Schizophrenia

Psychological treatments

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Treating schizophrenia

Non-drug-based therapies Behavioural Psychodynamic Cognitive-behavioural Family therapy

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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

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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