treatments of schizophrenia

Question 1

what are the psychological therapies /treatment for schizophrenia?

Answer 1

-Cognitive behavioural therapy
(СВТp)
-family therapy

Question 2

what is CBT?

Answer 2

involves both cognitive and behavioural elements

Question 3

what is the aim of CBT for schizophrenia?

Answer 3

-identify and challenge irrational
thinking/beliefs, including delusions and hallucinations of schizophrenia

Question 4

what assumption is CBT for schizophrenia based on?

Answer 4

the idea that SZ is caused by cognitive dysfunctions (e.g meta-representation & central control dysfunction)

Question 5

how does CBTp help?

Answer 5

-
a therapist works with the patient to identify cognitive dysfunctions and works with them to develop strategies to change the way they think and behave & ultimately improve their symptoms

Question 6

stages of CBTp:

Answer 6

1) initial assessment
2) techniques
↳ education/Identification of thoughts
↳ reality testing and behaviour experiments as homework

Question 7

CBTp: initial assessment

Answer 7

-the patients problems are identified
-a set of goals are then established, along with a plan on how to achieve the goals

Question 8

CBTp: technique
education/identification of thoughts

Answer 8

-if a client hears voices and believes the voices represent demonic forces, they will naturally be very afraid
-the therapist attempts to convince them that their voice actually comes from the malfunctioning speech centre in their own brain and it cannot hurt them, this is much less frightening

(therapist educates the patient about their symptoms)

Question 9

effects of education technique:

Answer 9

education will not eliminate the symptoms of schizophrenia but help people to better cope with it

Question 10

CBTp: technique
reality testing & behaviour experiments as homework

Answer 10

involves challenging the irrational thoughts & looking for evidence that disproves the thought so they can identify they are not based on reality

Question 11

behaviour experiment homework example:

Answer 11

if a patient has delusions of persecution, the behavioural experiment could encourage the patient to face a situation, such as going to the supermarket and reflect on weather anyone DID try to cause them harm.

Question 12

aim of reality testing and behaviour experiments as homework technique:

Answer 12

to enable the patient to recognise that the reality is not what they initially expected, demonstrating that there are cognitive issues that need to be worked on

Question 13

what other techniques can using during CBTp?

Answer 13

coping strategies to deal with symptoms…

-distractions from intrusive thoughts (which could trigger an episode)
-using relaxation techniques

Question 14

examples of distractions from intrusive thoughts:

Answer 14

loud music, positive self-talk

Question 15

examples of relaxation techniques:

Answer 15

meditation or muscle relaxation

Question 16

strengths of CBTp:

Answer 16

-there is evidence for its effectiveness
-CBTp has fewer side effects in comparison to drug therapy

Question 17

ao3 / strength of CBTp - there is evidence for its effectiveness

Answer 17

P - there is evidence for its effectiveness

E - E: Jauhar (2014) reviewed 34 studies of using CBT with schizophrenia, & concluded that there is clear evidence for significant effects on both positive and negative symptoms
↳ pontillo (2016) found reductions in frequency and severity of auditory hallucinations after having CBT

L - this evidence supports the benefits of CBT and how changing
irrational cognitions can ease symptoms of schizophrenia

Question 18

ao3 / strength of CBTp - CBTp has fewer side effects in comparison to drug therapy

Answer 18

P - CBTp has fewer side effects in comparison to drug therapy

E - however, CBTp is a more expensive treatment, and with cost being a key factor at a time of reduced health-care budgets, this might explain why it is not always readily available
↳ estimates argue that only 1 in 10 are offered this treatment in the UK and this figure is even lower in some areas of the country
↳ researchers found that only 6.9% of their sample of 187 sufferers were offered СВТр

L - this has economic implications because whilst CBTp is initially more expensive, the lack of negative side effects can help organisations such as the NHS save money due to patients not needing a further intervention like they would with antipsychotics

Question 19

limitations of CBTp: some people with schizophrenia do not benefit from CBT

Answer 19

P - CBT it is not appropriate for everyone with schizophrenia

E - kingdon et al. (2006) state that in a study of 142 patients in Hampshire, there were many
patients that were not deemed suitable for CBT, because they would not fully engage with
the therapy (interestingly, they found that older patients were less suitable than younger ones)
↳ it may be that CBT is not appropriate for all patients, especially those who are too
disorientated, agitated or paranoid to form trusting relationships with therapists

L - the overall effectiveness of CBT is reduced if it is not suitable for all patients

Question 20

what is family therapy based on?

Answer 20

the idea that as family dysfunction plays a role in the development of schizophrenia, and that altering relationship and communication patterns within families should help people with schizophrenia to
recover

Question 21

who does family therapy involve?

Answer 21

the whole family, not just the sufferer

Question 22

what are the aims of family therapy?

