Psychological therapy for schizophrenia add extra study and evaluation for family therapy

Question 1

cognitive behaviour therapy (CBT) definition

Answer 1

method for treating mental disorders based on both cognitive and behavioural techniques. form the cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts. the therapy includes behavioural techniques

Question 2

family therapy definition

Answer 2

psychological therapy carried out with all or some members of family with the aim of improving the communications within the family and reducing the stress of living as a family

Question 3

CBT as a psychological therapy for schizophrenia - how long does CBT take

Answer 3

takes place over a 5-20 sessions either in groups or on an individual basis

Question 4

CBT as a psychological therapy for schizophrenia - what does CBT aim to deal with

Answer 4

both thoughts (cognitions) and behaviour

Question 5

CBT as a psychological therapy for schizophrenia - how does it work

Answer 5

helps client make sense of irrational cognitions (such as delusions and hallucinations) impact on their behaviour

Question 6

CBT as a psychological therapy for schizophrenia - understanding symptoms

Answer 6

-understanding where symptoms come from can be hugely helpful for those with symptoms such as auditory hallucinations. if for example someone hear voices and believes the voices represent demonic forces, they will naturally be very afraid. if a therapist can convince them that the voice actually comes from them their malfunctioning speech centre in their own brain and that it cannot hurt them if they ignore it, it much less frightening and less debilitating. this will not eliminate the symptoms of schizophrenia but can make it so people can cope with them this is turn reduces stress and improves the ability to function adequately

Question 7

CBT as a psychological therapy for schizophrenia - how can people hearing voices be helped

Answer 7

-by teaching them that voice-hearing is an extension of the ordinary experience of thinking in words. this is called normalisation

Question 8

CBT as a psychological therapy for schizophrenia - how can delusions be challenged

Answer 8

-can be challenged for example by process of reality testing in which the person with schizophrenia and therapist jointly examine the likelihood that beliefs are true. in some cases where delusions are resistant to reality testing CBT can still be used to tackle the anxiety and depression that result from living with schizophrenia

Question 9

CBT as a psychological therapy for schizophrenia - who did a case example

Answer 9

Turkington et al

Question 10

CBT as a psychological therapy for schizophrenia - Turkington et al case example

Answer 10

-challenge where paranoid delusions come from
-paranoid client “mafia are trying to kill me”
-Therapists “you are obviously very frightened … there must be a good reason for this”
-paranoid client “do you think it’s the mafia”
-therapist “ it’s a possibility, but there could be other explanations. how do you know that it’s the mafia”

Question 11

Strength of CBT as a psychological therapy for schizophrenia - evidence for effectiveness

Answer 11

-Jauhar et al reviewed 34 studies using CBT with schizophrenia, concluding that there is a clear evidence for small but significant effects on both positive and negative symptoms. other studies have focused on symptoms, for example Pontillo et al found reductions in frequency and severity of auditory hallucinations. clinical advice form NICE (national institute for health and care excellence), recommends CBT for schizophrenia –> means that both research and clinical experiences support the benefits of CBT for schizophrenia

Question 12

limitation of CBT as a psychological therapy for schizophrenia - quality of evidence

Answer 12

-wide range if techniques and symptoms included in studies
-CBT techniques and schizophrenia symptoms vary widely from one case to another. Thomas points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. the overall modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms –> makes it hard to say how effective CBT will be for a person with schizophrenia

Question 13

evaluation of CBT as a psychological therapy for schizophrenia - does CBT cure

Answer 13

-CBT may improve the quality of life for people with schizophrenia but not actually cure them. as schizophrenia appears to be largely a biological condition we would expect that a psychological therapy like CBT just benefits people by improving their ability to live with schizophrenia
-on other hand studies report significant reductions in severity of both positive and negative symptoms. this suggests CBT does more than enhance coping

Question 14

family therapy as a psychological therapy for schizophrenia - who takes part

Answer 14

the families as well as the identified patient (described the one member of a dysfunctional family who expresses the family’s conflict)

Question 15

family therapy as a psychological therapy for schizophrenia - what does family therapy aim to achieve

Answer 15

aims to improve the quality of communication and interaction between family members

Question 16

family therapy as a psychological therapy for schizophrenia - range of approaches

Answer 16

range of approaches to family therapy in keeping with psychological theories like the double-bind and schizophrenogenic mother

Question 17

family therapy as a psychological therapy for schizophrenia - what 2 ways that Pharoah et al identified as ways that improve the functioning that has a member with schizophrenia

Answer 17

-reduces negative emotions
-improves the family’s ability to help

Question 18

family therapy as a psychological therapy for schizophrenia - reduces negative emotions

Answer 18

-aims to reduce levels of expressed emotion ie. reduce level of emotion generally but especially negative emotions such as anger and guilt create stress. reducing stress is important to reduce the likelihood of relapse

Question 19

family therapy as a psychological therapy for schizophrenia - improves the family’s ability to help

Answer 19

-therapist encourages family members to form a therapeutic alliance whereby they all agree on the aims of therapy. the therapist tries to improve families’ beliefs about and behaviour towards schizophrenia. a further aim is to ensure that family members achieve a balance between caring the individual with schizophrenia and maintaining their own lives

Question 20

family therapy as a psychological therapy for schizophrenia - who proposed model of practice

Answer 20

Burbach

Question 21

family therapy as a psychological therapy for schizophrenia - what model of practice did Burbatch propose

