Psychological Treatments For Schizophrenia

Question 1

✅[CBT]: CBT IS MORE EFFECTIVE THAN STANDARD CARE:

Answer 1

• The NICE review of treatments for schizophrenia found consistent evidence that CBTp reduces hospitalisation rates months after treatment.
• Additionally, CBTp has been shown to reduce symptom severity and improve social functioning.
• However, a limitation of this research is that most studies involve patients who are also receiving antipsychotic medication. This creates a confounding variable, making it difficult to isolate the effects of CBTp alone.
• Overall, the evidence suggests that CBTp is an effective therapy, but its success may depend on it being used alongside biological treatments. This highlights an issue with internal validity as it remains unclear how much of CBTp’s success is attributable to the therapy itself.

Question 2

✅[CBT]: CBT PROVIDES A SAFE AND EFFECTIVE ALTERNATIVE TO MEDICATION:

Answer 2

• Sensky et al. (2000) found that patients who had resisted antipsychotic medication experienced a reduction in both positive and negative symptoms after undergoing 19 sessions of CBT. Furthermore, these improvements were sustained even nine months after treatment had ended, highlighting the long-term benefits of CBT.
• This suggests that CBT offers an alternative to drug therapies, which often provide only short-term symptom relief. Additionally, unlike antipsychotic medication, CBT does not cause side effects, making it a more appealing option for many patients.
• However, CBT requires active engagement, which can be challenging for individuals experiencing severe negative symptoms like avolition or positive symptoms like paranoia, as these may lead to distrust of the process. It is also high cost, which limits its availability.
• While CBT is a valuable treatment option for schizophrenia, it is not universally suitable for all patients, limiting its generalisability. Combining CBT with antipsychotic medication to reduce severe symptoms, enabling patients to subsequently engage with therapy can enhance its applicability.

Question 3

❌[CBT]: POOR QUALITY RESEARCH MAY DISTORT EFFICACY IN THE META-ANALYSES:

Answer 3

• This is because the quality of the research is not normally taken into account. Some studies fail to randomly allocate participants, or researchers are aware of which treatment condition each group is assigned to, increasing the likelihood of researcher bias. Such flaws mean that conclusions drawn about the effectiveness of CBT may lack reliability.
• Wykes (2008) found that the more rigorous the study, the weaker the effect of CBT. This suggests that earlier positive findings may have been overestimated due to methodological weaknesses, such as poor control over confounding variables.
• This highlights the need for more rigorous, high-quality research to provide robust evidence for the effectiveness of CBT. Without this, the application of CBT in clinical practice may lack a strong scientific foundation, reducing confidence in its role as a treatment for schizophrenia.

Question 4

✅[FAMILY THERAPY]: REDUCES RELAPSE RATES:

Answer 4

• Leff (1985) investigated aftercare in patients with schizophrenia and found that 50% of those receiving standard outpatient care relapsed within 9 months, compared to just 8% who received family therapy. However, by two years, relapse rates increased to 50% for family therapy and 75% for standard care.
• This suggests that family therapy is highly effective at reducing hospital readmissions initially, as it promotes positive communication and reduces expressed emotion within families.
• However, the long-term benefits may decline as families struggle to maintain these behavioural improvements over time.
• This highlights the importance of addressing the reliability of family therapy’s long-term outcomes and suggests it should be used alongside other treatments to ensure sustained effectiveness and greater generalisability across different families and care settings.

Question 5

❌[FAMILY THERAPY]: THE LONG DURATION LIMITS THE APPLICATION OF FAMILY THERAPY:

Answer 5

• Family therapy can take up to a year to complete, requiring a long-term commitment from both the patient and their family.
• This can result in high dropout rates, especially for patients experiencing severe symptoms or disruptions due to family conflicts or crises. Additionally, the burden of attending regular sessions over an extended period may prove overwhelming for some families, reducing the therapy’s effectiveness.
• These practical difficulties limit the application of family therapy for many patients. While family therapy can significantly improve outcomes for those who remain engaged, its demanding nature raises concerns about its overall reliability as a widespread treatment option, particularly for individuals with unstable circumstances or severe symptoms that hinder long-term participation.

Question 7

✅[TOKEN ECONOMIES] (TENTATIVE) EVIDENCE TO SUPPORT THE USE OF TOKEN ECONOMIES:

Answer 7

• Dickerson et al. (2005) reviewed 13 studies on the use of token economy systems in treating schizophrenia and found that 11 studies reported beneficial effects. However, they also noted significant methodological issues in many of the studies, such as a lack of control groups and poorly defined outcome measures. These flaws reduce the reliability of the findings and raise concerns about bias and validity.
• This suggests that while token economies may be beneficial in encouraging desired behaviours and improving daily functioning for individuals with schizophrenia, their overall effectiveness remains uncertain.
• The methodological issues limit the generalisability of the findings to wider populations and highlight the need for more rigorous research to establish the reliability and long-term impact of this approach. This raises questions about its practical application and the robustness of the evidence base.

Question 8

❌TOKEN ECONOMIES ARE ONLY EFFECTIVE IN HOSPITAL SETTINGS:

Answer 8

• Corrigan (1991) highlights issues with delivering token economies to patients who live in the community.
• In a hospital ward, patients have constant monitoring by staff who can reward behaviours consistently throughout the day. However, in community settings, treatment is only provided for a few hours, making it difficult to maintain the consistent reinforcement required for the system to work effectively.
• This suggests that token economies have limited practical application and are only suitable for controlled environments like psychiatric wards. This reduces their ecological validity, as the real-world effectiveness of the treatment is questionable. It also raises ethical concerns, as the benefits are primarily restricted to hospitalised patients, leaving those in community care at a disadvantage in accessing effective behavioural support.