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Communication patterns and high expressed emotion in families may contribute towards
Considerable efforts have therefore been directed at changing communications through
The main objectives are:
o To get members of the family to be more tolerant and less critical
o To help all members of the family feel less guilt and feel less responsible for causing
o To improve positive communication and decrease negative types of communication
Help groups for family members also exist in which families meet with each other to provide
support, learn about what works for other families and maintain high motivation to continue
with new communication patterns and support for the member with schizophrenia
Chien et al., 2004
Aim: Hogarty et al. (1986) investigated the effectiveness of family therapy in comparison to three
other types of treatment for schizophrenia.
Method: People with schizophrenia received either medication only, medication plus social skills
training, medication plus family therapy or medication plus both social skills training and family
therapy. Patients were followed up over a 1-year period and the frequency of relapse for each type
of treatment measured.
Results: It was found that 40% of those in the medication-only treatment relapsed, compared with
20% relapse in the medication plus social skill training or family therapy treatments. The combination
of medication plus social skills training and family therapy resulted in no cases of relapse.
Conclusion: Family therapy helps prevent relapse in schizophrenia. When combined with social skills
training and medication relapse is very low indeed.
Cognitive-behavioural Therapies for Schizophrenia
Focus on individual symptoms, such as hallucinations and delusions
Patients experience distress with the more troublesome psychotic symptoms and certain
strategies are developed to help them cope with this
A study performed by Tarrier in 1987 led to the development of a new therapeutic approach
known as Coping Strategy Enhancement (CSE)
It involves teaching patients new coping strategies based on their own preferred strategy
The aim of CSE is to teach the individual how to use coping strategies to reduce the
frequency and intensity of psychotic symptoms
Already present strategies are worked on and new ones encouraged
The therapy involved a number of steps:
1. Assess the form and the content of the psychotic experience, e.g. `Is there one
voice or more?'
2. Assess the emotional response, e.g. `How do the voice make you feel; are you
afraid or anxious?'
3. Assess the person's thoughts that accompany the emotion, e.g. `Do you think
you are in danger?'
4. Assess any prior warning or antecedent, e.g. `Do you know when the voice will
5. Assess the individual's coping strategies, e.g. `How do you cope with this?'
6. The individual then rates each strategy in terms of its effectiveness
The therapy then progresses using two components:
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Education and rapport training creating an ambience and shared understanding so
that therapist and client can work together
o Symptom targeting a symptom is targeted, usually one for which a coping strategy
is already in use, and this strategy is enhanced and practiced during the session. The
client is then asked to assess the usefulness and effectiveness of the strategy and
make a record when at home
Evaluation of CSE:
Tarrier et al.…read more