Treatment: Flashcards
Cognitive behaviour therapy and family therapy as used in the treatment of schizophrenia. Token economies as used in the management of schizophrenia.
what are psychological treatments of SZ?
CBT and family therapy
explain how CBT is used to treat SZ
assumes SZ is the result of dysfunctional thought processes e.g. faulty cognitions such as delusions are identified with CBT and changed
therapist challenges irrational beliefs by logically disputing the reality of the delusions and helping to develop alternatives
Ellis’ ABCDE model is used to understand the source of the faulty cognition and provide a process to cognitively restructure irrational beliefs (delusions)
use the ABCDE model to explain how CBT works in restructuring delusions
A = activating event: drug therapy causes side effects
B = beliefs: hospital staff are trying to kill them
C = consequences: refuses treatment
D = dispute irrational beliefs: staff has no reason to kill them
E = effect: drugs are necessary
explain reality testing
it is a process in which the patient can demonstrate for themselves that their irrational thoughts (hallucinations and delusions) are not real (symptom targeting)
e.g. if the patient believes they can see into the future then the therapist may ask them to predict cards drawn from a deck
evaluations of CBT as treatment for SZ
+ Sensky et al showed that patients who resisted drug treatment had a reduction in positive and negative symptoms when treated by 19 sessions of CBT and continued to improve after treatment ended - suggests CBT is effective when drugs are not and can improve symptoms long-term unlike drugs which are short-term
- ending treatment early may lead to symptoms becoming severe as CBT requires engagement but negative symptoms may lead to an unwillingness to take part or positive leading to distrust of the process
- some patients may not be able to cope with the vigorous confrontation of beliefs that CBT require so anti-psychotics may be first used to reduce severity of symptoms
+- cost-benefit analysis - no side effects but has a cost to the NHS as it requires trained therapist over a long period of time
explain how family therapy can be used to treat SZ
assumes SZ is result of family dysfunction as it can increase the risk of relapse
family therapy attempts to improve the home situation of the person with SZ
family centred - intends to change behaviour of entire family
psychoeducation - family educated on symptoms of SZ in order to be more understanding
explain how family therapy works at tackling family dysfunction
reduces conflict: addresses anger within family
reduces stress: may be caused by caring responsibility or blame
reduce self-sacrifice: gets carer to consider their own needs
improves communication: considers how to limit expressed emotion
improves problem solving skills: predicts problems and works on solutions
evaluations of family therapy as treatment for SZ
+ Leff looked at the aftercare of patients with SZ - 50% of patients with standard outpatient care relapsed within 9 months compared to 8% of patients who received family therapy - suggests use of family therapy is helpful in reducing re-admission in short term
- however after 2 years: 75% with standard care and 50% with family therapy had relapsed - suggests family therapy may not be suitable long term as families may not maintain positive patterns of behaviour for long
- practical issues - often takes a year - patients may drop out - not effective
- family therapy cannot cure SZ or get rid of symptoms but only makes it more manageable by aiding the homelife
how can schizophrenia be managed?
token economy
what are token economies?
a behavioural therapy technique based on Skinner’s operant conditioning - learning through reinforcement of desired behaviour
what are tokens and how do they work?
used as type of positive reinforcement
it is an immediate reward for when a patient shows pre-defined target behaviour e.g. washing
tokens are then exchanged for something else they want e.g. chocolate
how and why does token economies work?
behaviour shaping: behaviour are progressively changed with tokens given for small changes in behaviour towards the ideal
psychiatric institutions: treatment is designed to produce easier to manage behaviour within the hospital or to prepare long stay patients for transfer into the community
mild negative symptoms: treatment can be used for patients with mild symptoms but more ill patients may be less willing to engage
evaluate token economies in managing SZ
+ Dickerson found when reviewing 13 studies into token economies that token economies can be effective in improving the adaptive behaviour of people with SZ
- token economies do not directly treat symptoms of SZ but attempt to manage negative symptoms such as poor motivation, poor attention and social withdrawal
- not effective with unresponsive patients or those with severe negative symptoms - may be seen as punishment for illness
- ethically problematic - may be seen as degrading for patients as it is effectively manipulating them like rats
