Schizophrenia: topic 7 ‘CBT and family therapy used to treat SZ’

Question 1

what is CBTp?

Answer 1

• The name given to CBT for patients with schizophrenia
• Cognitive behavioural therapy for psychosis

Question 2

how long does CBTp last?

Answer 2

• it usually takes place for between 5 and 20 sessions, either in groups or individually

Question 3

what is the ABCDE model of CBTp?

Answer 3

• activating event, belief, consequence, dispute, effect
• the basic assumption of CBTp is that it is not events themselves that cause the person problems (activating event) but the (belief) that they have about the events
• if the person has distorted beliefs this will have a negative effect on their feelings and behaviours (consequence)
• eg someone with schizophrenia may believe their behaviour is being controlled by something else, CBTp is used to help the patient identify and correct these faulty interpretations or beliefs
• the therapist will discuss with the patient how likely these irrational beliefs are to be true (reality testing) and consider all the more rational beliefs instead (dispute)
• this allows the patient to make sense of how their delusions and hallucinations impact their feelings and behaviour
• eg if a patient has voices and beliefs, the voices are Demons they will naturally be very afraid, by thinking about these more rational, disputes and beliefs, the client should feel the effect of challenging irrational thoughts and become less anxious which will have a positive effect on their behaviour

Question 4

strengths of CBTp

Answer 4

P - evidence to support the effectiveness of CBT comes from NICE
E/E - they reviewed a range of treatments for SZ and found that, compared with antipsychotic drug therapy, CBTp was far more effective in reducing symptoms of verity and improving in cognitive functioning
L - this seems to suggest that CBT is just as effective/more effective than drug therapy in SZ treatment

Question 5

limitations of CBTp

Answer 5

P - the effectiveness of CBT may be overstated
E - most studies of the effectiveness of CBTp have been conducted with patients treated at the same time with antipsychotic medication
E - more recent research has found that CBTp as a sole treatment for schizophrenia may actually be lower than originally thought
L - this address that it is difficult to assess the effectiveness of CBTp independent of antipsychotic medication in the treatment of schizophrenia

P - the effectiveness of CBTp may depend on the stage of the disorder
E - it has been claimed that CBTp may be more effective when it is made available at specific stages of the disorder
E - addington and addington claim in the initial phase of SZ, self reflection on symptoms is not particularly appropriate, however, following the stabilisation of the symptoms with antipsychotic medication, individuals can benefit from group based CBT which can help normalise the experience by meeting other individual individuals with similar issues
L - this suggests that CBT may only be useful for specific stages of treatment and may need to be constantly adapted

Question 6

what is family therapy?

Answer 6

• based on the idea that many patients returning home from institutional psychiatric care, I’m more likely to relapse if they return to families that show high expressed emotion
• the main aim of family therapy is to make family life less stressful and therefore reduce the risk of relapse
• family therapy is commonly used in conjunction with routine drug treatment and other forms of therapy

Question 7

how does family therapy work to help SZ patients?

Answer 7

• educating families about the risk of high expressed emotion and enabling them to understand schizophrenia better, which will enable families to reduce expressions of anger and guilt whilst also having more reasonable expectations for patient behaviour
• Families can also be taught about the warning signs to look out for to help prevent relapse occurring

Question 8

strengths of family therapy?

Answer 8

P - evidence to support the effectiveness of family therapy from NICE
E/E - found that the relapse in family therapy condition was 26% compared to 50% relapse in a control group receiving standard care
L - they suggests for my therapy is effective at preventing relapse over and above any therapy that only targets individuals

P/E/E- psychological therapy such as family therapy and CBT can be easily adapted to the needs of the individual patients and families (an idiographic approach) unlike many biological therapy such as drugs which treat every sufferer in a similar way (a nomothetic approach)
L - therefore psychological therapies may be seen as more appropriate therapies when there are so many individual differences between sufferers

Question 9

limitations of family therapy

Answer 9

P - further research has suggested other ways in which family therapy can be effective
E/E - meta analysis Shweta compliance with medication was significantly higher in patients where family therapy had been used compared to more standard care
L - they suggested family therapy may be effective but only in as far as it helps ensure patients stay on their medication

P - many would argue that psychological therapies only address the symptoms are not the true causes of schizophrenia
E/E - it has been argued that SZ has a biological cause such as a dopamine imbalance and so therapies like family therapy are only addressing the symptoms of the disorder rather than it’s underlying cause
L - this suggests that psychological therapies may only be appropriate to use in conjunction with biological therapies such as drugs which are needed to address the true problem