PSYCHOLOGICAL THERAPIES

CBT:

-A method for treating disorders based on both cognitive and behavioural techniques

-From cognitive viewpoint the therapy aims to deal with thinking, such as challenging negative thoughts

-involves up to 20 sessions, only 1-2-1 therapy the NHS offers

-Uses Ellis’s ABC model

-The aim in general is to help patients identify irrational thoughts and trying to change them

-How it helps: Helps to make sense of HOW their delusions and hallucinations impact their feelings and behaviour – just understanding where symptoms come from can be very helpful.

-Offering psychological explanations for the existence of hallucinations (for example) can help reduce anxiety, psychologists also challenge irrational beliefs and provide alternative explanations for them, use Normalisation techniques, give homework

Studies:

- Jauhaur et al – meta analyses on the effectiveness of CBT and also investigated publication bias. Results = overall symptoms (CBT vs no CBT) -0.62 v -0.15 with no consistent evidence of publication bias across analyses. Conclusions = therapeutic effect on symptoms in the ‘small range’, reduced further when sources of bias are controlled

-Jones et al – Cochrane review, all randomised controlled trials for CBT, 31 papers for 20 trials, no difference in overall effectiveness was found between CBT and other talking therapies, relapses and rehospitalisation was not reduced

-Evaluative point = the ceiling effect – drugs already improved Sz as much as possible

FAMILY THERAPY:

-Takes place with the family to improve quality of communication and interaction, to reduce stress and expressed emotion and ensure compliance with drugs

-The therapy works closely with the theory of expressed emotion

-Pharoah et al identified a range of strategies which aim to improve functioning of a family, eg. Reduction of anger and guilt in family members and improving behaviour and beliefs towards Sz

Studies:

Pharoah et al – randomised and quasi randomised studies on families with Sz and compared it to standard care. Results = decrease in the frequency of relapse (RR = 0.55), reduce hospital admission (RR = 0.78) and compliance to medication (RR = 0.6). BUT methodological issues – problem of randomisation (majority of studies from china which stated they used randomisation when they didn’t) and the lack of blinding (observer bias)

McCreadie et al – 52 families were offered family therapy, only 31 agreed and 14/30 didn’t attend – do people actually want family therapy?

TOKEN ECONOMY:

-a reward system to manage patients in psychiatric hospitals / modify bad habits or maladaptive behaviour

-based on operant conditioning to reinforce positive and desirable behaviour

-Tokens = secondary reinforcers (no value until reward is obtained), given immediately for desirable behaviour, this immediacy is important because it prevents delay discounting

-Rewards = the positive reinforcement

Studies:

McMonagle and Sultana- meta analysis of randomised studies comparing token economy to standard care. Results = Only 3 trials could be included, there was no usable data on target or non-target behaviour, one small study found an improvement in negative symptoms. Conclusions – token economy may have an effect on negative symptoms, but it still remains worthy of careful evaluation

Evaluation :

-improve quality of live but do not cure

	Created by mya chapman about 8 years ago

A level Psychology (:)) Note on Schizophrenia , created by mya chapman on 22/11/2016.