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Schizophrenia: Psychological therapies of schizophrenia - Coggle Diagram
Schizophrenia:
Psychological therapies of schizophrenia
CBT
Antipsychotic drugs are usually given first to reduce psychotic thoughts which makes the CBT more effective
CBT usually takes place once every 10 days for 12-16 sessions. The NICE organisation recommends 16 sessions
Typically delivered on a one-to-one basis
Based on the assumption that schizophrenic patients can be helped by identifying and changing their faulty cognitions
Main psychological treatment used with SZ and the NICE (2014) recommends all patients with SZ are offered this treatment
The patient takes an active part and are given homework between sessions (diary of delusions, ways of coping)
The therapist lets the patient develop alternatives to previous maladaptive explanations - ideally alternative explanations and coping strategies that are already present in the patient's mind
CBT helps the sufferer identify and correct these distorted irrational beliefs
CBT changes the maladaptive thinking and distorted perceptions to modify and improve their symptoms
Establishes links between the sufferer's thoughts, feelings, actions and their symptoms and general level of functioning
By monitoring these in relation to their symptoms patients can consider alternative ways of explaining why they feel and behave the way they do - also taught to recognise the signs of relapse
Evaluation
Strength/Limitation - Kuipers et al (1997):
Patients had lower drop-out rates and higher satisfaction when CBTp was used with antipsychotic meds
When they are used together they become more effective
However, it is hard to distinguish if it is the combination of both treatments or just CBT alone therefore no firm conclusions about the effectiveness of CBTp can be drawn
Strength - Tarrier et al (2000):
People with SZ recieving 20 sessions of CBT on a one-to-one basis with drug therapy, followed by four booster sessions during the year, made more significant improvements than sufferers recieving drug therapy alone
Strength - Sensky et al (2000):
Found CBT was effective in treating SZ patients who had not responded to drug treatments
Also found they continued to improve 9 months after treatment had ended and there was a reduction in + and - symptoms when treated by 19 sessions of CBT
Shows CBT is effective for drug-resistant patients and the positive effect was long lasting
Limitation - Jauhar et al (2014):
Performed a meta-analysis of 50 studies of CBT for SZ conducted over 20 years
Found only a small therapeutic effect on symptoms, including positive ones which CBT apparently targets specifically
Small effect disappeared when only studies using blind testing were considered
Blind testing is not routinely used in the research into CBT's effectiveness questioning the researches validity
Some studies also fail to randomly allocate ppts to either CBTp or a control group and others fail to mask the treatment condiiton for interviewers carrying out the assessments
Limitation - Haddock et al (2013):
CBT is a more expensive treatment so may not always be readily available - 1 in 10 are offered this treatment in the UK
They found only 6.9% of their sample of 187 sufferers were offered CBTp
This has economic implications because while CBT is initially more expensive, the lack of negative side effects can help organisations such as NHS save money due to patients not needing a further intervention like with antipsychotics
Family therapy
Treatment involving the whole family that improves positive and decreases negative forms of communication
Increases tolerance levels and decreases criticism levels between family members
Decreases feelings of guilt and responsibility for causing the illness among family members
Reduces the burden/stress of care for family members and enhances relatives' ability to anticipate and solve problems
NICE (2014)
suggest family therapy should be offered to all individuals diagnosed with SZ, who are in contact with or live with family members
The therapist meets regularly with the patient and close family members, encouraged to talk openly about the patient's symptoms, behaviour and progress
They are taught to support each other and be caregivers, with each person given a specific role in the rehabilitation process
No details should remain confidential and an emphasis on openness
Given for a set amount of time, usually between 3 months and a year and at least ten sessions
Aimed at reducing the level of expressed emotion (EE) within the family as it has been shown to increase relapse
Provides family members with info about SZ, finding ways to support the individual and resolving practical problems
Evaluation
Strength - McFarlane et al (2003):
Conducted a meta analysis and confirmed family therapy reduces relapse rates, leads to symptom reduction and improved relationships among family members, leading to increased well-being for patients
Suggests family therapy is an effective treatment
Strength - Cost-effective:
Appears to be cost effective - Decreases relapse rates and lowers hospitalisation and can educate family to help manage a patients medication regime
Schizophrenia Commission (2012) estimates family therapy is cheaper than standard care by £1004 a patient over 3 years so can save money
Also the extra cost of family therapy is offset by a reduction in costs of hospitalisation because of the lower relapse rate associated with the therapy
Limitation - Openness:
With the emphasis on openness there can be an issue with family members being reluctant to share info as it may cause or reopen family tensions
Some may not want to face up to the issues lowering the effectiveness as without family members being honest and engaging fully, the treatment cannot tackle the faulty family communication
Strength - Pharaoh et al (2010):
Conducted a meta analysis of 53 studies from Europe, Asia and the USA to investigate effectiveness of family therapy
Compared the outcomes from family therapy to 'standard' care
Found it increased a patient's compliance with medication and a reduction in relapse and hospial admission during treatment and for 24 months after
Effective in reducing relapse and more likely to benefit from the drugs because they are more likely to comply with their drug routine
However this shows the results may not be due to their family therapy
Token economy
Behaviourist approach based on Skinners operant conditioning where tokens are awarded for desired behavioural change
Clinicians set target behaviours they believe will improve the patient's engagement in their daily activities
Tokens are then awarded whenever the patient engages in one of the target behaviours and can be exchanged for various rewards at a later date
The patient will engage more often with desirable behaviours because they become associated with rewards and priveleges
Token is initially neutral and needs to be repeatedly presented alongside or immediately before the reinforcing stimuli (reward)
The neutral token then acquires the same reinforcing properties - process of classical conditioning - neutral tokens become secondary reinforcers and can be used to modify the behaviour in people with SZ
Frequent exchange periods mean the patients can be quickly reinforced and target behaviours can then increase in frequency
Effectiveness of token economy may decrease if more time passes between presentation of token and exchange of reward
Evaluation
Strength - Self esteem:
Patients become more independent and active, nurses then have increased respect for the patient leading to patients becoming more motivated and developing positive self-esteem
Token economies are an effective way of helping with institutionalisation which occurs when a patient has been in the hospital for a long time
Have also helped to create a more healthy, safe and stable environment in hospital wards
Staff and patient injuries reduce decreasing staff absenteeism and emergency incident levels
Strength - Ayllon and Azrin (1968):
Used a token economy on a ward of female patients with SZ
They were given plastic token each embossed with 'one gift' for behaviours such as making their bed
These tokens were later exchanged for reward such as being able to watch a film
Found the use of a token economy increased dramatically the number of desirable behaviours the patients performed each day
Strength/Limitation - Dickerson et al (2015):
Reviewed 13 studies, finding the technique useful in increasing the adaptive behaviour of people with SZ implying it is an effective treatment
Found to work best in combination with drugs though the specific benefits of the technique when used as a combination were not identified
Suggests that token economies should not be seen as a treatment for SZ in itself
Limitation - Unpractical:
Treatment does not work long term as the desirable behaviour becomes dependent on reinforcement
Reinforcement ends up leading to high re-admittance rates when released into the community
They are not able to engage with the target behaviours outside of the hospital setting without professional so does not work outside of the hospital
Limitation - Ethical issues:
It may be humiliating for patients with SZ as clinicians exercise control over important primary reinforcers such as food or privacy which are exchanged for a token
However it is accepted that all human beings have certain basic rights that cannot be violated regardless of the positive consequences that might be achieved by manipulating them