Psychological Therapy For Schizophrenia

What is cognitive behaviour therapy?

A method for treating metal disorders based on both cognitive and behavioural techniques.

What is CBT commonly used to treat?

People with schizophrenia. It usually takes place over a period of 5-20 sessions either in groups or on an individual basis.

What does CBT aim to deal with?

Both thoughts and behaviour.

What can CBT help a client make sense of?

How their irrational cognitions, such as delusions and hallucinations, impact on their feelings and behaviour. Just understanding where symptoms come from can be hugely helpful for those with symptoms like auditory hallucinations.

What is an example of how understanding where symptoms come from can be helpful for clients?

If a client hears voices and believes the voices represent demonic forces they will naturally be very afraid. If a therapist can convince them that the voice actually comes from the malfunctioning speech centre in their own brain and that it cannot hurt them if they ignore it, it is much less frightening and hence less debilitating.

Does CBT eliminate schizophrenia?

No, but it can make people better able to cope with their symptoms.

How can people hearing voices be helped?

By teaching them that voice-hearing is an extension of the ordinary experience of thinking in words - normalisation.

How can delusions be challenged?

By a process of reality testing in which the person with schizophrenia and their therapist jointly examine the likelihood that beliefs are true.

In cases where delusions are resistant to reality testing, what can CBT still be used to do?

Tackle the anxiety and depression that result from living with schizophrenia.

What is 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 of living as a family,

What does family therapy aim to do?

Improve the quality of communication and interaction between family members.

Are there different types of family therapy?

There are a range of approaches in keeping with psychological theories like the double-bind and the schizophregenic mother.

What did Pharoah et al. identify?

A range of strategies that family therapists use to try to improve the functioning of a family that has a member with schizophrenia.

What are the strategies identified by Pharoah et al.?

• It reduces negative emotions.

• It improves the family’s ability to help.

How does family therapy try to reduce negative emotions?

Family therapy aims to reduce levels of expressed emotion, ie reduce the level of emotion generally but especially negative emotions such as anger and guilt which create stress. Reducing stress is important to reduce the likelihood of relapse.

How does family therapy try to improve the family’s ability to help?

The therapist encourages family members to form a therapeutic alliance where they all agree on the aims of therapy. The therapist also 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 individual with schizophrenia and maintaining their own lives.

What has Burbach proposed?

A model for working with families dealing with schizophrenia.

What are the different phases proposed by Burbach?

This begins with sharing basic information and providing emotional and practical support. Then it develops through progressively deeper levels. Phase 2 involves identifying resources including what different family members can (and cannot) offer. Phase 3 aims to encourage mutual understanding, creating a safe space for all family members to express their feelings. Phase 4 involves identifying unhelpful patterns of interaction. Phase 5 is about skills training such as learning stress management techniques. Phase 6 looks at relapse prevention planning and Phase 7 is maintenance for the future.

What is the strength of CBT?

• Evidence of effectiveness.

How is evidence of effectiveness a strength of CBT?

Jauhar et al. reviewed 34 studies of using CBT with schizophrenia, concluding that there is clear evidence for small but significant effects on both positive and negative symptoms. Other studies have focused on symptoms, for example Pontillo et al. (2016) found reductions in frequency and severity of auditory hallucinations. Clinical advice from NICE recommends CBT for schizophrenia.

What does the evidence for effectiveness mean for CBT?

This means that both research and clinical experience support the benefits of CBT for schizophrenia.

What is the limitation of CBT?

• Quality of evidence.

How is the quality of evidence a limitation of CBT?

CBT techniques and schizophrenia symptoms vary widely from one case to another. Thomas points out that different studies have involved the use of different CBT techniques and people with different combinations of positive and negative symptoms. The overall modest benefits of CBT for schizophrenia probably conceal a wide variety of effects of different CBT techniques on different symptoms.

What does the quality of evidence mean for CBT?

This makes it hard to say how effective CBT will be for a particular person with schizophrenia.

What are the strengths of family therapy?

• Evidence of effectiveness,

• Benefits to the whole family.

How is evidence of effectiveness a strength of family therapy?

A recent review of studies concluded that family therapy was one of the most consistently effective treatments available for schizophrenia. In particular relapse rates were found to be reduced, typically by 50-60%. It was also concluded that using family therapy as mental health initially starts to decline is particularly promising. Clinical advice from NICE recommends family therapy for everyone with a diagnosis of schizophrenia.

What does the evidence of effectiveness mean for family therapy?

This means that family therapy is likely to be of benefit to people with both early and full-blown' schizophrenia.

How are benefits for the whole family a strength of family therapy?

Therapy is not just for the benefit of the identified patient but also for the families that provide the bulk of care. A review of evidence by Lobban and Barrowclough concluded that these effects are important because families provide the bulk of care for people with schizophrenia. By strengthening the functioning of a whole family, family therapy lessens the negative impact of schizophrenia on other family members and strengthens the ability of the family to support the person with schizophrenia.

What do the benefits for the whole family mean for family therapy?

This means that family therapy has wider benefits beyond the obvious positive impact on the identified patient.