Cognitive-behavioural therapy (CBT)
The basic assumption is that people often have distorted beliefs which influence their behaviour. Delusions are thought to result from faulty interpretations of events, and cognitive therapy is used to help the patient identify and correct these.
Patients are encouraged to trace back the origins of their symptoms to get an idea of how they developed. Also encouraged to evaluate the content of their delusions and to consider ways to test the validity of their faulty beliefs. They night also be set behavioural assignments with the aim of improving their general level of functioning.
During CBT the therapist lets the patient develop their own alternatives to these previously maladaptive beliefs, by looking for alternative explanations and coping strategies that are already present in the patients mind.
(+) (Gould, 2001)– All 7 studies in their meta-analysis reported a statistically significant decrease in all the +ve symptoms after treatment.
(-) Most studies of effectiveness of CBT have been conducted with patients treated at the same time with antipsychotics, therefore it is difficult to assess the effectiveness of CBBT independent of antipsychotic medication.
(Kingdon and Kirschen, 2006)– Many patients were not deemed suitable as they would not fully engage with the therapy. Older patients were less suitable than younger ones.
Family therapy
Attempts to make family life less stressful and reduce re-hospitalisation.
There are a number of strategies:
- Forming an alliance with the family members who care for the patient.
- Reducing the emotional climate and the burden of care for family members.
- Enhancing relatives’ ability to anticipate and solve problems.
- Reducing expressions of anger and guilt felt by family members.
- Maintaining reasonable expectations within the family of the patients performance.
- Encouraging relatives to set appropriate limits whilst maintaining some degree of separation when needed.
Commonly used in conjunction with drug treatments or outpatient clinical care.
(+) (NCCMH, 2009)– found significant evidence for the effectiveness of family intervention. When compared with patients receiving standard care, there was a reduction in hospital admissions during treatment and in severity of the symptoms both up to and including 24 months following the intervention. The relapse rate in the family intervention was 26% compared to 50% in the control group.
(+) Increases medication compliance- More likely to see benefits or medication because they are more likely to comply with their medication regime.
(+) (NCCMH, 2009)- was associated with significant cost savings when offered in addition to standard care. The cost of family intervention is offset by a reduction in costs of hospitalisation because of lower relapse rates associated with the intervention.
(-) Hospitalisation levels may differ significantly across countries, depending on clinical practise within those countries. Therefore, re-hospitalisation rates from non-UK countries may not be applicable to the UK setting.
Psychoanalysis
Based on the assumption that individuals are often unaware of the influence of unconscious conflicts on their current psychological state. The aim is to bring these conflicts to the conscious mind to deal with them. It assumes that all symptoms are meaningful and a product of the life history of the patient.
(+) (Malmberg and Fenton, 2001)– it is impossible to draw conclusions for or against the effectiveness of psychodynamic therapy and the schizophrenia patient outcome research team suggest it may be harmful. However a meta-analysis of 37 studies concluded it was an effective treatment.
(+) (Gottdiener, 2000)– 66% patients receiving psychotherapy improved, compared to 35% of those who did not. Psychoanalytic and cognitive-behavioural therapies produced similar levels of benefits. Results showed no difference in improvement when psychotherapy was accompanied by antipsychotic medication. Outpatients improved at a higher rate than inpatients.
(-) The relatively small number of studies meant it was difficult to assess the impact of variables such as therapist training of experiences. About half the studies didn’t allocate patients randomly to condition, introducing treatment bias, which may have affected the result.
(+) Despite evidence for effectiveness not being entirely convincing, the treatment guidelines of APA recommend that ‘supportive interventions’ such as psychodynamic therapy are appropriate when combined with antipsychotic medication.
(-) It’s expense prevents it being adopted on a large scale. Because it does not appear more effective than antipsychotics, it is not worth the extra expense. However, there is evidence to suggest that the overall cost of treatment decreases with therapy because they are less likely to seek inpatient treatment and more likely to gain employment.