psychological treatments

• cognitive behavioural therapy


  used to treat schizophrenia and is often used alongside antipsychotic drugs - takes longer than other methods (5-20 sessions)

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  aims to deal with both cognitions and behaviour - many issues are formed from cognitive dysfunction such as speech poverty/delusions, impacting emotions and behaviour

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  may involve discussions as to the likelihood of beliefs being true, and other, less threatening possibilities - it helps patients make sense of their hallucinations and delusions
• specific method of CBT: cognitive restructuring via ABCDE framework

  1. identify activating event (auditory hallucinations)
  2. exploring beliefs (voices are in control of my life)
  3. recognising consequences (desperation, isolation, anxiety)
  4. disputing irrational beliefs (reality testing)
  5. effect of restructured beliefs (voices are harmless and an expression of fears)
• study of CBT


  Chadwick et al. (1996) - reported the case of a man who believed he had the ability to predict what people were about to say - Nigel himself asked to prove himself

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  he was shown 50 video tapes of different scenarios and paused at certain intervals and asked him to predict what they would say next

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  he did not get a single prediction himself - the man concluded that he did not have any special ability through reality testing, showing that CBT can be successful in treating delusions
• ao3 - support for CBT

  Jauhar et al. (2014) conducted a meta-analysis of studies using CBT with patients with schizophrenia and found clear evidence of a small but significant effect on both positive and negative symptoms - but these are different combinations of symptoms in different ppts with different CBT techniques -> hard to generalise results to all patients
• ao3 - against CBT


  CBT requires significant effort and time - avolition may prevent effective engagement (interactionist)

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  the relationship between patient and practitioner is important (empathy, respect, unconditional positive regard), but patients can become dependent on a therapist or delusions (of paranoia) can prevent the formation of a trusting relationship

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  positive symptoms could lead to a lack of self-awareness, preventing CBT from working effectively
• family therapies


  used to treat schizophrenia, typically in those who live or are in close contact with family members - it is based off the idea of family dysfunction, primarily expressed emotion, can cause or lead to increased risk of relapse in those with schizophrenia

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  it takes a long period of time and the family need to be 'on-board' and committed to helping
• stages of family therapy

  1 - psychoeducation -> helps family and person with schizophrenia better understand the disorder e.g., explaining behaviours they might witness, how this behaviour could affect the family and how behaviours may change as a consequence of family therapy
• stages of family therapy

  2 - develop strategies to reduce expressed emotion and cope with the behaviours displayed by the individual with schizophrenia e.g., improving quality of communication between family members (opening discussing problems and negotiating potential solutions), sharing the burden to care (family members have specific roles in supporting person with schizophrenia) and creating a balance between caring/supporting the person with schizophrenia and maintaining their own lives
• ao3 - support for family therapies

  McFarlane (2016) - meta-analysis concluding family therapy to be one of the most effective treatments for schizophrenia with relapse rates reducing by over 50% - most effective when disorder caught early - but issues of publication bias and the different methods/measures of outcome in meta-analysis

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  ethical implications - improves quality of life of patient (and family), allowing them to stay in the community rather than be hospitalised - useful in patients who lack insight into their own condition/can't coherently explain their thoughts
• ao3 - support for family therapies

  implications for the economy - reduced relapse rates -> reduce expensive hospitalisation - as the family is able to provide bulk of care, the state does not need to pay for hospital care and family members can help a patients medication regime, saving money on clinicians having to do it - expensive but cost effective in long-term
• token economies


  used to manage schizophrenia - decline in use in UK due to shift away from hospitalisation into community care but still used (institutionalisation in the long-term)

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  follows behavioural approach for schizophrenia where patients are given tokens when they perform positive behaviours (adherence to medication regime, social interaction - institutionalisation -> dependence) to reinforce and encourage them - tokens (secondary reinforcers) can be exchanged for rewards e.g., sweets/cigarettes (primary reinforcements) - aimed at negative symptoms e.g., low mood, social withdrawal
• ao3 - support for token economies

  research identified 7 high quality studies on the effectiveness of token economies in a hospital setting - all showed a reduction in negative symptom and a decline in frequency of unwanted behaviours - but small sample size and publication bias

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  it can be tailored to an individual for most success - particular behaviours/particular rewards
• ao3 - against token economies


  not a treatment - improves quality of life in unison with other treatments and only effective when in hospital - no motivation to follow positive behaviours or remain independent as they may have been dependent on reward -> readmittance

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  ethical implications - if patients do not perform desired behaviours, they do not get tokens - for someone with a nicotine addiction, cigarettes may be their chosen reward - if they do not receive tokens they cannot access cigarette allocation and may suffer from unpleasant withdrawal symptoms as a result of the hospital