Psychological Therapies Flashcards Preview

Schizophrenia > Psychological Therapies > Flashcards

Flashcards in Psychological Therapies Deck (19):

Cognitive - behavioural therapy (CBT)

trace origins of symptoms to understand how they might develop, evaluate content of delusions/hallucinations and test validity
patient allowed to develop own alternatives to maladaptive beliefs


CBT - outcome studies

measure how well patient does often treatment compared to accepted form
show fewer hallucinations/delusions, recover functioning to greater extent


CBT - assumptions

people have distorted beliefs which influence behaviour
delusions thought to result from faulty interpretations of events


Outcome studies - Kuipers et al (1997)

drop-out rates lower and greater patient satisfaction when CBT + medication used


Family intervention - assumption

stressful family environment can increase risk of relapse


Family intervention - aim

make family life less stressful and reduce re-hospitalisation


Family intervention - strategies

form an alliance with relatives who care for patient, reducing EE and increasing capacity of relatives to solve problems
commonly used with drug treatments and clinical care


Effectiveness of CBT - Gould et al. (2001)

meta-analysis, 7 studies, reported significant decrease in positive symptoms


How much due to CBT?

most studies conducted with patients treated with medication, difficult to assess effectiveness of CBT
don't fully understand


Appropriateness of CBT - who benefits

Kingdom and Kirschen (2006): 142 SZ patients, Hampshire, patients not deemed suitable, they would not fully engage
older patients deemed less suitable


Appropriateness of CBT - raise self-esteem

involves realisation delusions and hallucinations can occur in healthy individuals
improve mental state


Effectiveness of family intervention - meta-analysis

32 studies (2500 ps.), significant evidence for effectiveness


Effectiveness of family intervention - supporting research

compared with patients receiving standard care, reduction in hospital admissions and severity of symptoms
relapse rates 26%, in control 50%


Effectiveness of family intervention - limited

not a cure
usually require drug therapy and social adjustment is lower than healthy individuals


Appropriateness of family intervention - economic benefits

NICE review: associated with cost savings when offered in addition to standard care
cost offset by reduction in costs of hospitalisation - lower relapse rates


Appropriateness of family intervention - cultural limitations

most evidence from studies outside UK
NICE study: hospitalisation level may differ across countries, data from other countries might not be applicable


Meta-analysis of family intervention studies

Pharoah et al: 53 studies in Europe, Asia, N. America
mental state - mixed
compliance with medication - increase
social functioning - not much effect on living independently, employment etc.


Methodological limitations of family intervention studies

randomisation - not always used in studies from China
lack of blinding - Pharoah et al study, 10 studies reported no blinding, 16 did not say


Ethical issues in research

BPS advise that possibility of harm should not increase
harm in outcome studies: medication discontinuation, use of placebo, capacity for informed consent