Psychological Therapies for Schizophrenia

• What are the two psychological therapies for sz?


  CBT and family therapy
• CBT


  5- 20, individual or group sessions.

  
  

  Aims to help patient to understand how their irrational

  cognitions/delusions/hallucinations affect the way they feel and the way they behave.

  
  

  • For example, if a patient hears voices that they believe are the devil, they will naturally be frightened. However, if the therapist can convince them that the voice is due to a malfunctioning in the language part of their brain, it will be much less frightening.
• CBT Normalisation


  Normalisation- teaching people that what they are experiencing is in some way normal e.g., hearing voices is an extension of thinking in words
• CBT: Reality Testing


  Reality testing - hallucinations and delusions can be challenged by examining the likelihood that they are real/true

  
  

  Discussing whether there is evidence for the belief
• Examples of Reality Testing

  Turkington et al (2004) describes an example of CBT used to challenge paranoid delusions:

  
  

  Patient: The mafia are observing me to decide how to kill me

  
  

  Therapist: You are obviously very frightened...there must be good reason for this

  
  

  Patient: Do you think it's the mafia?

  
  

  Therapist: It's a possibility, but there could be other explanations. How do you know it's the mafia?
• Family Therapy


  Family therapy usually takes place within the people's homes and typically two family therapists will work with the relatives and patient.

  • It lasts between 3-12 months with sessions every 2-4 weeks.

  
  

  A minimum of 10 sessions are recommended by NICE- depending on how the family is responding to the treatment

  
  

  • The aim is to reduce the high level of expressed

  emotion within the household
• Why are sessions spaced out?


  -They are spaced out because it is very emotionally tense
• What do the families learn as a result of family therapy


  • Family members learn more constructive ways of communicating and are encouraged to concentrate on any good things that happen rather than negative events

  
  

  E.g., instead of screaming and shouting that sit down and calmly communicate
• What do the families learn as a result of family therapy (2)


  • The relatives and the patient are also told that it is normal to feel angry and impatient towards each

  other but that they need to find ways of coping

  with these feelings without resorting back to high

  expressed emotion patterns of behaviour (which increase relapse.)
• More about family therapy:

  The relatives are made more aware of the information regarding psychosis and the particular diagnosis their relative has been given.

  
  

  The therapist encourages the relatives to ask questions and learn more about the disorder so they can properly understand the difficulties the patient faces.

  
  

  The patient will also be asked to discuss their symptoms with the family as they are the expert in this situation!

  
  

  The goal is also to provide the whole family with practical coping skills which enables them to manage the everyday difficulties arising from having schizophrenia in the family.

  
  

  Lastly, the family and the patient are trained to recognise the early signs of relapse so that they can respond rapidly to reduce the severity of it
• Example:

  If a child's father has Sz by learning how to communicate effectively with each other through family therapy will benefit them significantly and reduce high levels of EE
• Token Economy


  • Used in psychiatric hospitals.

  • Tackles institutionalisation - normalises behaviour in preparation for living in the community.

  • Tokens are awarded for personal care, some condition related behaviours e.g., avolition and social behaviours.

  • Individual programs
• Token economy Sz

  • Physical tokens are given immediately.

  • Makeup, sweets, magazine, movie, walk outside,

  appointment with social worker to prepare for life

  outside of hospital

  - So that they reinforce the likelihood of the desirable behaviour
• A03: Sup Ev CBT

  P- Jauhar (2014) reviewed results of 34 studies of CBT and concluded it has a significant but fairly small effect on positive/negative symptoms.

  
  

  E- This suggests that there is a less than 5% probability that these results are due to chance, which means that there is a more than 95% chance that it is due to CBT

  
  

  E- Furthermore, because it is a meta-analysis it is a large and representative sample

  
  

  L-However, it only has small effects so although it is a beneficial treatment it is not a cure
• A03: Sup Ev Family Therapy


  P- Pharoah (meta-analysis) found

  
  

  E- moderate evidence that family therapy reduced hospital readmission and improves quality of life for patients and family.

  L- This suggests that family therapy is a useful treatment for schizophrenia

  
  

  C- However, they also noted the results of different studies were inconsistent and problems with quality of some studies, which could be due to the engagement of the family with the therapy or the way in which different therapists conduct their therapy they may have different methods

  
  

  L- Overall, the evidence base for family therapy is fairly weak
• A03: Token Economy Sup Ev


  P- McMonagle and Sultana (2009) found only three studies where patients had been randomly allocated to conditions, with a total of

  only 110 patients.

  
  

  E- Only one of the three studies showed improvement in symptom

  
  

  E- Overall, there is only modest support for effectiveness of psychological treatments and sz remains one of the harder mental health problems to treat
• A03: Treatments don't cure


  P- Treatments help make Sz more manageable and improve quality of life:

  
  

  E- • CBT allows patients to make sense of symptoms

  • Family therapy reduces stress for family and patient

  • Token economies make behaviour more socially

  acceptable so patients can reintegrate with society

  
  

  C- However, all of the above (and anti-psychotic

  drugs) fail to cure sz.
• Ethical Issues- Token Economy


  P- Token economy - privileges etc become more

  available to patients with mild symptoms and less

  so for those with severe symptoms that prevent

  them from complying with desirable behaviours

  
  

  E- e.g., appointments with a social worker to prepare for life outside the hospital. This is why it is important to have individually tailored reward programmes

  
  

  E- This means severely ill patients suffer

  discrimination in addition to other symptom
• Ethical Issues- CBT

  • CBT- may involve challenging a persons paranoia, but at what point does this interfere with an individuals freedom of thought?

  • E.g. CBT challenges a patients belief in a highly

  controlling government, this can easily stray into

  modifying their politics

  • Such issues are a weakness of psychological

  treatments