Answer 21

-model of working with families dealing with schizophrenia

Question 22

family therapy as a psychological therapy for schizophrenia - how does model of practice begin

Answer 22

sharing basic information and providing emotional and practical support

Question 23

family therapy as a psychological therapy for schizophrenia - phase 2 of Burbach model of practice

Answer 23

involves identifying resources including what different family members can and cannot offer

Question 24

family therapy as a psychological therapy for schizophrenia - phase 3 of Burbach model of practice

Answer 24

aims to encourage mutual understanding, creating a safe space for all family members to express their feelings

Question 25

family therapy as a psychological therapy for schizophrenia - phase 4 of Burbach model of practice

Answer 25

involves identifying unhelpful patterns of interaction

Question 26

family therapy as a psychological therapy for schizophrenia - phase 5 of Burbach model of practice

Answer 26

about skills training such as learning stress management techniques

Question 27

family therapy as a psychological therapy for schizophrenia - phase 6 of Burbach model of practice

Answer 27

looks at relapse prevention planning

Question 28

family therapy as a psychological therapy for schizophrenia - phase 7 of Burbach model of practice

Answer 28

maintenance for the future

Question 29

strength of family therapy as a psychological therapy for schizophrenia - evidence of effectiveness

Answer 29

-review of studies by McFarlane concluded that family therapy was one of the most consistent effective treatments available for schizophrenia, in particular elapse rates were found to be reduce typically by 50-60%. McFarlane also concluded that using family therapy as mental health initially starts to decline is particularly promising. clinical advice from NICE recommends family therapy for everyone with diagnosis of schizophrenia --> means family therapy is likely to be of benefit to people with both early and full blown schizophrenia

Question 30

strength strength of family therapy as a psychological therapy for schizophrenia - benefits to whole family

Answer 30

-benefits all family members -therapy is not just for the benefit of identified patient but also for the families that provide the bulk of care. a review by Lobban and Barrowclough concluded that these effects are important because families provide the bulk of care for people with schizophrenia. by strengthening the functioning of a whole family members and strengthens the ability of the family to support the person with schizophrenia --> means that family therapy has wider benefits beyond the obvious positive impact in the identified patient

Question 31

evaluation strength of family therapy as a psychological therapy for schizophrenia - which matters the most

Answer 31

-because family therapy reduces relapse rates and makes families better able to provide the bulk of care it ahs huge economic benefits. the state does nit need to pay so much -on other hand, family therapy also has very significant therapeutic benefits for people with schizophrenia and their families

Question 32

how can CBT be used as a personal therapy

Answer 32

detailed evaluation of problems and experiences, their triggers and consequences, strategies used to cope

Question 33

what are the cognitive techniques used between patient and therapist during CBT as a personal therapy

Answer 33

-distractions from intrusive thoughts -challenging the meanings of intrusive thoughts -increasing or decreasing social activity to distract from low moods -using relaxation strategies

Question 34

why is CBT used as a personal therapy

Answer 34

-used to tackle personal problems faced by patients with schizophrenia when discharged from hospital, taking place in small groups or as one-to-one. Taught to recognise small signs or relapse, which can build up to produce cognitive distortions and unsuitable social behaviour

Question 35

how can rational emotive therapy be used as a CBT for schizophrenia

Answer 35

teach patients that emotional instability is a common feature of schizophrenia that they must live with. patients use muscle relaxation techniques to detect anger build ups and then apply relaxation skills to control emotions

Question 36

who researched CBT for schizophrenia

Answer 36

Tarrier et al

Question 37

Tarrier et al findings

Answer 37

-people with schizophrenia receiving about 20 sessions of personal therapy CBT in 10 weeks, coupled with drug therapy, followed y four booster sessions during the next year, did better than patients receiving drug therapy alone or supportive counselling -one third of patients with PT achieved a 50% reduction in psychotic experiences, with 15% free of all positive symptoms, compared with 15% in counselling group which had 7% positive symptom free, no patients with drug only were symptom free -one year later similar difference -2 years later advantage over counselling group gone but both outscored drug only

Question 38

Jahur et al findings

Answer 38

-meta analysis of 50 studies of CBT for schizophrenia conducted over last 20 years -only small therapeutic effect on symptoms, including positive symptoms, such as delusions and hallucinations which CBT mainly targets -even this small effect disappeared when only studies using blind testing were considered -strongly questions whether CBT should be used as a treatment for schizophrenia

Question 39

limitation of CBT - suitability for patients

Answer 39

those to disorientates, agitated or paranoid to form trusting relationships may not connect with cognitive aspect of CBT. for these it may be better for other treatments such as drug treatments (CBT is also time consuming)

Question 40

limitation of CBT - costs

Answer 40

CBT is a more expensive treatment for schizophrenia than drugs as many drugs can be manufactured which help many people in the time needed for one session of CBT, however it does have fewer side effect

Question 41

research for family therapy- Leff et al

Answer 41

-compared family therapy with routine outpatient care for patients with schizophrenia from families with high expressed emotion -first 9 months of treatment 8% family therapy relapsed compared to relapse of 50% from routine care -after 2 years 75% of routine care relapsed but only 50% of family therapy relapsed -suggest family therapy is a comparatively effectively therapy especially in short term

Question 42

limitation of family therapy --> sensitive information

Answer 42

-family therapy emphasises the openness which can be an issue as may be reluctant to share the sensitive information as may fear it will bring up family issued. this could lead to some members being reluctant to talk about or admit their problems which can reduce effectiveness of therapy