Sz: Psychological Therapies

Question 1

What is CBT?

Answer 1

cogntive behavioural therapy
- patients taught to recognise examples of dysfunctional or delusional thinking, then may receive help on how to avoid acting on these thought
- wont rid of the symptoms, but can make patients more able to cope with them
- 5-20 sessions
- involves identifying irrational thoughts and trying to change them
- some strategies include: distractive individual from intrusive thoughts/challenging their meaning (one way to distract is increasing or decreasing their social activity) another approach is to use breathing or other relaxation techniques.

Question 2

What was Tarriers coping strategy enhancement?

Answer 2

1- establish rapport with patient
2- identify personal triggers
3- find ways of dealing with them

Question 3

What are some of Tarriers cognitive strategies?

Answer 3

• distraction
• concentrating on a task
• positive self talk

Question 4

What was some of Tarriers behavioural strategies?

Answer 4

• relaxation (breathing techniques)
• social withdrawal/increasing it
• loud music to drown out voices
• behavioural experiments

Question 5

What’s some examples of triggers and coping?

Answer 5

• certain people (e.g. parent) —> deep breathing during difficult convos, positive self talk
• being alone —> increasing social contact, concentrating on a task (e.g. baking), listening to loud music
• being under stress —> deep breathing, concentrating on a task

Question 6

What what Senskys study on CBT treatment?

Answer 6

• compare CBT with non-specific be-friending interventions for patients with Sz
• randomised controlled design: patients allocated to either CBT group or non-specific befriending group
• 90 patients - had diagnosis that had not responded to medication aged 16-60
• both interventions delivered by 2 experienced nurses who receive regular supervision
• patients assessed by blind rater: at baseline: after treatment (lasting up to 9 months): at nine month follow up evaluation
• assessed on measures including the comprehensive psychiatric rating scale, the scale for assessment of negative symptoms, plus a depression rating scale
• the patients received a mean of 19 individual treatment sessions over 9 months

Question 7

What was the normal routine of CBT for Senskys study?

Answer 7

• initially engaging with patient
• psych education
• developing a reason for behaviour
• cognitive and behavioural interventions
• treatment of other disorders (e.g. depression)
• reducing relapse by planning ahead

Question 8

What were the specific techniques for positive symptoms of Sz used in Senskys study?

Answer 8

• critical analysis of believes about auditory hallucinations
• patients taught coping strategies to deal with the voices
• delusions and thought disorders were also addressed using cogntive strategies

Question 9

What was the befriending condition?

Answer 9

• the patients had the same time allocations at the same intervals as patients in the CBT condition
• the therapists were empathetic and non-directive
• there was no attempt at therapy —> the sessions focussed on hobbies, sport and current affairs

Question 10

What did Sensky find?

Answer 10

• both interventions resulted in significant reductions in positive and negative symptoms and depression
• after treatment, there was no significant difference between the 2 groups
• at the 9 month follow up evaluation, patients who had received CBT showed greater improvements on all measures —> they had improved, while the befriending group had lost some of the benefits

Question 11

What was the conclusions from Senskys study?

Answer 11

• CBT is effective in treating negative as well as positive symptoms in the Sz resistant to standard anti-psychotic drugs.

Question 12

What’s some strengths of CBT?

Answer 12

• effective
• allows people to function normally with symptoms and prevents learned symptoms from developing
• can be used in conjunction to other therapies
• improves symptoms, recovery and relapse rate
• no side effects
• good control and generalisability for Senskys study

Question 13

What’s some problems with CBT?

Answer 13

• culture bias (Senskys study only conducted in the UK)
• Senskys study had a relatively small sample
• not very rational to teach patients to see life through rose coloured glasses
• doesn’t work for everybody
• expensive and time consuming

Question 14

What is family therapy?

Answer 14

A form of therapy carried out with members of the family with the aim of improving their communication and reducing the stress of living as a family

Question 15

What are the aims of family therapy?

Answer 15

—> educate relatives about Sz
—> improve how families communicate/interact
—> teach patients and carers more effective stress management techniques

Question 16

What did Pharaoh identify?

Answer 16

A number of important strategies that can help reduce the levels of stress/expressed emotion and increase chance of patient complying with meds. This combination helps reduce the chance of relapse

Question 17

How is family meetings a strategy and how does it help?

