Schizophrenia : Psychological Therapies for Schizophrenia

Question 1

What are the 3 main psychological therapies for SZ?

Answer 1

Cognitive behavioural therapy
Family Therapy
Token economy systems

Question 2

What does CBT involve for a SZ patient?

Answer 2

Involves an initial assessment of the patient by a therapist where the patient’s symptoms and problems are clarified.

Question 3

What does CBT emphasise? How does this reassure the patient?

Answer 3

Emphasises the importance of understanding- although this treatment cannot directly ‘cure’ SZ, many patients find it comforting to understand the causes of their symptoms, especially if they are suffering from upsetting hallucinations or paranoid delusions . This understanding reassures patients that they are not ‘crazy’ , reducing the intrusive effects of their symptoms and increasing their self-awareness .

Question 4

How are more effective behaviours put into place through CBT?

Answer 4

By questioning the reality of the patient’s beliefs and considering other, more reasonable alternatives.

For example, beliefs about the Mafia can be raitonalised as simply being based upon a single day where an individual was staring at the patient for an extended period of time, perhaps lost in thought.

Question 5

What does family therapy aim to reduce?

Answer 5

Aims to reduce the stress of living together as a family, with a schizophrenogenic mother.

Question 6

How does family therapy reduce the stress of living together as a family?

Answer 6

The levels of expressed emotion are lowered through improving the families’ beliefs and attitudes towards schizophrenia, reducing stress, increasing feelings of self-efficacy and being trained to look for signs which may precede a schizophrenic episode.

Question 7

How does ft help the SZ patient?

Answer 7

The stress upon the SZ patient lessens, reducing the likelihood of relapse because they are more likely to be cooperative with medical advice and diligently take their medication.

Question 8

What are token economy systems based on?

Answer 8

Based on behaviourist principles and are frequently used in psychiatric institutions.

Question 9

How do token economies work?

Answer 9

Target, desirable behaviours are identified by the staff. Every time a patient displays one of these behaviours, they are rewarded with a token (secondary reinforcer) which can then be exchanged for a reward or privilege (primary reinforcer) Therefore, patients are motivated by the primary reinforcer to carry out the desirable behaviours, and their frequency of doing so increases as they are positively reinforced.

Question 10

Name some rewards that are token economies?

Answer 10

TV time, exercise, taken outside of the hospital grounds and favourite magazines.

Question 11

Limitations of psychological therapies?

Answer 11

• None of the three psychological therapies actually treat the patient and ‘cure’ their schizophrenia. Instead, these therapies simply improve their quality of life through making the symptoms more manageable. This suggests that an interactionist approach towards treatment is best adopted: biological therapies can treat the distal causes of SZ , whilst psychological therapies can treat proximal symptoms.
• There are serious ethical issues associated with the use of psychological therapies, and specifically concerning token economies. Some may argue that the ‘privileges’ that patients recieve upon displaying appropriate behaviours are actually rights. Preventing patients from calling home or exercising outside may increase their stress and so aggravate their condition further. CBT raises issues because the therapist essentially has control over the patient’s views .

Question 12

Strengths of psychological therapies of SZ

Answer 12

+ There are alternative psychological therapies which may address its limitations, such as the use of art therapy . This provides the patients with a creative outlet which reduces stress but does not require changing the patient’s beliefs (as is the case with CBT) or discriminate against severely ill patients (as is the case with token economies). Thus, this all suggests that psychological therapies are not appropriate for all patients bit mist be selected according to the type and severity of patients symptoms.

Question 13

What is CBT?

Answer 13

A combination of cognitive therapy (changing maladaptive thoughts and beliefs) and behavioural therapy (a way of changing behaviour in response to these thoughts and beliefs)

Question 14

What happens in CBT?

Answer 14

Patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how they might have developed . They are also encouraged to evaluate the content of their delusions or of any voices , and to consider ways in which they might test the validity of their faulty beliefs.

Question 15

What are the advantages of CBTp over standard care?

Answer 15

The NICE review of treatments for SZ found consistent evidence that when compared to standard care (antipsychotic medication alone) CBTp was more effective in reducing rehospitalisation rates up to 18 months following the end of treatment . CBTp was also shown to be effective in reducing symptom severity and compared to patient with standard care, there was some evidence for improvements in social functioning.

Question 16

Explain lack of availability of CBTp

Answer 16

It is estimated that only 1 in 10 of those who could benefit get access to this form of therapy. This figure is even lower in some areas of the country. A survey carried out by Haddock in the North West of England found that of 187 randomly selected patients, only 13 had been offered CBT. Of those who were offered it, a significant number either refuse or fail to attend, thus limiting its effectiveness even more

Question 17

What did Garety estimate relapse rates were for patients who received family therapy compared to standard care?

Answer 17

family therapy = 25%
standard care alone = 50%

Question 18

What was Pharoah et al’s procedure?

Answer 18

Reviewed 53 studies published between 2002 and 2010 to investigate the effectiveness of family intervention . Studies chosen were conducted in Europe, Asia and North America. These studies compared outcomes from family therapy to ‘standard’ care alone

Question 19

What were Pharoah’s findings?

Answer 19

Mental state - The overall impression was mixed. Some studies reported an improvement in overall mental state of patients compared to standard care , while others did not.

Compliance with medication - the use of family therapy increased the patient’s compluance with medication

Social functioning - although appearing to show some improvement on general functioning , family intervention did not appear to have much of an effect on more concrete outcomes such as living independently and employment

Reduction in relapse and readmission - there was a reduction in the risk of relapse and reduction in hospital admission during treatment and in the 24 months after.

Question 20

What are the economic benefits of family therapy?

Answer 20

The NICE review of family therapy studies demonstrated that family therapy is associated with significant cost savings when offered to people with SZ in addition to standard care. The extra cost of family therapy is offset by a reduction in costs of hospitalisation because of the lower relapse rates associated with this form of intervention . There is also evidence that family therapy reduces relapse rates fpr a significant period after the compeltion og the intervention. This means that cost savings associated with family therapy would be even higher.

Question 21

What impact does family therapy have on family members?

Answer 21

There may be additional advantage in that they have a positive impact on family members as well . Lobbhan analysed the results of 50 family therapy studies that had included an intervention to support relatives. 60% of these studies reported a significant positive impact of the intervention on at least one outcome category for relatives e.g coping and problem solving skills , family functioning and relationship quality Methodological quality of the studies was poor.

Question 22

what research support is there for the use of token economies?

Answer 22

Dickerson reviewed 13 studies of the use of token economy systems in the treatment of token economies . 11 of these studies had reported beneficial effects that were directly attributable to the use of token economies, It was concluded that overall these studies provide evidence of the token economy’s effectiveness in increasing the adaptive behaviours of patients with sz.

Question 23

Limitations of token economies

Answer 23

• less useful for patients living in the community
• ethical concerns