Psychological therapy for schizophrenia Flashcards
(12 cards)
What are the aims of CBT?
(CBT for Psychosis CBTp)
In general to help clients identify irrational thoughts (e.g. hallucinations and delusions) and try to change them
around 5-20 sessions either individually or as a group
Clients are helped to make sense of how their delusions and hallucinations impact their feelings and behaviour
e.g. a client may hear voices and believe they are demons so will be very afraid
NORMALISATION: explaining to the client that hearing voices is an ordinary experience
delusions can also be challenged - process of reality testing - therapist and client examine the likelihood of something happening
the ABC model is used to identify activating events that cause the emotional and behavioural consequences. The patient’s irrational beliefs can then be rationalised disputed and challenged
the patient can then develop their own alternative explanations for previously unhealthy assumptions -addressing faulty thinking patterns
case example of CBT for Schizophrenia?
Turkington treated a paranoid client who believed the Mafia were plotting to kill him
the therapist acknowledges the client’s anxiety and explained that there were other, less frightening possibilities and gently challenged the client’s evidence for his belief in the Mafia explanation
what is Family therapy?
Aims is to reduce negative emotions in the ‘identified patient’ and reduce levels of expressed emotion (EE) - especially negative emotions such as anger and guilt which create stress
what does the family therapy do?
Pharoah identified a range of strategies used in family therapy - to improve functioning of a family with a member who has schizophrenia
Reduces negative emotions - family therapy aims to reduce levels of expressed emotion (EE) - reduce level of emotion such as anger and guilt creating stress - reducing stress is importnant to reduce likelihood of relapse
improve families ability to help : the therapist encourages the family members to forms a therapeutic alliance whereby they all agree on the aims of therapy. they also try to improve the families beliefs about behaviour toward schizophrenia and ensure they achieve a balance between caring and maintaining their own lives
what is an example of family therapy ?
Burbach’s 2018 model:
Phases 1 and 2 - share information and identify resources family can offer (including what different family members can offer)
Phases 3 and 4 - learn mutual understanding and making a safe space for family members to express feelings, look at unhelpful patterns of interaction
Phases 5,6,7 - skills training (e.g. stress management techniques), relapse prevention and 7 is maintenance for the future
Strength of CBT is evidence for effectiveness
Jauhar reviewed 34 studies of CBT for schizophrenia and concluded that there is evidence for significant effects on symptoms
(Jauhar’s ‘small but significant’ difference disappeared when symptoms were assessed ‘blind’)
Pontillo found reductions in auditory hallucinations. Clinical advice from NICE recommends CBT for people with schizophrenia
This means both research and clinical experience support CBT for schizophrenia
Limitation for CBT is the quality of the evidence
Thomas points our that different studies have focused on different CBT techniques and people with different symptoms
(many people having CBT are also on antipsychotics - so hard to be sure what has caused the improvement)
Overall modest benefits of CBT for schizophrenia may conceal a range of effects of different techniques on different symptoms
this means that it is hard to know how effective CBT will be for treating a particular person with schizophrenia
Extra - CBT
CBT may improve quality of life but not cure - as schizophrenia is a biological condition, CBT should only improve the ability to live with schizophrenia
But studies report significant reductions in positive and negative symptoms - suggesting CBT does more than enhance coping
So it may be that CBT may be a partial cure for schizophrenia
Strength of family therapy is evidence for its effectiveness
McFarlane concluded that family therapy is effective for schizophrenia. Relapse rates were reduced by 50-60%
Particular promising during time when mental health initially starts to decline. NICE recommends family therapy
this means that family therapy is good for both people with both early and ‘full blown’ schizophrenia
Another strength is the benefits for the whole family
Therapy is not just for the benefit of identified patient, but also for the families that provide bulk of care for people with schizophrenia (Lobban and Barrowclough)
Family therapy lessens the negative impact of schizophrenia on the family and strengthens ability of the family to give support
this means family therapy has wider benefits beyond the obvious positive impact on the identified patient
extra - family therapy
family therapy reduces relapse rates and makes families better able to provide the bulk of the care so it has economic benefits
but family therapy also has therapeutic benefits for people with schizophrenia and their families
this suggests that everyone wins, ultimately therapy should be for the benefit of the person and their family - any economic gain is a bonus
Limitation of CBT
CBTp has been criticised for interfering with a patient’s freedom of thought, for example by challenging a person’s religious or political views on the government’s level of control.
