non-biological treatment for SZ

• what do the NICE guidelines say about schizophrenia

  for the first episode of SZ, medication is recommended, for the second episode, CBT is recommended and can be with or without family intervention
• how can CBT be used to treat schizophrenia

  • step 1 - changing maladaptive thinking
  • step 2 - identify irrational thoughts
  • step 3 - monitoring thoughts
  • step 4 - cognitive techniques
  • step 5 - homework
• step 1

  CBT aims to help people with SZ by changing the maladaptive thinking and distorted perceptions which underpin the disorder to modify and improve their symptoms (e.g: hallucinations & delusional beliefs)
• step 2

  therapist helps the client identify their irrational thoughts that lead to delusions and challenge them to prove the thoughts using reality - explaining that hallucinations come from irrational thought process can reduce clients anxiety around symptoms
• step 3

  by monitoring thoughts, feelings and actions in relation to symptoms, patients can consider alternative ways of explaining why they feel and behave the way they do - also taught to recognise signs of relapse
• step 4

  cognitive techniques developed between patient and therapist including: distractions from intrusive thoughts, challenging the intrusive thoughts by looking for evidence that disproves thoughts so they can understand they are not based on reality, meditation or muscle relaxation
• step 5

  CBT relies on patient taking an active part - given homework between sessions like keeping a diary of contents of their delusions and later on, homework may be to try out ways of coping learned during therapy
• example of CBT for schizophrenia

  • coping strategy enhancement (CSE)
  • belief modification
• what is coping strategy enhancement

  tarrier (1987) found that SZ can identify triggers for psychotic symptoms and develop coping strategies to reduce their distress (e.g: distractions, positive self talk)
• what does CSE aim to do

  develop and apply effective coping strategies to reduce frequency, intensity and duration of psychotic symptoms - specific coping techniques are practiced within the therapy & given homework to practice strategies and record its success
• what is belief modification

  • involves a process called cognitive challenge where clients are taught to regard their delusions or hallucinations as hypotheses rather than reality
  • learn to challenge initial negative hallucinations
  • (e.g: delusion - i can control anyone, challenge belief - make the person buy 3 chocolates)
• strength

  • evidence to support CBT through meta-analysis by NICE
  • found in randomised control trial based studies of CBT, it was effective in reducing rehospitalisation rates of SZ patients for up to 18 months & reduced time spent in hospital (8.26 days avg) - CBT reduced symptom severity & improved psychosocial functioning at end of treatment and 6 months later
  • shows CBT has value a a treatment for SZ
• strength

  • CBT teaches patients how to process and cope with their symptoms
  • beneficial as it can help patients live independently and not be reliant on drugs (e.g: antipsychotics) which have severe side effects - patient and therapist have to work collaboratively during CBT & helps with co-morbid disorders (e.g: anxiety & depression)
  • CBT may be a better form of treatment than antipsychotics as it requires more input from the patient so feel more in control
• weakness

  • evidence to suggest CBT does not reduce symptoms or prevent relapse
  • mckenna and kingdon (2014) compared CBT with routine treatments like psychotherapy and drug treatments and found CBT was only effective in 2 out of 9 trials
  • CBT may not be as effective as a treatment for SZ as NICE (2014) reports
• weakness

  • CBT requires more effort so an alternative may be taking drugs to treat SZ
  • meltzer (2004) found in a study of 481 SZ patients, antipsychotic drugs were more effective in decreasing positive/negative symptoms of SZ than a control - reported using a severity of illness & scores from a psychiatrist
  • antipsychotics, which require less effort than CBT where patients are exposed to distress are effective in reducing symptoms