Psychological therapies Flashcards
(20 cards)
What is cognitive behavioural therapy?
identify, challenge, change
- aims to help patients identify irrational thoughts and trying to change them
- involves a discussion on how likely patients beliefs are to be true and they consider other less threatening possibilities
- doesnt get rid of Schiz but helps with coping
- takes 5-20 sessions
How does CBT help patients
- they can male sense of how their delusions/hallucinations impact on their behaviour
understanding where symptoms come from can be helpful
offering a psychological explanation can help reduce anxiety
How do psychological therapies work
they work alongside antipsychotics
How are irrational thoughts challenged using CBT
help patients identify their own alternative explanation for their beliefs
- done by placing the client in experimental situations that will test the validity of the belief (hypothesis testing)
How are irrational thoughts changed using CBT
patients are set behavioural homework to help improve their level of functioning and -ve symptoms
How is CBT present orientated
majority of time spent is on what the person is currently experiencing
CBT focuses on current situations
What is Family therapy
takes place with families aiming to improve communication and the relationship between family members
therapist aim to reduce stress with in the family and levels of EE
- increases chances of **patients complying with medication and prevents relapse **
How does family therapy help patients?
- help form a therapeutic alliance with ask family members
- reduces stress of caring for a relative with Schiz
- reduces sheet and
What are strengths of psychological therapies as a treatment of schizophrenia
supported by evidence
improves the quality of life
What is a limitation of psychological therapies as a treatment of schizophrenia
ethical issues
Evaluate supported by evidence as a strength of psychological therapies as a treatment of schizophrenia
P: A strength of CBT and Family therapy is that we have evidence for its effectiveness.
E: Jauhar et al reviewed the results of 34 studies of CBT for schizophrenia.
They concluded that CBT has a significant but fairly small effect on both positive and negative symptoms.
Paroah et al. reviewed the evidence for the effectiveness of family therapy for families of schizophrenia sufferers. They concluded that there is moderate evidence to show that family therapy significantly reduces hospital readmission
over the course of a year and improves quality of life for patients and their families.
E: However, they also noted that results of different studies were inconsistent and that there were problems with the quality of some evidence. Overall then the
evidence base for family therapy is fairly weak.
L: Overall there is only modest support for the effectiveness of psychological treatments and schizophrenia remains one of the harder mental health problems to treat. This is a limitation of psychological treatments
Evaluate that it improves the quality of life as a strength of psychological therapies as a treatment of schizophrenia
P: They improve the quality of life of the patient
E: CBT helps by allowing patients to make sense of and challenge some of their symptoms. Family therapy helps by reducing the stress of living with schizophrenia in a family, both for the patient themselves and other family members.
E: These things are all worth doing but should not be confused with curing
schizophrenia. Of course, biological treatments do not cure schizophrenia either but they do reduce the severity of
some symptoms. The failure to cure schizophrenia is a weakness of psychological treatments.
Evaluate ethical issues as a limitation of psychological therapies as a treatment of schizophrenia
P: They are ethically questionable
E: CBT may involve, for example, challenging a person’s paranoia, but at what point does this interfere with an individual’s freedom of thought? If, for
example, CBT challenged a patient’s beliefs in a highly controlling government,
this can easily stray into modifying their politics.
E: Ethical issues like this are a weakness of psychological treatments for
schizophrenia. There are other psychological therapies that can be helpful for some people with schizophrenia that are less well-known and less likely to be
available to patients. For example, the National Institute for Health and Clinical Excellence (NICE) recommends art therapy, provided a qualified art therapist with experience of working with schizophrenia sufferers is available.
How can schizophrenia be managed
token economies
Describe token economies
Token economies are reward systems (based on the principles of operant conditioning)
used to manage the behaviour patterns of patients with schizophrenia, particularly those
who developed maladaptive behaviours through long periods in psychiatric hospitals
For example patients may develop bad hygiene
(staying in their PJs).
Modifying these negative behaviours makes it more possible for them to live outside a hospital setting rather than actually curing schizophrenia.
What are tokens
Tokens (coloured disks) are given out to patients when they carry out desirable behaviour
targeted for reinforcement (getting dressed, making a bed), according to each patients’
individual needs and behaviour issues.
The reward needs to be immediate to prevent ‘delay discounting’ - the reward is not as impactful when delayed
What are rewards
Tokens can be exchanged for rewards.
Tokens are secondary reinforcers as they only have value once the patient learns they lead to rewards.
Rewards can be sweets, cigarettes or services such as a room cleaned or a privilege such as time outside the hospital.
What is a strength of token economies for managing schizophrenia
supported by evidence
Evaluate supported by evidence as a strength of token economies for managing schizophrenia
P: Evidence for their
effectiveness.
E: Glowacki et al identified 7 high quality studies published between 1999-2013 that examined the effectiveness of token economies on patients with chronic mental heal issues such as schizophrenia
E: All studies demonstrated a reduction in negative symptoms. As a result Token economies help by making patients’ behaviour more socially acceptable so that they can better re-integrate into society.
L: However, these studies suffer the ‘file drawer problem’. A bias towards positive findings, particularly those with
a small number of studies (7). We therefore have to question the evidence of effectiveness for token economies.
Evaluate ethical issues as a limitation of token economies for managing schizophrenia
P: Ethically questionable
E: Although psychological treatments for schizophrenia do not have the serious side effects they can raise ethical issues.
In particular, token economy systems have proved controversial. The major issue is that privileges, services, etc.
become more available to patients with mild symptoms and less so for those with more severe symptoms of
schizophrenia that prevent them complying with desirable behaviours.
This means that the most severely ill patients suffer discrimination in addition to other symptoms, and some
families of patients have challenged the legality of this. This has in turn reduced the use of token economies in the
psychiatric system.
E: Ethical issues like this are a weakness of psychological treatments for schizophrenia. There are other psychological
therapies that can be helpful for some people with schizophrenia that are less well-known and less likely to be available to patients.
