SZ- Psychological Therapies

Question 1

What are the three main psychological therapies?

Answer 1

1) Cognitive Behavioural Therapy
2) Family Therapy
3) Token Economies

Question 2

What does CBTp stand for?

Answer 2

Cognitive Behavioural Therapy for Psychosis

Question 3

How does CBT work to treat schizophrenia?

Answer 3

• The basic assumption of CBT is that people often have distorted beliefs which influence their behaviour in maladaptive ways.
• In CBT, schizophrenia patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how the symptoms might have developed.
• They are also encouraged to evaluate the content of their delusions or of any internal voices they hear and to consider ways in which they might test the validity of their faulty beliefs.

Question 4

What phases are used in CBTp?

Answer 4

1) Assessment
2) Engagement
3) ABC model
4) Normalisation
5) Critical collaborative analysis
6) Developing alternative explanations

Question 5

What occurs in the assessment phase?

Answer 5

• Patient expresses thoughts to therapist

- Realistic goals for therapy discussed

Question 6

What occurs in the engagement phase?

Answer 6

• Therapist empathizes with patients perspective and feelings of distress
• Explanations for their distress can be developed together

Question 7

What occurs in the ABC model phase?

Answer 7

• The patient gives their explanation of the activating events that appear to cause the emotional and behavioural consequences.
• The patients thoughts are rationalised

Question 8

What occurs in the critical collaboration analysis phase?

Answer 8

• Therapist uses gentle questioning to help patient understand illogical deductions and conclusions.
• Therapists may use logical (does it make sense?), empirical (where is the evidence?) and pragmatic (how is the belief helpful?) disputing techniques

Question 9

What occurs in the developing alternative explanations phase?

Answer 9

• Patient develops their own alternative explanations for their previously unhealthy assumptions.

Question 10

Evaluate CBT in treating schizophrenia. (STRENGTHS)

Answer 10

1) CBTp TENDS TO BE MORE EFFECTIVE IN TREATING SZ COMPARED TO ANTIPSYCHOTIC MEDICATION ALONE
- The NICE review of treatments for SZ found consistent evidence that when compared to standard care (antipsychotic drugs) , CBTp was effective in reducing rehospitalisation rates up to 18 months following end of treatment.
- CBTp was also effective in reducing severity of symptoms and improvements in social functioning.

2) META-ANALYSIS RESEARCH SUPPORT
- Jauhar et al (2014) found in a meta-analysis of 34 studies that CBT had an effect on positive and negative symptoms. This effect was significant, but quite small.
- This is therefore moderate support for the effectiveness of CBT in treating schizophrenia.

Question 11

Evaluate CBT in treating schizophrenia. (LIMITATIONS)

Answer 11

1) CBT may involve challenging the validity of beliefs, which may interfere with freedom of thought.
- For example, trying to persuade an individual that the government is not watching or monitoring them in any way may interfere with their (possibly justifiable) fear of an over-controlling government.
- Therefore, CBT has potential ethical issues

2) Just challenging the dysfunctional thoughts through disputing may not be enough to change them if the thoughts have a biological basis.
- CBT is rarely used without drug therapy, suggesting it is not enough on its own to treat schizophrenia.

Question 12

What is the aim of family therapy?

Answer 12

• Family therapy is based on the theory that schizophrenia is associated with schizophrenogenic mothers, double bind communication, expressed emotion, or other dysfunction in the family.
• The aim in modern forms of this therapy is to reduce the stress in the family environment so preventing relapse.

Question 13

What techniques should family therapy use according to Pharoah et al?

Answer 13

• Enhance relatives ability to anticipate and solve problems
• Reduces expressions of anger and guilt by family members
• Helps the person and carers understand and be better able to deal with the illness

Question 14

Describe Pharoah et al’s study.

Answer 14

• Pharoah reviewed 53 studies to investigate the effectiveness of family intervention.
• The studies compared outcomes from family therapy to standard care (antipsychotic medication alone)
• The researchers concentrated on studies that were randomised controlled trials.

Question 15

What were the findings of Pharoah et als study?

Answer 15

• Increase in patients compliance with medication

- Reduction in relapse and reduction in hospital admission during treatment and in the 24 months after

Question 16

Evaluate family therapy in treating schizophrenia.

Answer 16

1) RESEARCH SUPPORT
Pharoah et al (2010) found that there is moderate evidence to show that family therapy reduces relapse rates and hospital readmissions in schizophrenia patients, as well as increasing patient compliance with medication but there were variances in the quality of research studies used. Therefore, there is (weak) research support for family therapy.

2) IT HAS LIMITED USE
- Family therapies may improve the quality of life for schizophrenia patients and their families, but do not provide a cure for schizophrenia, rather a management of the effects.
- This means it cannot be used to treat schizophrenia by itself.
- Family therapy is based on the premise that nurture (upbringing) is a significant factor in schizophrenia.
- The biological basis for schizophrenia is therefore not addressed at all in the therapy, limiting its use.

3) PROBLEMATIC PRACTICAL ISSUES :
Length process, there may be family incidents or its hard to schedule everyone time in the family due to busy lifestyle, leading to high drop out rates, requires a lot of commitment and time and effort from each member of family. Some patients may not have family. Has limited use, may not be suitable to whole population.

4) FURTHER RESEARCH SUPPORT : Leff (1985) looked at aftercare of patients with SZ, 50% of patients with standard outpatient care has relapsed within 9 months compared to 8% who received family therapy. However after 2 years, this raised to 50% with family therapy and 75% with outpatients. This suggests family therapy is helpful in reducing re-admission in short term, however families may fail to maintain positive behaviour patterns for long term.

Question 17

What is token economy?

Answer 17

-Token economy is a behavioural treatment for schizophrenia, based on operant conditioning (learning through reinforcement). In a token economy, tokens are given to reward people in psychiatric institutions for performing socially desirable behaviours, the aim being to encourage self-care.

Question 18

How is token economy used in psychiatric institutions?

Answer 18

• In a token economy, tokens are given to reward people in psychiatric institutions for performing socially desirable behaviours, the aim being to encourage self-care.
• It is common for patients who are institutionalised to develop bad hygiene or remain in pyjamas all day long.

Question 19

What type of reinforcers are tokens?

Answer 19

Tokens are secondary reinforcers, which are exchanged for rewards (primary reinforcers), for example food, being allowed to watch a film, and so on.

Question 20

Evaluate token economy in treating schizophrenia. (LIMITATIONS)

Answer 20

1) WEAK EVIDENCE TO SUPPORT IT
- McMonagle and Sultana (2009) found in a meta-analysis of 110 studies, where only 3 had used random allocation (so only these 3 have true comparison was available with an experimental and control group). Only 1 study showed improvement in symptoms and behavioural change in patients. Therefore, the evidence supporting token economies is very weak.

2) TOKEN ECONOMIES RAISE ETHICAL ISSUES
- The patients with the most severe symptoms are unable to access the tokens, as they are unable to perform the desirable behaviours.
- They are effectively discriminated against (in this case, denied rewards) for being more severely ill.
- The legality of this has been challenged, and the use of token economies has declined as a result.

3) LIMITED USEFULNESS
- Token economies are only likely to work in a clinical setting, where patients can be constantly monitored and the system of rewards is closely controlled. This limits the usefulness of token economies in treating schizophrenia.