treatment of SZ Flashcards
CBT
Identify and change irrational thoughts - The aims of CBT in general are to help clients identify irrational thoughts (e.g. delusions and hallucinations) and try to change them. 5-20 sessions, individually, or in a group.
CBT helps clients to understand their symptoms - Clients are helped to make sense of how their delusions and hallucinations impact on their feelings and behaviour. For example, a client may hear voices and believe they are demons so they will be very afraid. Normalisation involves explaining to the client that hearing voices is an ordinary experience.
Case example - Turkington et al (2004) treated a paranoid client who believed the mafia were plotting to kill him. The therapist acknowledged the client’s anxiety, and explained that there were other, less frightening possibilities and gently challenged the client’s evidence for his belief in the mafia explanation.
Family Therapy
Reduce negative emotions - Family therapy aims to reduce levels of expressed emotion (EE), especially negative emotions such as anger and guilt which create stress. Reducing stress is important to reduce the likelihood of relapse.
Improve family ability to help - The therapist encourages family members to form a therapeutic alliance whereby they all agree on the aims of therapy. The therapist also tries to improve families’ beliefs about and behaviour towards schizophrenia. A further aim is to ensure that family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.
A model of practice - Burbach’s (2018) model:
Phases 1 and 2 - share information and identify resources family can offer.
Phases 3 and 4 - learn mutual understanding, and look at unhelpful patterns of interaction.
Phases 5,6 and 7 - skills training (e.g. stress management techniques), relapse prevention and maintenance.
A03:One strength of CBT is evidence for its effectiveness.
Jauhar et al (2014) reviewed 34 studies of CBT for schizophrenia, and concluded that there is evidence for significant effects on symptoms. Pontillo et al (2016) found reductions in auditory hallucinations. Clinical advice from NICE (2019) recommends CBT for people with schizophrenia.
This means both research and clinical experience support CBT for schizophrenia.
A03:One limitation is the quality of evidence.
Thomas (2015) points out that different studies have focused on different CBT techniques and people with different symptoms. Overall modest benefits of CBT for schizophrenia may conceal a range of effects of different techniques on different symptoms.
This means that it is hard to say how effective CBT will be for treating a particular person with schizophrenia.
A03:One strength of family therapy is evidence of its effectiveness.
McFarlane (2016) concluded family therapy is effective for schizophrenia. Relapse rates were reduced by 50-60%. Particularly promising during time when mental health initially starts to decline. NICE recommends family therapy.
This means that family therapy is good for people with both early and full blown schizophrenia.
A03:Another strength is the benefits for the whole family.
Therapy is not just for the benefit of identified patients but also for the families that provide bulk of care for people with schizophrenia (Lobban and Barrowclough). Family therapy lessons the negative impact of schizophrenia on the family and strengthens the ability of the family to offer support.
This means family therapy has wider benefits beyond the positive impact on the identified patient.
