pyschological treatments

• CBTp


  • To challenge and modify delusory beliefs
  • To help the patient identify delusions and test the reality of the evidence
• Phases of CBTp


  1. Assessment

  2. Engagement

  3. The ABC Model

  4. Normalisation

  5. Critical Collaborative Analysis

  6. Developing Alternative Explanations
• Assessment


  The client expresses their experiences and symptoms to the therapist, and goals and expectations of therapy can be established
• Engagement


  The therapist provides a therapeutic environment for the patient where they can engage in therapy, empathising with the patient's perspective and distress
• ABC Model


  Patient describes the (A)ctivating event, their (B)eliefs/behaviour, and the (C)onsequences, which can then be challenged and changed
• Normalisation


  Knowing that others experience similar things can help reduce feelings of isolation and anxiety, and placing psychotic experiences on a continuum of 'normal' experiences can help patients feel less stigmatised
• Critical collaborative analysis


  Gentle questioning by the therapist to help the patient understand their illogical thought processes, in a non-threatening way due to the therapeutic relationship
• Developing alternative explanations


  Discussing alternative explanations for unhealthy assumptions, in collaboration with the therapist
• Nature of CBTp


  • Patients encouraged to trace the origins of their symptoms and evaluate their delusions or voices
  • Patients are set behaviour assignments
  • Therapist lets the patient develop their own alternatives to their beliefs
• Advantages of CBTp over standard care

  • Effective in reducing hospital admissions and symptom severity, and improving social functioning
  • When combined with antipsychotic drugs, there is a lower drop-out rate and greater patient satisfaction
• Most studies on CBTp have been conducted with patients also taking antipsychotic medications, so it's difficult to assess the effectiveness of CBTp alone
• Lack of availability of CBTp - only 1 in 10 patients in the UK can access it, and it's even lower in some areas
• CBTp is not effective for everyone, and needs to be tailored to the relevant stage of the illness
• England and Wales emphasise non-drug therapies like CBTp, whereas Scotland places more emphasis on antipsychotic medications
• Family therapy


  Seeks to treat members of the family as well as the patient with schizophrenia, to reduce the high level of expressed emotion within the household and support carers
• Aims of family therapy

  • To provide support for carers to make family life less stressful, reducing rehospitalisation
• How family therapy works

  1. Reducing levels of expressed emotions and stress by increasing ways to solve family related problems

  2. Psychoeducation to help the person and carers understand and deal with the illness

  3. Forming an alliance with the patient and carer

  4. Reducing expression of anger and guilt by family members
• Receiving family therapy leads to lower relapse rates (25%) compared to standard care (50%)
• What the family learns in family therapy

  • More constructive ways of communicating and concentrating on positive events rather than negative ones
  • Recognising early signs of relapse to respond rapidly
• Pharoah's review


  Found a clear reduction in relapse and readmission during treatment and in 24 months after, but mixed results on mental state and social functioning improvements
• Family therapy produces economic benefits by reducing the need for intensive medical and social care
• Family therapy has a positive impact on family members, improving their coping and problem-solving skills
• Some studies have found that family intervention is not necessary to improve outcomes compared to standard treatment, if carers already have low levels of expressed emotion
• Methodological limitations of family therapy studies include problems with random allocation and lack of blinding