Zusammenfassung der Ressource
Psychological Therapies for
Schizophrenia
- Cognitive Behaviour Therapy
- Appropriateness....
- New development
- Thought it would be
inappropriate because CBT
requires insight and logical
thinking, whereas SZ is a thought
disorder
- TARRIER 1987
- Interviewed SZs in depth and found they can
identify precursors to onset of symptoms...
and develop own methods of dealing with SZ
- Appropriate as symptoms are cognitive in
nature, e.g. delusions and disorganised speech
- Appropriate as gives SZs reassurances that delusions
and hallucinations are experienced by healthy people
- Not appropriate as doesn't deal
with negative symptoms
- Also ignores biochemical and genetic factors
- Effectiveness....
- TARRIER 1987
- 73% said strategies were successful... leading to
development of Coping Strategy Enhancement
- Education and rapport training.
(Enhance current strategies and
develop new ones)
- Symptom Targeting. (Focus on
symptom with specific strategy, can
practice it in a session. Homework to
practice strategy. Aim to devise two
strategies for each symptom)
- TARRIER ET AL 1993
- Compared CSE to those on waiting
list. Found signif alleviation of pos
symptoms, and improvement of
coping skills. Maintained at a 6
month follow up.
- Participant attrition. 45% of 49 refused
to cooperate and dropped out.
- No data for neg
- TARRIER 2000
- CBT in conjunction with drugs therapy much more
effective than drugs alone.
- 2yr follow up, CBT lost effectiveness but still fewer symptoms than those
receiving drugs alone.
- KUIPERS ET AL 1997
- CBT leads to signif reduction in severity of
delusional symptoms. Lower P drop out rates
and greater satisfaction when CBT used with
drug therapy.
- Description...
- Faulty cognitions (thoughts) lead to abnormal
behaviour, emotions and perceptions
- CBT is a form of psychotherapy that attempts to
change faulty cognitions
- Patient learns to identify distorted thoughts and
replace them with more productive ways of thinking
- 1. Establish trust
- SZ patient can feel isolated from others... (social
withdrawal neg symptom) so need to establish strong
relationship
- 2. Psycho-education...
ELLIS ABC
- Patient told of nature of SZ and how
Activating events affect Behaviour,
leading to the Consequence of
worsening symptoms
- Able to see their disorder are more
predictable and therefore more controllable.
RECOGNISE PRECURSERS OF ONSET TO
EPISODE
- 3. Normalise the symptoms
- Everyone has small hints of paranoia
- Symptoms are an exaggerated version of normal behaviour, so
just have to try normalise these reactions.
- 4. Cognitive and Behavioural
Interventions
- A strategy to make anything less worse
- Find out how SZ handles
their symptoms now and
build on this
- Distraction, ignoring voices, turning up TV
(cognitive strategies)
- (Behavioural strategies) encourage initiation of
social contact/ or withdrawal if worsened
symptoms, deep breathing, positive self talk
- 5. Reduce comorbidity by challenging
anxiety/depression which may co-occur
- 6. Reduce relapse by planning ahead
- RECTOR 2005
- Family Intervention Therapy
- Description....
- The level of expressed emotion or
communication deviance in families contributes
to likelihood of SZ developing.
- WAHLBERG ET AL 1997 (FINNISH ADOPTION STUDY)
- Children of SZ parents more likely to develop
disorder in adoptive families rated as being
psychologically disturbed.
- 1. Education provided to SZ and family about
bio nature of SZ and principles for treatment.
- 2. Family treated
as an ally,
discouraged from
feeling guilty and
blame.
- 3. Psycho-education workshop at beginning of programme.
Weekly/monthly meetings. Support provided by clinicians and
other families. Helps to normalise behaviours
- 4. Long-term, at least 2 years
- 5. Families assisted in improving coping methods
and communication
- 6. Treatment teams multi-disciplinary,
coordinate frequently and other agencies.
- 7. Medication closely followed. Attempts
to maximum compliance so SZ can
develop own insight and allow others to
help.
- Appropriateness....
- More SZs returning home than ever, so
important family is secure and stress-free...
FIT IS APPROPRIATE
- FIT aids SZ and social functioning skills, help to
become understood and less socially isolated
- Limited and IGNORES biochemical and genetics
- Best used in conjunction with drug therapy
- Not all SZs have a functioning family unit
- Can't provide cure, just a treatment
- Effectiveness....
- DIXON AND LEHMAN 1995
- Reviewed 16 FIT studies, FOUND an "impressive body evidence suggesting FIT
are efficacious at delaying, if not preventing, relapse in SZ with signif family
contact"
- Evidence for effectiveness reliable... but
participant attrition.... not suitable for all cos
requires motivation from everyone