psychological therapies

Question 1

what therapies are there?

Answer 1

1. CBT
2. family therapy
3. token economies

Question 2

overview of CBT

Answer 2

• 5-20 sessions
• designed to help patient deal with residual (left over) symptoms that antispyschotics didnt treat (persistent neg and pos symptoms)
• aims to identitfy how irrational thought patterns impact feelings and behaviour

Question 3

which irrational thoughts should be targeted in CBT?

Answer 3

delusions and hallucinations

Question 4

what does CBT encourage?

Answer 4

• think back to origins of symptoms
• evaluate content of hallucinations and delusions
• question validity of faulty beliefs

Question 5

CBT example of how would treat auditory hallucinations?

Answer 5

1. eg client hears voice and believes is demonic force
2. therapist would dispute their beliefs, target irrational beliefs, reassure not demonic force
3. outcome= less fightening and disabling, reduces their stress

Question 6

CBT example of how would treat delusions?

Answer 6

1. eg mafia are observing me to decide how to kill me
2. therapist would target irrational beliefs, evidence based testing reality, discuss likelihood
3. outcome= reduce their distress and question accuracy of delusions

Question 7

overview of family therapy?

Answer 7

• delivered to family
• 3-12 months, 10 sessions at least (lowers relapse rate, not quick fix)

Question 8

what does family therapy aim to do?

Answer 8

• improve quality of communication and interaction within the family

Question 9

focus of family therapy?

Answer 9

reducing stress and reducing levels of EE (criticism) in the family home, therefore reducing risk of relapse

Question 10

strategies used in family therapy?

Answer 10

1. psychoeducation (improve beliefs and behaviour towards SZ)
2. reducing anger and guilt between family
3. form therapeutic alliance with all family members

Question 11

how do the strategies reduce EE and stress?

Answer 11

• reduces conflict/criticism- become aware and know consequence. makes less stressful at home

Question 12

how do the strategies reduce risk of relapse?

Answer 12

• creates long lasting effect by targetting depths/creates more positive environment - reduces triggers

Question 13

overview of token economies?

Answer 13

• behavioural therapy that encourage desirable behaviours using selective reinforcement

Question 14

who are token economies reward system used with?

Answer 14

• patients who have adopted maladaptive behaviours from spending long periods of time in psychiatric hospitals eg bad hygiene

Question 15

what do token economies aim to do?

Answer 15

• modify behaviours to improve quality of life and manage schizophrenia
• not to treat SZ but manage it

Question 16

what is a primary reinforcer?

Answer 16

• anything that gives pleasure (food/comfort)
• dont depend on learning to have reinforcing value

Question 17

what is a secondary reinforcer?

Answer 17

• something that has no value on its own till paired with primary reinforcer
• tokens

Question 18

process of token economy?

Answer 18

1. tokens [SR] (eg stickers/coins) paired with rewarding stimuli [PR]
2. engage in desirable behaviours eg get out of bed or reduces inappropriate ones eg not shower
3. given token for engaging in target behaviours. acts as **immediate reinforcer **and reinfores
4. trades tokens for access to items/privledges

Question 19

evidence for effectiveness of CBT

Answer 19

Tarrier
- 20 controlled trials of CBT, persistent evidence of decrease symptoms especially positive, lower relapse and speddier recovery than acutely ill patients

counter-> short term benefits, follow ups needed to assess long term benefits

Question 20

suitability, time, effort for CBT

Answer 20

• not suitable for all especially those too disorientated/paranoid to trusting practioners
• long - 5-20 sessions= high drop out rate, requires effort. specific people

Question 21

cost of CBT

Answer 21

• more expensive in short term. £80 an hour
• cheaper than taking tablets everyday if it improves quality
• cost of drugs would outweigh cost of CBT (£1 to adminster)

Question 22

effectiveness research for family therapy?

Answer 22

Leff et al
- compared family therapy with routine outpatient care for 52 with families with high EE
- 50% relapse - routine care. 8% relapse- F.T, 50% after 2 years

counter-> only within short term, can be reopen to family tensions so be reluctant talk/admit problems

Question 23

suitability, cost for family therapy

Answer 23

• useful for patients who lack insight to illness, family can insight into their behaviour
• SZ Commission estimates F.T is cheaper than standard care by 1K over 3 years, expensive compared to anti-psychotics

Question 24

effectiveness research for token economies

Answer 24

review of evidence
- 3 studies, 1/3 showed improve in symptoms and none yield useful info about behaviour change

counter-> used random allocation- matched patients to treatment and control group
wider range of techiques= hard to compare, individual differences?

Question 25

other evaluation points for token economies?

Answer 25

- difficult to continue with token economies outside hospital setting= relapse rate is high as dont have support - help make patients behaviour more socially acceptable so better re-integrate into society - doesnt cure and is humiliating