Psychological Therapies for Schizophrenia

• Cognitive Behaviour Therapy (CBT):

  Commonly used to treat people with schizophrenia, usually lasting 5 to 20 sessions, either in groups or individually. The aim is to help people identify their irrational thoughts and alter these; involving an argument or discussion on how likely their beliefs are to be true, and a consideration of other less damaging beliefs. This doesn't cure any symptoms, but makes people better to cope with them.
• How CBT Helps:

  People can make sense of how their delusions and hallucinations impact their feelings and behaviour. Understanding their origins can be helpful for sufferers; if they hear voices of people believed to be demons, they will be naturally afraid. Offering psychological explanations for their existence can help reduce the anxiety surrounding them. Delusions can be challenged so the individual can learn they aren't based on reality.
• Family Therapy:

  Aiming to improve the quality of communication and interaction between family members. Some therapists see family as the root cause of SCZ (the schizophrenogenic mother and double-bind). Though nowadays, the role of family therapy is to reduce the stress within the family which may contribute to a person's risk of relapse- particularly aimed to reduce levels of expressed emotion.
• How Family Therapy Helps:

  Pharoah et al identifies a range of strategies to improve the functioning of a family with a member suffering SCZ: forming a therapeutic alliance, reducing the stress of caring for a relative with SCZ, improving family's ability to anticipate and solve problems, reducing the feelings of anger and guilt among family members, helping family members to maintain a balance between caring and living their own lives, and improving the family's beliefs about SCZ.
• How Family Therapy Helps:

  Pharoah et al suggests that these strategies work by reducing the levels of stress and expressed emotion, whilst increasing the chances of people complying with medication. This combination of benefits tends to result in a reduced likelihood of relapse and hospital re-admission.
• Token Economies:

  Reward systems used to manage the behaviour of people with SCZ, particularly those who have adopted maladaptive behaviour through spending long periods of time in psychiatric hospitals (institutionalisation). Under these circumstances, many develop bad hygiene. Modifying these habits doesn't cure SCZ but improves their quality of life, enabling them to live outside the hospital setting.
• Token Economies: Tokens

  Tokens (neutral stimulus), in the form of coloured discs, are given immediately to patients when they have performed desirable behaviour which has been targeted for reinforcement (e.g. getting dressed, making bed), these vary according to patient's individual behaviour issues. The immediacy of the reward is crucial as it prevents 'delay discounting', the reduced effect of a delayed reward.
• Token Economies: Rewards

  Although tokens have no value themselves, they can be swapped for more tangible rewards. Token Economies are a behavioural therapy based on operant conditioning; tokens are secondary reinforcers because they only have value once they can be used to obtain rewards (some in the form of materials- sweets, cigarettes; and some in the form of services- room cleaned, walk outside).
• AO3: Evidence for Effectiveness

  CBT: Jauhar et al reviewed 34 studies of CBT for schizophrenia and concluded that CBT has a significant but fairly small effect on both positive and negative symptoms of SCZ.
• AO3: Evidence for Effectiveness

  Family Therapy: Pharoah et al concluded that there is moderate evidence to show that family therapy significantly reduces hospital re-admissions over the course of a year, and improves quality of life for individuals and their family. However, they also noted that results over different studies were inconsistent, and that there were issues with the quality of some evidence. Making the evidence base for family therapy weak.
• AO3: Evidence for Effectiveness

  Token Economies: McMonagle and Sultana found only three studies where SCZ patients had been randomly allocated to conditions, only 110 patients in the meta-analysis. Random allocation is important in controlling extraneous variables. Only one of the three studies showed improvement in symptoms, and none had useful information about behaviour change. Only modest support for psychological treatments, and SCZ remains one of the harder mental health problems to treat.
• AO3: Treatments Improve Quality of Life, But Don't Cure

  All psychological treatments discussed aim to make living with SCZ more manageable and improve quality of life. CBT helps by allowing the person to make sense, and sometimes challenge, their symptoms. Family therapy reduces the stress within the family. Token economies help by making behaviour more socially acceptable to help them reintegrate into society. Whilst these are positive, they fail to cure SCZ, although biological treatments don't cure it either, they do reduce the severity of some symptoms.
• AO3: Ethical Issues

  Although the psychological treatments for SCZ don't have the serious side effects of drug treatments, they raise ethical issues. Particularly token economies are seen as controversial; as the privileges and services become more available to the patients with mild symptoms. Meaning the most severely ill patients suffer discrimination, and some families of these patients have challenged the legality of this. This has reduced their use in psychiatric systems.
• AO3: Ethical Issues

  CBT involves challenging a person's paranoia, but it is questioned at what point this interferes with an individuals freedom of thought. This then links to cultural bias- some cultures are more likely to acknowledge hearing voices (Escobar found that overwhelmingly White psychiatrists tended to over-interpret the symptoms and distrust the honesty of Afro-Caribbean's during diagnosis).
• AO3: Quality of the Evidence for Effectiveness

  Many small scale studies (IDA- Idiographic) where mental health professionals have compared patients before and after psychological treatments have found more positive results than those described before. However, these studies have problems as they often lack control groups, and if there is one, patients are rarely randomly allocated to a treatment or control condition. Often the conclusions are more optimistic than those who strictly control the conditions.
• AO3: Alternative Psychological Treatments

  There are other psychological therapies that can be helpful which are less known and available. E.g. the National Institute for Health and Clinical Excellence (NICE) recommends art therapy, provided that a qualified art therapist with experience of working with SCZ patients is available. This type of therapy would be useful for symptoms such as isolation and social withdrawal, allowing people to express themselves in a different medium, other than talking- making it more suitable for those who have difficulty communicating due to negative symptoms.
• IDA- Environmental Reductionism

  The token economy treatment attempts to explain the SCZ patients behaviour in terms of stimulus-response links, between the reinforcement behaviour and the tokens, this then makes them appear as passive to their environmental cues. Instead it could be a motivation within themselves which promotes these behaviour changes.
• IDA- Nurture

  All the psychological therapies focus on an individual's nurture determining their chance of having SCZ and its severity. However, this then discounts the idea of nature having an influence- through objective scientific methods Ripke et al identified 108 genetic variations which increased the risk of SCZ, meaning it isn't purely due to nurture. Perhaps an interactionist approach would be more appropriate- drug and talking therapies done alongside each other.