Psychological Therapy

• Psychological therapy for schizophrenia includes CBT and Family Therapy
• Cognitive Behaviour Therapy aims to deal with thinking by challenging negative thoughts and introducing behavioural techniques
• CBT usually takes between 5-20 sessions for treating schizophrenia (more than for usual treatment)
• CBT takes place either in groups or individually
• CBT treatments include understanding irrational cognitions (e.g. delusions), normalisation, and treating anxiety & depression resulting from the disorder
• Normalisation is teaching that voice-hearing is an extension of the ordinary experience of thinking in words
• CBT doesn't eliminate symptoms but helps the patients to cope with them
• There is evidence for the effectiveness of CBT e.g. Jauhuar et.al., Pontillo et.al., NICE
• Jauhuar et.al. reviewed 34 cases and found evidence for small but significant effects on positive & negative symptoms of schizophrenia
• Pontillo et.al. found reduction in frequency & severity of auditory hallucinations
• NICE provides clinical advice recommending CBT for people with schizophrenia
• There is limitations with CBT e.g. quality of evidence
• Neil Thomas suggests that CBT techniques and schizophrenia symptoms vary widely between each case so is hard to identify how effective the treatment will be for a particular patient
• Family Therapy is carried out with some or all members of the patient's family with the aim of improving communications and reducing stress of living
• The Identified Patient is the member of the dysfunctional family who expresses the family's conflicts
• Family Therapy treatments include reducing negative emotions by lowering levels of expressed emotion, and improving the family's ability to help
• Reducing negative emotions e.g. anger & guilt helps to reduce stress for both the patient and their family
• Improving the family's ability to help involves forming a therapeutic alliance, improving beliefs and attitudes towards schizophrenia, and achieving a balance between care and independence
• Frank Burbach devised a model for working with families that develops through progressively deeper levels e.g. identifying resources, skills training, future maintenance
• There is evidence for the effectiveness of family therapy e.g. McFarlane, NICE
• McFarlane identified family therapy as one of the most consistently effective treatments with reduced relapse rates of 50-60%
• NICE provides clinical advice recommending family therapy for everyone with a diagnosis
• Family Therapy provides benefits for the whole family as it lessens the impact on family members and strengthens their ability to support
• Family Therapy has economic benefits as it reduces relapse rates so the state does not have to continue to pay for treatment