Psychological Therapies for Sz.

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  • Psychological Therapies for Sz.
    • Before intro of drugs, not deemed appropriate for sz patients as they are detatched from reality and would not cope with cognitive & verbal communication in therapy. Is now often used alongside drug therapy.
    • Family Intervention.
      • Research into EE has shown family life can affect sz. Led to development of various family intervention programmes empahsising on inclusion & sharing info.
        • Sessions aim to develop cooperative & trusting relationships in the group. Contributions from all family members is valid.
          • Therapist provides info about cause, course & symptoms of sz. Ways of managing it are discussed eg improving communication styles, lowering EE, adjusting expectations & expanding social networks.
          • Family members and patient talk about their own experiences of the disorder
          • Family provided with coping strategies; encouraged to focus on the good, taught how to express feelings without resorting to high EE.
          • Trained to spot early signs of relapse so they can respind repidly & reduce its severity.
      • Effectiveness.
      • Appropriateness
        • Only appropriate for those returning to families
        • Needs to be used in conjunction with drug therapy.
    • Social Skills Training
      • Milieu Therapy
        • Aims to include the patient in decision making & managing wards. Can include token economy  systems were patient earns privileges by conforming to expected norms.
          • Criticised for being too controlling.
        • Effectiveness
        • Appropriateness
      • SST aims to teach complex interpersonal skills so that patients can manage their lives.
      • Wing & Brown: found differences in - symptoms between females in wards that were stimulating compared to those which werent.
        • This finding has led to practical applications such as influencing the policy of providing hospitals & day care environments that promote self esteem & personal control for sz patients.
      • Effectiveness
        • These interventions generally work but the gains are not always maintained after the programme has ended.
      • Appropriateness
        • Approach is more appropriate when used in conjunction with other therapies.
          • Hogarty: found patients on meds also recieving SST adjusted to living in the community & avoided re-hospitalisation more successfully than other groups on meds or SST alone.
    • CBT
      • Tarrier
        • Sz patients can often identify triggers to the onset of psychotic symptoms & can develop own coping strategies.
          • This study lead to the development of Coping Strategy Enhancement.
            • Aims to teach individuals to develop & apply effective coping strategies which reduce frequency, intensity & duration of symptoms & alleviates accompanying distress.
              • Education & Rapport: therapist & client work together to improve effectiveness of strategies & develop new ones.
              • Symptoms Targeting: Specific symptom is targeted and strategy is practised in session, client is helped with any problems.
              • Individual given homework tasks to make sure strategy is practised and record is kept.
              • At least 2 coping strategies are developed for each symptom.
            • Tarrier: found significant alleviation of + symptoms in a CSE group as apposed to a non-treatment group.
          • Strategies include: Use of distraction, concentrating on specific tasks, positive self talk. Initiation of social contact, withdrawal from social contact. Relaxation techniques, breathing exercises or ways of drowning out hallunicatory voices eg shouting.
            • 73% of patients reported that these strategies worked.
      • Beck & Ellis
        • Reality Testing: challenges negative beliefs & put them to a reality test.
          • Therapist asks for evidence that supports delusions & then encourages client to generate alternative, more plausible explanation.
          • Effectiveness
            • Kuiper: found it can significantly reduce severity of delusionsal symptoms.
            • Effective for + but not - symptoms.
            • Not known what part of the therapy is  ost important.
          • Appropriateness
            • Not a cure and treatments continue to develop however can improve certain symptoms of sz.
            • CBT is collaborative therapy & invloves active cooperation of the client so often avoids criticism of the patient becoming a passive recipient of treatment which would be unethical & often a criticism of drug therapy.
    • How Science Works
      • What constitutes as a cure?  Who decides the patient is cured? In whos interest is it to deem the patient cured? Who decides the patient is ill in the first place? Should the placebo effect be used first? Is it ethical t test therapies?


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