COGNTIVE TREATMENT OF SCHIZOPHRENIA

P S YC H O LO G I C A L T R E AT M E N T S , S U C H A S C O G N I T I V E B E H AV I O U RA L T H E RA PY ( C B T ) , C A N H E L P P E O P L E W I T H S C H I Z O P H R E N I A T O C O P E B E T T E R W I T H T H E S Y M P T O M S O F H A L LU C I N AT I O N S O R D E LU S I O N S . P S YC H O LO G I C A L T R E AT M E N T S C A N A L S O H E L P T O T R E AT S O M E O F T H E N E G AT I V E S Y M P T O M S O F S C H I Z O P H R E N I A , S U C H A S A PAT H Y O R A L A C K O F V O L I T I O N / H E D O N I S M ( M O T I VAT I O N / E N J OY M E N T I N L I F E ) .

A2 Psychology

QUICK QUIZ

1. Name one researcher that looked at a genetic link in auditory impairments in Sz

2. Give two criticisms of the cognitive explanation3. What are the 3 deficits identified by Frith?4. Frith’s model attempts to identify the onset and

maintenance of which types of symptoms?5. According to cognitive psychologists what is the

difference between a normal brain and the brain of a schizophrenic?

6. In what way does the cognitive explanation agree with the biological explanation?

7. Explain one way in which cognitive psychologists study the brain.

QUICK QUIZ

1. FARAONE et al 1999 - Found auditory impairments and suggest there is a predisposing gene for schizophrenia

2. Two marks for full answers. there are many3. Positive - Verbal hallucinations, delusions of control,

thought insertion4. In a normal brain there is a mechanism that filters

incoming stimuli. In a Schizophrenic brain the mechanism malfunctions and lets in too much stimuli,

5. Agrees with biological view that during hallucinations the brains of people with schizophrenia are producing strange and unreal sensations (triggered biologically)

6. PET or MRI – 2 marks for full answer

MAP TO SPEC – PAGE 59

3 Content

g) For schizophrenia describe and evaluate two treatments. Students must select one treatment each from two different approaches studied from the five in Units 1 and 2.

MAP TO SPEC – PAGE 60

• Describe and evaluate one treatment/therapy from each of the following approaches:

i. the Social Approach: either Family Therapy or Care in the Community programmesii. the Cognitive Approach: either Cognitive Behaviour Therapy or Rational Emotive Therapyiii. the Psychodynamic Approach: either free association or dream analysisiv. the Biological Approach: either the use of drugs (chemotherapy) or electro-convulsive therapy (ECT)v. the Learning Approach: either the Token Economy Programme or Systematic Desensitisation.

• Cognitive behavioural therapy (CBT) is based on the idea that most unwanted thinking patterns, and emotional and behavioural reactions are learnt over a long period of time.

WHAT IS CBT?

THE CBT APPROACH TO TREATMENT OF SCHIZOPHRENIA DIFFERS SLIGHTLY FROM

CONVENTIONAL CBT METHODS.

The aims of this therapy are as follows:

• To challenge and modify delusory beliefs• To help the patient to identify delusions

• To challenge those delusions by looking at evidence• To help the patient to begin to test the reality of the evidence

AN EXAMPLE OF A DELUSIONAL BELIEF

Event • Overhearing someone saying “I know what’s on your mind”

Interpretation• Everyone can read my thoughts

Feeling• Paranoid, scared and believing that others will attack me for

my thoughts

Behaviour• Take evasive action – avoiding situations that will bring me

into contact with others

CBT TECHNIQUES

• Patients are encouraged to trace back to the origins of their symptoms in order to get a better idea of how they may have developed.

• Try to help the patient come up with rational alternatives

LONG-TERM HELP

• The therapist encourages patient to come up with their own coping strategies for when they experience any symptoms

• They may then receive help and advice about how they can avoid acting on delusional thoughts.

CBT COURSE

• Most people will require between 8 to 20 sessions of CBT over the space of 6 to 12 months. CBT sessions usually last for about an hour.

This type of treatment has been shown to be effective for reducing the positive symptoms of schizophrenia, for reducing relapse and for enhancing recovery when schizophrenia is diagnosed early.

COGNITIVE TREATMENT SENSKY ET AL. (2000)

• To compare cognitive behavioural therapy (CBT) with non-specific befriending interventions for patients with schizophrenia

Design• A randomized controlled design. • Patients were allocated to one of two groups:– a cognitive behavioural therapy group.– a non-specific befriending control group.

Aim

PARTICIPANTS

• 90 patients. • 57 from clinics in Newcastle, Cleveland and Durham and 33 from London. They

had diagnoses of schizophrenia that had not responded to medication. • Aged 16–60 years.

Procedure• Patients were allocated to one of two groups.• Both interventions were delivered by two experienced nurses who

received regular supervision.• Patients were assessed by blind raters

– at baseline. – after treatment (lasting up to 9 months).– at a 9-month follow-up evaluation.

• They were assessed on measures including the Comprehensive Psychiatric Rating Scale, the Scale for Assessment of Negative Symptoms, plus a depression rating scale.

• Patients continued to receive routine care throughout the study. • The patients received a mean of 19 individual treatment sessions over 9

months.

Cognitive behavioural therapy condition

• A normal routine of CBT was used: • initially engaging with patient• psycho education• developing a reason for the behaviour• Cognitive and behavioural interventions• treatment of other disorders such as depression• Reducing relapse by planning ahead

• Specific techniques for positive symptoms of schizophrenia were used: – critical analysis of beliefs about auditory

hallucinations.– patients were helped to change their beliefs.– patients taught coping strategies to deal with

the voices.

• Delusions and thought disorders were also addressed using cognitive strategies.

CBT STRATEGIES USED

Befriending condition

• The patients had the same time allocation at the same intervals as patients in the CBT condition.

• The therapists were empathic and non-directive. • There was no attempt at therapy:

– The sessions focused on hobbies, sports and current affairs.

FINDINGS

• Both interventions resulted in significant reductions in positive and negative symptoms and depression.

• After treatment there was no significant difference between the two groups.

• At the nine-month follow-up evaluation, patients who had received cognitive therapy showed greater improvements on all measures. • They had improved, while the befriending group had lost

some of the benefits.

CONCLUSIONS

• Cognitive behavioural therapy is effective in treating negative as well as positive symptoms in schizophrenia resistant to standard antipsychotic drugs.

• Its efficacy is sustained for at least nine months.

Shown to be incredibly effectiveAllows people to function more normally with symptoms,

preventing Learned symptoms from developing.Can be used in conjunction with other therapiesImproves symptoms, recovery and relapse ratesNo side effects

Not very rational to teach patients to see life through rose coloured spectacles

Doesn’t work for everybody Expensive and time consuming

EVALUATION OF CBTFOR SCHIZOPHRENIA

PSYCHOLOGICAL TREATMENT; CBT

• 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

• 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)

READ THE CASE STUDY AND ANSWER THE QUESTIONS ON THE WORKSHEET

EXTENSION

Apply your knowledge:

• You have a friend that you believe has schizophrenia. You have been asked to explain to them why they might have schizophrenia. They also ask you about which treatments you would recommend. Which explanations / treatments would you share with them? Are there any that you would leave out?

Past paper - June 2011

There are many explanations for schizophrenia including biological ones.

Describe one explanation for schizophrenia and compare this with one other explanation. Comparisons include considering similarities and/or differences. (12 Marks)