Psychological therapies for schizophrenia

Families are important to prevent relapses in schizophrenic patients. High expressed emotions, such as hostility and criticism can have negative effects on the patient. This suggests that if families are taught how to communicate with their schizophrenic relatives it will be beneficial for them both.

Fallon et al (1985) created a new way of family management, for families with schizophrenic patients returning home. It focused on teaching everyone in the family how to improve communication styles, to lower expressed emotions, be less demanding and less empathic.

Families were also warned to not have high expectations and to avoid stressful interactions with the schizophrenic family member. This family managment was used  with patients in families with high expressed emotions.

CBT was originally thought to be inappropriate for schizophrenic patients, as they lacked the knowledge that there were ill. However, it is argued that CBT can help schizophrenic patients.

CBT assumes that patients are not in touch with reality and feel like they are being manipulated by something/someone else. CBT is therefore used to try and fix these 'faulty thoughts'. CBT focuses on the positive symptoms (e.g. hallucinations and delusions), it is hardly used to try and treat the negative symptoms of schizophrenia.

Belief modification is a type of CBT. It's used to counter delusional beliefs and hallucinations and involves cognitive challenge and reality testing.

• The therapist and patient discuss the delusion and/or the voices they hear.
• They then plan a activity to test the validity of the delusions, to prove their beliefs are  wrong.
• The patient is then set 'homework', to preform activities to show their beliefs (delusions/hallucinations) are wrong.
• The patients need to learn to challenge these delusions.

A meta-analysis found that family therapy can significantly reduce the relapse rate schizophrenia patients and re-admission to hospital (Pharoah et al, 2003).

Fallon et al (1985) looked at 2 groups of schizophrenic patients (both groups getting drug treatment) and found that out of the group which also received family therapy, only 11% returned to the hospital, compared to 50% of the group who didn't receive family therapy.

McFarlane (2003) found that family therapy reduced relapse rates and  improved family relations.

However, family therapies success should not be exaggerated, even if schizophrenic patients didn't relapse, they still need to take the drugs.Drugs and family management are most effective if used together.

A third of schizophrenic patients do not have a functioning family, so family therapy is not a option. Finally family management only helps patients fit in with society, it doesn't provide a cure.

Gould et al (2001) looked at 7 studies in a meta analysis and found that CBT significantly reduced the positive symptoms of CBT.

Studies on the effectiveness of CBT also show that there is a drop in hallucinations and delusions, and there is greater recovery of functioning abilities in patients, than if they were on drugs alone.

However, CBT fails to identify which part of the therapy produces the most benefit (e.g. identifying the delusions or challenging them or reality testing, etc).

Patients who have used CBT have always been on medication too, this raises the question of how effective CBT is without medication.

CBT is not appropriate to all schizophrenia patients, as they may lack the verbal and cognitive engagement needed.

Finally, CBT can only reduce some symptoms of schizophrenia, it cannot be used on patients with negative symptpoms.

These therapies are about coping, rather than curing schizophrenia. Despite the new developments in cognitive therapies, they only help patients to fit in with society and don't cure them.

CBT also requires the active involvement of the patient, and requires more effort thant taking drugs. However, CBT doesn't have side effectives, unlike drugs which can have serious side effects.