Schizophrenia: Treatments and Therapies

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Schizophrenia Treatments and Therapies

• Drug, Humanistic, Behaviour and Cognitive
  Therapies

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Introduction

• Psychological problems are both distressing and
  disruptive for the individual sufferer.
• So, there is an immediate need to alleviate these
  conditions through appropriate forms of therapy
  and/or treatment.

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Treatment v Therapy

• Definition of Treatment the medical or surgical
  management and care of a patient.
• Examples Chemotherapy, prescription of medicines
  to cure/treat symptoms of a disease or disorder.
• Definition of Therapy In the broadest sense,
  Therapy is a term that can be applied to any form
  of treatment for any illness or disorder.
• For example, antacid is a form of therapy for
  heartburn, rehabilitation is a form of therapy
  for addiction, and exercise is a form of therapy
  for obesity.
• As it relates to mental health and mental
  disorders, therapy is usually a general term used
  to reference the sessions held between a
  therapist and a patient. E.g. Cognitive
  Behavioural Therapy (CBT), Family Therapy, etc.

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Treatments and Therapies for Schizophrenia

• Schizophrenia can be treated via the following
  ways-
• Drug Treatment (medicinal)
• Humanistic Therapy (especially Client-Centred
  Therapy)
• Behaviour Therapy (Family Therapy)
• Cognitive Therapy (CBT)

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1. Drug Treatment

• Drug therapies for schizophrenia have radically
  revolutionised the way schizophrenia sufferers
  are treated and cared for.
• The use of effective antipsychotic drugs became
  common in the 1960s and 1970s, seeing a drastic
  reduction in the number of schizophrenic
  sufferers who need long-term institutionalised
  care.
• It has led to such sufferers reaching a level of
  normal functioning that permits care to take
  place in the community.
• Indeed, Lamb (1984) found that prior to the
  1980s, it was estimated that 2 of 3 patients
  would spend their lives in a psychiatric
  institution the average length of stay is down
  to about 2 months, post 1980s.

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Drug Treatment Contd

• Antipsychotics, e.g. chloropromazine and
  haloperidol, block dopamine receptors and help to
  reduce the high levels of dopamine in the brains
  of schizophrenics.
• These drugs not only reduce the major positive
  symptoms, e.g. thought disorder and
  hallucinations, but can also reduce major
  negative symptoms, e.g. social withdrawal, too.
• The NHS use recommend the use of both typical
  (those developed in the 1950s) and atypical
  antipsychotics (those developed during the 1990s)
  to patients till episodes of acute schizophrenia
  have passed.
• The NHS also recommend their long-term use to
  prevent further acute schizophrenic episodes
  occurring.

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The NHS have reported the following side effects
which schizophrenic patients have had-

• Typical Antipsychotics
• drowsiness,
• shaking,
• trembling,
• muscle twitches, and
• spasms.

• Typical and Atypical Antipsychotics
• weight gain,
• blurred vision,
• constipation,
• lack of sex drive, and
• dry mouth.

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2. Humanistic Therapy

• Throughout the 20th century, many
  psychotherapists felt that psychological therapy
  was focussing to much on structures, like
  personality losing sight of how the sufferers
  felt.
• Consequently, a number of Humanistic therapies
  developed Client-Centred Therapy and Gestalt
  Therapy
• Key features of humanistic therapies include-
• They were holistic therapies- considering the
  patient as a whole, and not just their particular
  psychopathological symptoms
• Therapy should help enable patients to make their
  own decisions and solve their problems, rather
  than imposing structured treatments or ways of
  thinking on to them
• Focus on the therapist-client relationship should
  be based on genuine care and empathy, rather than
  the limited, constrained type which professional
  specialists maintain.
• Emotional awareness in patients need to be
  developed, before patients can face and resolve
  their life problems, as it helps alleviate
  psychological distress.

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Client-Centred Therapy

• Carl Rogers (1902-87), a psychologist who
  developed client-centred therapy during the 1940s
  and 1950s
• It is also known as Person-Centred Therapy (PCT)
  and Rogerian Psychotherapy
• Crucial to this therapy is the creation of a
  therapeutic climate that allows the client to
  progress from a state of rigid self-perception to
  one which encourages the client to become
  independent, self-directed and who can pursue
  self-growth.

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Client-Centred Therapy Contd

• There are three core elements of practice in
  client-centred therapy
• Empathy being able to put yourself in the
  clients shoes is the central important feature
  of any therapist-client relationship, as it helps
  guide the client to resolve their own life
  problems
• Unconditional Positive Regard The therapist
  demonstrates that they value the client for who
  they are and refrain from judging them
• Congruence Sharing a genuine, consistent rapport
  with the client, where therapists primarily act
  as an understanding listener who assists the
  client by offering advise only when asked.

