Psychological Therapies for Schizo

Behavioural Therapy
1. Outline
  1. use of classical / operant conditioning
    1. re-educate the schizo through classical or operant conditioning
      1. deals with the current problems
2. Selective Positive Reinforcement
  1. reward desired beh. e.g. token economy
    1. encourage them to do it again
  2. targets specific beh.
  3. Paul & Lentz
    1. used token economy - to develop social & work-related skills
      1. found: those schizos looked after themselves - symptoms reduced
3. Social Skills Training
  1. modelling - learning from observing the beh. of others & reinforcement
  2. encouraged to role-play & rewarded for desirable responses
4. Evaluation:
  1. strengths:
    1. token economies = effectively used in mental institutions - promote hygiene & social interactions
    2. therapy only deal with what can be seen & measured = scientific
  2. weaknesses:
    1. never been used to remove the main symptoms
      1. question the usefulness of treatment
      2. limited to removing symptom
    2. underestimates cognitive factors in schizo
      1. many of the symptoms = cognitive not behavioural
    3. extrinisic rewards may destroy instinct rewards
      1. doing it for the external reward rather than the original instinct reward
    4. mechanistic
      1. focusing only on physical factors
  3. token economy - only works in highly structured enviro.
    1. can't extrapolate ben. to real life
Cognitive Therapy
1. challenges dysfunctional thoughts - so cognition can operant "normally"
2. Coping Strategy Enhancement
  1. Tarrier
    1. focused on the onset of symptoms
    2. found: schizos were often aware, just before an episode, that one was likely to occur
  2. 1) teaches how to look out for symptoms
    1. :) using their own experiences of their own illness to help themselves
    2. 2) then focus on something else (distract them)
      1. 3) think positive thoughts / talking positively to themselves
        4) encourages - them to engage in social contact i.e. not staying withdrawn
  3. 73% of schizo = able to manage their own symptoms
3. Evaluation
  1. strengths:
    1. shown to sometimes help (73% fig)
    2. used to improve those who don't respond to drug therapy
    3. psychiatric med & cognitive therapy - shown to be more effective than when alone
    4. no side effects etc
  2. weaknesses:
    1. causality isn't clear
      1. does the disorder thinking cause schizo
        or
        schizo cause disordered thinking
    2. not everyone with cognitive deficits = schizo
      1. can't be only explanation
    3. not very scientific
      1. dealing with issues which can't be measured = abstract
        self report - isn't highly variable
Psychodynamic Therapy
1. psychoanalysis - can't be used with schizo
  1. patients don't have the ability to be insightful
    1. arent able to fully engage in psychoanalysis - as their perceptions of the world are dysfunctional
      1. casts doubt on the explanation - as no suitable therapy so support it
Family Therapy
1. more EE = more likely to relapse & have another episode
  1. 1) structured interviewers conducted - to get EE rating
    1. 2) family therapy = used to reduce the amount of EE within the family interactions
2. Goldstein et al.
  1. 104 schizo patients in fam therapy
    1. e.g 6 weeks - focused weekly sessions - educate fan, build acceptance & discuss future plans
      1. found: those undergoing family therapy = significantly lower relapse at 6 mouth point
        compared with - schizos on low doses of anti-psychotic meds
        Hogarty et al.
        103 schizos = training for 2 years = significantly reduce relapse at 1 & 2 year follow up points
3. Evaluation
  1. strengths:
    1. appears to be effective in preventing relapse
    2. Rosenhan et al.
      1. when used with drugs = most effective treatment
    3. may treat one of the underlying causes
  2. weaknesses:
    1. question the validity of the construct of EE
    2. some researchers - report no differences in relapse rates

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Psychological Therapies for Schizo

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