psychological therapies

• cognitive behavioural therapy

  takes place between 5 and 20 sessions - not events that cause person problems (activating events) but belief they have about events - if a person has distorted beliefs will have a negative effect on feelings and behaviours (consequence) - used to help identify and correct faulty beliefs - therapist discusses how likely irrational beliefs are to be true and consider more rational beliefs (dispute) - thinking more rationally should have effect of feeling less anxious and have a positive effect on behaviour (ABCDE model)
• CBT EVALUATION - NICE

  reviewed range of treatments for sz and found compared with antipsychotic drug therapy CBTp was far more effective in reducing symptom severity and improving cognitive functioning - suggests CBT as effective as drug therapy
• CBT EVALUATION - effectiveness may be overstated


  most studies of CBTp have been conducted when patients are being treated with antipsychotic medication at the same time - more recent research found CBTp as a sole treatment may be lower than originally thought - difficult to assess effectiveness of CBTp independent of antipsychotic medication in treatment of sz
• CBT EVALUATION - effectiveness may depend on stage of the disorder

  claimed that CBTp may be more effective when available at specific stages of disorder - e.g. Addington and Addington claim in initial phase of sz self reflection on symptoms not particularly appropriate - following stabilisation of symptoms with antipsychotic medication individuals can benefit from group CBT which can help normalise experience by meeting other people with similar issues - only useful for specific stages of treatment and may need to be constantly adapted
• family therapy

  many patients returning home from institutional care more likely to relapse is they return to families that show high expressed emotion (hostile and over involvement) - main aim to make family life less stressful and reduce the risk of relapse - educate families about high risk of expressed emotion and understand sz better - reduce expressions of anger and guilt and having more reasonable expectations for patient behaviour - families taught warning signs to help prevent relapse - usually part of an overall treatment package and used in conjunction with routine drug treatment
• FAMILY THERAPY EVALUATION - NICE

  found that relapse rate in family therapy condition was 26% compared to 50% relapse in a control group receiving standard care - suggests family therapy is effective at preventing relapse over any therapy that only targets individuals
• FAMILY THERAPY - effectiveness

  Pharoah conducted meta-analysis which showed compliance with patient medication was significantly higher in patients where family therapy had been used compared to more standard care - suggests family therapy may be effective but only in as far as it helps patients stay on their medication
• FAMILY THERAPY EVALUATION - only address symptoms not cause


  argued that sz has biological cause such as dopamine imbalance and so therapies like family therapy only address symptoms of disorder rather than underlying cause - suggests psychological therapies may only be appropriate when used in conjunction with biological therapies such as drugs which are needed to address true problem
• Token economy

  form of behavioural therapy clinicians set target behaviours to improve patients engagement in daily activities - particularly targets those who have developed patterns of maladaptive behaviour through spending long periods in psychiatric hospitals - all behaviour is learned so can be unlearned (counter-conditioning) uses operant conditioning (learning through reinforcement) to encourage behaviour - patients given token for behaving in appropriate ways and can be exchanged for privileges (e.g. token given for making bed and exchanged for time watching TV)
• TOKEN ECONOMY EVALUATION - effectiveness

  Dickerson - conducted meta-analysis of 13 studies and found 11 of these studies had reported beneficial effects - suggests economies are effective in increasing adaptive behaviours of sz patients in institutional care
• TOKEN ECONOMY EVALUATION - only useful in institutions 


  work because environment of an institution is carefully structured so good behaviour can consistently be rewarded - outside world very different patients may find it hard to transfer what they have learned to everyday life once released - suggests token economies may be effective in institutions they may not be effective preparation for life in the outside world
• TOKEN EXONOMY EVALUATION - fails to acknowledge individuality


  although standardised system helps maintain controlled institution might not be acceptable to patient if they had free choice - rewarded behaviours may not be the way the patient would normally choose to behave - may be seen as inappropriate to expect patients to all behave in a standard way all the time
• TOKEN ECONOMY EVALUATION - ethical concerns


  viewed as taking all power away from individual and giving too much power to others (potential for abuse) - Corrigan claimed token economy can be abusive and humiliating - suggests not always appropriate when used for reasons other than treatment of patient