Psychological treatments

• What is CBT?

  • A method which uses both cognitive and behavioural techniques.
  • Deals with thinking such as challenging negative thoughts.
  • Individuals or in groups
• What is the aim of CBT?

  Aim is to identify irrational thoughts and try to change them.
• How does CBT work?

  • The therapists role is to challenge irrational beliefs, this can be through empirical disputing or logical disputing.
  • Done in a delicate way through the use of discussion about how likely a patients beliefs are and what more rational alternative explanations might exist.
  • The therapist will help the client identify the activating event, explaining beliefs, recognise consequences, disputing irrational beliefs and restructuring beliefs.
• Why does CBT work for schizophrenia?

  • It helps patients to understand their symptoms and the impact this has on how they feel/behave.
  • Discussing these symptoms e.g hallucinations and exploring more rational alternatives reduces anxiety and fear,
  • The irrational beliefs are ‘cured’ because the patient realises the belief is not based off of reality.
• How might CBT have helped Brown’s delusions?

  • CBT could be used to help Brown understand that there are other reasons for her frightening experience of external control.
  • CBT would also allow the beliefs to be challenged.
  • The therapist might for example ask her to consider whether the experience might be due to the SZ rather than the real attempts to control her.
• Research support for the effectiveness of CBT?

  • Jauher et al reviewed 34 studies of using CBT with SZ, concluding that there is clear evidence for significant effects on both positive and negative symptoms.
  • Pontillo found reductions in the frequency and severity of auditory hallucinations.
  • CLinical evidence from NICE recommends CBT for SZ.
  • Therefore this shows that both research and clinical experience support the benefits of CBT making it an effective and valid treatment.
• What practical implications are involved in using CBT?

  • For CBT to be effective the necessity for self-awareness can be a considerable challenge for people experiencing SZ as they are disconnected from reality.
  • Additionally, engaging in vigorous confrontation may heighten feelings of threat and challenge, potentially escalating distress rather than aiding the therapeutic progress.
  • This suggests that it may be difficult to developer CBT when patients are experiencing extreme symptoms like hallucinations or delusions.
• Why does CBT not cure SZ?

  • SZ does appear to be a largely biological condition, therefore it may require treatments to cure it. CBT may enhance the ability of an individual to ignore auditory hallucinations and so experience less anxiety, but this is not the same as eliminating those symptoms.
  • It may be that drugs are needed to target neurotransmitters like dopamine alongside CBT for treatment to be effective.
  • May not be an effective method to treatment SZ alone.
• What is family therapy?

  • Carried out with all or some members of the family with the aim of improving communication and interaction within the family.
  • Therapist aims to reduce stressors (expressed emotion) from within the family which could lead to relapse to hospital and increases compliance with medication.
• How does family therapy work?

  • Pharoah et al
  • Reduces negative emotions: Reading the level of negative emotions like anger which creates stress. Reducing stress reduces the likelihood of relapse.
  • Improves families ability to help: Therapist encourages family members to form a therapeutic alliances whereby they all agrees on the aims of therapy. Therapist aims for family members to achieve a balance between caring for the individual and maintaining their own lives.
• Burbach method for family therapy

  • Starts with basic level of information sharing and moving to deeper levels
  • Identifying what resources family members can and cannot offer,
  • Encourage mutual understanding and safe environment for family members to express feelings.
  • Identifying unhelpful patterns of interactions
  • Skills training such as stress management techniques
  • Relapse prevention
  • Maintenance of healthy patterns for future
• Research support for family therapy

  • McFarlane concluded that family therapy is one of the most consistently effective treatments available for SZ.
  • McFarlane also concluded that using family therapy as mental health initially starts to decline is promising. Clinical advice for NICE recommends family therapy for everyone with a diagnosis of SZ.
  • Family therapy is effective in reducing symptoms of SZ. More beneficial for people with early SZ.
• How does family therapy benefit the whole therapy?

  • Research by Lobban and Barrowclough emphasised the significance of these effects considering that families predominantly provide care for the individual with SZ>
  • Strengthening the families overall functioning through therapy lessens the adverse impact of SZ on other members and strengthens the ability of the family to support the person with SZ.
  • Family therapy has wider benefits beyond the positive impact on the identified patients.
• What negative consequences can family therapy have on the family?

  • McFarlane highlights that participation in a family program places a series of demands on caregivers, including requirements for transportation, financial resources, time, motivation and energy.
  • These demand can significantly augment the existing stress within the family dynamic. Stigma associated with therapy may lead to relatives to discontinue their involvement.
  • These challenges including increased stress, stigma-related withdrawal and potential feelings of blame can undermine the effectiveness.