Psychological Therapies for Schizophrenia

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

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Psychological Therapies for Schizophrenia

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	Created by Natalie Smith18 almost 10 years ago