Psychological Treatments for Schizophrenia

• Aim of family therapy

  To improve the quality of communication and interaction between family members
• Family therapy

  • Typically offered for a period of between 3 and 12 months
  • At least ten sessions
  • Commonly used in conjunction with routine drug treatment and outpatient clinical care
• During family therapy

  1. Therapist encourages family members to listen to each other

  2. Openly discuss problems

  3. Negotiate potential solutions together
• Therapist may focus on

  • Decreasing the level of expressed emotion within the family
  • Hostility, verbal criticism and over-involvement increase the likelihood of relapse
• If a family is over-involved in a patient's life


  1. Therapist may discuss how patient may be encouraged to act independently

  2. To reduce avolition
• Psychoeducation


  • Provided to the family so they can learn about schizophrenia as an illness
  • How they can help
• If a family understands that hearing voices is a common symptom


  They may be more likely to empathise with the patient
• If they understand what happens during a psychotic episode

  • They will be more able to help avoid the triggers
  • Know how best deal with such situations calmly
• Individuals with paranoid schizophrenia

  May be suspicious about their treatment provided by an unknown health professional
• Involving the individual and their family more actively in their treatment


  Helps them to overcome this problem
• Family therapy

  Therapy for families of schizophrenia sufferers
• Family therapy reduced hospital readmission over 24 months
• Family therapy improved the quality of life for patients and their families
• Results of different studies on family therapy were inconsistent
• There were problems with the quality of some evidence on family therapy
• Family therapy

  • Can be effective in helping family members to achieve a balance between caring for the individual with the condition and maintaining their own lives
  • The main reason for its effectiveness may be that it increases medication compliance rather than improving symptoms directly
• NICE (The National Institute for Health and Care Excellence)


  Recognises the importance of research that shows family therapy is more effective in relieving symptoms of schizophrenia than other types of psychodynamic or social therapies
• Patients are more likely to comply with their medication regime when encouraged by a supportive family
• Family therapy is more effective in relieving symptoms of schizophrenia than other types of psychodynamic or social therapies


  This is especially important in preventing relapse in families with high levels of expressed emotion
• NICE recommendation

  All individuals diagnosed with schizophrenia who are in contact with or live with family members should be offered family therapy
• Supportive family network


  Is crucial to aid prevention of persistent symptoms or high risk of relapse
• NICE stresses that such family therapy interventions should be considered a priority where there are persistent symptoms or a high risk of relapse
• Family therapy for schizophrenia

  • Inappropriate for most individuals with schizophrenia to access in the first instance
  • Demanding lengthy therapy sessions patients would find too challenging and be unable to concentrate
  • Especially a problem with patients suffering from negative symptoms such as avolition or cognitive impairments
  • Depends on the family and patient wanting to know where the illness has come from, but a patient with schizophrenia may have little or no interest in the cause of their problem and as a result they are unlikely to benefit from this form of treatment
• Antipsychotic drugs

  May be more appropriate for the individual in the short term to address schizophrenic symptoms preventing them from engaging in psychological therapy
• When patient is ready

  Then introduce family therapy in order to improve quality of life
• Cultural differences


  The way in which family therapy is delivered will be determined by the beliefs within the local cultural setting and how this relates to the local beliefs of a mental illness
• Individualist cultures

  • UK
  • US
• Individualist cultures


  • Families vary between those that have members living in close proximity to one another and those that are fragmented, with relatives living in different places
• Collectivist cultures and more traditional families


  • Members live together and there are closer ties
• Patients in developing countries may function better simply because of the greater kinship that provides a greater tolerance to unusual behaviours
• In westernised countries, schizophrenia is viewed as a stigmatised mental illness, but in other parts to the world (e.g. Africa and South America), it is treated with more compassion
• Differences in the degree to which members want to be involved in helping

  Affects which treatment would be more appropriate for the patient with schizophrenia
• Cognitive Behaviour Therapy (for psychosis) (CBTp)


  Targets a patient's dysfunctional thoughts and distorted beliefs which causes maladaptive feelings and behaviours
• Delusions


  • Thought to result from faulty interpretations of events, and CBT is used to help the patient identify and correct these faulty interpretations
• NICE guidelines


  • Recommend at least 16 sessions of CBT to achieve this
• Aims of CBT for schizophrenia

  1. Help the patient establish links between their delusional thoughts, feelings and actions as suggested by the ABC(DE) model

  2. Patient is taught to dispute (D) their delusional beliefs and replace them with effective (E) alternative ways to think

  3. This reduces distress and so improves functioning
• ABC(DE) model

  A - Activating events, B - Delusional beliefs, C - Emotional and behavioural consequences, D - Dispute, E - Effective alternative ways to think
• Specific disputing techniques

  1. Empirical disputing (D) - Therapist asks patient to provide evidence for their belief

  2. This could lead the patient to have a more adaptive belief (E)
• Behavioural homework assignments


  1. Patients investigate their irrational thinking and start adopting more adaptive behaviours

  2. Patients report back to therapist in the proceeding session, who then assesses their progress and may set a more challenging assignment
• Behavioural homework assignments


  • If a patient has paranoid thoughts about the world, a therapist may ask them to record their thoughts and feelings in a thought diary to find out what may be triggering these thoughts (A)
  • If a patient suffers from avolition they may be encouraged to sit in the garden one week, and if successful, walk around the block the next