Psychotherapy Treatments for Schizophrenia

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  • An umberella term used to describe therapies such as congnitive therapy, CBT and psychoanalysis
  • Once thought to be innapropriate for schizophrenic patients due to their confused thinking, lack of insight and communication problems
  • There is now developing evidence which supports that psychological, rather than biological process may be responsible for generating and maintaing psychotic symptoms, in particualr hallucinations and delusions.
  • Psychotherapies such as CBT have been developed to target and challenge these dysfunctional thoughts associated with the disorder
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Cognitive Behavioural Therapies (CBT)

Designed to help individuals who have recently been released from hospital and so require support in preventing relapse and adjusting to everyday life.

Individuals are taught a range of skills in either a group setting or on an individual basis, including:

  • Lerning to identify signs of relapse and what to do in those circumstances
  • Acquiring relaxation techniques designed to help them deal with anxiety stress caused by challenging events
  • Identifying innapropriate emotional and behavioural responses to events and learning new responses
  • Learning to deal with negative feedback from other and to resolve interpersonal conflicts
  • Leaning to comply woith medication requirements

A second form of CBT has been used to give patients skills and strategies to cope with irrational thoughts, delusions and hallucinations. One example is challenging the bias that many individuals have towards interpreting their hallucinations as threatening.

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Coping Strategy Enhancement (CSE)

  • A form of a CBT programme
  • Recently been found that many schizophrenics use coping strategies when dealing with psychotic symptoms, many of these however are not effective
  • Nayani reported many coping strategies are ineffective with some actually increasing the frequency of hallucinations- referred to as safety behaviours--> they prevent the patient from disconfirming their belief that the hallucination is threatening
  • CSE is used to help the patient to develop or improve already existing coping strategies and involves 6 steps:

1. Assess the content of the psychotic content (how many voices? what are they saying?)
2. Assess the emotional response
3. Assess the person's thoughts that result from the emotional response
4. Assess any prior warning
5. Assess the individual's coping strategies
6. Get the individual to rate the coping strategy in relation to its effectiveness

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Evaluation of Coping Strategy Enhancement (CSE)

Tarrier- To investigate the use of coping strategies during psychotic episodes

  • Method: 25 schizophrenic patients who suffered hallucinations and/or delusions following a psychotic episode were intervied about their experiences and their use of coping strategies
  • Results: 1/3 of ppts identified triggers to the symptoms, 75% reported major distress and 1/3 reported disruption in the thinking and behaviour. 75% disclosed the use of coping strategies e.g. distraction
  • Conclusion: The use of coping strategies helped patients to cope with their symptoms
  • Evaluation: This type of study relies on the client being able to recall and communicate effectively, which is not possible in many cases involving people suffering from schizophrenia
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Evaluation of Psychotherapy

  • Studies have shown that CBT enables patients to cope once discharged from hospital. The improvement in social and cognitive skills gained from CBT is still evident 24 months after entering the therapy programme
  • Studies have indicated that CBT is more effecrtive than standard psychiatric treament as an adjunctive treatement for positive symptoms of schizophrenia--> used together with primary treatments (drugs). The use of neuroleptic drugs reduces symptoms, allowing patients to communicate their thoughts and emotions more clearly
  • The therapeutic effects of CBT have found last for up to 12 months--> only a short term treatment with refresher sessions needed to maintain its effects
  • CBT has been successfull been used in preventative programmes designed to reduce future symptoms in individuals at risk for developing psychotic symptoms
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