SZ - non-bio treatment Flashcards
what is the non-biological treatment for schizophrenia?
(psychological)
CBT (cognitive behavioural therapy)
how does CBT work in SZ?
behavioural experiments
Behavioural experiments are where delusions and hallucinations may be combatted by verbally challenging the client’s perceived reality
Evidence collected in the experiments can then be discussed and used to debunk mistaken beliefs. This should help the individual to differentiate between the ‘confirmed reality’ and the ‘perceived reality’
behavioural activation
Behavioural activation ensures that motiviational deficits are reduced by rewarding positive behaviours, such as becoming more socially active and explainding the range of pleasurable activities that the person is involved in
cbt - evidence it is effective
evaluation (SZ)
P - Evidence CBT is effective
E - NICE (2014) conducted a meta-analysis and found:
* Reduced rehospitalization rates for up to 18 months
* Reduced time spent in hospital (8.26 days on average)
* Reduced symptoms severity and improved psychosocial functioning (ability to perform activities of daily living, have relationships and engage in the community) up to 12 months later
T = valid treatment
cbt - evidence it isn’t effective
evaluation (SZ)
P - Evidence CBT isn’t effective as it may not work for everyone
E - Mckenna & Kingdon (2014) compared CBT with drug therapy. Found CBT was only better in 2 out of 9 studies.
T - less valid
cbt - less ethical issues
evaluation (SZ)
P -Less ethical issues (side effects) than drug therapy
E- No unpleasant physiological side effects
Social control is not an issue - patient is not being controlled through chemicals to make them easier to manage, they are learning a new skill set through collaboration with the therapist which they can use independently throughout the rest of their life. It is an empowering way to reduce and control symptoms, with long term benefits, whereas drug therapy relies on medication to feel better, a short-term solution.
T - greater compliance/ = effective
cbt - still some ethical issues
evaluation (SZ)
P - Some ethical issues
E - CBT can be distressing for the individual as they have to challenge delusions and hallucinations.
They must question their own beliefs and their own sanity, which can be distressing if you realise you aren’t in touch with reality.
The clinician must handle this gradually and sensitively.
T - use with caution
cbt - effective for drug resistant people with SZ:
evaluation (SZ)
P - Effective for drug resistant people with SZ:
E - Kuipers (1997) found that drug resistant clients improved when given CBT which targeted their delusions and hallucinations, so it is a good alternative if drugs don’t work.
T = useful/effective
cbt - more time consuming than drug therapy
evaluation (SZ)
P - More time consuming than drug therapy:
- CBT involves 5 to 20 weekly sessions which last 30-60 mins
- Relies on commitment from the individual with SZ. This may be difficult if they relapse into a severe episode or are struggling with negative symptoms (lack of energy, motivation, engagement).
T - Drug therapy can take a few weeks to work, therefore CBT can take longer to work and involves more time.
cbt - holistic
evaluation (SZ)
P - Holistic because it focuses on the whole individual and can be used in combination with drugs
E- In order for treatment to be successful the individual must be treated as a whole. They may need to take medication in order to stabilise enough to engage with CBT and their personal experiences of symptoms such as delusions and hallucinations (how many voices, their gender, what they say etc) must be recognised by the clinician in order for the treatment to be effective, generic treatment would not work.
Because the patient’s experiences are treated individually the CBT can be tailored to their specific needs.
T = useful/effective
cbt - relies on therapeutic relationship to be built
evaluation (SZ)
P - Relies on a therapeutic relationship to be built to be effective:
E - Therapeutic relationship is very important, the therapist must be trusted, non-threatening and supportive.
Collaboration between the therapist and patient to discuss the subjective experience of symptoms, specific problems are targeted and focused on rationally.
Therapist helps to motivate the patient.
If this is not established or the patient finds it difficult to communicate then CBT won’t be effective.
T = may not work for all
