Psychological treatments of schizophrenia Flashcards
(14 cards)
How can token economies be used?
Schizophrenia, like any other behaviour is learnt from the environment through operant conditioning or social learning . Therefore, the behaviour can be unlearnt and replaced by a more adaptive behaviour using the same processes.
· Identifying the undesirable or maladaptive behaviour.
· Identifying the reinforcers that maintain such behaviour.
· Restructuring the environment so that the undesirable behaviour is no longer reinforced.
How does a token economy work?
- patient learns value of token to be used as a reward
- presented with it alongside positive reinforcer
- ## tokens are then used which can be exchanged for other things e.g watching tv
strengths of token economies
Dickerson et al (2005) reviewed 13 studies in their use of token economy and found that 11 of them reported beneficial effects.
· There may be additional effects for patients as they are in a safe and secure environment that is therapeutic to their needs.
· These are tailored to the needs of the patient and their specific disorder.
limitations of token economies
Kazdin & Bootzin (1972) have claimed that the token economy does not lead to permanent behavioural change and that once the reinforcement is removed, the undesirable behaviours return to their initial level.
· This is palliative as it addresses the symptoms and not the reasons why they have schizophrenia.
· This only works where patients live within a controlled community such as a psychiatric hospital and does not work in other situations.
How does CBT work?
This aims to help schizophrenics by changing maladaptive thinking and distorted perceptions seen as underpinning the disorder in order to modify hallucinations and delusional beliefs. In CBT, disorded and delusional thinking can be replaced with thought processes that are more constructive and in line with reality.
stages of cognitive behavioural therapy
(A) Identifying activating event - Patients are encouraged to trace back the origins of their symptoms in order to get a better idea of how the symptoms might have developed. What causes your onset of symptoms?
· (B) Exploring beliefs - What are you thinking about this stimulus?
· (C) Recognising consequences - They are also encouraged to evaluate the content of their delusions or of any internal voices they hear. Can you see how you have come to this conclusion?
· (D) Disputing irrational beliefs - They are encouraged to test the validity of their faulty beliefs. Questions may be asked such as “Have you got any evidence that this will happen to you if you don’t do what the voice tells you?” and “Is there any logic in thinking this way?”have you considered this alternative?
· (E) Restructured belief - how does this alternative make you feel?
What did tarrier (2000) find?
CBT has a significant impact on reducing schizophrenic symptoms when compared to drugs however,
has an improved impact with drugs.
strengths of cbt
CBT is available on the NHS therefore it is free and relatively easy to undergo making these a more appropriate therapy alongside antipsychotic medication.
· CBT is catered to the needs of the patient therefore taking an ideographic approach in comparison to drugs which use a nomothetic approach.
limitations of cbt
CBT is normally used in conjunction with antipsychotic medication therefore it is difficult to establish whether CBT on its own has an impact.
· Although CBT in conjunction with medication seems to have benefits not everyone with schizophrenic may be able to achieve the benefits from CBT.
· It requires a lot of effort from the patient to go to the sessions which they should attend almost every week for a long period of time.
how can family therapy work?
As can be seen from Brown et al (1972), criticism and hostility in the homes of schizophrenic’s increases relapse rates therefore, family intervention would help in the curing of the disorder or minimisation of relapse.
examples of family therapy in practice
Forming an alliance with relatives who care for schizophrenic
· Reduce the emotional climate and the burden of care
· Enhance relatives ability to anticipate episodes and solve problems
· Reduce family members expressing guilt or anger
· Enforce reasonable expectations with family members
· Encourage to maintain some separation but have limits
what did pharoah’s research into family therapy find?
Mental state - There was a mixed opinion on the effect of mental state with some saying it helped and others saying it did not. ·
Compliance with medication - Compared to those who received standard care, they found an increased compliance with taking medicine in comparison to standard care.
· Social Functioning - Has minor effects on social functioning however, no significant impact on wide range functioning such as independent living or employment.
· Reduction in relapse and readmission - Overall, there was a reduced relapse rate during treatment and 2 years after treatment.
strengths of family therapy?
There is an economic bonus to family therapy as this is the cheapest of options that produces favourable outcomes. Arguably this is £1004 cheaper than standard care over 3 years.
· It provides a wider education of the disorder allowing the schizophrenic to operate in everyday situations more ably.
limitations of family therapy
Family therapy may have an impact simply because it increases medication use therefore, itself may not truly treat schizophrenia.
· Not all schizophrenics have families that can support them or that want to support them through their treatment.
· Family members may appear reluctant to actually engage in the therapy or potentially lie about their engagement which can be a further issue with studies.
· It is argued that this therapy only changes the patient’s quality of life and does not act as a cure therefore it may not be an appropriate treatment technique
