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Outline and evaluate psychological therapies as treatments of Sz. (24 marks)
There are many psychological therapies used in the treatment of Sz. The use of drugs is common
form of therapy however, it is thought treatment is more effective when used in conjunction with but
psychological therapies which can help people develop the skills and the confidence to live normally
in the community.
Cognitive Behavioural Therapy (CBT) is the main psychological treatment of Schizophrenia (Sz). CBT is
based on the idea that people with mental disorders have irrational and unrealistic ways of thinking.
The aim of CBT is to adjust thinking patterns and alter inappropriate beliefs. Patients are encouraged
to track back the origins of their symptoms and evaluate the content of their delusions o test the
validity of their faulty beliefs. Understanding where symptoms originate can be crucial to some
patients as offering a range of explanations for the existence of hallucinations and delusions can help
An example of CBT is called belief modification, which teaches strategies to counter delusional
beliefs and hallucinations. Patients are taught to regard their delusions and hallucinations as
hypotheses rather than reality and learn to challenge these initial negative symptoms. Typically, CBT
is administered around once every 10 days for about 12 sessions to identify and alter irrational
There is much supporting research for CBT and it has been shown to have a significant effect on
improving symptoms of patients Sz. Outcome studies measure how well a person does after
treatment and outcome studies of CBT suggests that patients experience fewer hallucinations and
delusions. Drury found benefits in terms of reduction on positive symptoms and a 25-50% reduction
in recovery time for patients who used a combinations of antipsychotic medication and CBT.
In a meta-analysis by Gould, it was found that seven studies reported a statistically significant
decrease in the positive symptoms of Sz after CBT. Some research, such as Turkington found a
reduction in both positive and negative symptoms concluding that CBT is highly effective and should
be used as a mainstream treatment wherever possible. However, CBT is not a definite cure for Sz as
although some studies have shown CBT can improve certain symptoms, it only treats the symptoms
as it does not offer a cure, but rather a way of `normalizing symptoms'.
Pilling also concluded that CBT was the superior treatment, particularly referring to long-term
outcomes. Whereas patients who did not receive CBT tended to lose benefits of other treatments,
CBT patients maintain their gains over longer periods.
Also, as many symptoms of schizophrenia are cognitive in nature, it makes sense to use a cognitive
therapy to help counteract these delusions and hallucinations as CBT directly targets cognitive
processes. Many people with schizophrenia use coping strategies to control their delusions and
hallucinations, so it makes sense for a therapy to build on these coping strategies.
CBT has also been found effective particularly to new patients. Morrison et al administered six
months of CBT to patients showing early signs of Sz and twelve months later significantly fewer had a
full diagnosis than was the case in a control group.
There are various issues involved in research into psychological treatments that we need to consider
however. In Tarrier's study of the effectiveness of CBT therapies, out of the initial sample of 49
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As Tarrier's experimental design
was outcome research, the significantly high dropout rate causes loss of valuable data, making this
research unreliable. There are also ethical issues to consider in Sz research, as research on therapies
for Sz must be carried out in a way that does not place vulnerable individuals at unreasonable risk.
Researchers must not increase the probability that patients would come to any form of harm.…read more
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Of the five patients able to be
discharged, none of them were readmitted within a one year follow-up. This is however an
extremely small sample and other studies have tended to found that behaviour changes did not
continue after the tokens were withdrawn. This suggests behavioural therapy only treats the effect
of Sz, not the actual causes.
There are many problems with the research of treatments, especially when measuring relapse rates
and effectiveness outside of hospitals and institutions.…read more