Psychological Therapy for Schizophrenia

• Cognitive Behaviour Therapy & Schizophrenia

  - CBT can help a client make sense of their irrational cognitions (such as delusions and hallucinations) impact on their feelings and behaviour

  
  

  - this understanding can help clients manage symptoms such as hallucinations and make them less frightening and debilitating

  
  

  - this doesn't cure symptoms of schizophrenia but rather makes them manageable

  
  

  - CBT is also used to tackle anxiety and depression in patients with resistant delusions
• CBT Techniques for Treating Schizophrenia

  - normalisation: teaching clients that auditory hallucinations are an extension of the ordinary experience of speaking words

  
  

  - challenging delusions: testing the likelihood of beliefs being true
• Family Therapy


  therapy that treats the family as wells as the identifies patient (the member of the family who expresses the family's conflicts)

  
  

  - aims to improve the quality of communication and interaction between family members

  
  

  - there is a range of approaches to family therapy for schizophrenia, in keeping with psychological theories link double-bind and the schizophrenogenic mother

  
  

  - (Pharoah et al, 2012) identified a range of strategies used to try and improve the functioning of a family who has a member with schizophrenia:

  
  

  . reduce negative emotions

  
  

  . improves family's ability to help
• Family Therapy: Reduces Negative Emotions


  - family therapy aims to reduce levels of expressed emotion (EE), especially anger and guilt which increase stress as reduced stress decreases the chance of a relapse
• Improves Family's Ability to Help

  - family members are encouraged to form a therapeutic alliance whereby they agree on the aims of the therapy

  
  

  - the therapists also aim to improve members beliefs about schizophrenia as well as teaching them how to care for an individual with schizophrenia as well as maintain their own lives
• Evidence of Effectiveness: CBT (Strength)

  - (Jauher et al, 2014) reviewed 34 studies using CBT with schizophrenia and found there is clear evidence for small but significant effects on both positive and negative symptoms

  
  

  - (Pontillo et al, 2016) found reductions in frequency and severity of auditory hallucinations

  
  

  - (NICE, 2019) and the National Institute for Health and Care Excellence both recommend CBT for treatment of schizophrenia

  
  

  - meaning both research and clinical experience support the benefits of CBT for schizophrenia
• Quality of Evidence:Limitation

  - there are a wide range of techniques and symptoms included in studies

  
  

  - (Thomas, 2015) points out that different studies have involved different techniques and people with different combinations of positive/negative symptoms

  
  

  - the overall modest benefits for CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms

  
  

  - this makes it hard to say how effective CBT will be for a particular person with schizophrenia
• Does CBT Cure?: Evaluation Extra


  - CBT may improve the life of people with schizophrenia but it doesn't actually 'cure' them

  
  

  - as a largely biological condition, we would expect psychological therapy of CBT just benefits people by improving their ability to live with schizophrenia

  
  

  - however studies show a reduction in the severity of both positive and negative symptoms , suggesting that CBT does more than enhance coping
• Evidence of Effectiveness: Family Therapy (Strength)

  - (McFarlane, 2016)'s review of studies, showed that family therapy was one of the most consistently effective treatments for schizophrenia

  
  

  - relapse rates were found to be significantly reduced ( typically 50-60%)

  
  

  - McFarlane also concluded that using family therapy as mental health begins to decline is also promising

  
  

  - clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia

  
  

  - meaning family therapy is likely to benefit people with both early and 'full-blown' schizophrenia
• Benefit to the Whole Family: Strength

  - family therapy benefits the whole family not just the the identified patient

  
  

  - (Loban & Barrowclough, 2016) concluded these effects are important because families provide the bulk of care/support

  
  

  - by strengthening the functioning of a whole family, family therapy lessens the negative impact of schizophrenia and strengthens the family's ability to support the person with schizophrenia

  
  

  - this means family therapy has wider benefits beyond the obvious positive impact on the identified patient
• Which Matters Most?: Evaluation Extra

  - because family therapy reduces relapse rates and makes families better be able to provide the bulk of care has huge economic benefits

  
  

  - this means the State doesn't need to pay so much

  
  

  - on the other hand, family therapy also has significant therapeutic benefits for people with schizophrenia and their families