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CBT and family therapy in the treatment of sz - Coggle Diagram
CBT and family therapy in the treatment of sz
family therapy
aim is to develop corporative relationship and improve communication skills
reduces stress within family environments means patients less likely to relapse
therapist provides info about the cause, course and symptoms of sz
family members including individual with sz share experiences of disorder
goal is to develop practical coping skills that enable them to manage the issues associated with having sz in the family
family learns constructive ways of communicating and interacting with each other
lasts approx 3-12 months
family encouraged to recognise signs of relapse so they can respond quickly/reduce its severity
family encouraged to express anger in other ways rather than high expressed emotion
evaluation
appropriateness- not suitable for patients with delusions/hallucinations as may find difficult to attend. only suitable for ppl with sz who live in a family set up and are motivated to attend therapy.
effectiveness- support evidence from meta analysis of 53 trials across world comparing family therapy and standard care. found fam therapy reduces amount of expressed emotion, frequency of relapse, chance of hospital admissions and compliance with medication. means useful treatment
cognitive behavioural therapy
coping strategy enhancement (CSE)
patients are helped to develop cognitive strategies to cope with their hallucinations and delusions eg, use of distraction, concentrating on a specific task and positive self talk
behavioural strategies include initiating or withdrawing from social contact, relaxation techniques and breathing exercises and finding ways of drowning the hallucinatory voices by shouting STOP! or turning up the tv
patients encouraged to test reality of delusional beliefs eg. via homework- recoding when they have hallucinations/delusions and testing the effectiveness of coping strategies
Cognitive treatments based on assumption faulty thought processes make a person vulnerable to schizophrenia. Therefore, cognitive treatments, such as CBT, aim to identify and challenge the negative/ irrational thoughts.patient and therapist should work together to clarify the patient’s problem (e.g. delusional thoughts) & identify the thoughts (faulty cognitions) that would benefit from challenge.
thoughts must be challenged by the patient taking an active role in their treatment (reality testing).
evaluation
appropriateness- requires regular therapy sessions over a long period of time and need motivation to engage and see improvement. negative symptoms such as abolition can result in patients being unwilling to engage eg.not completing homework tasks- so not appropriate for everyone
effectiveness- research support of meta analysis of CBT including 392 ptpts. findings indicate that CBT produced higher rates of 'important improvement', had positive effects on mental state and a low drop out rate. shows effective treatment and improves mental state of patients
token economies
reward systems used to manage the behaviour of patients with sz
aimed particularly at those who have been institutionalised for long periods and have developed bad habits (staying in pjs, not brushing teeth)
aim to improve patients quality of life
based on principle of operant conditioning- positive reinforcement
Staff positively reinforce the patients by giving them tokens when they perform desirable behaviours e.g. getting dressed in the morning. Tokens are secondary reinforcers that patients can swap for tangible rewards e.g. being able to go for a walk or sweets
evaluation
appropriateness-do not address symptoms of sz so can't be classified as treatment. patients treated as lab rats who can be manipulated using principles based on animal behaviour which underestimates role of cognitive factors such as motivation. also privileges may be more available to those with mild symptoms and less likely for those with severe symptoms. therefore viewed as unethical and discriminative and not appropriate for everyone.
effectiveness- supporting evidence for the use of token economies in management of sz. meta analysis involving 110 ppl found slight evidence for improved mental state, especially with negative symptoms.
evaluation
other treatments- biological, so psychological treatments to the only effective treatment of sz
dispute whether psychological treatments treat underlying cause as offer way of managing symptoms but not necessarily a cure. some argue more likely to treat underlying cause than biological therapies, which only treat the symptoms whilst being taken. suggests psychological treatments can lead to patients having an enhanced quality of life in long term
economic implications- drug therapies tend to be cheaper as do not require regular appointments however psychological led to reduction in relapse and hospital stays which can be very costly to the economy.