Psychological therapy

Cards (15)

  • Cognitive behaviour therapy (CBT) = a method for treating mental disorders based on both cognitive and behavioural techniques.
  • CBT can help a client make sense of how their irrational cognitions impact on their feelings and behaviour.
  • CBT:
    Just understanding where symptoms come from can be hugely helpful for those with symptoms like auditory hallucinations. If a client hears voices and believes the voices represent demonic forces, they will naturally be very afraid. If a therapist can convince them that the voice actually comes from the malfunctioning speech centre in their own brain and that it cannot hurt them if they ignore it, this is much less frightening and debilitating. This will not eliminate any symptoms but make them easier to cope with. This reduces their distressed improves their ability to function adequately
  • CBT:
    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.
  • CBT:
    Delusions can also be challenged by a process of reality testing in which the person with schizophrenia and their therapist jointly examine the likelihood that beliefs are true. In some cases where delusions are resistant to reality testing CBT can still be used to tackle the anxiety and depression that result from living with schizophrenia.
  • Family therapy = a psychological therapy carried out with all or some members of a family with the aim of improving the communications within the family and reducing the stress of living as a family
  • Pharoah et al. identified a range of strategies that family therapists use to try to improve the functioning of a family that has a member with schizophrenia.
  • Family therapy aims to reduce negative emotions. It aims to reduce levels of expressed emotion (especially negative emotions such as anger and guilt which create stress). Reducing stress is important to reduce the likelihood of relapse.
  • Family therapy aims to improve the family's 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 family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.
  • Burbach has proposed a model for working with families dealing with schizophrenia.
  • Burbach:
    Phase 1 is sharing basic information and providing emotional and practical support. Phase 2 involves identifying resources including what different family members can and cannot offer. Phase 3 aims to encourage mutual understanding creating a safe space for all family members to express their feelings. Phase 4 involves identifying unhelpful patterns of interaction. Phase 5 is about skills training such as learning stress management techniques. Phase 6 looks at relapse prevention planning and Phase 7 is maintenance for the future.
  • There is evidence for the effectiveness of CBT. Jauhar et al. reviewed 34 studies of using CBT with schizophrenia, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Other studies have focused on symptoms, Portillo et al. found reductions in frequency and severity of auditory hallucinations. Clinical advice from NICE (National Institute for Health and Care Excellence) recommends CBT fro schizophrenia. This means both research and clinical experience support the benefits of CBT for schizophrenia.
  • However, CBT techniques and schizophrenia symptoms vary widely from one case to another. Thomas points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. The overall modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms. This makes it hard to say how effective CBT will be for a particular person with schizophrenia.
  • There is evidence for the effectiveness of family therapy. A review of studies by McFarlane found that family therapy was one of the most consistently effective treatments for schizophrenia. In particular relapse rates were found to be reduced, typically by 50-60%. McFarlane also concluded that using family therapy as mental health initially starts to decline is particularly promising. Clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia. This means family therapy is likely to be of benefit to people with both early and 'full-blown' schizophrenia.
  • However, therapy is not just for the benefit of the patient but also for the families that provide the bulk of care. A review of evidence by Lobban and Barrowclough concluded that these effects are important because families provide the bulk of care for people with schizophrenia. By strengthening the functioning of a whole family, family therapy lessens the negative impact of schizophrenia on other family members and strengthens the ability of the family to support the person. This means family therapy has wider benefits beyond the obvious positive impact on the identified patient.