Schizophrenia - Psychological treatments for schizophrenia Flashcards
How is CBT used to treat schizophrenia?
- CBT assumes that schizophrenia is the result of dysfunctional thought processes
- For example: Faulty cognitions such as delusions are identified with CBT and then ultimately changed
- The therapist challenges irrational beliefs, using logic to dispute the reality of the delusions to help work towards an alternative thought process
- Ellis’ ABCDE model is used to identify, challenge and ultimately restructure faulty cognitions (Delusions)
- The therapist may then use a technique called reality testing
What is Ellis’ ABCDE model for CBT?
-Ellis’ ABCDE model is used to understand the source of the faulty cognition and provide a process to cognitively restructure irrational beliefs (Delusions)
-A = Activating event
[Drug treatment causes side effects]
-B = Beliefs
[Hospital staff are trying to kill them]
-C = Consequences
[The patient may refuse to continue with their treatment]
-D = Disputing irrational beliefs (Using logic)
[The staff have no reason to kill them]
-E = Restructured belief (The effect)
[The drugs are necessary and the staff are working in the patients best interests]
What is reality testing?
- The patient demonstrates for themselves that their beliefs are irrational (In a safe in environment)
- For example: If the patient believes that they can predict the future, the therapist might use a deck of cards and ask the patient to predict what card will be drawn
What is a strength of using CBT to treat schizophrenia?
- Sensky et al provided supporting research evidence that showed that patients who had resisted drug treatments, had a reduction in positive and negative symptoms when treated by 19 sessions of CBT
- Also they continued to improve even 9 months after the treatment had ended
- This suggests that CBT can be effective when drugs are not, but also CBT is an improvement on drug therapies as drugs only reduce symptoms in the short term
What is a weakness of CBT?
- A criticism of using CBT to treat schizophrenia is that ending treatment early is common due to the long length of treatment, symptoms may become severe if the patient stops attending the therapy too early
- CBT requires engagement, negative symptoms can lead to an unwillingness to take part and positive symptoms may lead to distrust in the process
What is another weakness of CBT?
- Some patients, due to severity of symptoms or personality may not be able to cope with the vigorous confrontation of beliefs that occurs in CBT
- In this case anti-psychotic medication can be used first to reduce the severity of the symptoms so the CBT can resume
What is a strength of CBT?
- CBT does not cause the side effects seen from drug therapy, this makes it the preferred treatment plan for many patients
- However the significant cost of working with a trained therapist over multiple sessions mean that drug therapy is more common
How can family therapy be used to treat schizophrenia?
- Family therapies attempt to improve the home situation of the person with schizophrenia
- Family therapy aims to change the behaviour of the entire family to make the family less dysfunctional (The therapy is family-centred)
- The family is educated on the symptoms of schizophrenia in order for them to be more understanding of their family members behaviour (This is called psychoeducation)
What are the objectives of family therapy?
- Reducing conflict, by addressing anger within the family
- Reducing stress, caused by caring responsibilities
- Reducing self sacrifice, by getting the carers to consider their own needs
- Improving communication, by considering how to limit expressed emotion
- Improving problem solving skills, by predicting problems and having solutions ready
How does Leff’s study support the use of family therapy to treat schizophrenia?
- Leff provided supporting research looking at the aftercare of patients with schizophrenia
- Of those provided with standard outpatient care, 50% had relapsed within 9 months. Compared to only 8% who received family therapy, however after two years this had risen to 50% with family therapy and 75% with standard outpatient care
- This suggests that the use of family therapy is helpful in reducing re-admission in the short term, however families may not maintain positive patterns of behaviour over the longer term
What is a weakness of family therapy?
- There are problematic practical issues such as the length of the therapy
- Family therapy can often take up to a year
- During this time patients may drop out, especially if they have particularly severe symptoms or if a family incident has occurred
What is another weakness of family therapy?
- Family therapy is about improving symptoms, aiding home life of the family and ultimately avoiding admission to a mental health facility
- However it is not a cure for the disorder, so more manageable symptoms may remain
- Family therapy is about the management of the disorder rather than curing it
How can a token economy system be used to treat the symptoms of schizophrenia?
- Token economies are a behavioural therapy technique based on Skinners operant conditioning theory
- This is learning through reinforcement of desired behaviours
- Tokens are used as a type of positive reinforcement
- They are an immediate reward for when patients show pre defined target behaviours (Such as washing)
- Tokens are then exchanged for something else they want (Activities, chocolate)
- Behavioural shaping is used as behaviours are progressively changed, with tokens first being given out for small changes in behaviour and as time goes on they will only be given out for larger changes towards desired behaviours
- Token economies are not designed to reduce symptoms but instead, to produce easier to manage behaviour within the hospitals/psychiatric institutions or to help patients prepare for transferring into the community so they can cope with daily life challenges
- Token economies should only be used for patients with mild negative symptoms, as patients with more severe symptoms may be less willing or unable to engage
How does Dickerson’s meta analysis support the use of token economies to treat schizophrenia?
-Dickerson reviewed the findings of 13 studies on token economies and found that they can be effective in improving adaptive behaviour of people with schizophrenia
What is a weakness of using token economies to treat schizophrenia?
-Token economies do not directly treat the symptoms of schizophrenia, they only attempt to manage negative symptoms such as poor motivation, attention and social withdrawal
