Psychological therapies for schizophrenia

Cognitive behaviour therapy

A method for treating mental health conditions based on cognitive and behaviourist techniques.

From a cognitive viewpoint the therapy aims to deal with thinking e.g. challenging negative thoughts.

Includes behaviourist techniques like behavioural activation

Family therapy

A psychological therapy carried out with all or some members of a family with the aim of improving the communications within the family and reducing the stress created by family dynamics.

How CBT helps with schizophrenia

Helps a client make sense of their irrational cognitions.

Understanding where the symptoms come from can be helpful for those with symptoms like auditory hallucinations. If a therapist can convince someone that their voices comes from the malfunctioning speech centre in their brain and that it cannot hurt them, then it is less frightening and less debilitating.

This doesn’t eliminate the symptoms of schizophrenia but it can help people to cope with them. Reduces their distress and improves their ability to function adequately.

People hearing voices can be helped by being taught that voice-hearing is an extension of the ordinary experience of thinking - Normalisation.

Delusions can be challenged through reality testing where the client and therapist examine the likelihood that these beliefs are true.

CBT can also be used to tackle anxiety and depression that results from living with schizophrenia

How family therapy helps

Pharoah

Identified a range of strategies that family therapists can use to improve the functioning of a family that has a member with schizophrenia

• Reduces negative emotions

• Improves the family’s ability to help

Reduces negative emotions

Family therapy helps to reduce levels of expressed emotion i.e. reduce the level of emotion generally but especially negative emotions like anger and guilt which create stress.

Reducing stress important to reduce the likelihood of relapse.

Improves the family’s ability to help

The therapist encourages family members to form a therapeutic alliance where they all agree on the aims therapy.

The therapist tries to improve families’ beliefs about and behaviour towards schizophrenia.

A further aim is to ensure that family members achieve a balance between caring for the person with schizophrenia and maintaining their own lives

Burbach therapy for families dealing with schizophrenia

Share basic information and provide emotional and practical support

Identify resources e.g. what different family members can offer

Encourage mutual understanding

Identify unhelpful patterns of interaction

Skills training e.g. learning stress management techniques

Relapse prevention planning

Maintenance for the future.

CBT S Research support

Jauhar - Meta-analysis

Found that CBT had a positive effect on both positive and negative symptoms by allowing the patient to make sense of their disorder.

The NICE (National Institute for Health and Care Excellence) review of treatments found that CBT was effective in reducing the risk of hospitalisation compared to other treatments.

Suggests that research and clinical experience support the beliefs of CBT as a treatment.

CBT W Individual differences in effectiveness

Addington + Addington

Group-based CBT can help to normalise someone’s life experiences. They claim that self-reflection is not always appropriate in the initial stages so therapy may not be appropriate. Medication may be needed first.

People with more experiences of their own conditions and a deeper understanding of their problems will benefit more from individual CBT.

Suggests that CBT may not be an effective treatment for everyone with schizophrenia especially in the early stages.

CBT W Ethical issues

Involves challenging patient’s beliefs e.g. that the government are watching them.

Doing this can lead to distrust for the patient and create an atmosphere of distrust. Can also be seen as interfering with someone’s freedom of thought.

Suggests that CBT is not always suitable for people with specific symptoms like delusions and hallucinations.

Family therapy S McFarlane

Evidence for effectiveness

Concluded that family therapy was one of the most consistently effective treatments for schizophrenia. Using family therapy when mental health starts to decline is promising.

Relapse rates were reduced by 50-60%.

Clinical advice from NICE recommends family therapy to everyone with a schizophrenia diagnosis.

Suggests that family therapy is good for many aspects of schizophrenia.

Family therapy W Garety

Not a worthwhile treatment

Failed to show better outcomes for patients given family therapy in comparison to those who have a carer with no therapy. Similar relapse rates between the 2 groups

People who did not have a carer or family therapy showed an increase in relapse rate.

This can suggest that the support given by the carer may have benefitted the patient just as much as family therapy would so the extra treatment may not be needed.

Suggests that family therapy can reduce the stress caused by the symptoms but cannot cure schizophrenia.

Family therapy W

Risk of parent-blaming

Insecure attachment and early trauma are risk factors for schizophrenia as they are for many conditions. Recognising this comes at a price as families may feel they are to blame.

Although family therapists do not blame parents, some of the theories where family therapy developed do blame parents. This makes parental distress worse in an already stressful situation.

Suggests that some therapists/families may prefer to explore other treatments