Answer 22

1) to improve positive and decrease negative forms of communication (decreasing criticism, increasing praise)

2) to reduce the high level of EE within the household which is causing the relapse

3) reduce the burden/stress of care for family members

Question 23

where does family therapy usually take place?

Answer 23

family therapy usually takes place within the people’s homes and typically two family therapists will
work with the relatives and patient

Question 24

is family therapy used alone?

Answer 24

it’s commonly used in conjunction woth drug therapy and other out-patient care (e.g. CBTp)

Question 25

stage 1 of family therapy:

Answer 25

the therapist meets regularly with the patient and close family members, who are encouraged to talk openly about the patient's symptoms, behaviour and progress ↳ the therapist forms an alliance with relatives who care for the person with SZ

Question 26

stage 2 of family therapy:

Answer 26

they are taught to support each other and be caregivers, with each person given a specific role in the rehabilitation process

Question 27

stage 3 of family therapy:

Answer 27

there is an emphasis on openness, with no details remaining confidential, although boundaries of what is and is not acceptable are drawn up in advance

Question 28

stage 4 of family therapy:

Answer 28

like CBTp it is given for a set amount of time, usually between 3 months to a year, and at least ten sessions

Question 29

stage 5 of family therapy:

Answer 29

**technique: reduce negative emotions** -aimed at reducing the level of expressed emotion within the family (esp. anger and guilt which create stress) -family members learn more constructive ways of communicating -family members are encouraged to concentrate on any good things that happen rather than negative events

Question 30

why is it important to reduce stress?

Answer 30

to reduce the likelihood of relapse

Question 31

stage 6 of family therapy:

Answer 31

**technique: psycho education** -typically involves providing family members with information about schizophrenia (education) -finding ways to support the individual and resolving any practical problems, like ensuring the sufferer keeps medical appointments and takes their medication

Question 32

stage 7 of family therapy:

Answer 32

**technique: improving the family's ability to help** -provides the whole family with practical coping skills which enables them to manage the everyday difficulties arising from having a person with SZ in the family -to ensure that family members achieve a balance between caring for the individual with schizophrenia and maintaining their own lives

Question 33

last stage of family therapy:

Answer 33

the family and the patient are trained to recognise the early signs of relapse so that they can respond rapidly to reduce the severity of it

Question 34

ao3 / strengths of family therapy:

Answer 34

-there is evidence of its effectiveness -there are benefits for all family members

Question 35

ao3 / strengths of family therapy - there is evidence of its effectiveness

Answer 35

P - there is evidence of its effectiveness E - mcfarlane (2016) concluded that family therapy was one of the most consistently effective treatments available for schizophrenia / relapse rates were found to be reduced, typically by 50-60% / using family therapy as mental health initially starts to decline is particularly promising L - this means that family therapy is likely to be of benefit to people with both early and 'full-blown' schizophrenia

Question 36

ao3 / strengths of family therapy - there are benefits for all family members

Answer 36

P - there are benefits for all family members E - therapy is not just for the benefit of the patient with schizophrenia, but also for the families / a review of evidence by researchers 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, family therapy lessens the negative impact of schizophrenia on other family members L - this means that family therapy has wider benefits beyond the obvious positive impact for the patient

Question 37

how can schizophrenia be managed?

Answer 37

through token economies

Question 38

what are token economies?

Answer 38

a token economy programme involves a system of rewards being set up for desired behaviour, sometimes with punishments to discourage behaviour which is undesirable

Question 39

what are the rewards in token economies?

Answer 39

usually tokens or points, these can be periodically exchanged for something that the individual wants

Question 40

what were token economies used for when introduced?

Answer 40

when it was introduced in the 1970s, it was mainly used with long-term hospitalised patients to enable them to leave the hospital and live relatively independently in the community

Question 41

what is the main aim of token economies?

Answer 41

changing negative symptoms of schizophrenia, such as low motivation, poor attention and social withdrawal

Question 42

how was token economy management developed?

Answer 42

-a token economy system was trialled in a ward of women with schizophrenia -every time the participants carried out a task such as making the bed or cleaning up they were given a plastic token embossed with the words 'one gift' -these tokens could then be swapped for ward privileges -the number of tasks carried out increased significantly

Question 43

institutionalisation and schizophrenia

Answer 43

-institutionalisation develops under circumstances of prolonged hospitalisation -people often develop bad habits, for example, stopping socialising with others (a response to living without the kind of routine and small pleasures we experience in everyday life)

Question 44

modification of behaviour…

Answer 44

does not cure schizophrenia but it has two major benefits

Question 45

what are that two major benefits of behaviour modification:

Answer 45

1) **improves the person's quality of life within the hospital setting** (e.g social interaction for a usually sociable person) 2) **'normalises' behaviour** makes it easier for people who have spent time in hospital to adapt back to life in the community

