Psychological therapy of schizophrenia

CBT

It can help people understand where their symptoms have come from and to help them make sense of how their hallucinations and delusions are impacting their everyday life.

CBT - Turkington (2004)

Paranoid client: The Mafia are observing me to decide how to kill me.

Therapist: You are obviously very frightened... there must be a good reason for this.

Paranoid client: Do you think it's the Mafia?

Therapist: It's a possibility, but there could be other explanations. How do you know that it's the mafia?

Support for CBT

Jauhar (2014) reviewed 34 studies of using CBT with SZ. Found there are small but significant effects on both positive and negative symptoms

CBT too ranged

Thomas (2015) different studies use different techniques for CBT with different patients and various positive and negative symptoms

Family therapy

Pharoah (2010) found strategies: reduces negative emotions (EE) and improves family’s ability to help

It aims to give patients a less stressful family life (as this can be seen to cause relapse)

Family therapy - Burbach (2018)

Family therapy model:

Phase 1 = Sharing information, providing emotional and practical support

Phase 2 = Identifying resources the family can offer

Phase 3 = Creating a safe space for the family to talk about their feelings

Phase 4 = Identifying unhealthy problems of interaction

Phase 5 = Skill training (e.g. stress management)

Phase 6 = Relapse presentation

Phase 7 = Maintenance for the future

Benefits of family

Lobban + Barrowclough (2016) family benefits are important because they can provide the most care. It lessens the emotional impact within the family

Support for family therapy

McFarlane (2016) relapse rate falls by 60%. Recommended by NICE for early onset and long term cases

Token economies

Based on operant conditioning and reinforcement (primary reinforcement = privileges, secondary reinforcement = tokens).

Support for token effectiveness

Glowacki (2016) identified seven high quality effectiveness studies (1999-2013). All found reduction in negative symptoms and frequncy of unwanted behaviour.

Ethical issues

Gives professionals considerable power to control the behaviour of people in the role of patient.

Restricts the availability of pleasures to those with less severe symptoms.

Hard transition from institutionalisation to society.

Better alternatives

Chiang (2019) found art therapy might be a good alternative. Encourages individuality, no ethical issues, NICE guidelines recommend art therapy for schizophrenia.

Although, evidence base is small and some methodological limitations. But it appears to show that art therapy is a high-gain low-risk approach to managing schizophrenia.