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Discuss Two or More Psychological Therapies for Schizophrenia (24 Marks)

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Discuss two or more psychological therapies for schizophrenia (24 marks)
Psychological therapies in dealing with schizophrenia are Cognitive-behavioural therapy (CBT), Family intervention and Behavioural therapy; token economy.
Cognitive- Behavioural therapy is used to treat distorted believes which influences schizophrenic behaviour in maladaptive ways. For example a schizophrenia person may believe that they are being controlled by someone or something else, cognitive therapy is used to treat faulty interpretations of these events. In CBT patients are told to trace the origins of the symptoms to get a better understanding of how it started. Then patients are told to evaluate the content of their symptoms so they are able to test the validity of their faulty believes. Patients are then set behavioural assignments to improve their general levels of functioning. During the therapy the therapists allows the patients to come to their alternatives for dealing with maladaptive behaviour by looking for other explanations and coping strategies that is already present in the patients mind. Research has found that patients that receive cognitive therapy receive CBT experience fewer hallucinations and delusions and have a better recovery than those who receive antipsychotic medication. However Gould et al that found that all seven studies in the meta-analysis reported a statistically significant decrease in the positive symptoms of schizophrenia after treatment. Although most studies conclude that patients treated at the same time with antipsychotic medication has been more effective. Drury et al found a reduction in positive symptoms and a 25-50% reduction in recovery time for patients given a combination of antipsychotic medication and CBT. This was further supported by Kuipers et al that also confirmed these advantages but noted that there were lower patient drop-out rate and greater patient satisfaction when CBT was used in addition to antipsychotic medication. However CBT only deals with trying to get less distressing symptoms rather than trying to eliminate them completely. Although the use of CBT and medication can be successful research by Kingdon and Kirschen in a study of 142 schizophrenic patients in Hampshire found that patients were not deemed suitable for CBT because it was believed that they would not fully engage with the therapy. In particular they found that older patients were deemed less suitable than younger patients.
However CBT does not treat negative symptoms CBT is specifically designed to reduce only certain positive symptoms of schizophrenia. Therefore, it does not treat the negative symptoms. CBT is a reductionist as it ignores other relevant factors, e.g. biological factors associated with schizophrenia. However because it involves counselling that takes part in real-life so it has maudem realism so it had real life application.

One other form of psychological therapy is family intervention, the main aim of family intervention, therefore, is to attempt to make family life less stressful and reduce relapses. Research by brown et al found family environment had a potential role causing schizophrenia. Schizophrenics in families that expressed high levels of criticism, hostility or over involvement had more frequent relapses than people with schizophrenia that were less expressive in their emotions. Family invention makes use of a number of strategies like forming an alliance with relatives who care for the person with schizophrenia, reducing emotional climate within the family and the burden of care for family members, reducing expression of anger and guilt by family members, maintaining reasonable expectations among family member for patient behaviour. Research by Falloon et al found that relapse rate was higher among patients that received individual therapy rather than family therapy. 50% of patients that received individual therapy went back to hospital while only 11% of patients that took part in family therapy went back to hospital. Birchwood and Jackson found that the relapse rate over 12 months was 60% for patients with schizophrenia receiving routine treatment, but was between 25% and 33% for those receiving family therapy. McFarlane et al carried out a meta-analysis on the effects of family psychoeducation on patients with schizophrenia. They concluded that it was associated with reduced relapse rates, improved recovery, and improved family well-being. Pharaoh et al studied the effectiveness of family intervention in a meta-analysis and established that family interventions was effective in improving clinical outcomes such as a mental state and social functioning. However the main reason for its effectiveness was less to do with family intervention and more to do medication compliance. However there are some cultural limitations research by NICE which was conducted outside the UK and particularly focused on china. Found that hospitalisation levels may differ for counties depending on the clinical practice within those countries therefore data on hospitalisation rates from non-UK countries might not be applicable to the UK setting.
Research to family interventions is Reductionist as Family therapy does not consider other relevant factors, such as genetic or biochemical factors, and so only focuses on one level of behaviour
However I could be said that family interventions could be deterministic because it doesn’t take into account that family intervention might not work for all everybody also individual group therapy might work for some vice versa. This is because of individual differences that schizophrenic patients might have will influence what type of treatment that people will respond to. However there are some ethical issues in schizophrenia research because research on therapies for schizophrenia must be carried out in a way that does not place vulnerable individuals at risk is schizophrenic patients take part in retrospective therapy that makes they go back to the source that has caused them to fall ill in the first place. Schizophrenic patients may also be put at risk of harm if they take part in research that requires them to be giving a placebo and their medication to be discontinued, they would need to ask for informed consent from the schizophrenics but they would not be right ind sent to give an honest response.

Another psychological therapy for schizophrenia is token economy Token economy is based on the use of selective positive reinforcement or reward. This tends to be used with institutionalised patients, who are given tokens for behaving in appropriate ways. These tokens can later be used to obtain various privileges like cigarettes or watching television. Research supporting token economy is by Ayllon and Fzrin that found token economy to be successful in socialising the patients into taking more responsibility for themselves. They reported on the use of token economy with female patients with schizophrenia, who had been hospitalised for an average of 16 years. They were rewarded with plastic tokens for actions such as making their beds or combing their hair. The tokens were exchanged for pleasant activities, such as seeing a film or an additional visit to the canteen. The number of chores the patients performed each day increased from five to over forty. Thus, token economy was found to be successful. Additional support came from Dickerson, Tenhula, and Green-Paden. They used studies of token economy through a meta-analysis and reported beneficial effects were reported in 11 of 13 studies. They also concluded that token economy was best used in combination with other therapies such as psychosocial and/or drug therapy. Therefore supporting the effectiveness of token economy.
However research by ayllon and fzrin study cannot be generalizable because it is gender bias because they have only used females so finding cannot be generalised to outside population. However their study is longitudal so it has more validity because the researcher cam gain an more detailed inside to the use of token economy on the schizophrenic patients behaviour.
Research by Ayllon and Fzrin is also Reductionist as it focused more on the behavioural treatment for schizophrenia and ignores other relevant factors like genetic factors, biochemistry, and poor communication within the family, that play important roles in developing schizophrenia. Token economy doesn’t treat all symptoms more serious symptoms cannot be treated with a token system, e.g. delusions, hallucinations, and lack of emotion. Also there is no lasting change because token economy produce rather short-lasting and even superficial changes in behaviour that fail to generalise well to the outside world. Therefore, they do not meet the goal of therapy to provide lasting change. Because patients simply learn what behaviours lead to a reward or a sanction and are less likely to repeat behaviours that produce sanctions.

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