Psychological treatments

• Cognitive behavioural therapy assumes schizophrenia is the result of dysfunctional thought processes. For example, faulty cognitions such as delusions are identified with CBT and are then challenged.
• Ellis's ABD(DE) model is used to understand the source of the faulty cognition and provide a process to cognitively restructure the irrational beliefs:

  • A = Activating event.
  • B = Beliefs.
  • C = Consequences.
  • D = Disputing irrational beliefs.
  • E = Effect of restructured belief.
• Reality testing is a process in which the patient can demonstrate for themselves that their irrational thoughts (hallucinations and delusions) are not real. This is known as symptom targeting. Such as if the patient believes they can see into the future, then the clinician may ask them to predict cards drawn from a deck.
• Strengths of CBT:

  • Supporting research - Sensky showed that patients who had resisted drug treatments has a reduction in positive and negative symptoms when treated through 19 sessions of CBT. They continued to improve even after 9 months after the treatment had ended. This suggests CBT can be effective when drugs are not, but also the improvement of drugs only tend to be short-term.
• Limitations of CBT:

  • Time consuming - Ending treatment early is common due to the length of treatment and symptoms which may become more severe during this time. CBT requires engagement and negative symptoms can lead to an unwillingness to take part, as opposing to positive symptoms which could lead to the distrust of the process.
• Limitations of CBT:

  • Not inclusive - Some patients, due to the severity of the symptoms or personality, may not be able to cope with the vigorous confrontation of beliefs that CBT requires. In this case, antipsychotic medication can be used first to reduce the severity of the symptoms.
• Family therapies attempt to improve the home situation of the person suffering with schizophrenia.

  • Family centred - Therapy intended to change the behaviour of the whole family.
  • Psychoeducation - Family is educated on the symptoms in order for them to become more understanding of the sufferers behaviour.
• Family therapy aims to...

  • Reduce conflict by addressing anger within the family.
  • Reduce stress caused by caring responsibilities.
  • Reduce self sacrifice by getting carers to consider their own needs.
  • Improve communication by considering how to limit expressed emotion.
  • Improve problem solving by predicting problems and having early solutions.
• Strengths of CBT:

  • Effectiveness of CBT - Jauhar (2014) reviewed 34 studies of CBT for SZ, and concluded that there is evidence for significant effects on both positive and negative symptoms. Additionally, Pontillo found reductions in auditory hallucinations. Clinical advice from NICE (2019) recommends CBT for people with SZ. This means both research and clinical experience support CBT for SZ.
• Strengths of family therapy:

  • Supporting research - Leff looked at the aftercare of patients. Those who were provided with standard outpatient care had 50% of them relapsing in the first 9 months. This was compared to the 8% who received family therapy. After 2 years, this had increased to 50% in the family therapy groups and 75% in the standard outpatient group, suggesting the use of family therapy is helpful in reducing re-admissions in the short term.
• Limitations of family therapy:

  • Problematic - Practical issues such as the length of the therapy often leads to patients dropping out due to either severity of symptoms or going through family issues. This can have negative implications on the economics of hospitals and therapists.
• Token economies are behavioural therapy techniques based on Skinners operant conditioning. This is learning through the reinforcement of desired behaviours.
• Tokens are used as a type of positive reinforcement. They are an immediate reward for when patients show pre-defined target behaviours (eg - practicing good hygiene). These tokens are then exchanged for something they want (eg - activities or chocolate).
• Token economies aim to...

  • Behaviour shaping - Behaviours progressively changed with tokens first given for small changes in behaviour towards the ideal.
  • Psychiatric institutions - Treatment designed to produce easier to manage behaviour within hospital or to prepare long stay patients for transfer into the community.
  • Mild negative symptoms - Treatment can be used less for patients with mild symptoms but more profoundly ill patients are less able or willing to engage.
• Strengths of token economies:

  • Supporting evidence - Dickerson found when reviewing 13 studies that token economies can be effective in improving the adaptive behaviour of people with schizophrenia.
• Strengths of token economies:

  • Effectiveness - Glowacki identified 7 high quality studies published between 1999 and 2013 on the effectiveness of token economies in a hospital setting. All the studies showed a reduction in negative symptoms and a decline in frequency of unwanted behaviours. This supports the value of token economies.
• Limitations of token economies:

  • Existence of more pleasant and ethical alternatives - Chiang found other approaches do not raise ethical issues (eg - art therapy is a high-gain low-risk approach to managing the disorder). Even if the benefits of art therapy are modest, this is true for all approaches to treatment and management of SZ and art therapy is a pleasant experience. This means that art therapy might be a good alternative to token economies because there are no side effects or ethical abuses.