Psychological Therapies
Schizophrenia
Introduction
•Although the use of drugs is crucial in thetreatment of schizophrenia, many people donot experience the effects and stillexperience distressing symptoms.
•There are many forms of psychotherapywhich can be successful in treatingschizophrenia.
Cognitive Behavioural Therapy
•Assumption – People suffering from schizophreniaoften have distorted beliefs which influence theirbehaviour in maladaptive ways.
•They may feel someone controls their behaviour.
•These delusions are thought to result from faultyinterpretations of events.
•Cognitive therapy is used to help the patient toidentify and correct these faulty thoughts.
CBT Techniques
•In CBT, patients are encouraged to trace backthe origins of their symptoms in order to get abetter idea of how the symptoms may havedeveloped.
•They are also encouraged to evaluate thecontent of their delusions or of any internalvoices they hear, and to consider the validity oftheir faulty beliefs.
CBT Techniques
•Patients might also be set behavioural assignments withthe aim of improving their general level of functioning.
•The learning of maladaptive responses to life’sproblems is often the result of distorted thinking by theschizophrenic, or mistakes in assessing cause or effect(e.g. assuming that something terrible happenedbecause they wished it).
CBT Techniques
•During CBT, the therapist lets the patientdevelop their own alternatives to these previousmaladaptive beliefs, by looking for alternativeexplanations that are already in the patientsmind.
•They learn to change their initial negativeinterpretations.
Outcome Studies
•Outcome studies measure how well a patientdoes after a particular treatment.
•These studies suggest that patients who receivecognitive therapy experience fewerhallucinations and delusions and recover theirfunctioning to greater extent than those whoreceive antipsychotic medication alone.
Outcome Studies
•Drury et al (1996) – Found benefits in terms of areduction of positive symptoms and a 25-50% reductionin recovery time for patients given a combination ofantipsychotic medication and CBT
•Kuipers et al (1997) – Found lower patient drop out ratesand greater patient satisfaction when CBT was used inaddition to antipsychotic medication.
Effectiveness
•Supporting Research
Several studies have shown that CBT can be effective intreating schizophrenia.
Gould et al found that all seven studies in their meta-analysis reported a statistically significant decrease inthe positive symptoms of schizophrenia after treatment.
Effectiveness
•CBT Alone
Most studies on effectiveness of CBT have beenconducted with patients treated at the same timewith antipsychotics.
It is therefore difficult to assess the effectivenessof CBT independent of antipsychotic medication.
Effectiveness
•Lone Term Benefits
Jones et al (2000) found CBT reduced both thefrequency and the intensity of hallucinations. It was lesseffective with delusions but it did seem to reduce theaccompanying distress.
Drury et al (2000) found that CBT had immediate andshort term gains but in a five year follow up study thetreatment showed no long term advantage.
Appropriateness
•Who Benefits?
The use of CBT in conjunction with other therapiesseems to have benefits but it is commonly believed thatnot everyone will benefit.
Kingdon and Kirschen (2006) - found that many patientsare not suitable for CBT as they would not cooperatewith it. It was also seemed more appropriate withyounger people.
Appropriateness
•Not a cure
Although some studies have shown thatCBT can improve certain symptoms ofschizophrenia, CBT does not offer a cure.
Appropriateness
•Ethics
CBT is a collaborative therapy andinvolves the active cooperation of thepatient. This avoids the criticism of madeof drug therapy where the patientpassively receives drugs.