Schizophrenia

Schizophrenia

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Psychological treatments

Treating schizophrenia Non-drug-based therapies    

Behavioural Psychodynamic Cognitive-behavioural Family therapy psychlotron.org.uk

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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 psychlotron.org.uk

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Behavioural therapies Token economies  

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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 psychlotron.org.uk

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Psychodynamic therapies

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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: 

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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   

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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  

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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:   

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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:  

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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 (