Psychological Treatments of Schizophrenia

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  • Created by: sia sundu
  • Created on: 20-05-13 11:07

Psychodynamic Therapies

Refers to treatments: free association, TAT test, hypnotic regression and dream analysis.

The analyst uncovers the unconscious conflicts casing the patient's symptoms and interprets them for the patient to create a subjective resolution of the problem.

Fromm-Reichmann (1948) & Rosen (1947) pioneered the use of modified psychoanalytic therapy to treat SZ, but there's no evidence of its effectiveness.

Tarrier (1990) - over-stimulation provided by such therapy can promote relapse.

Drake & Sedrer (1986) - patients exposed to psychoanalytic therapy may need longer hospitalisation, develop worse symptoms and are more likely to refuse further treatment. 

The theoretical basis for using psychodynamic therapies with SZ is weak and there's little supporting evidence for its use, unless as a combination therapy with drug treatment therapy: there's no strong case for its use as a sole treatment.

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Behavioural Therapy

It's based on the assumption that classical and operant conditioning can change unwanted behaviours into a more desirable pattern.

It focuses on current problems and behaviour and on attempts to remove any symptoms the patient finds troublesome. 

Token Economy - use of selective postive reinforcement or reward, used with institutionalised patients who are given tokens for behaving in appropriate ways.

Dickerson et al (2005) reviewed 13 studies of token economies being used with patients with SZ; beneficial effects were reported in 11 of these studies. They concluded that token economies were especially effective when used in combination with psychosocial and or drug therapy.

Effectiveness - successful in increasing the frequency with which patients with SZ produce various kinds of desired behaviour. But: it's difficult to use outside of the institution, doesn' address cognitive symptoms & it might produce only token i.e minimal learning. 

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Cont.

Appropriateness -

Patients that behave as if there isn't enough postive reinforcement in thier lives, token economies are specifically designed to provide adequate rewards to increase thier motivation.

However, "desired behaviours" are decided by the psychologists or institution and might not be acceptable to the patient is he/she had a free choice.

Aren't likely to improve symptoms such as delusions, hallucinations and lack of emotion.

It doesn't focus on some of the factors ( genetics, biochemistry or poor communication within the family) that play important roles in producing SZ.

Majority of SZ patients are treated in the commnity and token economies are much less effective in community settings.

It produces rather short-lasting and superficial changes in behaviour that fail to generalise well to the outside world.

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Social Interventions (SI)

SI make use of behavioural techniques

Evidence to suggest that social factors affect the course of SZ, .:. makes sense to assume that some kind of social intervention might have a therapeutic effect on people diagnosed with SZ.

Wing & Brown (1970) found marked differences in negative symptoms between women from wards which were stimulating and those which were not.

After social changes were introduced at the less-stimulating hospitals, significant improvements were observed in about 1/3 of the patients.

Milieu therapy is similiar to SI & used while the individual is still in institutional care or in day-care centres.

It aims to include the patients in decision-making and in managing wards. The programmes focus on improving self-care routines, conversational skills and job role skills. It can also include a token economy system.

Even though this approach has been criticised for being too controlling, it's been shown to be effective in helping patients to achieve independent living.

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Cont.

Social skills training (SST) programmes help modify or improve the social behaviour of people diagnosed with SZ.

SST is an active therapy that uses various behavioural techniques such as modelling, reinforcement, role-playing and practice in real-life situations to enable individuals to acquire appropriate verbal and non-verbal skills.

Halford & Hayes (1992) produced a training programme comprising a no. of modules: conversation skills, assertion and conflict management, medication self-management, time use, survival skills and employment skills.

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The training didn't generalise to real-life situations, but as the training programmes improved and developed, this criticism became less valid.

Birchwood & Spencer (1999) found that such programmes are generally beneficial in increasing the individual's competence and assertiveness in social situations.

However, it appears that some kind of active intervention needs to be maintained otherwise social skills will start to deteriorate again.

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Cognitive-behavioural therapy (CBT)

Tarrier (1987) - people SZ can identify triggers or precursors to the onset of their psychotic symptoms and that they develop their own methods of coping with the distress caused by hallucinations and delusions.

Cognitive strategies: use of distraction, concentrating on a specific task & positive self-talk.

Behavioural strategies: initiation of social contact or withdrawal from social contact.

Relaxation techniques: breathing exercises or ways of drowning out the hallucinatory voices by shouting or turning up the volume of the TV.

73% of Tarrier's sample reported that these strategies were successful in managing their symptoms.

From this a therapeutic approach call Coping Strategy Enhancement (CSE) was developed.

It aims to teach individuals to develop and apply effective coping strategies which will reduce the frequency, intensity and duration of psychotic symptoms and alleviate the accompanying distress.

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Cont.

There are 2 components:

  • Education and rapport training: therapists and client work together to improve the effectiveness of the client's own coping strategies and develop new ones.
  • Symptom targeting: a specific symptom is selected for which a particular coping strategy can be devised.

A controlled trial carried out on people diagnosed with SZ by Tarrier et al. (1993), found a significant alleviation of positive symptoms in a CSE group as opposed to a non-treatment group held on a waiting list, and a significant improvement in the effective use of coping skills.

This kind of research study is encouraging and suggests that CSE provides an effective way of helping people with the disorder to control their symptoms.

CBT is an appropriate form of treatment: several symptoms of SZ are mainly cognitive in nature, as many patients use coping strategies to control their hallucinations and delusions, it's reasonanle to develop therapeutic techniques to improve those coping strategies.

However: it's specifically designed to reduce only certain positive symptoms, it only has modest beneficial effecys on relapse rate & doesn't take in biological factors.

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Beck & Ellis

Irrational beliefs about the self and about significance of events are directly responsible for causing distress or other negative emotions.

The goal of this therapy is to challenge these negative beleifs and put them to a reality test.

If the evidence obtained by the patient challenges their delusory beliefs it becomes possible to present alternative explanations of their experiences that may become more adaptive for them.

Kuipers et al. (1997) - this therapy is effective as it has shown that it can bring about significant reduction in the severity of delusional symptoms.

Integrated Psychological Therapy (IPT) has found to be effective in improving attention and concept formation. IPT aims to identify the specific cognitive deficits shown in SZ and to remedy them.

Studies have shown that people treated with this therapy show lower hospitalisation rates and decreased scores on psychopathology than control groups.

However, while it leads to modest improvements in how the individual thinks, it doesn't eliminated schizophrenic patterns of thinking.

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Family Intervention

Research shows that certain aspects of family life can affect the course of SZ,

Central to these programmes is the emphasis on inclusion and sharing information.

Sessions aim - to develop a cooperative and trusting relationship with the family group and the contributions of all family members are valued.

Goal of sessions - to provide the whole family with practical coping skills that enable them to manage the everyday difficulties arising as a consequence of having SZ in the family.

The family and the individual with SZ are also trained to recognise the early signs of relapse so that they can respond rapidly and reduce its severity.

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There has been overwhelming support for the effects of family intervention.

It has been shown not only to reduce the rate of relapse but to improve compliance with medication and to reduce ratings for EE within the family.

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Conclusion

We don't know what causes SZ - it's most likely a combination of biological and psychological triggers (diathesis:stress model).

Biological treatments are most commonly used to control schizphrenics and reduce the symptoms quickly.

Schizophrenics often have poor social skills and problems with everyday living so psychological therapies and family intervention programmes can help.

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