Psychological therapy for schizophrenia

• Cognitive behaviour therapy (CBT)

  = Based on both cognitive and behavioural techniques.

  • Aims to deal with thinking such as challenging negative thoughts.
  • Deals with thoughts and behaviour
• Can help make sense of how irrational cognitions (hallucinations, delusions) impact on their feelings and behaviour.

  • Understand where symptoms come from.
  • Eg: auditory hallucinations, therapist can convince them the voices actually come from the malfunctioning speech centre in their own brain, it cant hurt them, this is less frightening and debilitating. This wont eliminate the symptoms of schizophrenia but can help them cope. This reduces their distress and improves their ability to function adequately.
• Can also help by teaching them that voice hearing is an extension of the ordinary experience of thinking in words= normalisation.
• Delusions can be challenged by reality testing in which the person with schizophrenia and the therapist jointly examine the likelihood that beliefs are true.

  • Can also be used to tackle the anxiety and depression that result from living with schizophrenia.
• Evaluation- CBT, evidence of effectiveness

  • Jauhar concluded that using CBT there is clear evidence for small but significant effects on both positive and negative symptoms.
  • Pontillo found reductions in frequency and severity of auditory hallucinations.
  • Clinical evidence from NICE recommends CBT for schizophrenia.
  • Both research and clinical experience support the benefits of CBT for schizophrenia
• Evaluation- quality of evidence

  Limitation= wide range of techniques and symptoms included in studies.

  • CBT techniques and schizophrenia symptoms vary from one to another.
  • Thomas points out that different studies have involved the use of CBT techniques and people with different combinations of positive and negative symptoms.
  • The overall benefits may conceal a variety of effects of different CBT techniques on different symptoms.
  • Hard to say hoe effective CBT will be for a particular person with schizophrenia.
• Family therapy

  = Aims to improve the quality of communication and interaction between family members.

  • In helping with psychological theories like double bind and schizophrenic mother.
• • Pharoah identified a range of strategies that family therapists use to try to improve the functioning of a family with a schizophrenic member.
• Reduces negative emotions

  = Reduced levels of expressed emotion. This will reduce stress which is important to reduce the likelihood of relapse.
• Improves the families ability to help

  = Encourage family members to form a therapeutic alliance whereby they all agree on the aims of therapy.

  Try to improve families beliefs about and behaviour towards schizophrenia.

  Ensure family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives.
• Model of practice

  Burbach proposed a model or working with families dealing with schizophrenia.

  1. Sharing basic information and providing emotional and practical support.
  2. Identifying resources including what different family members can offer.
  3. Aims to encourage mutual understanding, creating a safe space for all family members to express their feelings.
  4. Identifying unhelpful patterns of interaction.
  5. Skill training- learning stress management techniques.
  6. Relapse prevention planning.
  7. Maintenance for the future.
• Evaluation- evidence of effectiveness, family therapy

  • McFarlance concluded that family therapy was one of the most consistently effective treatments available for schizophrenia.
  • Relapse rates reduced by 50-60%
  • Using family therapy as mental health initially starts to decline is promising.
  • Clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia.
  • So family therapy is likely to benefit people with both early and long term schizophrenia.
• Evaluation- benefits to whole family

  • Therapy is also a benefit for the families that provide care.
  • Lobban and Barrowclough concluded that these effects are important because families provide bulk care for people with schizophrenia.
  • By strengthening the functioning of a whole family, family therapy lessens the negative of schizophrenia on other family members and strengthens the ability of the family to support the person with schizophrenia.
  • So family therapy has wider benefits beyond the positive impact on the identified patient.