Psychological Treatments of Schizophrenia

1. Psychoanalysis

• This is the psychodynamic treatment for schizophrenia and it was founded by Sigmund Freud.
• Freud believed that a person could be cured through talking about their unconscious thoughts and motivations (making them conscious thoughts).
• Psychoanalysis therapy aims to release repressed emotions and experiences thus gaining insight into the patient’s mind.
• The therapy consists of parapraxes (‘Freudian slip’), free association and interpretation (includingdream analysis).

Evaluations:

• It aims to treat the cause of the disorder; rather than reduce or ‘mask’ the symptoms – aims to solve the conflict between the id, ego and the superego.
• The treatment gives a lot of control to the patient by allowing them to talk freely and make their own connections between events and experiences – they may be more comfortable and cooperative.
• Most studies into psychoanalysis as an effective treatment for schizophrenia have been case studies – records of interviews with individuals used to demonstrate the effects of psychoanalysis on behaviour. Case studies = greater ecological validity and considers the complexity of schizophrenic behaviour.
• It has had an enormous impact on western culture and intellectual life by influencing the mental health field as well as other areas including art, literature and popular culture. Sigmund Freudchanged the face of psychology in a dramatic way.
• Despite attempts, there is no scientific laboratory test that can show and prove the effects it has on a schizophrenic patient. Difficult to prove effectiveness because it is based on subjective data and the idea of an “unconscious mind”.
• For this reason, Fonagy (1981) questions whether attempts to validate Freud’s approach through laboratory tests have any validity themselves.
• Ignores biological factors such as neurochemical imbalance. These can be cured directly through medication and have an almost immediate effect on some patients but psychoanalysis is a long, expensive and time-consuming therapy.
• Other forms of treatment have been found to be more effective, (i.e. CBT).

2. Cognitive Behavioural Therapy

• This is a mixture of cognitive and behavioural therapies. It combines the two approaches because how we behave often reflects how we think about certain things or situations.Techniques include goal setting, goal attainment, and tracking goal progress to encourage the patient to change their thinking and thus their behaviour.
• CBT is based on the idea that people with mental disorders have irrational and unrealistic ways of thinking.
• The aim of CBT is to adjust thinking patterns and alter inappropriate beliefs. Patients are encouraged to track back the origins of their symptoms and evaluate the content of their delusions to test the validity of their faulty beliefs.
• Understanding where symptoms originate can be crucial to some patients as offering explanations for their hallucinations and delusions can help reduce anxiety.
• Belief modification teaches strategies to counter delusional beliefs and hallucinations. Patients are taught to regard their delusions and hallucinations as hypotheses rather than reality and learn to challenge these initial positive symptoms.
• CBT is often administered around once every 10 days for about 12 sessions to identify and alter irrational thinking.

Evaluations:

• Zimmermann et al (2005) found that CBT was effective in that it was better at treating the positive symptoms of schizophrenia than having no treatment at all.
• There is a lot of research to support the effects of CBT and it has been shown to have a significant effect on improving symptoms of schizophrenic patents
• Outcome studies measure how well a person does after treatment – these studies suggest that patients experience fewer hallucinations and delusions.
• Drury found that there was a reduction on positive symptoms and a 25-50% reduction in recovery time for patients who used a combination of antipsychotic drugs and CBT.
• In a meta-analysis by Gould, it was found that seven studies reported a statistically significant decrease in the positive symptoms of schizophrenia after CBT.
• Turkington found a reduction in both positive and negative symptoms concluding that CBT is highly effective and should be used as a mainstream treatment wherever possible.
• The symptoms are cognitive in nature so it is appropriate to use a cognitive therapy to help counteract these delusions and hallucinations – many people with schizophrenia use coping strategies to control their delusions and hallucinations, so it makes sense for a therapy to build on these coping strategies.
• CBT treatment is often used in addition to drug therapies meaning that it is not considerably effective as a treatment on its own.
• Although it combines both behaviour and cognitive approaches to schizophrenia, it ignores the biological factors.
• CBT does not offer a cure, but rather a way of ‘normalizing symptoms’.
• In Tarrier’s study of the effectiveness of CBT therapies, out of the initial sample of 49 people, 45% refused to co-operate or dropped out during the trial. As Tarrier’s experimental design was outcome research, the significantly high dropout rate causes loss of valuable data, making this research unreliable.