Non-biological treatments of sz

AO1 - What is CBT

• Cognitive Behavioural Therapy (CBT) is a psychological treatment that aims to change the way individuals think, feel and behave.

• It is based on both the cognitive approach (faulty thinking patterns) and learning approach (behaviours shaped through reinforcement and modelling).

• CBT for schizophrenia focuses on identifying and challenging faulty beliefs and delusions, helping patients manage symptoms rather than eliminate them.

• Therapy is usually one-to-one, collaborative, and focuses on the patient’s subjective experience.

• Techniques include belief modification, where delusions are challenged and tested against reality, and focusing and reattribution, where hallucinations are analysed and patients are encouraged to recognise them as self-generated.

• Normalising is also used to reduce distress by helping patients see symptoms as understandable rather than catastrophic.

• CBT can also be used after the acute phase and may involve group therapy, structured activities and coping strategies.

AO1 - What is Family Therapy

• Family therapy is often used alongside CBT and focuses on improving the social environment of the patient.

• It involves educating family members about schizophrenia, including symptoms, causes and treatment, to reduce blame and stigma.

• The therapy encourages open communication, allows family members to express concerns in a controlled setting, and may involve the clinician acting as a mediator.

• It aims to reduce expressed emotion (EE), such as criticism and hostility, which is linked to relapse.

• Family therapy also promotes medication compliance and creates a supportive environment, which helps reduce relapse rates and improve long-term outcomes.

AO3 - SUPPORT (CBT effectiveness)

• There is evidence supporting the effectiveness of CBT for schizophrenia.

• Chadwick and Lowe (1994) found that 10 out of 12 patients showed a reduction in the conviction of their delusions after CBT, suggesting it is effective in modifying irrational beliefs.

• Bentall et al (1994) found that patients were able to reattribute hallucinations to themselves, reducing the distress associated with them.

• This suggests CBT is particularly effective at targeting the cognitive processes underlying symptoms, increasing its validity as a treatment.

AO3 - CRITIQUE (CBT limitations)

• However, research into CBT has several methodological limitations.

• Many studies rely on small samples and self-report data, which reduces reliability and may be affected by social desirability bias.

• There is also treatment bias, as patients selected for CBT are often more motivated or less severely affected, meaning findings may not generalise.

• Additionally, CBT does not directly address the biological causes of schizophrenia and may be less effective for individuals experiencing severe psychotic symptoms, limiting its overall effectiveness.

AO3 - SUPPORT (Family therapy effectiveness)

• Family therapy has strong support for improving long-term outcomes.

• Goldstein and Miklowitz (1995) found that family therapy combined with medication reduced relapse rates more than medication alone.

• Pilling et al (2002) also found that family interventions improve medication compliance and reduce relapse.

• This suggests that family therapy is effective because it targets environmental stressors, such as high expressed emotion, which are linked to relapse.

• Therefore, it is particularly useful as a long-term management strategy rather than a short-term treatment.

AO3 - OTHER EXPLANATION (biological treatments)

• An alternative explanation is that schizophrenia is best treated using biological treatments, such as antipsychotic drugs.

• Drug treatments directly target dopamine imbalance, which is a key underlying cause of schizophrenia.

• This suggests that CBT and family therapy may only manage symptoms rather than address the root cause.

• Therefore, non-biological treatments are often most effective when used alongside medication, supporting a combined approach.

AO3 - Application

• A strength of non-biological treatments is their real-world application.

• CBT helps individuals develop coping strategies, reduce distress and improve daily functioning, which can increase independence.

• Family therapy improves communication and support, reducing isolation and helping patients reintegrate into society.

• However, these treatments require time, trained therapists and patient engagement, making them less accessible.

• Family therapy in particular relies on the willingness of family members to participate, which can lead to high attrition rates and limit effectiveness.

AO3 - Synoptic

• This links strongly to the nature vs nurture debate, as CBT and family therapy focus on nurture factors such as thinking patterns and social environment.

• However, the need for drug treatments highlights the importance of biological (nature) factors, such as dopamine imbalance.

• This supports the interactionist approach, particularly the diathesis-stress model, where a biological vulnerability interacts with environmental stressors (e.g. family conflict or cognitive distortions) to produce schizophrenia.

• It also links to reductionism vs holism, as non-biological treatments are more holistic, considering cognitive, emotional and social factors, whereas biological treatments are reductionist.

• Additionally, there are links to psychology as a science, as CBT is based on scientific principles but relies on subjective experiences, making it harder to measure objectively compared to biological treatments.