PSYCHOLOGICAL THERAPIES FOR SCHIZOPHRENIA

mind map of the psychological therapies for schizophrenia

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  • Created on: 13-12-12 09:05
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  • PSYCHOLOGICAL THERAPIES FOR SCHIZOPHRENIA
    • Cognitive-Behavioral Therapy (CBT)
      • Patients are encouraged to trace the origins of their symptoms in order to get an idea of how they may have developed. Encouraged to evaluate the context of their delusions or internal voices and think of ways they might test the validity of their faulty beliefs, may also be set behavioral assignments with the aim to improve general functioning
        • The therapist lets the patient come up with their own alternatives to their faulty beliefs, ideally by looking at alternate explanations and coping strategies that are already present in the patients mind
          • Disordered and delusional thinking is replaced with thought processes that are more constructive and in line with reality
      • Outcome Studies
        • Drury et al. (1996) ---found benefits in terms of a reduction in positive symptoms. 25-50% reduction in recovery time for patients given a combination of anti-psychotics and CBT
        • Kuipers et al (1997) ---confirmed the advantages fround in the Drury study. Also noted lower drop-out rates and greater paitent satisfaction when CBT was used with anti-psychotics
      • Appropriateness
        • Negative symptoms may serve as a 'safety behaviour' e.g. in a psychiatric setting strong expression of emotion can lead to increased medication. Inactivity and withdrawal may be a way to stop positive symptoms from worsening, CBT offers hope to alleviate these maladaptive thought processes
        • Kingdon and Kirschen (2006) ---142 schizophrenic patients in Hampshire. Many patients were not suitable for CBT because psychiatrists believed they wouldn't fully engage with therapy. Older patients were deemed less suitable than younger patients.
      • Effectiveness
        • Gould et al ---found that all 7 studies in their meta-analysis reported statistically significant decrease in positive symptoms after treatment
        • Most studies on the effectiveness of CBT have been conducted where the patient is also treated with anti-psychotics, it has been difficult to asses CBT independent of anti-psychotics
    • Psychodynamic Therapy: Psychoanalysis
      • The psychodynamic approach to schizophrenia assumes that all symptoms are meaningful and are the product of the life history of the individual
      • Therapist attempts to create an allience with the patient by offering real help for what the patient feels is the problem; the more severe the disorder the more support the therapist must provide.
        • Freud believed that schizophrenics could not benefit as they could not form a transference with the analyst
          • Some psychologist do use psychodynamic therapies. They gain the patients trust, which is done by replacing the harsh and punishing conscience with one that is less destructive and more supportive. As the patient gets healthier, they become more active role in their own recovery
      • Appropriateness
        • Despite evidence that psychodynamic therapy isn't a convincing treatment the guidelines of the American psychiatric Association (APA) recommend that 'supportive interventions' such as psychodynamic therapy are appropriate when combined with anti-psychotics
        • psychodynamic therapists are expensive and treatment is long-term, preventing it from being used on a large scale. Critics say that because psychodynamic therapies appear less effective than anti-psychotics its not worth the expense
          • Karen and VandenBoss (1981) ---suggest that the overall cost of treating schizophrenics with therapy decreases as they are more likely to gain employment and less likely to seek inpatient treatment
      • Effectiveness
        • Malmberg and Fenton (2001) ---argue that its impossible to draw definite conclusions for or against the effectiveness of psychodynamic therapy
          • The schizophrenia Patient Outcome Research Team (PORT) has argues that some psychodynamic therapies are harmful for schizophrenic patients
            • Gottdiener (2000) concluded that psychodynamic therapy was an effective treatment for schizophrenia
        • May (1968) ---found that patients treated together with anti-psychotics and therapy had significantly better outcomes than those treated with therapy alone. Anti-psychotic medication alone was more effective than psychodynamic therapy
        • Karen and VandenBoss (1981) ---found patients treated with therapy improving more than those on just medication

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