Psychological therapy

• CBT


  Cognitive behavioural Therapy is a method for treating mental disorders based on both cognitive viewpoints the therapy aims to deal with thinking such as challenging negative thoughts and includes behavioural techniques.
• CBT for irrational cognitions 


  Helps a client make sense of their irrational cognitions (delusions and hallucinations) and how they impact thoughts and behaviours. Just understanding where they come from can be hugely helpful with symptoms like auditory hallucinations, making them less frightening. This doesn't eliminate symptoms but helps them to cope with them, reducing distress and improving their ability to function adequately.
• CBT for hearing voices


  People hearing voices may also be helped by teaching them it is an extension of the ordinary experience of thinking in words. This is called Normalisation.
• CBT for challenging delusions

  Delusions can also be challenged by reality testing where the therapist and client explore the likelihood that beliefs are true. In some cases where delusions are resistant to reality testing CBT can still be used to tackle the anxiety and depression that can result from living with schizophrenia.
• Example of CBT in use for Sz 

  Douglas Turkington et al. (2004) used CBT to challenge where a paranoid client's delusions came from.

  The patient thought they were being hunted by the mafia, he challenged this asking why they thought that, how they knew.
• Strength of CBT for Sz


  One Strength of CBT is evidence of its effectiveness. Jauhar et al (2014) reviewed 34 studies using CBT with Schizophrenia concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Other studies have focused on symptoms like Pontillo et al. (2016) found reductions in the frequency and severity of auditory hallucinations. Clinical evidence from NICE (2019) recommends CBT for Sz. This means both research and clinical experience support the benefits of CBT for Sz.
• Limitation of CBT for Sz


  One limitation is the wide range of techniques and symptoms included in studies. CBT techniques and Sz symptoms vary widely in each case. Thomas (2005) points out different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. The overall modest benefits of CBT probably conceal a wide variety of effects of different CBT on different symptoms. This makes it hard to say how effective it will be for an individual.
• How effective is CBT? (Evaluation) 


  CBT may improve quality of life but not actually 'cure' them. Sz appears to be largely biological so CBT is only able to improve their ability to live with the condition.

  On the other hand, studies report significant reductions in the severity of both positive and negative symptoms. This suggests CBT does more than enhance coping.
• Family Therapy


  A psychological therapy carried out with some or all of the family with the aim of improving the communication within the family and reducing the stress of living as a family.
• Burbach's (2018) model for family therapy

  • Phase 1- Sharing basic information and providing emotional and practical support
  • Phase 2- Identifying resources including what members can or can't offer
  • Phase 3- encourages mutual understanding, creating a safe space for family members to express their feelings
  • Phase 4- identifying unhelpful patterns of interaction
  • Phase 5- skills training e.g. learning stress management techniques
  • Phase 6- relapse prevention and planning
  • Phase 7- maintenance for the future

   
• Evidence for Family Therapy


  One strength of Family therapy is evidence for it's effectiveness. A review of studies by McFarlane (2016) concluded family therapy was one of the most consistently effective treatments available for SZ. Relapse rates were found to be reduced typically by 50-60%. He also concluded using family therapy as mental health begins to initially decline is particularly promising. Clinical advice from NICE recommend family therapy for everyone with a diagnosis of Sz. This means family therapy is likely to be a benefit for people with both early and more developed Sz.
• Benefits of family therapy for family members

  A further strength is there are benefits for all the family members. Lobban and Barrowclough (2018) concluded that these effects are important as families provide the bulk of care for people with Sz. By strengthening the function of the whole family, it lessens the negative impact Sz may have on the other family members and strengthens their ability to support the person with Sz. This means that family therapy has a wider benefit beyond the obvious positive effect on the identifies patient.
• Economical benefits of family therapy

  Because family therapy reduces the rate of relapse  and allows families to better provide the bulk of care it has huge economic benefits. The state does not need to pay so much.
• How Family therapy helps


  Fiona Pharoah et al. (2010) identified a range of strategies used by family therapists to try to improve the functioning of a family with a member who has Sz. Key features are reducing negative emotions and improving the family's ability to help.
• How family therapy helps to reduce negative emotions


  Family therapy aims to reduce expressed emotions generally but especially negative emotions like anger and guilt, which cause stress. This is important to reduce the chance of relapse
• How family therapy improves the family's ability to help


  Therapist encourages the family to form a therapeutic alliance where they all agree on the aims of the therapy. The therapist also aims to improve family beliefs about and behaviour toward Sz. They also aim to ensure the family members maintain a balance between caring for the individual with Sz and their own lives.