Psya4 - P - Psychological Therapies For S, Including Evaluation In Terms Of Appropriateness And Effectiveness

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Psychological therapies for S, including evaluation in terms of appropriateness and effectiveness

Cognitive Behavioural Therapy
A01

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* A major symptom of S is disorganised thinking. The purpose of CBT is to help the individual consider and organise their disordered thoughts in a rational way.
* CBT helps to make the patient aware of the connections between their disordered thinking and their illness. It also challenges their interpretations of events by asking them to discuss the evidence for their beliefs.
* These techniques help to primarily deal with positive symptoms such as hallucinations and delusions, but they are also effective in making the patient more self-reliant when dealing with their illness because they have the task of challenging their own perceptions.

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Psychological therapies for S, including evaluation in terms of appropriateness and effectiveness

Cognitive Behavioural Therapy
A02 - appropriateness

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+ SELF EFFICACY - CBT requires the client to confront their own problems, rather than being the passive recipient of advice offered by a therapist.

- APPROPRIATE? If individuals with S have such disorganised thinking will they be up to the challenge of interpreting events or how will they cope with discussing the evidence on which they base their belief if they suffer from the classic S symptom of ‘poverty of speech’?
- DAMAGING? Some believe that CBT may encourage delusional thinking or that paying attention to the voices they hear may result in them acting in a way their voice instructs. However, Romme & Escher (2000) disagree as they believe focusing on voices reduces the likelihood of harm to the self or others. These contradictory viewpoints are not going to be easily assimilated until scientific research provides evidence for CBTs effectiveness in treating S.

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Psychological therapies for S, including evaluation in terms of appropriateness and effectiveness

Cognitive Behavioural Therapy
A02 - effectiveness

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- CONTRADICTORY FINDINGS - Laws (2014) reported only a “small therapeutic effect” from using CBT with patients with S. However a month later, Morrison (2014) reported that CBT significantly reduced psychiatric symptoms in those individuals with S. Perhaps the difference in these findings occurred because Morrison’s cohort had choice in their own treatment plan and thus being able to exercise ‘choice’ was beneficial in reducing the severity of their symptoms of S?
? LONG TERM EFFECTIVENESS - LEWIS (2002) found CBT during a patients’ first episode of S shortened the length of the episode BUT 18 months after diagnosis they had the same relapse rate as patients who hadn’t had CBT. This initially seems to suggest that any benefit of CBT is short-lived, however Lewis did also note the CBT group still seemed to be less negatively affected by their S symptoms.

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Psychological therapies for S, including evaluation in terms of appropriateness and effectiveness

Family Intervention
A01

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The findings of research from the 1970s such as Vaughn & Leff, clearly showed a link between the family ‘climate’ and the risk of individuals with S relapsing. Family Intervention (FI) strategies were developed to reduce the ‘expressed emotion’ levels in family interactions.

Pharoah et al (2000) noted that FI could include strategies such as forming an alliance with the carers; increasing the capacity of relatives to anticipate and solve problems; reducing the expressions of anger and guilt by family members; maintaining reasonable expectations for how the ill family member should perform and promoting desirable changes in the relatives' behaviours and belief systems.
FI’s ‘treatment’ of S is probably unique in that it treats the family and not just the individual with S, recognising the fact that our familial situation is linked to our psychological well-being.

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Psychological therapies for S, including evaluation in terms of appropriateness and effectiveness

Family Intervention
A02 - appropriateness

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Is FI really appropriate for everyone with S? Weisman (1988) suggested relatives attributed + symptoms to S, but - symptoms to the individual with S. Relatives become more angry/critical of those with -symptoms, which may explain the higher relapse rates of those with - symptoms. This suggests that FI is particularly important for these families.
- Some claim FI isn't really a therapy, it just trains relatives about the importance of taking medication and that it is the greater adherance to medication that explains lower relapse rates.

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Psychological therapies for S, including evaluation in terms of appropriateness and effectiveness

Family Intervention
A02 - effectiveness

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The Cochrane review concluded FI significantly reduces relapse events at 12 and 24 months. So it would seem FI is effective, but is its effectiveness based on reducing the expressed emotion in the family or is it the fact that FI greatly increases compliance to antipsychotics and hence this increased drug compliance explains the reduced relapse rates?

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Psychological therapies for S, including evaluation in terms of appropriateness and effectiveness

CONCLUSIONS

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By themselves, psychological therapies have little to offer the treatment of S as most require the individual to have insight into their own behaviours, and this is only really an option if the psychologicaol therapy is combined with antipsychotic medication.