Schizophrenia - Psychological therapies

A look into family therapy and cognitive-behavioural therapy (CBT)

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Family therapy (AO1)

High levels of expressed emotion can lead to increased relapse rates and other negative outcomes. Therefore, it is suggested that by improving the communcation style in a family, it will reduce relapse rates. 

Falloon et al created a type of family management. It was designed to decrease levels of expressed emotions, be constructive, less demanding and empathic towards to the schizophrenic relative. 

They were also warned to not have high expectations and to avoid stressful interactions with the schizophrenic person. This therapy was used on those patients who lived in familys with high EE.

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Family therapy (AO2)

Falloon et al found that the relapse rate was significantly lower with the patients who recieved family therapy and drug therapy. 50% of those in individual therapy returned to hospital, where as only 11% of those who recieved family therapy returned to hospital. 

McFarlane's meta analysis found that family therapy had reduced relapse rates, improved recovery and improved family relations. 

However, despite family therapy the schizophernic patients continue to need drug therapy. Also, around a third of schizophrenic patients do not belong to functional families, so family therapy is not a option. Finally, family therapy only allows the patients to fit in society better, but doesn't provide a cure.

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CBT is used to help schizophrenic patients to challenge their inaccurate and irrational beliefs. They believe that these thoughts can be combated with CBT, to help the patient decide what is reality and what isn't. Therefore CBT focuses on the positive symptoms and not on negative symptoms. 

One type of CBT is belief modification, this requires teaching a patient how to challenge the delusional beliefs and hallucinations. This is called cognitive challenge and reality testing.

1) The therapist asks the patient to indentify the delutions and/or voices they hear.

2) Then the therapist and patient plan how to test the validity of these beliefs and perceptions.

3) The patient is then required to preform the tests on their own.

4) The client learns how to challenge the beliefs and perceptions and how to find alternative explinations.

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CBT has been shown to improve symptoms of schizophrenia. The patients recieve less hallucinations and delutions and recover better function capacity, than if drugs were used alone.

However, it is unknown which specific part of the therapy is the most effective (e.g. identifying and challenging the belifes, reality testing or considering alternative conclusions.)

Those who recieve CBT also recieve drug treatement at the same time, so it is hard to assess the effectiveness of CBT on its own. CBT also requires active engagement to the therapy, therefore it is not possible to use CBT on all schizophrenic patients.

CBT is designed to reduce positive symptoms and not negative symptoms, so it cannot reduce the negative symptoms.

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