Question 46

examples of normalised behaviour:

Answer 46

getting dressed in the morning or making the bed

Question 47

stage 1 of behaviour modification:

Answer 47

-clinicians set target behaviours that they believe will improve the patient’s engagement in their daily activities (e.g. brushing their hair) -target behaviours are decided on an individual basis, and it is important to know the person in order to identify the most appropriate target behaviours

Question 48

stage 2 of behaviour modification:

Answer 48

-tokens are awarded immediately whenever the patient engages in one of the target behaviours -the tokens have no value, they are swapped later for tangible rewards at a later date. (sweets or magazines; access to activities like a film or a walk outside)

Question 49

stage 3 of behaviour modification:

Answer 49

the idea behind token economy is that the patient will engage more often with desirable behaviours because the behaviours become associated with these rewards and privileges

Question 50

stage 4 of behaviour modification:

Answer 50

-with the token economy, the tokens in themselves are neutral -to give the neutral token value it needs to be repeatedly presented alongside or immediately before the reinforcing stimuli (e.g. the reward). -by pairing the neutral tokens with the reward, the neutral token acquires the same reinforcing properties

Question 51

secondary reinforcers:

Answer 51

tokens are secondary reinforcers: they become secondary reinforcers because they only have value when the person receiving them has learned they can be used to obtain meaningful rewards

Question 52

primary reinforcers:

Answer 52

the meaningful rewards are primary reinforcers

Question 53

stage 5 of behaviour modification:

Answer 53

-during the early stages of the treatment, frequent exchange periods mean that the patients can be quickly reinforced and target behaviours can then increase in frequency -the effectiveness of the token economy may decrease if lots of time passes between the presentation of the token and exchange for the reward

Question 54

token economies vs talking therapy:

Answer 54

-based on behaviourist theory (TE) v based on cognitive theory (CBT) -reward positive desirable behaviours (TE) v challenge irrational thoughts / dysfunctional home life (CBT/FT) -management only (TE) v focus on building new thoughts and behaviours (CBT)

Question 55

strength of token economies:

Answer 55

some research indicates that token economy is effective in managing schizophrenia

Question 56

ao3 / strength of token economies - some research indicates that token economy is effective in managing schizophrenia

Answer 56

P - some research indicates that token economy is effective in managing schizophrenia E - Glowacki (2016) identified seven high quality studies published between 1999 and 2013 that examined the effectiveness of token economies for people with chronic mental health issues like schizophrenia and involved patients living in a hospital setting → all the studies showed a reduction in negative symptoms and a decline in the frequency of unwanted behaviours L - this shows the value of TE in managing the behaviour of patient with SZ

Question 57

criticism of token economies:

Answer 57

P - any positive effects of the management are short-lived

Question 58

ao3 / criticism of token economies - any positive effects of the management are short-lived

Answer 58

P - any positive effects of the management are short-lived E - the management does not appear to work long-term as the desirable behaviour becomes dependent on reinforcement. ↳ upon release into the community, reinforcement ends, leading to high re-admittance rates ↳ it appears that without the professionals there to constantly reinforce the behaviour of people with schizophrenia, they aren’t able to engage in the target behaviours outside of the hospital setting L - therefore, token economies do not work outside of the hospital

Question 59

ao3 / criticism of token economies - there are ethical concerns about the use of TE within an institution

Answer 59

P - there are ethical concerns about the use of TE within an institution E - the use of token economies raises ethical issues because it gives professionals considerable power to control the behaviour of patients ↳ this inevitably involves imposing one person's norms on to others, which is especially problematic if target behaviours are not identified sensitively ↳ for example, someone who likes to get up late might have this freedoms curtailed, restricting the availability of pleasures (e.g. having sweets or seeing films) / if people who behave as desired, seriously ill people, who are already experiencing distressing symptoms, have an even worse time L - some question the ethics behind this treatment, arguing it is humiliating for people with schizophrenia

Question 60

what does the interactionist approach suggest?

Answer 60

taking into consideration both biological and psychological factors in the development of schizophrenia

Question 61

what does the interactionist approach see as the best treatment of schizophrenia?

Answer 61

combinations of different treatments

Question 62

what does the interactionist approach encompass?

Answer 62

the diatheses-stress approach

Question 63

what does the diatheses-stress model suggest?

Answer 63

both a vulnerability to schizophrenia (through genetics for example) and a stress trigger (say dysfunctional family dynamics) are necessary for schizophrenia to develop

Question 64

the importance of vulnerability AND stress:

Answer 64

many factors, such as genetics or biochemistry can make a person vulnerable, but they will not develop schizophrenia without stress

Question 65

what does diatheses mean?

