Psychological Therapies A02

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CBT - Improved Symptoms

Research has tended to show that CBT has significant effects on improving the symptoms of patients with schizophrenia

For example, Gould et al found that in all 7 studies of their meta-analysis reported statistically decrease in the positive symptoms of schizophrenia

However, most studies have been conducted with patients treated at the same time with antipsychotic medication

It has been difficult, therefore, to assessthe effectiveness of CBT independent of anti-psychotic medication

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CBT - Less Distressing

CBT for Sz works by trying to generate less distressing explanations for psychotic experiences, rather then trying to eliminate them completely.

Negative symptoms may well serve a useful function for the person so can be understood as ‘safety behaviours’.

For example, within a psychiatric setting, the strong expression of emotion might lead to increased medication or a hospital admission. Similarly, inactivity and withdrawal might be seen as a way of avoiding making positive symptoms worse.

CBT therefore, offers some hope of alleviating these maladaptive thought processes. 

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CBT - In Conjunction with Other Treatments

The use of CBT in conjunction with medication seems to have benefits.

But it is commonly believed within psychiatry that not everyone with Sz may benefit from CBT.

For example, in a study of 142 schizophrenic patients in Hampshire, Kingdon and Kirschen (2006) found that many patients were not deemed suitable for CBT because psychiatrists believed they would not fully engage with the therapy.

In particular, they found that older patients were deemed less suitable than younger patients. 

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CBT - Empirical Support

There is empirical support for the effectiveness for CBT.

Tarrier et al  (1993) tested the effectiveness of Coping Strategy Enhancement. Patients with schizophrenia showed significantly more reduction in positive symptoms than patients on a waiting list for treatment, and the improvement was still evident after 6 months after the end of treatment. 

The patients showed an improvement in coping skills, and this improvement was associated with decreased hallucinations and delusions.

The main problem was that almost half of the patients scheduled to take part in the study refused to participate or dropped out. 

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CBT - More Ethical

CBT could be considered more ethical than drug therapy.

One of the first phases of CBT is to establish a therapeutic alliance between the clinician and the schizophrenic patient. 

CBT is a collaborative therapy and involves the active cooperation of the client.

For this reason, it often avoids the criticisms made of drug therapy that the client becomes a passive recipient of treatment.


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Family Therapy - Effective Treatment

Research by Fallon et al provides overwhelming support that family therapy is an effective form of treatment because it significantly reduced relapse rates.

The researchers compared the relapse rates between patients having family therapy and a control group who received individual help from a therapist. Both groups continued to have drug therapy.

Results showed that within 1 year, 50% of patients receiving individual therapy had relapsed but only 11% of those patients who had attended family therapy had the same outcome.

Therefore it is effective because family therapy significantly reduced the number of patients being hospitalised as a result of their relapse. 

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Family Therapy - Appropriate?

Family therapy may not be an appropriate treatment for schizophrenia because it assumes that every schizophrenic has a family to go back to.

In reality, many patients do not have a family.

For example, they may not have married, or there may be situations in which the family is not necessarily willing to have the schizophrenic patient back in the family home or even go to family therapy. 

Clearly for these types of patients, family therapy would not be an appropriate form of treatment so the effectiveness of the therapy depends on the patients individual circumstances. 

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Family Therapy - Relapse

Approximately 65% of schizophrenic patients that are hospitalised later go home to live with their families after their condition shows sign of improvement, therefore it could be argued that family therapy is an appropriate way of treating schizophrenia because the family environment is an important area in terms of relapse.

Many of the symptoms of schizophrenia, such as disorganised speech can make the patient feel socially isolated and alone.

Therefore, family therapy is appropriate because it aims to improve the schizophrenic patients social functioning and their environment.

This form of therapy is effective as it addresses the cause of the disorder as well as the observable symptoms. 

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