Discuss The Effectiveness Of Psychological Treatments For Schizophrenia

Submitted By LilyW
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Discuss the effectiveness of psychological treatments for schizophrenia (24 marks)

It is clear that biological therapies alone cannot cure schizophrenia as many clinicians believe that the most beneficial treatment combines antipsychotic medication with a psychological intervention. The patients that are only treated with biological therapies and have left the hospital have a greater chance of relapse as the medication is not sufficient for them to function in their natural environment, therefore psychological interventions have been shown to be useful at stopping this pattern of re-hospitalisation. The psychological approach views schizophrenia as being caused by childhood experiences and negative thought processes. Therefore, focusing on learned behaviour which can be treated using non-medical treatments, aimed at dealing with the causes rather than the symptoms of schizophrenia.

Social interventions are a good example at helping those with schizophrenia to adapt to their everyday functioning as this treatment is not intended as a cure since there is considerable evidence that social factors affect the course of schizophrenia. Social skills training (SST) programmes have been developed to help improve behaviour of schizophrenics; it is an active therapy which uses behavioural techniques such as modelling, reinforcement, role-playing and practice in real-life situations so individuals can acquire verbal and non-verbal skills. Halford and Hayes produced a training programme which includes aspects such as conversation skills, medication self-management, time use, survival skills and employment skills. At first critics felt that this therapy didn't generalise to real-life situations, but after much improvement and development the criticism became less valid, and in fact Birchwood and Spence found that these programmes are generally beneficial in increasing the individual's competence and assertiveness in social situations. Group Milieu therapy is a similar idea used in institutional care centres to include the patients in decision-making. Token economy is a form of therapy used with institutionalised patients based on the use of selective positive reinforcement or reward as they are given tokens (e.g. coloured counters) for behaving in appropriate ways, and these tokens can be used to obtain privileges (e.g cigarettes, television time). This treatment was amongst the first forms of hospital-based treatment to show clear evidence of reducing the symptoms of schizophrenia, however once they become used to the rewards the benefits are greatly reduced. This therapy is also unlikely to improve symptoms such as delusions and hallucinations as it does not address the cognitive symptoms of schizophrenia. Another problem is that it only works because of the carefully structured environment and therefore since the outside world is so different the patients find it difficult to transfer what they have learnt in token therapy to the outside world. Therefore some believe that this therapy does more harm than good as there are also ethical concerns, since the “desired behaviours” are decided by the psychologists or institution, and therefore might not be acceptable to the patient if he or she had a free choice.

Tarrier found that schizophrenics can often identify triggers to onset their psychotic symptoms and that they develop their own methods of coping with the distress. Cognitive-behavioural therapy (CBT) is based on the view that people with schizophrenia have irrational and unrealistic thought processes which are generally negative (e.g. “It is essential that everyone likes me”). Therefore the goal of is to identify the faulty thought processes and replace them with more appropriate and desirable thoughts by distinguishing that they are wrong, so that the patient can try to understand the world differently. This can be accomplished by giving the client “homework” which they can carry out in real-life situations, for example if a