Psychological Therapies for Sz

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  • Created by: imanilara
  • Created on: 12-06-16 15:34

Assumptions of Cognitive Behavioural Therapy

Assumption behind CBT is that people have distorted beliefs which cause maladaptive behaviour, examples:

- believing thoughts are being controlled by outside agency 

-making mistakes in distinguishing between cause and effect- and indi feels something terrible has happeend because they wished it 

Delusions like this = faulty interpretation of events and cognitive therapy is intended to help the patient identify and correct these 

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General CBT Techniques

  • Trace back the origins of their symptoms to get a better idea of how they may have developed 
  • Evaluate contents of delusions of hallucinatory voices 
  • Consider how they may test the validity of their ideas 
  • Find alternative exps and coping strategies for events 

Behavioural assignments are also given to improve level of functioning

Eg Chadwick et al (1996) report case of individual who believed he could make things happen just by inking them- shown paused vid recordings and asked to say what would happen next. In over 50 trials, he made no correct predictions+ was able to understand he didnt have influence over events 

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Coping strategy Enhancement (CSE) TARRIER

Individuals taught to develop and apply effective coping strategies to reduce the frequency intensity and duration of psychotic symptoms and alleviate the accompanying distress - 2 components :

  • education + rapport training - therapist + client work together to improve effectiveness of coping strategies and help develop new ones
  • symptom targeting - specific symptoms targeted and coping strategies developed for each 

strategy is practice during the session + the client is helped thru any probs applying it- then they are given homework tasks to ensure they practice strategies in the outside world + may keep a diary of how it has worked. The aim of CSE is to ensure the adoption of at least two appropiate strategies per distressing symptom. 

Eg: cognitive coping strategies for managing hallucinations/delusions: distraction, concentrating on a specific task, positive self talk 

E.g. of behavioural coping strategies:  Initiation of social contract, withdrawal of social contract, relaxation techniques, breathing exercises, ways of drowning out hallucinatory voices 

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Commentary- EFFECTIVENESS

Outcome studies measure how well a patient does after a particular treatment compared w the ACCEPTED form of treatment for the condition- outcome studies suggest CBT+ meds = reduced hallucinations+ delusions and recover their functioning to a greater extent than those who just use anti-psychotics alone. 

Drury et al 1996- 25-20% reduction in recovery time in those who used CBT+ meds compared to just drugs

Kuipers et al 1997- CBT techniques can bring about a significant reduction in the severity of delusional symptoms (25% reduction in score on brief psychiatric rating score BPRS) when they compared CBT+ meds and just meds w a group who were meds resistant. Patient drop out were lower and satisfaction higher 

Gould et al (2001) - found that all seven studies in their meta analysis reported a statistically sig decrease in positive symptoms of Sz after treatment 
Most studies look at CBT+ meds- hard to know effectiveness of CBT alone 

Tarrier et al 1993- sig alleviation of +ve symptoms thru CSE compared to non-treatment group+sig improvement in coping skills 

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APPROPIATENESS

Strategy involved in CBT- develop less distressing exps for psychotic symptoms rather than just eliminating them. Negative symptoms such as social withdrawal, flattening of affect and inactivity could be construed as safety behaviours to reduce likelihoood of hospital admissions + medication. If progress made w alt. coping strategies ie those taught by CBT, fewer neg symptoms may occur- no need for safety behaviours

Commonly believed that not every patient will benefit from CBT- older less likely than younger - approach suggests either the treatment is not appropiate for all Sz patients or that the expectations of medical staff about its effectiveness for different indi's will mean it won't be used, i.e. EXPERIMENTER EFFECTS 

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ETHICS

COULD GO IN ANY TREATMENT ESSAY:

Research on therapies for Sz must be carried out in a way that does not put vulnerbale indi's at unreasonable risk. BPS advice is that when P's take part in psychological investigation, this should not increase probability of psych harm. 

Probability of harm increased when vulnerable groups eg people w Sz used - potential areas for harm in outcome studies:

  • medication discontinuation - studies involve taking people off meds- could lead to relapse
  • placebo use as a treatment- issues of deception+ physical/psych harm in relapse 
  • issues w informed consent- difficult 
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