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PSYCHOLOGICAL TREATMENT SZ, LACK VALIDITY - Coggle Diagram
PSYCHOLOGICAL TREATMENT SZ
CBT
Cognitive behavioral therapy psychosis
Cognitive Behavioural Therapy for Psychosis
Challenging beliefs (including origin of ‘voices’) and reality testing to reduce distress
Believed symptoms are a result of faulty interpretations and irrational beliefs
Help patients: establish links between thoughts, feelings, actions and symptoms
5 – 20 sessions
NATURE OF CBTP
Origins:
Trace the origins of their symptoms to get a better idea of how they developed
Challenge beliefs:
Test the validity of their faulty beliefs
Involves argument or discussion of how likely the beliefs are to be true
Challenge delusions – people learn their beliefs are not based on reality
Coping strategies:
Patient looks for alternative explanations and coping strategies – consider less threatening possibilities
Give coping strategies to gain control of the hallucinations and delusions
CBTp
Normalisation:
Providing information that many people have these experiences
Reduces anxiety and sense of isolation
Feel less alienated
Challenging beliefs:
‘if your voices are real, why can’t other people hear them?’
ABCDEF MODEL
cognitive restructuring via ABCDE framework:
Identifying activating event (A)
Exploring beliefs (B)
Recognising consequences (C)
Disputing irrational beliefs (D)
Effect – restructured belief (E)
Develop more positive feelings (F)
AO3:
Study to support
Jauhar
Reviewed 34 studies
CBT has a small but significant effect on both positive and negative symptoms
NICE
CBT compared to standard care (antipsychotic medication alone)
CBT:
Reduced relapse rates
Reduced symptom severity
Improvements in social functioning
However: most studies conducted using patients on a combination of CBT and medication – difficult to assess effectiveness of the CBT alone
General therapies
CBT requires self-awareness and willingness to engage with process:
positive symptoms lead to lack of awareness
negative symptoms lead to reluctance / inability to engage)
Practical issues, e.g. length of therapy is time consuming (leading to drop out at times of severe episodes)
Not all clients are suited to vigorous confrontation and not all can open up to a therapist
More expensive than drugs
No side effects unlike drugs
FAMILY THERAPY
Takes place with families rather than individual patients
Some therapists see families as the cause of schizophrenia: double blind and schizophrenogenic mother
Aim to improve the quality of communication and interaction between family members
Aim: reduce stress in the family that might contribute to risk of a relapse
Reduce levels of expressed emotion (EE)
FAMILY THERAPY
Range of strategies to improve functioning of a family:
Psychoeducation: help families understand and better deal with the illness
Reduce the stress of caring for a patient
Reducing anger and guilt in family members
Achieving a balance between caring and maintain their own lives
Enhancing their ability to anticipate problems
Improving relationships within the household – listen and discuss
Commonly used in conjunction with drug treatment
Based on the principle that schizophrenics in high EE families have higher chances of relapse
Increase tolerance and reduce negative attitudes
AO3
General therapy issues
Therapy requires self-awareness and willingness to engage with process:
positive symptoms lead to lack of awareness
negative symptoms lead to reluctance / inability to engage
Practical issues, e.g. length of therapy is time consuming – 3-12 months (leading to drop out at times of severe episodes)
More expensive than drugs
No side effects unlike drugs
Study to support
Pharoah: meta-analysis (53 studies)
Family therapy .v. drugs
Mental state = mixed results
Compliance with medication = family therapy increased compliance
General functioning = no effect on living independently
Reduction in relapse
Improves quality of life for patients and families
Main benefit may be increasing medication compliance
Methodological issue
Pharoah: meta-analysis identified many issues with studies
Random allocation: although all 53 claimed to be RA a large number of studies were from China and it has been claimed these were not
Lack of blinding – possibility of observer bias where raters were ‘not blinded’ to the condition. 10 studies had no blinded. 16 more did not mention if it was blinded or not.
Treatment does not cure schizophrenia
Helps by reducing the stress of living with schizophrenia
Worth doing but….
Should not be confused with curing schizophrenia
Failure to cure schizophrenia is a weakness of psychological treatments
AO3:Impact on family members
Additional advantage of this therapy = positive impact on family members
Lobban – reviewed 50 studies
60% reported positive impact e.g. coping and problem solving skills, relationship quality (including EE)
Once again methodological quality of the studies was poor
LACK VALIDITY
NICE: 1 in 10 get access to this therapy
Haddock (2013):
187 randomly selected patients
13 (7%) offered CBT
Of those who are offered it: significant number refuse or fail to attend