schizophrenia psychological treatments psychlotron.org.uk
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Schizophrenia
Psychological treatments
psyc
hlot
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org.
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Treating schizophrenia
Non-drug-based therapies Behavioural Psychodynamic Cognitive-behavioural Family therapy
psyc
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org.
uk
Behavioural therapies
Reinforcing coherent/non-delusional speech Some success e.g. Nydegger (1972) -
apparent reduction in hallucinations, delusions
May be that patients learn not to talk about symptoms rather than symptoms actually reduced
Results do not generalise well to non-clinical situations
psyc
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Behavioural therapies
Token economies Early successes, esp. with negative
symptoms May be due to better organisation/more
positive staff behaviour, not reinforcement Changes may not last Ethical/human rights problems
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Psychodynamic therapies
Traditional psychoanalysis not likely to be effective
Rosen (1946) suggested ‘direct analysis’ involving: Brutal confrontation of patient’s problems Regression to childhood Therapist becomes a substitute
parent/nurturer
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Psychodynamic therapies
Success claimed by Rosen and others Drake & Sederer (1986) suggest some
therapies actually harmful esp. when they involve: A close relationship Regression High levels of emotionality
These lead to longer hospitalisation & worsening of symptoms
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Cognitive therapies
CBT strategies to challenge & help modify delusory beliefs Identify delusions Challenge evidence on which delusions are
based Design ‘experiments’ to test reality of this
evidence Chadwick & Lowe (1993) – significant
reductions in delusions in 10 out of 12 patients
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Cognitive therapies
Normalising strategies where patient is taught to understand the nature of schiz. symptoms Challenge ‘catastrophising’ beliefs about
schizophrenia Help patient feel that symptoms are
understandable and ‘normal’ Helps 70% of patients although other
30% may deteriorate (Kingdon & Turkington, 1996)
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Family therapies
Aimed at reducing ‘expressed emotion’ in the family environment through: reducing negative interactions Increasing understanding of schiz.
symptoms Tackling feelings of guilt & anxiety
Hoped to prevent relapse in patients following release
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Family therapy
Some success: Lower relapse rates compared with
individual therapy (12% vs. 50%; Falloon et al, 1985)
As effective as social skills training (both 20% relapse) but most effective when both combined (<10% relapse rate; Hogarty et al, 1986)
Follow-up data suggest that relapse is delayed, not prevented
psyc
hlot
ron.
org.
uk