psychological treatments

• Family therapy:

  • Aims to improve the quality of communication and interaction between family members - reduced expressed emotion 
• • Pharoah et al - identified strategies that family therapists can use to try and improve the functioning of a family that includes someone with schizophrenia in open discussions
  • Reduce negative emotions - focus on reducing emotions that create stress like guilt or anger - important in reducing relapse rate
  • Improve family's ability to help - encourage family to form a therapeutic alliance whereby they agree to the aims of therapy - improve beliefs about schizophrenia - help in managing the balance for families between caring and maintaining their own lives 
• Things that family therapy must involve:

  • Education - learning about schizophrenia, what to expect and how to manage it 
  • Problem solving - working together to find solutions to practical problems
  • Crisis management - planning how to respond to difficult situations 
  • Emotional processing - helping people regulate their emotions and process them 
  • Communication - improving communication patterns and promoting empathy 
• Burbach (2018):

  1. Share basic information and provide emotional and practical support
  2. Identify resources - including what each family member can and cannot provide - boundaries
  3. Encourage mutual understanding - creating a safe space for all family members to express their feelings 
  4. Identify unhelpful patterns of interaction 
  5. Train skills such as learning stress management techniques 
  6. Plan how to prevent relapse 
  7. Maintain positive progress for future 
• Supportive evidence:

  • Pharoah - multi cultural meta-analysis - varied results on improving mental states - family therapy increases compliance with drug therapy - no change in social functioning (getting a job, living alone etc), reduction in relapse and re-admission. BUT… raters of each therapy were aware of which treatments patients were receiving, creates bias
• strengths -

  Comparison:

  • No physical side effects unlike drug therapy 

  Ecological validity:

  • NICE states that family therapy is associated with significant cost savings when paired with standard care - offsets the reduction in hospitalisation and relapse 
• Opposing evidence:

  • Claxton - relapse reduction diminishes after 6 months - relapse is reduced but only for 6 months roughly 
  • Family therapy is a large commitment - can be a lengthy process =, potentially taking longer than a year - this increases risk of dropout. 
• supportive evidence-

  • McFarlane - meta-analysis found family therapy one of the most consistently effective treatments - relapse rates reduced by 50-60% - beneficial to initial schizophrenia development, prevents a full blown schizophrenic episode