When people think of a psychologist, most would imagine a person sitting across from a patient in an armchair, with a notepad ready to dissect every word that comes out of a patient's mouth. While not as simplified as this, psychological therapies certainly offer therapies that are similar to the stereotype. Psychological therapies for schizophrenia focus primarily on three forms of therapy, in an attempt to help patients cope with the positive and negative symptoms of their disorder.
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Jetzt kostenlos anmeldenWhen people think of a psychologist, most would imagine a person sitting across from a patient in an armchair, with a notepad ready to dissect every word that comes out of a patient's mouth. While not as simplified as this, psychological therapies certainly offer therapies that are similar to the stereotype. Psychological therapies for schizophrenia focus primarily on three forms of therapy, in an attempt to help patients cope with the positive and negative symptoms of their disorder.
In the case of schizophrenia, there are three main psychological therapies we like to consider. Each therapy offers a
different avenue of treatment whilst aiming to address the disorder itself, purely from a psychological perspective.
Unlike the biological approach, most psychological therapies focus on addressing and altering the mind state by addressing a patient’s thought patterns and behaviours.
Different therapies use different techniques to treat the underlying cause of schizophrenia. Psychological therapies in schizophrenia address the symptoms as well as try to discern potential causes by exploring patients mind states, emotions, and personal backgrounds and situations. They tend to be much more person-centred approaches.
There are three main types of psychological therapies that we will cover:
Cognitive behavioural therapy (CBT) is one of the most used therapies out there currently. Curated by Aaron Beck in the 1960s, the main aim of CBT is to identify and then attempt to correct (or at least alter positively) dysfunctional thoughts. Dysfunctional thoughts in schizophrenia are the irrational beliefs schizophrenic patients have, and can manifest in a number of ways.
CBT, for instance, would work by addressing irrational beliefs and working through them logically, which works for positive symptoms such as hallucinations and delusions. Reality testing is a core part of CBT in the case of delusions and hallucinations.
Typically, CBT heeds the following format (Kingdon & Turkington, 2006):
Patients explain their situation to their therapist, identifying problematic thoughts and the potential causes for these thoughts. Reflection is a core aspect of the assessment stage, requiring the patient to truly think back on themselves and understand where their symptoms are coming from and what makes them better/worse. Rating scales are used to monitor progress.
Once the above issues have been identified, the therapist can set out a cognitive framework to address these issues and logically work through them (so, if a schizophrenic patient is having delusions of grandeur, a therapist would identify this with them and logically work through it to show it is a delusion). Socratic questioning is employed, alongside a vulnerability-stress model. Empathy is heavily emphasized between patient and therapist.
CBT adopts the ABC model, established by Ellis and Harper (1961). The ABC model attempts to cognitively restructure a schizophrenic patient's thought patterns through identifying activating events, behaviours and beliefs, and any subsequent consequences.
CBT then works on disputing these irrational beliefs through reality testing, normalisation, and critical analysis. Overall, CBT usually lasts anywhere from 12 to 20 sessions and aims to help reduce the uncomfortable symptoms of schizophrenia.
Family therapy focuses on the people around the patient, involving them in the treatment process. Research has shown that many relapses in schizophrenia tend to occur after a patient has returned to their family environment. There are multiple reasons why this is the case.
Relapse, according to research, is typically due to expressed emotions (EE), stress, guilt, and an overall lack of education or ignorance about the disorder where family environments are concerned.
Families are not perfectly attuned to every possible mental health disorder out there, so until it directly affects them, no one will truly know about these issues (and even then, it requires a lot of time, patience, and effort to understand mental health). Family members, especially the main support provider, often report feeling guilty and shameful. It is important, then, that therapy provides help to all those affected.
Family therapy usually involves an interview process, observation of the family, and then frank discussions about the situation and disorder.
The goal of family therapy is to provide or offer (Caqueo-Urízar et al., 2015):
In schizophrenic patients, token economies focus on maladaptive behaviours that prevent a patient from adapting to new situations, treating both positive and negative symptoms of schizophrenia. Although this treatment method has fallen out of fashion (with the fall in institutionalisation), it does employ some well-established psychological theories.
Token economies (TES), developed in the 1960s, involve a behavioural-based reward system that encourages 'good behaviours' and discourages 'bad behaviours'. It is based on the concept of operant conditioning.
TES usually involves the following process:
Overall, primary reinforcers give power to the secondary reinforcers.
Schizophrenic patients may be given a token for getting out of bed and showering. With enough tokens, they can then trade this in for a reward, such as a new book or a day out. Rewards are tailored towards patients' likes and dislikes.
TES is catered specifically to the patient (so their wants and needs can be directly addressed and influence their behaviour).
As with all treatment plans, psychological therapies have their strengths and weaknesses. Let's assess the effectiveness of psychological therapies for schizophrenia. The following can be considered strong points of psychological therapies:
Let's explore the strengths of psychological therapies for schizophrenia.
Let's explore the weaknesses of psychological therapies for schizophrenia.
This is up for debate, as both biological and psychological therapies have their strengths and weaknesses, so we cannot conclusively say one is perfect for schizophrenia. However, cognitive behavioural therapy combined with drug therapy has shown promising results.
Psychological therapies help schizophrenia by addressing dysfunctional thoughts and helping a patient logically work through them, which is also transferrable to everyday life (it can be practised outside of a therapy session). It also allows patients to reflect on their behaviours and potentially address their social circle and family life.
In terms of the psychological factors of schizophrenia, this could be referring to the imbalance in dopamine and serotonin (the neurotransmitters affecting the person's brain with the disorder). Ultimately, this results in positive symptoms (hallucinations, delusions of grandeur) and negative symptoms (alogia, depression, lack of motivation).
Interventions can come in the form of family therapy, group therapy, cognitive behavioural therapy, and general counselling sessions.
Yes, primarily when used in combination with drug therapies. Although, whether it has long-term effects is still up for debate.
What is cognitive behavioural therapy (CBT)?
Cognitive behavioural therapy is a psychological talking therapy that explores dysfunctional, maladaptive thoughts and behaviours and employs behavioural learning techniques to combat these issues, usually through analysing cognition and behaviour logically and restructuring these thought processes.
How long does CBT usually take?
Around 6 to 12 weeks depending on the patient’s needs.
What are the stages of CBT?
Assessment and engagement.
True or False: A clinician may use the ABC model when providing cognitive behavioural therapy.
True.
Who established the ABC model?
Ellis and Harper (1961)
What is the ABC model in cognitive behavioural therapy?
Activating event: what is causing the problem? Patients often give their own estimation of what they think activating events are.
Behaviour and beliefs: how does the patient react in these situations? The patient's own beliefs are linked intrinsically to the activating and events and consequences, bridging the missing gaps in the patient's knowledge of their behaviours.
Consequences: what impact does this have on the patient’s life and their relationships with others? What are the emotional and behavioural consequences?
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