CBT and family therapy

• Cognitive behavioural therapy works out ways to recognise negative thoughts and test faulty beliefs when they arise, and then challenge and re-think them. Anti - psychotics are usually given first to control positive symptoms. Then CBT for around 12 sessions.
• Helps the client to make sense of how their irrational cognitions affect their feelings and behaviour.

  
  

  Drawings are often used to display the links between thoughts, actions and emotions and help the client by understanding where they come from.

  
  

  For hearing voices, a client can be helped to understand that this may be due to faulty processing in the speech centres of the brain and by ignoring the voice it cannot hurt them. It doesn't eliminate the thought but makes someone feel better able to cope with it and have normal functioning.
• Therapy may also use coping techniques such as the cognitive strategies of distraction, concentrating on a specific task or positive self talk. Behavioural strategies include relaxation techniques or loud music to drown out voices.
• A03 - CBT Supporting Evidence

  • Studies have reported a reduction in both positive and negative symptoms.
  • Tarrier
  • Conducted a review of 20 controlled studies of CBT involving a total of 739 patients.
  • Found evidence of reduced symptoms, in particular, positive ones.
  • Lower relapse rates, and a speedier recovery were found as well.
  • However, these were short term effects so follow up is needed on the long term benefits.
  • OVERALL the research into this area supports the idea that CBT is better if used alongside family therapy and/or drug treatments
• A limitation is that CBT May not be suitable for everyone, especially those too disorientated, agitated or paranoid to form trusting alliances with practitioners.
• CBT alone does not have serious side effects but it is more costly.
• Some critics argue that CBT does not actually rid the patient of hallucinations or delusions, it just makes them seem less of a threat. So rather than treating them, CBT teaches patients strategies on how to manage them.
• Family therapy -

  Involves the schizophrenic patient and other family members. The aim is to improve the quality of communication and interaction between family members. Although there is not a unique approach for family interventions, evidence based family therapies usually include psychoeducation, stress reduction, emotional processing, cognitive reappraisal and structured problem solving. It is commonly used alongside drugs.
• Firstly, all agree on the aims of the therapy and this encourages a therapeutic alliance. Then it involves an education phase where the family members become more aware of how they may be acting in relation to the person's schizophrenia. This can promote empathy, emotional support and working together.

  Therapy also tries to resolve conflicts beterrn family members and reduce stress that may lead to relapse. This may focus on reducing level of expressed emotions such as anger and guilt in family members which lead to stress.
• New skills may be taught to help the patient move forward such as listening, "compromise and negotiation" and "requesting a time out." This is mainly aimed at lowering expressed emotions.
• A03 - Family therapy

  Supporting evidence

  • Pharoah's meta analysis of 53 studies comparing it with drugs.
  • Analysis found mixed results for mental state, increased compliance with medication and no effect on living independently.
  • Overall, the studies suggested that it improves the quality of life for patients and their families.
  • Main benefit - increasing their medication compliance.
• A03- Family Therapy

  Supporting evidence

  • Recent research review that suggested positive benefits to family members looking after an individual with schizophrenia.
  • Found benefits such as coping skills, improved relationships, problem solving and reduced stress which lessened the impact on family members and strengthened the ability of the family to support the person with schizophrenia.
• A03 - Family therapy

  A problem with family therapy compared to anti psychotic medication is that it can take up to 3-12 months which makes it more expensive. However despite this it can be argued that it can ultimately reduce the long term cost to society if individuals are now able to cope and care for a person with schizophrenia placing less burden in the future on healthcare services.