Psychological Therapies of Schizophrenia

Question 1

What is the aim of psychological therapies?

Answer 1

Individuals can overcome schizophrenic symptoms by learning to use more appropriate cognitions, the aim is to be positive and rational

Question 2

Outline family therapy

Answer 2

• Family therapy should be offered to those schizophrenic people who are in contact or live with family
• Should be a priority for those with persistent symptoms or high risk of relapse
• It’s offered for 3 to 12 months with at least 10 sessions

Question 3

How does family therapy help with SZ?

Answer 3

• It’s aim to reduce the level of EE in the family, especially anger and guilty which creates stress, to then reduce likelihood of relapse
• The therapist tries to improve the families beliefs about SZ by providing information about SZ, and findings ways they can support the schizophrenic person while still maintaining their own life
• Improves household relationships as the therapist encourages family to listen to each other and to discuss problems

Question 4

Give evaluation for family therapy (effectiveness)

Answer 4

• Pharoah et al did a meta-analysis and found family therapy was effective in improving mental state and social functions for SZ patients
• However the main reason for its effectiveness may have less to do with any improvements in these clinical markers and more to do with how it increases medication compliance.
• This suggests that the main benefit of this therapy is that it makes people more likely to comply with their medication regime

Question 5

Give evaluation for family therapy (benefits to the whole family)

Answer 5

• Lobban et al analysed the results of 50 family studies that had interventions to support relatives,
• 60% of the studies reported a significant positive impact for relatives in areas such as coping and problem-solving skills, family functions and relationship quality.
• Suggests that family therapy is effective in strengthening the family and improving EE

Question 6

Give evaluation for family therapy (economic benefits of family therapy)

Answer 6

• The NICE review of family therapy studies shows that family therapy is linked with significant cost saving when offered to people with SZ in addition to antipsychotics.
• This is due to the reduction in costs of hospitalisation because of lower relapse rates with family therapy
• This means that family therapy can also ease the finical burden on the state, suggesting it’s effective for all parties involved

Question 7

Outline cognitive behavioural therapy (CBT) for SZ

Answer 7

• The basic assumption is that people have distorted beliefs which influence their feelings in maladaptive ways.
• It’s used to help individuals to correct faulty interpretations from delusions
• NICE recommends around 16 sessions for SZ

Question 8

How does CBT help with SZ?

Answer 8

• The aim is to establish links between the patients thoughts, feelings and actions, which helps them to understand how they act the way they do which reduced stress and improves functioning
• e.g. a therapist may try to convince patients that auditory hallucinations come from a malfunctioning centre in their brain and it can’t hurt them if they ignore it, which reduces stress
• Clients benefit from being taught that their auditory hallucinations is an extension of normal experience of thinking in words, called normalisation
• Therapist challenges delusions through reality testing, examining the likelihood that beliefs are true

Question 9

In CBT how are patients encouraged to dispute these beliefs?

Answer 9

• Logical disputing: do irrational thoughts match facts?
• Empirical disputing: actual evidence to support irrational thoughts?
• Pragmatic disputing: thinking this way will not do me any good

Question 10

Give evaluation for CBT for SZ (advantages of CBTp over standard care)

Answer 10

• The NICE review of treatments for SZ found consistent evidence that when compared with antipsychotics alone, CBTp was effective in reducing rehospitalisation rates up to 18 months after treatments
• This means that CBT may be more effective in treating symptoms and preventing relapse than antipsychotics alone.
• However, most studies of the effectiveness of CBTp has been done with patients using antipsychotics at the same time. This means it’s difficult to assess the effectiveness of CBTp alone, and it may be actually assessing medication compliance.

Question 11

Give evaluation for CBT for SZ (effectiveness of CBTp is dependent on the stage of the disorder)

Answer 11

• Addington and Addington claim that in initial acute phase of SZ, self-reflection isn’t appropriate. It’s only after stabilisation of the psychotic symptoms with antipsychotics, may the individual benefit from group-based CBT
• This means that it’s only individuals with more experience of their SZ and a greater realisation of their problems that can benefit from CBT, so it isn’t appropriate for everyone with SZ.

Question 12

Give evaluation for CBT for SZ (lack of availability of CBTp)

Answer 12

• Despite being recommended by NICE as a treatment for those with SZ, it’s estimated that in the UK only 1 in 10 of those who could benefit get access to it
• Haddock et al in the North West of England found that of 187 patients with SZ, only 13 had been offered CBTp
• This questions the effectiveness of CBTp as isn’t offered to those who would benefit most from it