Psycholgoical therapies

• Cognitive behaviour therapy

  A method for treating mental disorders based on both cognitive and behavioural techniques. From the cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts. The therapy includes behavioural techniques.
• Family therapy

  A psychological therapy carried out with all or some members of a family with the aim of improving the communicators within the family and reducing the stress of living as a family.
• Cognitive behavioural therapy (CBT)

  • Commonly used to treat people with schizophrenia
  • Usually takes place over a period of 5-20 sessions, either in groups or an individual basis
  • Aims to deal with both thoughts and behaviour
• CBT aims to

  1. Identify and change irrational thoughts

  2. Help patients understand their symptoms
• CBT helps patients to understand their symptoms

  • A patient may hear voices and believe they are demons, so they will be very afraid. If the therapist can convince them that the voice actually comes from the malfunction speech centre in their own brain and it cannot hurt them, they can ignore it = less debilitating.
• CBT for delusions

  1. Normalisation - helping people hearing voices understand that voice-hearing is an extension of the ordinary experience of thinking in words

  2. Reality testing - the person with schizophrenia and their therapist jointly examine the likelihood that beliefs are true
• Case example of CBT

  • Paranoid client - the mafia are observing me to decide how to kill me
  • Therapist - you are obviously very frightened...there must be a good reason for this
  • Paranoid client - do you think its the mafia?
  • Therapist - it's a possibility but there could be other explanations. How do you know that it's the mafia?
• Family therapy

  • Aims to improve communication and interaction in the family
  • Tries to reduce stress within the family that may contribute to patients risk of relapse (reduce levels of expressed emotion)
• Strategies used in family therapy(pharoah et al. 2010)


  1. Reduce stress of caring for a relative with schizophrenia

  2. Improve ability of family to anticipate and solve problems

  3. Reduce guilt and anger in family members

  4. Improve beliefs about and behaviour towards schizophrenia

  5. Improve the families ability to help
• Expressed emotion (EE)

  The level of emotion expressed generally but especially negative emotions such as anger and guilt which create stress
• Burbach 2018 proposed a model for working with families dealing with schizophrenia
• Strengths of CBT for schizophrenia

  • Evidence for its effectiveness - Jauhar et al 2014 review found 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) recommends CBT for schizophrenia
• Limitations of CBT for schizophrenia

  • Wide range of techniques and symptoms included in studies - different studies have involved different CBT techniques and people with different combinations of symptoms, making it hard to say how effective CBT will be for a particular person
• CBT may improve quality of life for people with schizophrenia but not actually cure them
• Strengths of family therapy for schizophrenia

  • Evidence of effectiveness - review by McFarlane 2016 found family therapy reduced relapse rates typically by 50-60%, NICE recommends family therapy for everyone with a diagnosis of schizophrenia
  • Economic benefits - reduces the state's costs for hospital care
  • Benefits for all family members, not just the identified patient
• One strength for CBT is the evidence for its effectiveness.

  Jauhar et al in 2014 reviewed 34 studies of using CBT with SZ, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Other studies have focused on symptoms, e.g., Pontillo et al 2016 found reductions in frequency and severity of auditory hallucinations. Clinical advice from NICE (2019), recommends CBT for SZ. This means that both research and clinical experience support the benefits of CBT for SZ.
• One limitation of CBT for SZ is the wide range of techniques and symptoms included in studies.

  CBT techniques and SZ vary widely from one case to another. Thomas 2015 points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. The overall modest benefits of CBT for SZ 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 SZ.
• Both pro & con à CBT may improve quality of life for people with SZ but not actually cure them. As SZ appears to be largely a biological condition we would expect that a psychological therapy like CBT just benefits people by improving their ability to live with SZ. On the other hand studies report significant reductions in the severity of both positive and negative symptoms. This suggests that CBT does more than enhance coping
• one strength of family therapy for SZ is evidence of its effectiveness.

  A review of studies by McFarlane 2016 concluded that family therapy was one of the most consistently effective treatments available for SZ. In particular relapse rates were found to be reduced typically by 50-60%. McFarlane also concluded that using family therapy as mental health initially starts to decline is particularly promising. Clinical advice from NICE recommends family therapy for everyone with a diagnosis of SZ. This means family therapy is likely to benefit both early and ‘full blown’ SZ.
• Because family therapy reduces relapse rates and makes families able to better provide the bulk of care, it has huge economic benefits. The state does not have to pay so much for the care of SZ patients in hospital.
• +ve of family therapy for SZ


  +ves for all family members
• Therapy is not just for the benefit of the identified patient but also for the families that provide the bulk of the care
• Lobban & Barrowclough 2016: 'These effects are important because families provide the bulk of the care for people with SZ'
• Benefits of strengthening the functioning of a whole family

  • Lessens the -ve impact of SZ on other family members
  • Strengthens the ability of the family to support the person with SZ
• Family therapy has wider benefits beyond the obvious +ve impact on the identified patient