Psychological Therapies

• aim and backgroundof CBT

  psychological therapy that aims to identify, challenge and replace irrational thinking and equip individuals with coping strategies, usually over several weeks or months and can be individual or group
• engagement/empathy(CBT)

  builds a rapport and reduces feelings of alienation
• critical collaborative analysis (CBT)

  joint questioning and disputing of unhealthy beliefs on empirical, logical and pragmatic grounds
• developing alternative explanation (CBT)

  for unhealthy beliefs to allow the individuals to see that their beliefs may be untrue
• teaching of coping strategies (CBT)

  positive self talk and self-distraction to counter delusional thinking or drown out auditory hallucinations
• aim and background of family therapy

  • takes place with families rather than individual clients aiming to improve the quality of communication and interaction between family members
  • some therapists see the family as the root cause of the condition
  • however, most family therapists now are more concerned with reducing stress within the family that might contribute to a person's risk of relapse
  • it aims to reduce levels or expressed emotion
• alliance forming (family therapy)

  • forming a trusting therapeutic alliance between the therapist, family members and patient to ensure effective working
  • by including the patient, the aim is to make them less suspicious of treatment
• psychoeducation (family therapy)

  teaching the patient and their family about the condition and how to deal with it
• emotional expression (family therapy)

  improving emotional climate by reducing expressions of anger and guilt by relatives
• expectation management (family therapy)

  managing reasonable expectations about how the patient will be and any improvement overtime
• limits and boundaries (family therapy)

  encouraging the setting of appropriate boundaries and limits without being too restrictive of interfering in a patient's life
• effectiveness of CBT

  • NICE recommended
  • effective st reducing rehospitalisation after 18 moths compared to standard care
  • effective at reducing symptom severity and improving social functioning compared to standard care
  • effectiveness may depend on the stage of SCZ - early stages of SCZ may not work as it his hard to self reflect
  • effectiveness is overstated
  • Jauher et al (2014) only small therapeutic effect was seen
  • differences within the UL recommended therapies
• effectiveness of family therapy

  • meta-analysis of 53 family intervention studies published since 2002 from Europe, Asia, Australia and North America
  • the authors focused on randomised controlled trials that compared family therapy to standard care
  • impact on mental state and functioning was unclear
  • family therapy was better at improvising rates of compliance with medication
  • family therapy reduced relapse and hospitalisation for up to 24 months after intervention
  • results of different studies were inconsistent and there problems with the quality of some evidence
  • evidence base for family therapy is fairly weak
• appropriateness of CBT

  not necessarily appropriate for those in the early stages of SCZ as it may not work because it's hard to self reflect or engage
• appropriateness of family therapy

  • positive outcomes for family members too - social skills, empathy, problem solving, understanding of stress etc.
  • we are more tolerant as a society no so don't necessarily need to be educated about SCZ and having positive relationships - family therapy no more effective than good family care
  • reduced the stress of SCZ for both patients and family members