Psychological Treatments

• What are the three forms of psychological treatments?

  CBT, family therapy and token economy
• What does CBT stand for?

  Cognitive behavioural therapy
• What does CBT assume about schizophrenia?

  Delusions are the result of dysfunctional thought processes
• How do cognitive behavioural therapists treat schizophrenia?

  Identify faulty cognitions and challenge the irrational beliefs with logic
• What is Ellis's ABCDE model of CBT?

  1. Activating event
  2. Beliefs
  3. Consequences
  4. Disputing irrational beliefs
  5. Effect (restructured belief)
• What is reality testing?

  A process in which the patient can show themselves that their irrational thoughts are not real
• STRENGTHS of CBT

  • CBT is effective- Sensky et al (2000)
  • No side effects
• What was Sensky et al's (2000) study?

  Drug resistant patients had reduced positive and negative symptoms when treated by 19 sessions of CBT. Continued to improve 9 months after treatment ended
• WEAKNESSES of CBT

  • Length of treatment
  • Alternative treatment
  • Expensive
• Why is length of treatment a weakness?

  Patients often end treatment due to symptoms increasing in severity, making it harder to engage with treatment
• What alternative treatments to CBT are there?

  Drugs can reduce the severity of symptoms, severe symptoms can make it difficult for patients to cope with the vigorous confrontation of beliefs
• Why is CBT being expensive a weakness?

  Working with a trained therapist is expensive, and not everyone can afford the amount of sessions needed to see improvements
• What does family therapy aim to achieve?

  Improving the relationship between the family and patient to prevent relapse
• Family centred


  The therapy is intended to change the behaviour of the whole family, not just the person with schizophrenia
• Psychoeducation


  The family is educated on the symptoms of schizophrenia to help them be more understanding of their family member's behaviour
• Reduce conflict


  Addresses anger in the family
• Reduce stress caused by caring responsibilities
• Reduce self-sacrifice by getting carers to consider their own needs
• Improve communication by considering how to limit expressed emotion
• Improve problem solving skills by predicting problems and having solutions ready
• STRENGTHS of family therapy

  • Effective- Leff (1985)
• What did Leff (1985) find?

  Patients in standard outpatient care had a relapse rate of 50% after 9 months and 75% after 2 years

  Patients who had family therapy had a relapse rate of 8% after 9 months and 50% after 2 years
• What does Leff (1985) show?

  Family therapy is useful in short term, however families may not maintain positive patterns of behaviour over the long term
• WEAKNESSES of family therapy

  • Length of treatment
  • Not a cure
• Why is length of treatment a weakness of family therapy?

  It can take up to a year and some patients may drop out if symptoms worsen or a family incident occurs
• Why is family therapy not a cure?

  Family therapy focuses on improving symptoms, adjusting family life and avoiding relapse. Does not focus on eliminating symptoms and so many symptoms remain
• What is token economy based on?

  Operant conditioning
• How does token economy work?

  Rewards pre-defined target behaviours by giving tokens which can be exchanged for something the patient really wants
• What is behaviour shaping?

  Start by rewarding small behaviours but move to reward larger behaviours
• Why is token economy used in psychiatric institutions?

  Can help manage patient's behaviours and help integrate them back into society
• Who is token economy most beneficial for?

  Patients with mild negative symptoms
• STRENGTHS of token economy

  • Effective- Dickerson (2005)
• What did Dickerson (2005) find?

  Token economies improve the adaptive behaviours of patients
• How many studies did Dickerson (2005) review?

  13
• WEAKNESSES of token economy

  • Limited value
  • Not effective with severe symptoms
  • Ethical issues
• Why does token economy have limited value?

  It does not treat symptoms, only addresses motivation
• Why is token economy not effective with severe symptoms?

  Those who have strong negative symptoms cannot respond as well with token economy, it is unethical to give those with more severe symptoms less treatment as it can be seen as punishment for illness
• Why can token economy be seen as unethical?

  Manipulates patients into behaving a certain way, treats them like lab rats