Psychological Therapies for Schizophrenia

• For 5 - 20 weeks, either individually or as a group
• Aims to help patients identify irrational thoughts and tries to change them
• Takes place as an argument, or a discussion, about how likely the beliefs are to happen and  less threatening possibilities are discussed/considered
• E.g. if a paranoid patient thought the Mafia were trying to kill them, the therapist would ask how they know it's the Mafia
• Doesn't get rid of symptoms but helps patients to deal with them better
• Helps patients to make sense of hallucinations and dellusions
• E.g. if a patient believes the voices are demons, learning about psychological explanations for hallucinations can be hugely comforting, thus reducing anxiety
• Delusions challenged so that patients know they aren't based on reality

Pharoah defined family therapy as:

• Based on EE and aims to decrease these levels, particularly stress
• Getting as many family members together as possible to provide support for everyone
• Gives information on Sz to give a better understanding
• Enforces idea that nobody is to blame - reduction of anger and guilt
• Gives coping strategies to improve communication and interactions
• This increases the chance of patients complying with medication

Evaluation

• Falloon found 11% relapse after family therapy, compared to 50% relapse after individual therapy
• Only appropriate for those with supportive family, many with Sz don't - lots of homeless people have Sz and increase of Sz in those abused as a child
• Pharoah found weak and inconsistent evidence for overall effectiveness

• Reward systems used to manage maladaptive behaviours, e.g. not showering
• Based on behaviourist approach
• Only used in institutions with patients who have been institutionalised for a long period of time
• Patients rewarded with a 'token' if they carry out desired behaviour - positive reinforcement
• Tokens can be swapped for tangible rewards, e.g. cigarettes, sweets, TV time
• Immediacy of reward is important otherwise the reward loses its effect
• Based on operant conditioning - tokens are secondary reinforcers and tangible rewards are primary reinforcers
• Doesn't cure Sz but modifying maladaptive behaviour prepares patients for life outside the instituion, makes it easier to intergrate back into society and improves their quality of life

• Found that CBT is a safe and effective alternative to medication with symtoms improving and no side effects, unlike drug therapies
• Can be offered to patients unable or unwilling to take drug treatments, as half of Sz patients do not take antipsychotics due to fear of side effects
• 41% receiving CBT had improvements of over 50% in positive and negative symptom scores
• CBT helps patients to understand their illness, make it more manageable and improve quality of life
• However, Jauhar reviewed 34 patients receiving CBT and found it had a significant but small effect on symptoms
• Sz is a harder mental illness to treat

Strength

• Paul and Lentz found that after 4 years, 98% of Sz patients treated using token economies were reintergrated into society compared to 45% receiving no specific treatment

Weaknesses

• Ethical issue - treating adults as children is an abuse of power and controversial
• Rewards are more available to patients with mild symptoms so those with severe symptoms are unable to comply to desired behaviours
• Discrimination, with some families questioning legality of this method - reduction in use of token economies

Alternative therapy

• NICE recommends art/dance/music therapy with a qualified therapist
• Suitable for those who struggle to communicate and gives patients a different medium