Schizophrenia - Psychological Therapies Flashcards
What is family therapy
range of interventions aimed at the family of someone with SZ.
Why is family therapy important
SZ families that expressed high levels of criticism, hostility or over involvement had more frequent relapse than families who were less expressive than their emotions
when is family therapy offered
offered for a period of between 3 and 12 months and at least ten sessions
What does family therapy involve
providing family members with info on SZ,supporting someone with SZ and resolving any practical problems
What does family therapy result in
improved relationships within the household because the therapist encourages family members to listen to each other and discuss problems and solutions
Who looks at family therapy
Pharaoh et al (2010)
what was Pharaoh et al (2010) procedure
reviewed 53 studies published between 2002 to 2010 to investigate the effectiveness of family intervention and compared the outcomes of therapy to standard care alone and concentrated on the studies that were randomised controlled trials
In Pharaoh et al (2010) study where did they choose the studies from
Europe, Asia and North America
what did Pharaoh et al (2010) compare the outcomes of family therapy to
standard care - antipsychotic medication
what was Pharaoh et al (2010) main results comparing individuals receiving family therapy with those receiving standard care(no explanation)
mental state
compliance with medication
social functioning
reduction in relapse and readmission
Pharaoh et al (2010) looked at mental state explain what he found comparing individuals receiving family therapy with those receiving standard care
Some studies reported an improvement in the overall mental state of patients compared to the ones receiving standard care but some did not
Pharaoh et al (2010) looked at compliance with medication explain what he found comparing individuals receiving family therapy with those receiving standard care
the use of family intervention increased patients compliance with medication
Pharaoh et al (2010) looked at social functioning explain what he found comparing individuals receiving family therapy with those receiving standard care
family intervention did not appear to have much of an effect on more concrete outcomes such as living independently or employment
Pharaoh et al (2010) looked at reduction in relapse and readmission explain what he found comparing individuals receiving family therapy with those receiving standard care
there was a reduction in the risk relapse and a reduction in hospital admission during treatment in the 24 months after
What study is used to look at the effectiveness of family therapy
Pharaoh et al (2010)
Why can Pharaoh et al (2010) be used to look at the effectiveness of family therapy
that family therapy ca be used to improve clinical outcomes such as mental state and social functioning but this may be more due to the it increase medicine compliance as there more likely to reap the benefits if they keep up with their medication regime
What are two methodological limitations of family therapy studies
the problem of random allocation
lack of blinding
Explain the problem of random allocation as a methodological limitation of family therapy studies
although 53 studies claimed to have randomly allocated participants to treatment conditions but most of the studies were from the Peoples Republic of china and random allocation was stated but not used Wu et al 2006
Explain lack of blinding as a methodological limitation of family therapy studies
raters were not bonded to the condition to which people were allocated
10 studies had not used blinding
and 26 did not mention whether or not blinding had been used
What is an advantage of family therapy
It has considerable economic benefits associated with the treatments of schizophrenia
Why is family therapy economically beneficial
Nice review (NCCMH,2009)The extra cost of therapy is an offset by the reduction in costs of hospitalisation as therapy comes with lower relapse rates the standard care and even after intervention there is reduced relapse rates meaning cost savings are even higher
What did Lobban et al 2013 do
Lobban et al 2013
analysed the results from 50 therapy studies that had included intervention to support relatives
Explain the impact on family members on family therapy with a study
60% of the studies reported a significant positive impact of the intervention on at least one outcome category for relatives such as family functioning
What is a disadvantage of what Lobban et al 2013 did
found the methodological quality of the studies was generally poor making it difficult to distinguish from effective to ineffective intervention
How does family therapy work?
reducing levels of expressed emotion and stress and increasing the capacity of relatives to solve related problems.
What does family therapy aim to do
Reduce the incidence of relapse with the person with SZ
Give some strategies used in family therapy (5)
psychoeducation
forming an alliance with caring relatives
reduce emotional climate and burden of care for family
enhancing families ability to solve and anticipate problems
reduce expressions of anger and guilt
What should the patient do in family therapy sessions
talk to their family and explain what sort of support they find helpful and what things makes it worse for them
Who looks at if family therapy is worth while
Garety et al 2008
What did Garety et al 2008 do
failed to show any better outcomes for patients who had family therapy and those who had just had a carer , both had low relapse and carers showed low levels of expressed emotion
What did Garety et al 2008 suggest
for many people family intervention may not improve outcomes further the a good standard of treatment as usual
Explain what CBT does (2)
identify and change irrational thoughts
Helps patients understand their symptoms
Explain how CBT identifies and changes irrational thoughts
may involve discussion of how likely the beliefs are to be true + consideration of less threatening possibilities
Explain how CBT helps patients understand their symptoms
Help to make sense of the positive symptoms and offer an explanation which reduces anxiety and helps the patient realise their beliefs are not based on reality
Give limitations of CBT as a psychological therapy using a study for one
Jauhar et al (2014)
ethical issues
What did Jauhar et al (2014) do
found CBT had a significant but small effect on + and - symptoms
Explain ethical issues as a limitation for CBT
CBT may challenge a persons paranoia but might that interfere with their freedom of thought?
E.g If a patient believes in a controlling government the CBT could stray them to modifying their politics
What are the two sections of token economies
operant conditioning
classical conditioning
Explain token economies as operant conditioning
TE are reward systems used to manage the behaviour of patient with SZ who spend long periods in psyc hospitals. Tokens are given to patients who carry out desirable behaviours which reinforces this behaviour + because they are given immediately it prevents ‘delay discounting’
Explain token economies as classical conditioning
tokens have no value but can be swapped late for a tangible reward such as sweets they are secondary reinforcers because they only have learned association with innate primary reinforcers
what is a limitation of token economies
Controversial as severely ill patients cannot get privileges as they are less able to comply with desirable behaviours than moderately ill patients and so they are discriminated against.
What are 2 limitations of psychological therapies
quality of some evidence
alternative psychological therapies are under researched
Explain quality of some evidence as a limitation
small-scale studies that compare patient before and after therapies have has positive results however these therapies lack a control group or lack random allocation to conditions this may mean the effectiveness of psychological therapies is overestimate by the evidence
Explain alternative psychological therapies are under researched as a limitation
e.g. NICE recommends art therapy if a qualified art therapist is available who has experience working with SZ patients however these are not well researched and it is unclear how effective they are which questions whether they should be made available to patients
