Schizophrenia

AQA A Spec “Psychological therapies for schizophrenia, for example, behavioural, psychodynamic and cognitive-behavioural, including their evaluation in terms of appropriateness and effectiveness”

Psychological Therapies Cognitive Behavioural Therapy Psychotherapy

Activity Role plays 1. CBT 2. Dream Analysis 3. Free Association 4. Projective test

1. CBT

Recap of cognitive approach ·  Cognitions affect behaviour: Behaviour is primarily affected by an individual’s thoughts and cognitions. ·  ‘Cognitive errors’ (Beck 1967a): It is the way individuals think about problems not the problems themselves that cause mental disorders. Therefore; Abnormal behaviour is a result of disordered cognitions or thinking.

CBT CBT is active and directive. The aim of the therapy is to help the client identify their negative, irrational thoughts and replace these with more positive rational ways of thinking. The therapy involves both a Cognitive and a Behavioural element Eg. SIT and Hardiness

CBT Cognitive element: The therapist encourages the client to become aware of beliefs which contribute to anxiety or depression. This involves questions from the therapist such as: ‘tell me what you think about….’ Behavioural element: The therapist and client decide on how to role-play the faulty cognitions so the client can recognise the consequences of the thoughts, and then set new goals of more realistic and rational beliefs.

Cognitive Behavioural Therapy Cognitive Behavioural Therapy (CBT) is based on the assumption that patients can be helped by.. ..identifying and changing their faulty cognitions.

It is a form of psychotherapy in which the patient is given challenges so that these irrational thought processes can be replaced with more appropriate and rational thoughts and the patient can try and understand the world differently.

Cognitive Behavioural Therapy Schizophrenic patients are encouraged to reality test their hallucinations and delusions, e.g. to question and try to control the voices they hear. Are the voices true ?? Are the voices true ??

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Cognitive Behavioural Therapy They do role play exercises and homework to test out their ‘faulty thinking; and are helped to see the consequences of thinking differently. Through this they can gradually realise where the ‘faults’ in their thought patterns are and can begin to change them.

EVALUATION Effectiveness Appropriateness – for you to research

Cognitive Behavioural Therapy EFFECTIVENESS Sensky et al (2000) found that CBT was effective in treating schizophrenic patients who had not responded to drug treatment .It was helpful with positive and negative symptoms, and patients continued to improve nine months after treatment had ended.

Cognitive Behavioural Therapy EFFECTIVENESS CBT puts patients in charge of their own treatment by teaching them self-help strategies. This means there are fewer ethical issues than with other therapies (e.g. drug therapy)

EFFECTIVENESS In the past he stigma of mental illness prevented the effective use of CBT as treatment for schizophrenia as by the time patients were hospitalised medical practitioners believed that patients were too sick to benefit from this therapy.

EFFECTIVENESS Most patients by this stage were sectioned and often viewed as dangerous to themselves and others leading to an over prescription of drugs or ECT which often left the patients in a “zombie” like state and not capable of discussing their problems.

EFFECTIVENESS However more recent clinical trials have found that CBT can be useful for many of the symptoms of schizophrenia. In stable outpatients that are already receiving regular medication, it can decrease hospital admissions, increase social skills and decrease the distress from symptoms such as voices and other hallucinations.

EFFECTIVENESS It also has shown benefit in treating the negative symptoms such as flattening and feeling de-motivated.

EFFECTIVENESS A study by Startup et al (2004) randomly allocated patients suffering from schizophrenia who were on regular medication into two groups; a control group that continued to receive their regular treatment and an experimental group that received regular treatment plus up to twenty five CBT sessions.

EFFECTIVENESS The findings showed that after one year that those who had received CBT were better able to manage their positive (delusions, hallucinations, paranoia) symptoms and negative symptoms as well as an overall improvement in social functioning.

Effective Another study by Trower et al (2004) aimed to determine whether the use of CBT therapy could help the patient manage the serious symptoms of command auditory hallucinations. These are destructive messages that the person feels compelled to follow or else they may face serious risks.

EFFECTIVENESS Like in the previous study, patients who were of their auditory hallucinations were randomised into two groups. The experimental group that received CBT were taught to ‘outrank’ the voices in order to diminish the importance of the messages to make them less of a threat. They found that the experimental group had fewer command auditory hallucination and were less likely to act upon them.

EFFECTIVENESS Both of these studies show that CBT when used with other regular treatments seems to have positive benefits in managing the serious symptoms of schizophrenia will benefit from CBT as more serious hospitalised in-patients were not tested and further research in this area is needed.

EFFECTIVENESS Lynch et al (2009) in the meta-analysis of clinical trials looking at the effectiveness of CBT as a treatment for schizophrenia found that CBT alone was not effective and the relapse rate was high, even when patients were given placebo medication.

