psychological treatments for sz

• 2 psychological therapies?

  1. family therapy
  2. cognitive behavioural therapy
• what is used to manage symptoms?

  token economy
• what is family therapy?

  • form of psychotherapy based on idea that family dysfunction plays role in development & maintenance of sz
  • alters relationship & communication patterns in family
  • family create therapeutic alliance to work on relationship & set common goals
• family therapy aims to:

  1. improve positive & decrease negative forms of communication
  2. increase tolerance & decrease criticism levels between family members
  3. decrease feelings of guilt & responsibility for causing illness among family members
  4. encourage family to develop problem solving skills to support patient
• family therapy achieves aims by:

  1. therapist regularly meets with patient & family
  2. therapy encourages openess & teaches family members to support each other
  3. work to educate family about disorder & what to expect
  4. happens for around 9-12 months
• family therapy ALLI?

  A - alliance with family

  L - lower levels of criticism - ee

  L - lower levels of guilt

  I - increase positive forms of communication
• 2 * of family therapy?

  1. evidence from leff of lower relapse rates
  2. cheaper than standard care
• 2 X of family therapy?

  1. not effective in long term
  2. relies of family being open
• * evidence from leff 1985?

  • compared family therapy with routine outpatient care for sz with high ee families
  • found within first 9 months of treatment 50% of those with routine care relapsed
  • compared with 8% for family therapy
  • effective
  • has low relapse rates so its effective in treating sz in short term
• X not effective in long term?

  • leff found that after 2 years of treatment 75% with routine care relapsed
  • 50% for family therapy
  • ? effective
  • not effective in long term
  • means as soon as therapy stops symptoms start to resurface
  • may be more suitable therapy
• * cheaper than standard care?

  • although fam therapy more expensive than drug therapy - patient pays for trained therapist over period of 9-12 months
  • sz commission 2012 estimates fam therapy cheaper by £1000 a patient over 3 years
  • accessible for people with lower household income
  • a more economical therapy means more money available to deal with urgent care for patients who are at risk of suicide/need more time in care
  • appeals to wider population - fam may choose to share cost of treatment opposed to responsibilty resting with individual patient who may be out of work due to severity of symptoms
• X relies on family being open?

  • therapy works on basis that families can form trusting therapeutic alliance & all committed to attending
  • some less open with each other & extremely hostile - high levels of ee
  • some not capable of this level of introspection - not appropriate
  • ? appropriate
  • not suitable for families that are not open with one another
  • may be better therapies available that accommodate all families
• what is cbtp?

  cognitive behaviour therapy for psychosis
• explain cbt?

  • psychological therapy based on cognitive explanation of sz
  • completed on individual basis/small group
  • lasts 5-20 sessions
  • aims to identify & challenge faulty thought processes that leads to positive symptoms
  • patient given homework & asked to keep diary of thoughts between sessions
  • build rapport to develop rational interpretations for symptoms
  • promotes increase in social activity & use of relaxation strategies as coping techniques
• 3 * for cbt?

  1. evidence from tarrier
  2. fewer side effects than drug therapy
  3. evidence from sensky
• * evidence from tarrier 2005?

  • reviewed 20 controlled trials of cbt using 739 patients
  • found persistent evidence of reduced symptoms especially positive ones
  • lower relapse rates & speedier recovery in short term
  • 50% of cbt experiences reduced psychotic episodes compared to 15% in control group
  • effective
  • has reduced symptoms
  • lower relapse rates so better for patients in short term
• X tarrier et al not effective in long term?

  • research highlights cbt effective in short term
  • still unknown whether its effective in long term
  • more research needs to be done
  • ? effective
  • may not be effective in long term leading to people relapsing
• * fewer side effects?

  • drug therapy many side effects varying from minor issues - dry mouth/confusion
  • severe long term conditions - tardive dyskinesia
  • cbt focuses on changing thought processes - no invasive effects
  • appropriate
  • fewer side effects
  • suitable for treating sz in all patients
  • does not cause additional harm
  • can be used more regularly for patients over long period of time
• X not appropriate for severe sz symptoms?

  • may not be able to identify irrational thoughts with therapist - speech poverty so will not be able to communicate properly in order to discuss issues
  • feel unmotivated - avolition
  • delusions of persecution may surface & develop distrust between them & therapist
  • ? appropriate
  • not suitable for everyone with disorder
  • especially those with severe sz & may be better treatments
• * evidence from sensky et al?

  • showed that patients who resisted drug therapy had reduction in +/- symptoms when treated by 19 sessions of cbt
  • continued to improve 9 months after treatment ended
  • effective
  • reduced relapse rates shows therapy tackles root cause of issues
  • helps to remove irrational thoughts & treat disorder unlike drug therapy which masks symptoms
• what is token economy?

  • manages sz
  • behaviourist therapeutic approach
  • tokens awarded to patient when they show desired behavioural change
  • particularly aimed at changing avolition
• token economy - operant conditioning?

  • patient receives secondary reinforcer (token) for desired behaviour
  • exchange these tokens for goods & privileges - primary reinforcer
  • leads to increased likelihood of repeating desired behaviour to gain same rewards
  • decreasing negative symptoms
• 2 * for token economy?

  1. evidence from ayllon & azrin
  2. can be tailored to needs of individual patient
• 2 X for token economy?

  1. only works in an instituition
  2. unethical
• * evidence from ayllon & azrin 1968?

  • found TE is successful technique with female sz patients who were hospitalised
  • rewarded for brushing hair & making beds with tokens - could be exchanges for viewing film/visiting canteen
  • average number of chores completed rose from 5 to 42
  • effective
  • reduces symptoms
  • motivates patients & theyre more productive
• X evidence from ayllon & azrin?

  • findings based solely on females
  • ungeneralisable to male patients
  • further research required to investigate how effective TE is for patients of all genders
• X only works in instituition?

  • 66% of patients do not live in instit & live in community instead
  • shows TE not appropriate for most sz patients - environment cannot be managed as closely
  • in instits tokens controlled & can more accurately measure improvements in patients & management of sz
  • ? effective
  • only effective for severe patients in instits
  • not everyone can afford to be placed in specialised units/severe enough for inpatient care
  • using TE not effective in all settings
• X unethical?

  • TE give rewards for completing everyday tasks
  • can be seen as infantilising patients & potentially damaging their self esteem
  • those with severe sz less likely to show desired behaviours so do not gain tokens - wont gain same privileges
  • those with more severe sz discriminated against
  • ? appropriate
  • not suitable as it restricts privileges of those with severe sz
  • symptoms prevent them from being equal to other sz patients
• * can be tailored to needs of individual patient?

  • patients can choose thier own rewards/privileges from tokens
  • means each patient will be individually motivates to receive tokens
  • one patient may be interested in having extra visitor time rather than extra tv time or vice versa
  • so by having tokens tailored to each patients its beneficial in managing sz
  • appropriate
  • its effective individually & can be used for all people with sz