Psychological Therapies for SZ (Token economy systems (EVALUATION (Less…
Psychological Therapies for SZ
CBT- Uses cognitive and behavioural techniques in order to deal with negative, irrational thoughts in order to improve their wellbeing.
How CBT helps- Patients can be helped into understanding the effect the hallucinations and or delusions have on them. They are challenged and compared to how likely they are to be real and in reality.
Case example- Turkington came up with a dialogue involving the mafia in order to show how a therapist should not dismiss the ideas of the sufferer, but merely compare them to the realism of everyday life.
Lack of availabilty- Haddock found in North West England out of 187 randomly asked SZ sufferers- only 13 had been offered CBT. Out of these 13, some refused to attend sessions, lowering effectiveness.
Problems with meta-analysis- Different studies fail to meet different guidelines, for example some don't randomly allocate- others don't use a control- so when this data is grouped it may create biased findings.
Dependent on disorder stage- Addington x2 claim that in initial phase self reflection isn't done, and as experience of it goes on then CBT has a more positive effect, particularly in group discussions.
Benefits may be overstated- Jauher found in his meta analysis only a small therapeutic effect. They disappeared when study was done blind. Different parts of the UK use different techniques to treat.
Advantages over standard care- NICE reviews of treatments for SZ found consistent evidence that CBT was effective in reducing rehospitalisation rates. Reduces symptom severity and improves social functioning. However often studied whilst on antipsychotics, so unsure how large the effect CBT has.
Family therapy- Carried out with members of the family in an attempt to improve communication. Aims to reduce levels of EE (Expressed Emotion).
Pharoah identified a range of strategies by which therapists aim to improve relationship and functioning in family:
1) Form therapeutic alliance with family members.
2) Reduce stress of caring for relative with SZ.
3) Improve ability of family to anticipate/solve problems.
4) Reduce anger and guilt in family members.
5) Maintain balance between caring for and living their own lives.
6) Improve families belief about behaviour towards SZ.
However, the treatment may improve the quality of life but doesn't deal with the cure.
Not all SZ sufferers have a family willing or capable of attending the therapy courses.
Useful for those lacking insight
Relatively cost effective.
Reduces relapse and hospitalisation
Garety et al. (2008) found no better outcome compared with those having normal therapy.
There is evidence to support its effectiveness. Eg Leff et al. (1985) - compared routine outpatient care for families where there was high E.E with F.T. Found 50% relapse rate in first 9mths of treatment for those receiving routine care, compared with 8% for those receiving F.T. After 2yrs it was 75% compared with 50% for those receiving F.T.
Token economy systems
Reward systems used to manage behaviour by rewarding desired behaviour (reinforcement). This can be used to modify bad habits.
Rewards- Tokens are then swapped for tangible rewards. Tokens are used as secondary reinforcers so that the sufferer is able to use it to gain rewards.
Less useful for those in community- Corrigan argues that there are problems administrating tokens when patients live in a community. The token method will only be part of their day, so may not be a maintenance of positive behaviour.
Ethical concerns- The manipulation of rewards may break human rights.
Comer suggests a major problem in assesing- all patients go through it so there is no control group. Therefore a comparison can only be made between previous behaviour.
Doesn't actually tackle the root cause of SZ.
Research support- Dickerson et al reviewed 13 TE studies, 11 reported to have beneficial results, and TES's proved effective in increasing adaptive behaviours.