kingdon and Kirschen
Kingdon and Kirschen?
Many patients (in particular older ones due to memory deficits, negative attitudes to change etc.) weren’t deemed suitable for CBT as psychiatrists believed they wouldn’t fully engage
What does family intervention aim to do?
Doesn’t aim to ‘cure’ SZ but to prevent relapse by reducing EE and stress
Research on EE?
Brown
Brown?
SZs in families with high EE have more frequent relapses
What does family intervention do?
Teaches coping and problem solving strategies, creating a warm and supportive atmosphere
NICE recommendations on family intervention?
That it be carried out for between 3 months and 1 year and include at least 10 planned sessions in conjunction with antipsychotics
How many stages in family intervention?
5
First stage of family intervention?
Therapist establishes alliance and co-operative relationship with family and gives information about SZ (causes, course and treatment), patient discusses their symptoms
Second stage of family intervention?
Relatives and patients told it’s normal to feel angry/impatient towards each other and discuss how they feel when certain events happen
Third stage of family intervention?
Family learns more constructive ways of communicating and are encouraged to concentrate on good things rather than the negative events
Fourth stage of family intervention?
Practical coping skills and problem solving skills are taught
Fifth stage of family intervention?
Family and patients trained to recognise early signs of relapse (e.g. withdrawal, difficulty concentrating) so they can respond rapidly and reduce severity
Strengths of effectiveness of family intervention?
Support
Effective with drugs
Long-term benefits
Support for family intervention?
NCCMH
NCCMH?
26% relapse in family intervention condition compared to 50% in the control standard-care condition (meta-analysis of 32 studies)
Research on effectiveness of daily intervention with drugs?
Pharoah et al
Pharoah et al?
53 studies from 2002-10 in Europe, Asia and N America - family intervention increased mental state, social functioning, and compliance with medication (so more likely to reap the benefits)
LT benefits of family intervention?
Hogarty et al
Hogarty et al?
At a 2 year follow up 25% of those who’d received family intervention had relapsed compare to 62% on medication alone (103 SZ patients in high EE households)
Strengths of appropriateness of family intervention?
Economic benefits
Weaknesses of appropriateness of family intervention?
Cultural limitations
Economic benefits of family intervention?
NCCMH found the extra costs of family intervention is offset by a reduction in costs of hospitalisation because of lower relapse rates (26% v 50%)
Cultural limitations of family intervention?
NCCMH found hospitalisation levels may differ significantly across countries depending on clinical practice (e.g. most of the evidence has come from studies outside the UK, principally in China)