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3. Behaviour Therapy

• During the 1940s and 1950s, dissatisfaction
  towards the unscientific approaches towards
  psychopathology was growing
• Psychologists looked towards experimental
  psychology for objective knowledge that might be
  used to inform treatment and therapy
• Conditioning the body of knowledge which
  psychologists gradually resorted to and this gave
  rise to the development of Behaviour Therapies

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Types of Behaviour Therapy

• Classical Conditioning
• Flooding
• Counter-conditioning
• Systematic Desensitization
• These are used to treat phobias and anxiety-based
  disorders.

• Operant Conditioning
• Functional Analysis (treats challenging
  behaviour)
• Token Economy Schemes, including Group/Family
  Therapy
• Response Shaping (treats severe learning
  difficulties)
• Self-Control (treats addictive behaviours)

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What is Group Therapy?

• Therapy can be taken in groups as well as on a
  one-to-one basis
• Group therapies are found to be useful to treat
  individuals suffering from problems by sharing
  their ordeal with one another and having a
  facilitator guiding them towards finding ways of
  resolving their problems.
• Examples of Group therapies Self-Help groups,
  Alcoholics Anonymous, Gamblers Anonymous and
  Family Therapy.

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Family Therapy

• Dallos and Draper (2002) have found that Family
  Therapy is becoming increasingly helpful as a
  means of dealing with psychopathology that may
  result from the relationship dynamics within the
  family.
• According to the NHS, who use family therapy to
  treat schizophrenic sufferers-
• Many people with schizophrenia rely on family
  members for their care and support. While most
  family members are happy to help, the stress of
  caring for somebody with schizophrenia can place
  a strain on any family.
• Family therapy is a way of helping both the
  sufferer and their family to cope better with the
  condition.
• Family therapy involves a series of informal
  meetings that take place over a period of six
  months.
• Meetings may include
• discussing information about schizophrenia,
• exploring ways of supporting somebody with
  schizophrenia, and
• deciding how to solve practical problems that can
  be caused by the symptoms of schizophrenia.
• Often the therapist applies the systems theory,
  which attempts to understand the family as a
  social system, as a treatment to understanding
  the complex relationships and alliances that
  exist between family members. The next step would
  be remould these relationships into those
  expected in a well-functioning family.
• Source http//www.nhs.uk/Conditions/Schizophrenia
  /Pages/Treatment.aspx

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Family Therapy Videos

• Video Clip on Structured Family Systems
• http//www.youtube.com/watch?v91wTCgPa_xw
• Video Clip from the BBC 2 Series The British
  Family
• http//www.bbc.co.uk/programmes/b00q08ft

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3.Cognitive Therapy

• Over the latter part of the 20th Century, one of
  the most impressive developments in our
  understanding of psychopathology has been our
  evolving insight into cognitive factors that play
  important roles in causing and maintaining
  psychopathology.

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Key features of Cognitive Therapy include-

• Cognitive therapy is all about learning how our
  our thoughts create our moods.
• In CT we discover that we all have inherent
  tendencies to certain negative thoughts that
  evoke unhappiness and disturbance - especially in
  response to particular trigger situations.
• Once we accept that fact, we can learn to spot
  these negative thoughts as they arise, and then
  challenge and re-think them.

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Who pioneered Cognitive Therapy?

• Albert Ellis
• Developed one of the first cognitive therapies to
  address how people construe themselves, their
  life and the world (circa 1962)
• He came up with Rational-Emotive Therapy (RET)
  which challenges irrational beliefs and persuades
  patients to set more attainable life goals.

• Aaron Beck
• a medical doctor, psychiatrist and psychoanalyst
  who came to believe that he was not getting
  enough improvement in his patients through
  analysis. (circa 1967)
• He realised that often what was holding back
  patients were negative thoughts such as 'I'll be
  hopeless at that', or 'I'm unlovable', or 'I'm
  stupid'.

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Contemporary Cognitive Behaviour Therapy (CBT)

• CBT came out from these earlier forms of
  Cognitive Therapies.
• CBT is an intervention for changing both thoughts
  and behaviour, representing an umbrella term for
  many different therapies that share the common
  aim of changing both cognitions and behaviour.
• CBT is generally perceived to be an
  evidence-based, cost-effective form of treatment
  that can be successfully applied to a broad range
  of psychopathologies, including Schizophrenia and
  Depression.

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Characteristics of a CBT Intervention

• A CBT intervention usually possesses the
  following characteristics-
• The client is encouraged to keep a diary noting
  the occurrence of significant events, associated
  feelings, moods and thoughts in order to
  demonstrate how these might be interlinked.
• With the help of the therapist, the client is
  urged to identify and challenge irrational,
  dysfunctional, or biased thoughts/assumptions
• Clients are given homework in the form of
  behavioural experiments to test whether their
  thoughts and assumptions are accurate and
  rational.
• Clients are trained in new ways of thinking,
  behaving and reacting in situations that may
  evoke their psychopathology.
• Tip- You may want to visit this link to know
  more about how CBT is applied to clients with
  severe disorders and as well on those who suffer
  from negative thinking and stress.
• http//www.netdoctor.co.uk/diseases/depression/cog
  nitivetherapy_000439.htm

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Summary Chart