Psychological Treatments for Schizophrenia: CBT, Family Therapy + token economies

Psychological Treatments

Help patients cop with positive symptoms and treat negative symptoms of schizophrenia. They work best alongside anti-psychotic drugs (interactionist approach).

Cognitive Behavioural Therapy (CBT)

Functions on assumption that unhealthy beliefs lead to unhealthy emotional and behavioural consequences. The therapy aims to identify and challenge irrational beliefs using disputing techniques employed by therapists (logical, empirical, pragmatic). This involves patients being taught to recognise hallucinations + delusions, consider the emotional and behavioural consequences of these and receiving advice on how to lessen and manage these consequences. This helps patients avoid isolation, manage emotions and function adequately.

Pro - CBT - Evidence

One strength of CBT is that there is evidence supporting its effectiveness for treating schizophrenia. One treatment review found that when comparing patients only being treated with anti-psychotics and patients that are treated with CBT and anti-psychotics those receiving CBT as well as drug therapy were least likely to be hospitalised. Therefore, this suggests that CBT is undeniably effective at treating schizophrenia.

Con - CBT - Independently

One weakness of CBT is that it is difficult to determine the effectiveness of CBT alone as a treatment. This is because most patients studied have been treated with both CBT and anti-psychotic drugs (as it is the thought the most effective treatment). This means that there is a very small sample of schizophrenics only receiving CBT to be studied, and that sample is likely to be unrepresentative as there is usually an underlying reason patients are not given drugs. Therefore, research about CBT’s effectiveness independent of drug therapy is of a low external validity and difficult to establish.

Con - CBT - Availability

One weakness of CBT is that it is not very widely available. One study found that only 6.9% (13/187) of diagnosed schizophrenics in North West England were offered CBT as a result of its costs due to its time demands and need for a therapist to give it. Therefore, CBT is a weak treatment as it is largely inaccessible.

Family Therapy

This aims to reduce levels of Expressed Emotion within the family to reduce chances of relapse and hospital re-admission in schizophrenics. It does this by employing strategies such as: informing family about schizophrenia, improving family’s ability to anticipate and solve problems, reducing anger and guilt in family members and helping family members balance caring for the schizophrenic and maintaining own life.

Family Therapy - Pro - Evidence

One strength of family therapy is that there is evidence to support its effectiveness. For example, a study by Pharoah et al found that family therapy reduces hospital re-admission and improves the schizophrenic’s quality of life. Therefore, this suggests family therapy is an effective treatment for preventing relapse in schizophrenics.

Family Therapy - Con - Expensive

One weakness of family therapy is that it is expensive and time consuming. Treatment occurs in sessions with the family and a therapist over a course of many months. Therefore, this means that the treatment is widely inaccessible for some families due to the time it takes up and the cost (whether the family cannot afford it or national healthcare cannot offer it) and so it is weak.

Token Economies

This a behavioural therapy, based in operant conditioning, which seeks to manage schizophrenics’ behaviours with a reward system. It particularly targets hospital patients at risk of developing bad habits like staying in PJs all day. These habits are modified by the offering of rewards for performing certain behaviours by hospital staff. This is not a cure for schizophrenia, but it does improve quality of life.

Token Economies - Con - Hospitals

One weakness of token economies is that their are only shown to be effective in hospitals. In a psych ward, where patients receive 24 hour care from doctors and nurses, is the only place where schizophrenics are observed enough to be awarded appropriately. This is not the case for outpatients, as there is no one there to observe and award desired behaviours. Therefore, the results of token economies are unlikely to be awarded beyond that environment and so these behaviours may not be repeated outside that environment (due to lack of reward).