Schizophrenia- psychological therapies

Question 1

CBT, strength, double whopper, effectiveness

JAUHAR ET AL

Answer 1

There is some support for the benefits of CBT.
Jauhar et al. (2014) reviewed the results of 34 studies of CBT for schizophrenia.
They concluded that CBT has a significant, but fairly small effect on both positive and negative symptoms.
This shows CBT is an effective therapy for schizophrenia

Question 2

Family therapy, both, combo whopper, effectiveness

PHARAOH ET AL

Answer 2

There is some support for the benefits of family therapy.
Pharoah et al. reviewed the evidence of effectiveness of family therapy for families of schizophrenia sufferers.
They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission over the course of a year and improves quality of life for patients and their families.
However, they also noted that results of different studies were inconsistent and that there were problems with the quality of some evidence.

Question 3

Token economy programmes, limitation, double whopper, effectiveness
MONAGLE AND SULTANA

Answer 3

There are methodological issues with evidence into token economy programmes.
McMonagle and Sultana (2009) completed a review of the evidence for token economy programmes and found only 3 studies were patients had been randomly allocated to conditions, with a total of only 110 patient.
Random allocation is important in matching participants in treatment and control groups.
Only one of the three studies showed improvement in symptoms and none yielded useful information about behaviour change questioning the effectiveness of token economy programmes as a treatment for schizophrenia.

Question 4

All, limitation, double whopper, effectiveness

QUALITY OF EVIDENCE

Answer 4

Small scale studies into psychological treatments often have methodological problems.
There is often a lack of a control group, or if there is one then patients are not randomly allocated between the treatment group and the control group.
Where these studies are included in reviews, conclusions are generally more optimistic than those that strictly control which studies are included.
This impacts the quality of the evidence into the effectiveness of psychological therapies for schizophrenia.

Question 5

All, limitation, hamburger, effectiveness

NOT A CURE

Answer 5

CBT, family therapy and token economy progammes as therapies for schizophrenia aim to make it more manageable and improve the patients quality of life.
For example, CBT helps by allowing patients to make sense of and in some cases challenge some of their symptoms.
These therapies are worth doing, but should not be confused with curing schizophrenia.

Question 6

Token economy programmes, limitation, double whopper, appropriateness
ETHICAL ISSUES

Answer 6

Ethical issues are a major problem with token economy programmes used to manage schizophrenia.
The issue is that privileges and services become more available to patients with mild symptoms and less so, for those with more severe symptoms of schizophrenia that prevent them from complying with desirable behaviour.
This means that the most severely ill patients suffer discrimination and some families have challenged the legality of this.
This questions the appropriateness of token economy programmes as a therapy.

Question 7

All, limitation, double whopper, appropriateness

ALTERNATIVES EXIST

Answer 7

There are other psychological therapies that can be helpful for some people with schizophrenia that are less well-known and less likely to be available to patients.
The National Institute for Health and Clinical Excellence recommends art therapy, provided a qualified art therapist with experience of working with schizophrenia sufferers is available.
It is unlikely that one type of therapy will address all the symptoms involved in schizophrenia, and symptoms such as isolation and social withdrawal may be helped by the patient engaging in programmes using art, music and dance as part of the therapy.
This allows people to access and express their feelings through a different medium other than talking therapy so may be suitable for some people who have difficulty with communication and help combat their negative symptoms.