Answer 17

• families taught to have weekly family meetings solving problems on family and individual goals
  —> this works to resolve conflict between members and pinpoint stressors

Question 18

What is an observation strategy and how does it help?

Answer 18

• through interviews and observations, the therapist identifies strengths and weaknesses of family members and identifies problem behaviours
  —> gives the family specific goals to work on and helps them understand what communication strategies are counterproductive. Can focus on what they are doing well and doing more of it.

Question 19

What is the information transfer strategy and how does it help?

Answer 19

• information transfer is teaching the patient and the family actual facts about the illness - causes and effects of stress and guilt
  —> more empathy from family members who might not understand the severity and causes of Sz

Question 20

What is the communication skills training strategy and how does it help?

Answer 20

• teaching families to listen, express emotions and discuss things - ‘compromise and negotiation’ and ‘requesting time out’ are also taught
  —> reduce expressed emotion and means that situations are less likely to escalate, thus reducing stress

Question 21

What is the balance strategy and how does it help?

Answer 21

• helping family members balance caring for relatives with maintaining their own lives
  —> increases overall wellbeing of carer, which will have a knock on effect on the sufferer. Also reduces guilt they feel if they put their own lives first

Question 22

How are token economies used?

Answer 22

Token economies aim to manage Sz rather than treat it.
- they are a form of behavioural therapy, where desirable behaviours are encouraged by the use of selective reinforcement and is based on operant conditioning
- given after, e.g. brushing teeth, engaging a therapy session, etc.
- rewards - primary enforcer - e.g. watching a movie, chocolate, money, etc.

Question 23

What’s some evidence to support Family therapies?

Answer 23

• A study by Anderson et al. (1991) found a relapse rate of almost 40% when patients had drugs only, compared to only 20 % when Family Therapy or Social Skills training were used and the relapse rate was less than 5% when both were used together with the medication.
• Pharaoh - meta – analysis found family interventions help patient understand their illness and live with it, developing emotional strength and coping skills, thus reducing rates of relapse.

Question 24

What are some strengths of family therapies?

Answer 24

• Family therapy can improve people’s quality of life by reducing stress of living in a family with Sz, both for the person who has Sz and their family members. This can help prevent relapse but does not cure the Sz
• highly cost effective as it reduces relapse rates, so patients less likely to take up hospital beds and resources.

Question 25

What are some studies potentially limiting the family therapies theory?

Answer 25

• Pharoah reviewed evidence for effectiveness and concluded there is moderate evidence to show that family therapy reduces hospital readmission a year and improves quality of life. However, also noted that results of different studies were inconsistent and that there were problems with the quality of some evidence.
• Lobban reports that other family members felt they were able to cope better thanks to family therapy. In more extreme cases the patient might be unable to cope with the pressures of having to discuss their ideas and feelings and could become stressed by the therapy, or over-fixated with the details of their illness —> sharing with their family could increase their symptoms.

Question 26

What’s some studies to support token economies?

Answer 26

• Paul and Lentz - Token economy led to better overall patient functioning and less behavioural disturbance; more cost-effective (lower hospital costs) —> individual differences
• Upper and Newton found that the weight gain associated with taking antipsychotics was addressed with token economy regimes. Chronic Szics achieved 3lbs weight loss a week.

Question 27

What are some studies that refute token economies?

Answer 27

• A review of the evidence for token economies (McMonagle and Sultana) found only 3 studies where people with Sz had been randomly allocated to conditions, with a total of only 110 patients. Random allocation is important in controlling extraneous variables. Only one of 3 studies showed improvement in symptoms and none yielded useful information about behaviour change. —> small sample
• Kazdin et al. Found that changes in behaviour
  achieved through token economies do not remain when tokens are withdrawn, suggesting that such treatments address effects of Sz rather than causes. It is not a cure. —> only effective when in use

Question 28

What’s some problems with token economies?

Answer 28

• individual differences - e.g. different places with have different schemes, etc.
• Ethical issues – severely ill patients can’t get privileges because they are less able to comply with desirable behaviours than moderately ill patients – may suffer from discrimination.
  process is seen to be dehumanising, subjecting the patient to a regime which takes away their right to make choices.