psych therapies

• What is the aim of cognitive behavioural therapy in treating schizophrenia?

  CBT seeks to collaborate with the client in order to identify their irrational thoughts and change them by discussing how the patients belief is not likely to be true by teaching them techniques to improve their self-management of symptoms.
• AO3 - Gould et al (2002) - Meta-analysis into effectiveness of CBT.


  - Gould conducted a meta-analysis of 7 studies investigating the effectiveness of CBT - reported statistically significant decrease in the positive symtpoms of schizophrenia after treatment.

  - Suggests CBT is effective.

  - Another benefit is that this study is a meta-analysis - meaning it has added validity and reliability.
• AO3 - Bradshaw (1999) - Case study


  - Bradshaw undertook a case study on a girl hospitalised 12 times in 7 years prior to CBT.

  - Girl received CBT sessions over a 3 year period and showed significant progress in her physiological functioning.

  - Symptoms reduced dramatically and there were no hospital readmissions.

  - Suggests CBT is effective.

  - However, the are validity issues as it is a case study.
• AO3 - Appropriateness of CBT - Kingdon and Kirschen (2006).


  - Kingdon and Kirschen conducted a study of 142 schizophrenic patients in Hampshire, and found that many patients were not deemed suitable for CBT because they did not believe they could fully engage in the therapy.
• What led to the development of family intervention therapy?

  - Research into how expressed emotion can increase the risk of schizophrenic relapse, has shown that the interaction patterns and nature of family relationships can have an effect.

  - Family therapy aims to improve family relationships and provide an environment that can support and protect the sufferer.
• What is the emphasis of family therapy?


  Inclusion within the family, and the sharing of information.
• Where does family therapy usually take place and for how long?

  - In the home.

  - Lasts between 3-12 months with sessions every 2-4 weeks - minimum of 10 sessions recommended by NICE.

  - 2 family therapists will work with the relatives and patient.
• What do the therapists work on with the family?

  - Start by developing a co-operative and trusting relationship within the family group and developing an ethos that all contributions are valued.

  - Work with family to develop strategies to cope better with schizophrenia and its symptoms - leads to more supportive atmosphere, which helps the patient make better progress, and makes the relatives feel more positive about their supporting roles.
• What does the therapist provide to the family?

  - Information about the cause, course and symptoms of Schizophrenia.

  - Family members and patient encouraged to share their own experiences of living with the disorder - therapist encourages family members to ask questions, which lets them learn more about the disorder.
• Summarise the aim of family therapy in 4 bullet points.

  1 - To improve communication.

  2 - To lower expressed emotion.

  3 - To adjust expectations within the family.

  4 - To expand the individual's social networks.
• Summarise the aim of family therapy in one sentence.

  To provide the whole family with practical coping skills that enable them to manage the everyday difficulties arising as a consequence of having schizophrenia in the family.
• AO3 - Effectiveness - NCCMH (2009)


  - Meta-analysis involving 32 studies and nearly 2500 patients.

  - Compared those having family therapy with those recieving drug (standard) therapy.

  - Found relapse rate for those recieving family therapy was 26%, compared to a rate of 50% in the control (drug) condition,

  - Also a reduction in hospitalisation during treatment and in the severity of symptoms, up to 24 months following intervention.
• AO3 - Effectiveness - Tarrier (1994)


  - Found relapse rates 8 years following family therapy was 67% compared to 88% of those having standard medication in a sample of 83 schizophrenic patients.

  - However, those receiving family therapy almost always take drugs as well - makes it difficult to measure its effectiveness alone.
• AO3 - Increases compliance


  - Family therapy is probably successful in reducing relapse as the support of the family can increase the compliance of the patient in taking their medication.
• AO3 - Limitations


  - Family therapy may not be suitable for everyone, e.g. people who are estranged from their famiy, those without family or those with family unwilling to participate.

  - Family therapy requires specially trained therapists and cn be costly.
• AO3 - Strength - cost saving

  - Reviews have demonstrated how when family therpay is offered to people in addition to standard care, it is significantly cost saving.

  - Extra cost of family intervention is offset by a reduction in costs of hospitalisation due to the lower relapse rates.
• AO3 - 1 strength and 3 limitations of token economies.

  - Strength - Can be tailored to meed individual requirments of different patients - uses the same principles but to target different behaviours, meaning it is a flexible treatment.

  - Limitation - Work best in unison with antipsychotic drugs and other personalised treatments - should not be seen as a therapy in its own right.

  - Limitation - Desirable behaviour becomes dependent on being reinforced - upon discharge, the reinforcement ceases, leading to high re-admittance rates.

  - Limitation - Not favoured by all clinicians, due to perceptions that participation is humiliating - treated like children, or prisoners.
• How does CBT work

  Help patients make sense of their delusions and hallucinations by understanding where their symptoms came from eg if the patient is hearing voices and believes theyre demons then explaining hallucinations and delusions can reduce the anxiety
• How does family therapy work

  1. forming therapeutic alliance with family
  2. reducing stress of care to Schiz relative
  3. improves ability of family to anticipate and solve problems
  4. reduces anger and guilt in family
  5. improves family belief towards Schiz