Schizophrenia- Psychological Therapies For Schizophrenia

Question 1

Cognitive behaviour therapy (CBT) -

Answer 1

A method for treating mental disorders based on both cognitive and behavioural techniques. From the cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts. The therapy also includes behavioural techniques.

Question 2

Family therapy -

Answer 2

A psychological therapy carried out with all or some members of a family with the aim of improving their communication and reducing the stress of living as a family.

Question 3

Token economies -

Answer 3

A form of behavioural therapy, where desirable behaviours are encouraged by the use of selective reinforcement. For example, people are given rewards (tokens) as secondary reinforcers when they engage in correct/socially desirable behaviours.
The tokens can then be exchanged for primary reinforcers - favourite foods or privileges.

Question 4

What is the purpose of Cognitive Behavioural Therapy (CBT) for individuals with schizophrenia?

Answer 4

CBT aims to help people identify irrational thoughts and work to change them, often through discussion or argument about the likelihood of their beliefs being true, and by considering less threatening possibilities.

Question 5

How long does CBT treatment for schizophrenia typically last?

Answer 5

CBT usually takes place for between five and twenty sessions.

Question 6

Can CBT eliminate the symptoms of schizophrenia?

Answer 6

No, CBT does not eliminate symptoms, but it can help individuals cope with them more effectively.

Question 7

How does CBT help people with schizophrenia understand their symptoms?

Answer 7

CBT can help individuals make sense of how delusions and hallucinations affect their feelings and behavior, which can be helpful in reducing anxiety about their symptoms.

Question 8

How can understanding the origin of symptoms help individuals with schizophrenia?

Answer 8

Understanding the psychological basis of hallucinations and delusions can reduce anxiety, as it offers a less frightening explanation for these experiences.

Question 9

How can CBT address delusions in schizophrenia?

Answer 9

CBT can involve challenging delusions so that individuals learn their beliefs may not be based on reality.

Question 10

What is an example of CBT in practice for a paranoid delusion?

Answer 10

In Turkington et al. (2004), a therapist works with a paranoid client who believes the Mafia is observing them. The therapist encourages the client to consider alternative explanations for their fear.

Question 11

In the Turkington et al. (2004) case example, what technique does the therapist use to address the client’s delusion about the Mafia?

Answer 11

The therapist acknowledges the client’s fear but gently questions the evidence, suggesting other possible explanations for the client’s belief.

Question 12

Who is involved in family therapy for schizophrenia?

Answer 12

Family therapy takes place with families rather than individual clients.

Question 13

What is the main aim of family therapy for schizophrenia?

Answer 13

Family therapy aims to improve communication and interaction within the family and to reduce stress that might contribute to a risk of relapse, specifically by lowering levels of expressed emotion (EE).

Question 14

What was the earlier perspective on the role of the family in schizophrenia?

Answer 14

Earlier approaches, such as the double bind theory and the schizophrenogenic mother theory, saw the family as a root cause of the condition.

Question 15

How has the focus of family therapy shifted over time?

Answer 15

Most family therapists now focus on reducing family stress rather than seeing the family as the cause of schizophrenia.

Question 16

According to Fiona Pharoah et al. (2010), what are some strategies family therapists use to help families with a member experiencing schizophrenia?

Answer 16

•Forming a therapeutic alliance with all family members
•Reducing the stress of caring for a relative with schizophrenia
•Improving the family’s ability to anticipate and solve problems
•Reducing anger and guilt in family members
•Helping family members balance caring for the person with schizophrenia with their own lives
•Improving family beliefs and behaviors towards schizophrenia

Question 17

How do the strategies identified by Pharoah et al. (2010) help individuals with schizophrenia?

Answer 17

These strategies reduce stress and expressed emotion, increase compliance with medication, and generally lower the likelihood of relapse and hospital re-admission.

Question 18

What are token economies used for in the treatment of schizophrenia?

Answer 18

Token economies are reward systems used to manage the behavior of people with schizophrenia, especially those who have developed maladaptive behavior patterns from long-term hospitalization (referred to as “institutionalized”).

Question 19

How do token economies help individuals with schizophrenia?

Answer 19

They help modify maladaptive behaviors like poor hygiene or staying in pajamas all day, improving quality of life and increasing the likelihood of living outside a hospital setting.

Question 20

What are tokens in a token economy system?

Answer 20

Tokens are items, such as colored discs, given immediately to patients when they perform a desirable behavior targeted for reinforcement, like getting dressed or making a bed.

Question 21

Why is the immediacy of receiving tokens important in a token economy?

Answer 21

Immediate rewards prevent “delay discounting,” where the effectiveness of a reward decreases when it is delayed.

Question 22

What type of therapy are token economies based on?

Answer 22

Token economies are based on operant conditioning, a type of behavioral therapy.

Question 23

Why are tokens considered secondary reinforcers?

Answer 23

Tokens have no inherent value but gain value as the patient learns they can be exchanged for tangible rewards.

Question 24

What kinds of rewards can tokens be exchanged for in a token economy?

Answer 24

Tokens can be exchanged for material rewards (e.g., sweets, cigarettes, magazines), services (e.g., room cleaning), or privileges (e.g., walks outside the hospital).

Question 25

Evidence for effectiveness:

Answer 25

There is some support for psychological treatments for schizophrenia. Sameer Jauhar et al. (2014) reviewed 34 studies of CBT and concluded it has a significant but small effect on positive and negative symptoms.

Question 26

Effectiveness of family therapy:

Answer 26

Pharoah et al. reviewed family therapy for schizophrenia and found moderate evidence that it reduces hospital readmissions over a year and improves quality of life. However, study inconsistencies and weak evidence quality limit these conclusions.

Question 27

Effectiveness of token economies:

Answer 27

A review by McMonagle and Sultana (2009) on token economies found only three studies with random allocation, involving 110 patients. Only one study showed symptom improvement, and none provided useful behavior change data.

Question 28

Overall effectiveness of psychological treatments:

Answer 28

Psychological treatments provide modest support and help improve quality of life for schizophrenia patients but do not cure the condition, which remains hard to treat.

Question 29

Improving quality of life, not curing:

Answer 29

Psychological treatments aim to make schizophrenia more manageable. CBT helps with symptom understanding, family therapy reduces stress, and token economies encourage socially acceptable behavior, but none cure schizophrenia.

Question 30

Ethical issues in psychological treatments:

Answer 30

Psychological treatments lack serious side effects but raise ethical concerns. Token economies may favor patients with mild symptoms over those with severe symptoms, potentially leading to discrimination.

Question 31

Ethical issues in token economies:

Answer 31

Token economies may be discriminatory, as patients with severe symptoms struggle to comply with desirable behaviors and thus receive fewer privileges. This has led to legal challenges and reduced use in psychiatry.

Question 32

Ethical issues in CBT:

Answer 32

CBT can raise ethical concerns by challenging patients’ thoughts. For example, questioning a patient’s belief in a controlling government could interfere with freedom of thought and stray into modifying personal beliefs.

Question 33

Quality of evidence for psychological treatments:

Answer 33

Small-scale studies often show more positive results than larger reviews, but many lack control groups or random allocation. Reviews with strict study inclusion criteria may seem pessimistic, but uncontrolled studies might be overly optimistic.

Question 34

Alternative psychological therapies:

Answer 34

The National Institute for Health and Clinical Excellence (NICE) recommends art therapy by a qualified art therapist for schizophrenia patients, though it is less widely available than CBT or family therapy.