EFFECTIVENESS Therefore, highlighting that CBT is only effective when used in conjunction with medications which makes the therapy an additional labour intensive and expensive treatment.

  EFFECTIVENESS CBT only treats the symptoms of schizophrenia – it does not address the cause of the disorder.

EFFECTIVENESS   P Folens (2009) suggests that subjectivity of results gained in data collection for CBT may be an issue. E They suggest that because methods rely on patients self-report measures (E e.g. diaries) and therapists interpretations, it is difficult to guarantee objectivity of results. More flexible PEE combination

2. Psychotherapy clip

Freud’s Theory Freud thought schizophrenia was caused by an overwhelming anxiety which led to ego defence mechanisms like regression being activated He thought people regressed into an early stage of development called “primary narcissism” Psychotherapy attempts to combat the effects of this unconscious ego defence mechanism

Improving communication Schizophrenics are thought by psychotherapists to use language as a defence and use it to put up barriers to keep other people at a distance One way that therapists try to help schizophrenic patients is to teach them adult forms of communication

Psychotherapy The therapist examines the life history of the patient and any maladaptive interpersonal relationships they may have currently or in the past Anxiety is one way that schizophrenics are thought to keep a distance between themselves and others so therapists try and build a trust and form a bond with the patient so they’re comfortable

METHODS USED.. ..TO ACCESS THE UNCONSCIOUS MIND ..

WHAT THEY’RE TRYING TO ACHIEVE..

RELEASING REPRESSED MATERIAL Therapist helps the patient to release material that has been repressed as an ego defence mechanism which allows them to realise the true meaning behind it, i.e. to gain insight This restructures ego defence mechanisms so the patient can deal with the past more effectively For example, to get the patient to regress

Hypnotherapy Dream Analysis Free Association Projective tests All these methods try to access the unconscious mind.. Hypnotherapy Dream Analysis Free Association Projective tests

1. Hypnotherapy Initially Freud used hypnosis as a way of tapping into the patient’s unconscious mind but later went on to use dream therapy.  In 1901 Freud published his classic book ‘The Interpretation of Dreams,’ in which he outlined how the mind disguises unconscious desires behind symbols while we sleep.  Freud called dreams ‘the Royal road to the unconscious.’ 

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Dream analysis What is the difference between Latent Content and Manifest Content? Latent content: Anxieties and concerns are ‘hidden’ in dreams. Therefore the latent content is the ‘real concern’. Manifest content: What we can recall from the dream. I.E: A dream of a collapsing bridge (manifest content) may symbolise anxiety about marriage.

3. Free Association Picture association Word association To allow repressed material to ‘slip out’ into conscious awareness e.g. freudian slips

4. Projective tests

Designed to.. Project the patients personality onto the image by interpreting their responses and drawing ‘inferences’ about their desires/impulses

Effectiveness Aims to treat the causes of the disorder not just the symptoms because it goes back into the unconscious mind Patients control the therapy more than in others i.e. drug therapy Gottdiener (1973) did a meta analysis and found psychotherapy to be an effective treatment for schizophrenia

Effectiveness Malmberg and Fenton (1971) claim it is impossible to draw definite conclusions about long-term effectiveness Patient and Outcome Research Team claim psychotherapy can be harmful to schizophrenics Kraeplin (1968) argued schizophrenia is an organic problem and not psychological so psychotherapy is therefore an inappropriate method for treatment

Effectiveness Other forms of treatment (e.g. CBT) have been found to be more effective It is more difficult to prove the effectiveness of the psychotherapy it is based on subjective data and the unconscious mind.

Appropriateness There is also a risk that patients will develop false memories (Looked at in AS Psychology) e.g. of child hood abuse (Eysenck ,1968)…

Appropriate ? Psychotherapy-false memories clip

Essay question – April 2013 “Compare & contrast psychological therapies used in the treatment of schizophrenia” (5 + 10 marks)

PLAN AO1 ½ page 5 marks A02 1 page 10 marks Briefly outline main points of CBT Compare with Psychotherapy e.g. “whereas…” then briefly outline main points of Psychotherapy A02 1 page 10 marks Evaluation of appropriateness/effectiveness of CBT + Psychotherapy by using research to compare them, e.g. “..by contrast…” “.. But in…” Conclusion not needed

Or …

Essay question “Compare and contrast biological and psychological therapies used in the treatment of schizophrenia” (10 marks +14 marks)

PLAN V A01 DESCRIBE Biological therapies BIOCHEMICAL ECT PSYCHOSURGERY DRUGS DIFFERENCES Psychological therapies CBT / REBT PSYCHOTHERAPY V

A02 + A03 Evaluation Debate Supporting + critical research for biological Supporting + critical research for psychological Comparative research Don’t forget IDA + A03 Research Method terms