psychological therapy for schizoprenia

• CBT:

  • 5-20 sessions (this is longer than for other conditions), either in groups or on an individual basis.
  • Aim: helping patients to identify irrational thoughts and trying to challenge them.
  • Method: argument/discussion of how accurate/true the patient’s beliefs are AND a consideration of other less threatening possibilities. 
• CBT:

  • Example: Demonic forces - malfunctioning speech centre
  • People hearing voices can also be helped by teaching them that voice-hearing is an extension of the ordinary experience of thinking in words - this is called normalisation.
  • Delusions can also be challenged by reality testing in which the client and the therapist jointly examine the likelihood that beliefs are true.

  CBT can still be used to tackle the anxiety and depression that result from living with schizophrenia.
• family therapy:

  • Aim: of improving the communications by reducing expressed emotion within the family and reducing the stress of living as a family. 

  Some therapists see the family as the root cause of the condition (family dysfunction explanations), whilst others focus on preventing relapse
• family therapy:

  • Pharoah et al (10) identified a range of strategies
  • Forming a therapeutic alliance with all family where they all agree on the aims of therapy.
  • Reducing the stress of caring for a relative with schizophrenia and improving the ability of the family to anticipate and solve problems.
  • Reduction of anger and guilt in family members and helping family members achieve a balance – caring for the person with schizophrenia vs maintaining  their own life.
  • Improving families’ beliefs about and behaviour towards schizophrenia.
• family therapy:

  • These strategies work by reducing stress and expressed emotion and increasing the patient’s rate of compliance with medication. 

  This combination can result in less relapse and readmission to hospital.
• CBT may improve the quality of life for people with schizophrenia but not actually 'cure' them. As schizophrenia appears to be largely a biological condition we would expect that a psychological therapy like CBT just benefits people by improving their ability to live with schizophrenia.

  On the other hand studies report significant reductions in the severity of both positive and negative symptoms. This suggests that CBT does more than enhance coping.
• -evidence base for CBT. Thomas 2015 lot of variation in the CBT techniques used to treat sz, sz symptoms vary widely between patients, the improvement gained by using CBT is quite small and this finding may conceal a wide variety of effects of different CBT techniques on different symptoms. Each of these variables confound the final result and make the judgement of the effectiveness of CBT very difficult to judge. Future research may concentrate on making more controlled comparisons only compare one aspect of CBT (like psychoeducation) between studies to assess its specific effectiveness.
• Supporting evidence for the effectiveness of CBT in treating sz comes from Jauhar et al. (2014) who conducted a meta analysis. They found a small but statistically significant effect on both positive and negative symptoms. This finding is further replicated by Pontillo et al. (2016) who found CBT lead to reductions in frequency and severity of auditory hallucinations. This clearly demonstrates CBT can have a positive effect on sz symptoms and that this finding is reliable because of its consistency. Although there may be some methodological limitations.
•  Often a problem with meta-analyses is the file-drawer phenomenon, whereby studies who reported no positive effect are left out of the analysis. Paired a small effect size, we might question just how effective CBT is in treating sz symptoms. That said, NICE (2019) still recommends CBT for the treatment of sz, which suggests there is some utility in the treatment.
• effectiveness of FT McFarlane 2016 found FT is the most consistently effective treatments for Sz, with relapse rates reduced by 50-60%. Also finding that using FT early process is particularly effective. Supporting these findings NICE recommends FT for everyone with a diagnosis of Sz. Although positive results, ft not always relevant or possible. As with all psychological treatments, the client need to be willing and motivated to take part. In families with a history of abuse or schism, family members may refuse to take part which weakens the effectiveness
• Family therapy has secondary benefits. Lobban & Barrowclough (2016) argue that FT benefits the whole family as they often take on the bulk of care for the Sz sufferer. FT also strengthens the functioning of the whole family and lessens the negative impact of Sz on other family members and overall strengthens the ability of the family to support the person with Sz. With these benefits clear to see it may be questioned why chemical treatments for sz receive vastly more funding and scientific attention than FT.
• One possible reason for this is a bias we may have for what is known as ‘hard’ and ‘soft’ psychological evidence. Munro and Munro (2015) found that students gave more credence to neurological/biological evidence than psychological evidence because it is seen as more scientific. Another reason may be to do with cost-effectiveness. Chemical treatments are less expensive and appear to be more effective in reducing the symptoms when compared to FT which require trained professionals to administer.