Psychological Therapies

• CBT aim

  help identify and change irrational thoughts
• CBT in schizophrenia

  not get rid of symptoms - only makes it better to cope with them
• How CBT helps/works

  helps make sense of how delusions and hallucinations impact their feelings and behaviour

  • patient believes the voices are demons therefore are afraid - CBT can reduce fear and anxiety by teaching/challenging them that their beliefs aren't based on reality
• case example of CBT - Turkington 2004 et al.


  Paranoid client's delusion that 'mafia' is spying on and trying to kill them

  Therapist challenges them - how do they know it's the Mafia?
• Family Therapy

  therapy with family members

  • double bind
  • schizophrenogenic mother
• Family Therapies aims

  • improve quality of communication and interaction between family
  • reduces levels of expressed emotion and stress
• How Family Therapy helps - Pharoah 2010 et al.

  • form therapeutic alliance with members and balance between caring for schizophrenic relative & maintaining own life
  • reduce stress of caring for schizophrenic relative and anger/guilt in family members
  • improve family's ability to solve problems & families' beliefs and behaviour towards schizophrenia
• Pharoah 2010 et al.

  Family therapy reduces stress and expressed emotion whilst increasing chances of patients complying with medication therefore reduce likelihood of relapse and readmission to hospital
• Token Economies

  reward systems based on operant conditioning to manage behaviour of schizophrenic patients, particularly maladaptive behaviour of those in psychiatric hospitals
• Token Economy aims

  modify bad habits and improve quality of life therefore more likely to live outside hospital
• Tokens

  secondary reinforcers given immediately after carrying our desirable behaviour for reinforcement - only valuable once patient learns they can be used to obtain rewards
• why is immediacy important


  prevents 'delay discounting'
• delay discounting

  the reduced effect of a delayed reward
• examples of desirable behaviour


  getting dressed in morning, making a bed
• Rewards


  materials - sweets, cigarettes, magazines

  service - room cleaned

  privileges - walk outside
• Support - effective

  • Jauhar 2014 = 34 studies show CBT has effect on negative and positive symptoms
  • Pharoah 2010 = family therapy reduces hospital admission and improves quality of life
• Counter - effective

  inconsistent studies and issues with quality of evidence therefore weak support for family therapy
• Limitation - token economies

  McMonagle & Sultana 2009 = 1 out of 3 studies with 110 randomly allocated patients showed improvement in symptoms but not showed useful info about behaviour change - therefore not significant support
• Limitation - fails to cure

  Family therapy reduces stress of living with schizophrenic relative and token economies make patient's behaviour more socially acceptable for re-integating into society therefore only improves quality of life, not cure

  CA: reduces severity of some symptoms
• Limitation - ethical issues

  • token economy leads to rewards being less available to patients with severe symptoms and families challenged legality - discrimination against most severely ill patients therefore token economy is used less
  • CBT can interfere with patient's freedom of thought - challenging their paranoia can modify their politics eg challenging their belief of a controlling government