Schizophrenia Psychological Therapies

What do we need to know? 0 What are they? 0 What do they do? 0 Are they effective? 0 Are they appropriate?

Behavioural Therapy (and it’s sub types) 0 What do we know about behavioural therapy? 0 What two concepts is it based around? 0 Behavioural therapies are not used as widely as biological treatments. Why might his be?

Token Economy 0 This type of therapy is mainly used on patients who are institutionalised and is a method of helping them to manage / control their impulses and behaviour. 0 Patients are given coloured counters which can get them privileges like cigarettes and watching TV.

Allyon and Azrin Female patients with schizophrenia had been hospitalised for an average of 16 years and were rewarded for actions like making their beds / brushing their hair. 0 On average the number of ‘good’ acts increased from 5 to over 40 with the introduction of token based rewards such as TV and extra canteen trips.

Paul and Lentz Used a token economy with patients hospitalised with long-term schizophrenia. 0 Patients developed social skills and work related skills. They became better at self care and their symptoms appeared reduced. 0 What made these results even more interesting was concurrently the drug doses of these patients was reduced. 0 After 4 ½ years 98% of patients in the token economy half been released compared to only 45% of those who had been given no specific treatment.

Dickerson, Tenhula and Green- Paden Reviewed 13 studies of token economies, benefits were reported in 11 of these. 0 It was noted that token economies are beneficial when used in conjunction with drug therapies and psycho social therapies.

Are Token Economies Effective? 0 They were one of the earliest forms of psychological treatment to actually show positive effect. 0 They seem reasonably effective in patients where all else has failed and do seem to increase the frequency of ‘good’ behaviours amongst patients.

But… 0 Good behaviour quickly ceases when the rewards go away which makes this therapy hard to transpose into the outside world. 0 Hallucinations, disorganised speech and delusions have not been shown to improve from this therapy. 0 It has been argued that patients in token economies merely mimic ‘normal’ behaviour and do not actually believe it… 0 It is hard to quantitatively measure improvements in an ecologically valid fashion…

Are Token Economies Appropriate? 0 Negative symptoms include catatonic states and lack of motivation, Token economies provide the motivation to improve these kinds of symptoms and can be a powerful tool.

However… 0 ‘Desired’ behaviours are decided in most cases by the hospital or institution, what are the ethical concerns with this? 0 Token economies cannot control positive symptoms so well or focus on the biomedical explanations of the condition. 0 In reality not many patients with schizophrenia actually live in institutions anymore… It is hard to create token economies in the real world as we cannot have sufficient control in the environment. 0 The effects of token economies are relatively short term and artificial. The dot seem to translate well to the ‘outside world’ and so the benefits may not necessarily last…

Exam Tips 0 How effective and appropriate are treatments across ALL the symptoms. 0 Consider the patients level of functioning when assessing this… 0 How effective is the treatment in regard to relapse rates? 0 What is the motivation from patients to use the treatment / the drop out rates? 0 Can the treatment be fully understood? 0 Ethical issues surrounding the treatment