Schizophrenia - Psychological Therapies (Cognitive Behaviour Therapy (CBT)…
Schizophrenia - Psychological Therapies
Cognitive Behaviour Therapy (CBT)
- method of treatment based on cognitive and behavioural techniques. Cognitive aspect aims to deal with thinking, such as challenging negative thoughts.
Usually takes place for between five and twenty sessions, either in groups or individually.
Helps patients identify irrational thoughts and try to change them, involving argument/discussion about how likely the thoughts are to be true and consideration of less threatening possibilities. Does not get rid of symptoms but makes patient more able to cope with them.
How it helps
- patients helped to make sense of how hallucinations and delusions impact on feelings and behaviour. Understanding psychological cause can be useful for some patients (instead of believing they are caused by demons for example). Delusions can also be challenged so patient learns they are not a reality.
- psychological therapy carried out with all or some members of family with aim of improving their communication and reducing stress of living as a family.
Therapists concerned with reducing stress within family that might contribute to a patient's risk of relapse. Aims to reduce levels of expressed emotion (EE).
How it helps:
with all family members
Reduces stress of caring for relative
Reduction in anger and guilt
of family members
Helps family members achieve
balance between caring for individual with schizophrenia and living their own lives.
Pharoah et al suggest that this works because it
reduces levels of stress and expressed emotion whilst increasing chances of patients complying with medication
. This combination tends to result in
reduced likelihood of relapse and re-admission to hospital.
Pharoah et al. (meta-analysis of 53 studies investigating effectiveness compared to standard care). Concluded that there is
moderate evidence to show family therapy significantly improves quality of life for patients and family. Positive benefits of medication compliance, mental state and social functioning
Results of different studies were inconsistent
and there are
problems with the quality of some evidence
. Overall, the evidence is weak.
- meta-analysis found
reduction in hospital admissions
during treatment and a
decrease in severity of symptoms
both during and up to 24 months following treatment.
Relapse rates: family intervention group - 26%, control group - 50%.
when offered in addition to standard care. Extra cost of intervention offset by
reduction in costs of hospitalisation because of lower relapse rates
Cognitive Behaviour Therapy
- Sameer Jauhar reviewed 34 studies of CBT treatment on schizophrenia.
Has significant but fairly small effect on positive and negative symptoms.
Improves quality of life
- allows patient to make sense of, and in some ways challenge their symptoms.
However does not CURE
- CBT may involve challenging a person's paranoia, but this could reach the point of interfering with individual's freedom of thought. E.g. if delusion was about a highly controlling government, challenging it could modify their politics.
- McMonagle and Sultana found
only three studies where patients had been randomly allocated
to conditions, a total of only 110 patients. Random allocation is
important in matching patients to treatment and control groups
Only one of the three studies showed improvement in symptoms and none yielded useful results about behaviour change.
Improve quality of life
- make patients' behaviour more socially acceptable so can better reintegrate into society.
However does not CURE
privileges, services etc. more available to patients with mild symptoms and less for those with severe symptoms
. This means
those with severe symptoms suffer discrimination
, which has reduced how often this is used.
- behavioural therapy where desirable behaviours are encouraged by selective reinforcement. Uses principle of operant conditioning.
for patients who have developed maladaptive behaviours
through spending long periods of time in psychiatric hospitals (being 'institutionalised'). Common to develop
bad hygiene or stay in pyjamas all day etc
. TE seeks to
improve these habits
, which does not cure schizophrenia but
improves quality of life.
- e.g. coloured discs, given immediately to patients after they carry out a desirable behaviour e.g. showering, tidying room etc. Given immediately to reduce 'delay discounting' (patient forgetting why they are being rewarded resulting in behaviour not being reinforced). Secondary reinforcers because they do not have immediate face value, they are exchanged for rewards.
- given in exchange for the tokens.
Actual rewarding gifts
, such as sweets, cigarettes or magazines, or
like having room cleaned
like a walk outside the hospital.
as these are the real rewards.