Psychological treatments for schizophrenia Pages 209-210 of Year 2 book Family Therapy and Token economy

5 mins for 5 things recap Operant Conditioning

Token Economies NOTE: This is NOT a cure or treatment. It is a system to encourage positive behaviour and change patterns of maladaptive behaviour, which has developed through spending a long period of time in an institution. Tokens are given immediately after P demonstrates a desired behaviour, like getting dressed, making the bed etc. Remember - tokens are secondary reinforcers! Primary reinforcers are what the tokens are swapped for.

Token Economies: How it works .... Remove reinforcers (behaviour then becomes less likely to be repeated) Undesirable behaviour is repeated because it is being reinforced Punishment will also decrease the likelihood of the behaviour being repeated Desired behaviour is displayed e.g. making the bed Positive reinforcement is given i.e. token (secondary reinforcers) The tokens then can be exchanged for privileges i.e. Watching TV, listening to music, sports activity. Ethics Print page 205 - new guidebook Basic commodities like food, water and sleep are human rights they cannot be withheld from patients……?????

AO2 - Apply You work in a progressive treatment unit offering psychological alternatives to those suffering from schizophrenia who have, until now, been unresponsive to antipsychotic medication. Your task is to devise a psychological treatment programme for them to improve their symptoms. Be specific What are your target behaviours What are your Primary reinforcers? What are your secondary reinforcers? Will you include punishments? Is this ethical?

Family Therapy - Focus on Communication Family therapy aims to improve the communication and interaction between family members. As we know, high EE can cause a patient to relapse. Encourage family to discuss what it is like to live with a schizo P. Allow everyone’s voice to be heard, to reduce tension in the family Give family the info they need to understand the illness Help family understand that they are not to blame. Goals of family therapy Takes place over many weeks, usually in Ps home, as a group session

How it works: Pharoah et al (2010) Form therapeutic alliance with the family members Reduce the stress of caring for schizo relative Improve family’s awareness of relapse triggers Reduce anger and guilt in family members Help family achieve a carer-own life balance Improve beliefs about schizophrenia Budget cuts in mental health - shortage of clinician and hospital beds…. Evidence shows that family therapy is effective at educing readmissions to hospitals and encourages Ps to comply with medicine. DISCUSSION: It puts a lot of responsibility and burden back onto the family – should it be the responsibility of the family? Or the responsibility of the mental health professionals?

AO2 - Apply You work in a progressive treatment unit offering psychological alternatives to those suffering from schizophrenia who have, until now, been unresponsive to antipsychotic medication. Your task is to devise a psychological treatment programme for them to improve their symptoms. You have employed a systemic family therapist to support their families. Research and feedback how this professional would work within your organisation. https://www.youtube.com/watch?v=aBjIvnRFja4

Evaluation of Psychological Therapies Effectiveness - Using evidence Before we examine evidence, it is worth noting the limitations of ALL evidence of effectiveness. When Ps are compared before and after the administration of a treatment, there are positive results. However, these studies tend to be small scale There is often the lack of a control group or, if there is, the Ps are not randomly allocated Conclusions in the above designs of studies tend to be more optimistic in comparison to those where controls have been used (or is it the other way round, the controlled studies are too pessimistic?) DISCUSS: What are the implications/consequences of the issues raised above?

But - active vs passive, independent vs dependent. AO3: Still no cure….. All psychological therapies improve the quality of life in some way…. CBT (making sense of the world) Family therapy (reducing stress at home) Token economies (reinforcing acceptable behaviour so that Ps can reintegrate into society - washing etc) Comparisons with biological treatments - Drugs = reduce severity of symptoms, often need to be prescribed before other types of therapy can take place….. But - active vs passive, independent vs dependent.

Tutor2u Worksheet

ETHICS - Over to you Read the information on ethics. Jot down some of the concerns for your notes What do you think about these ethical concerns? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2719554/ What other ethical difficulties might psychiatrists face when treating a patient with schizophrenia?

Tasks: Over to you, psychologists! Some researchers have suggested that teaching people with schizophrenia to meditate would help them to control their auditory and/or visual hallucinations. They have already obtained a sample of 4o volunteers who are all currently medicated with antipsychotic drugs but still experience unpleasant symptoms. Outline a procedure for a study to investigate the effectiveness of meditation for a treatment of the positive symptoms of schizophrenia. (8 marks)

Some hints and tips: ‘Procedure’ = what the Ps will be required to do. You already have the sample, as stated. So do not mention how this will be obtained. How will Ps be allocated to different conditions? How many sessions, how long, on their own or in groups? How will you assess the baseline condition and the effectiveness after treatment? How will you control extraneous variables? How will you avoid experimenter bias?