Psychological therapies for schizophrenia

CBT is based on the idead that distorted bliefs alter the persons behaviour in maladaptive ways - in schiz - the prson may believe that their behaviour is being controlled by somebody or something else - delusions are thought to be a result from faulty interpretations of an event - CBT is used to help the patient identify and correct these faulty beliefs 

Techniques - patients are encouraged to trace the origins of their symptoms to see how they might have developed - evaluate the content of any delusions or voices and consider ways in which they might test the vailidity of their faulty beliefs - develop their own alternatives to previous maladaptive beliefs and develop appropriate coping strategies

Outcome studies - of CBT suggests that patients who recieve CBT experience fewer hallucinations and delusions and recover their functioning to a greater extent than those who recieve antipsychotics alone

Effectiveness - research has shown that CBT has a significant effect on improving the symptoms of schiz - Gould - all seven studies in their meta-analysis reported a significant decrease in the postive symptoms of schiz after treatment - Kuipers - significant reduction in the positive symptoms following CBT combined with antipsychotics - lower rate of patient drop out and greater patient satisfactionwhen 2 types of treatment were combined BUT most of the studies on the effectiveness of CBT have combined CBT with antipsychotics and so it is difficult to assess the effectiveness of CBT independantly of antipsychotics 

Appropriateness - CBT for schizs works by generating less distressing explanations for negative experiences rather than trying to eliminate them completely - negative symptoms may serve a useful function to the individual so may be understood as safety behaviours

commonly believed within psychiatry that not everybody with schiz would benefit with CBT - study of schiz patients in UK -Kingdon and Kirschen - many patients were not suitable for CBT such as older patients as they would not engage fully with the therapy

Psychoanalytic therapy is based on the assumption that individuals are often unaware of the influence of unconcsious conflicts in their psychological state - psychoanalytical approach to schiz assumes that all symptoms are meaningful and reflect unconcsious conflicts that must be brought into the conscious mind to be dealt with

belief that the first task of psychodynamic therapy is to win the trust of the patient and to build a relationship with them - achieves this by replacing harsh and punishing conscience with one that is less destructive and more supportive - as patient gets healthier they take a more active role in their own recovery - takes a long time to complete so many patients withdraw without completing their therapy

outcome studies -Gottdiener reviewed 37 studies - 2642 patients - psychological therapies had been used in treatment of schiz - results showed that psychodynamic and CBT therapies produced similar levels of therpeutic benefit - no difference in improvement when psychological therapy was used with antipsychotics

Effectiveness - Gottdieners meta-anaylsis of psychological treatment concluded that psychodynamic therapy was effective for schiz but the relatively small sample size used meant it was difficult to assess the impact of vaiables such as therapist training on the outcome for patients - half of the studies did nt randomly allocate patients to treatment conditions so introduced a treatment bias that may have affected results

Malmberg and Fenton - its impossible to draw conclusions for or against the effectiveness of psychodynamic therapy - research has suggested that some forms of psychodynamic therapy are harmful for schizos and many find the experience of psychodynamic therapy stressful and traumatic

May - patients treated with psychodynamic therapy and antipsychotics had better outcomes than those treated with therapy alone - antipsychotics alone was better than therapy alone - but other research found the opposite - patients recieving therapy alone improved more than those on medication alone

Appropriateness - despite uncertain nature of the effectiveness of psychodynamic therapy - APA recommends supportive interventions such as this type of therapy when used with antipsychotics

costly - argument against the use of this therapy is that is it costly and it takes a long time to complete - no more effective than antipsychotics so the extra expense is not justified

but the extra expense is worth it becase the overall cost of the treatment decreases with time as patients are less likely to seek inpatient treatment and are more likely to gain employment