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Schizophrenia

Schizophrenia. Psychological treatments. psychlotron.org.uk. Treating schizophrenia. Non-drug-based therapies Behavioural Psychodynamic Cognitive-behavioural Family therapy. psychlotron.org.uk. Behavioural therapies. Reinforcing coherent/non-delusional speech

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Schizophrenia

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  1. Schizophrenia Psychological treatments psychlotron.org.uk

  2. Treating schizophrenia • Non-drug-based therapies • Behavioural • Psychodynamic • Cognitive-behavioural • Family therapy psychlotron.org.uk

  3. 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 psychlotron.org.uk

  4. 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 psychlotron.org.uk

  5. 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 psychlotron.org.uk

  6. 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 psychlotron.org.uk

  7. 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 psychlotron.org.uk

  8. 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) psychlotron.org.uk

  9. 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 psychlotron.org.uk

  10. 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 psychlotron.org.uk

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