Answer 65

vulnerability

Question 66

what does stress mean?

Answer 66

psychological experience

Question 67

traditional diatheses-stress:

Answer 67

-the diathesis was entirely genetic. -a schizogene led to a schizotypic personality which is especially sensitive to stress

Question 68

genes & diatheses:

Answer 68

-lots of research has indicated that schizophrenia has a biological component (genes or biochemistry)… ➣ several genes have been identified to increase vulnerability – polygenic (108 genes implicated) ➣ genetic factors are linked to abnormal functioning in other neurotransmitters

Question 69

what is the diatheses-stress models idea about diatheses?

Answer 69

-the diathesis-stress model argues that biology alone does not cause the illness (concordance not 100% for MZ twins) -instead, biological vulnerability increases the risk that environmental stressors can trigger schizophrenia

Question 70

new definitions of diatheses:

Answer 70

it is now understood that there is no single ‘schizogene’, many genes appear to increase vulnerability

Question 71

diatheses now includes…

Answer 71

a range of factors ➣**e.g. psychological trauma** it has been proposed that early psychological trauma alters an infant’s developing brain and causes vulnerability, as the HPA system becomes overactive, making the person more vulnerable to stress

Question 72

how did the original diatheses model explain stress?

Answer 72

-it argues that stress is psychological in nature -in the context of schizophrenia it was caused by dysfunctional family dynamics -stress was limited to just parenting style and family dynamics.

Question 73

how does the diatheses model explain stress? (modern views of stress)

Answer 73

nowadays a broader definition has been adopted and refers to anything that risks triggering schizophrenia: ➣ cannabis use for example, can be a stressor as it disrupts the body’s dopamine system → smoking cannabis increases the chances of developing SZ by 7 times

Question 74

what is the interactionist approach to treating schizophrenia?

Answer 74

the idea that combining treatments, both biological and psychological, is most effective, this acknowledges the influence of diathesis and stress in causing the illness

Question 75

is it possible to state which combination of treatments is most best?

Answer 75

no, it is affected by each patient’s circumstances and needs for example, there is little point in combining drugs with family therapy if the patient has little contact with their relatives

Question 76

which approach does britain take to treating schizophrenia?

Answer 76

an interactionist approach

Question 77

how does britain treat schizophrenia?

Answer 77

1) antipsychotic drugs are usually given first to reduce the patient’s symptoms so that any psychological treatment provided, usually in the form of CBT, has a better chance of being engaged with 2) it is unusual for a person with schizophrenia to be offered a psychological therapy alone

Question 78

how does the USA treat schizophrenia?

Answer 78

-the USA doesn’t tend to adopt an interactionist approach and instead typically offers medication without any psychological treatments -it is rare for either country to offer a psychological treatment like CBT, without the use of medication

Question 79

strengths of the interactionist approach:

Answer 79

-there is evidence to support the interactionist approach to explaining schizophrenia -Tienari et al. (2004) -combining treatments can be cost-effective

Question 80

ao3 / strength of interactionist approach - there is evidence to support the interactionist approach to explaining schizophrenia -Tienari et al. (2004)

Answer 80

P - there is evidence to support the interactionist approach to explaining schizophrenia [Tienari et al. (2004)] E - Tienari et al. (2004) investigated the combination of genetic vulnerability and parenting style in children adopted from Finnish mothers with schizophrenia ↳ the adoptive parents were assessed for child-rearing style and the rates of schizophrenia were compared to those in a control group of adoptees without any genetic risk ↳ a child rearing style characterised by high levels of conflict and criticism was implicated in the development of schizophrenia but only for the children with high genetic risk L - this supports the interactionist explanation that both genetic vulnerability and family-related stress are important in the development of schizophrenia

Question 81

ao3 / strength of interactionist approach - combining treatments can be cost-effective

Answer 81

P - combining treatments can be cost-effective E - schizophrenia often has biological and psychological components and therefore combined treatment is desirable ↳ the antipsychotics treat the biological elements, and the psychological treatments tackle the psychological elements L - though combining treatments increases the initial cost of treatment, the effectiveness also increases ↳ patients get better quicker and stay better for longer, the combination works out more cost effective in the long-run (economic benefit)

Question 82

criticisms of the interactionist approach:

Answer 82

the diatheses stress model isn’t fully explained

Question 83

ao3 / criticism of the interactionist approach - the diatheses stress model isn’t fully explained

Answer 83

P - the diathesis-stress model proposes that schizophrenia is caused by a combination of biology and environment E - it is not known precisely how these risk factors (how biological, environmental, psychological and social factors) contribute to the diathesis-stress interaction, as the causes may differ between individual schizophrenics L - this approach is weakened as we do not fully understand the mechanisms by which the illness develops and how both vulnerability and stress produce it