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When people think of a psychologist, most would imagine a person sitting across from a patient in an armchair, with a notepad ready to dissect every word that comes out of a patient's mouth. While not as simplified as this, psychological therapies certainly offer therapies that are similar to the stereotype.
In the case of schizophrenia, there are three main psychological therapies we like to consider (specifically for your exam). Each treatment offers a different avenue of treatment whilst aiming to treat the disorder itself, purely from a psychological perspective. Unlike the biological approach, most psychological therapies focus on addressing and altering the mind state through addressing a patient’s thought patterns and behaviours.
Let's now outline and evaluate psychological therapies for schizophrenia.
Psychological therapy, Flaticon
Different therapies use different techniques to treat the underlying cause of schizophrenia. Psychological therapies in schizophrenia also address the symptoms as well as try to address the cause.
There are three main types of psychological therapies that we will cover:
Cognitive behavioural therapy (CBT) is likely one of the most used therapies out there currently. Curated by Becks in the 1960s, the main aim of CBT is to identify and then attempt to correct (or at least alter positively) dysfunctional thoughts.
We mean by dysfunctional thoughts in schizophrenia by the irrational beliefs schizophrenia patients suffer from more than others.
CBT, for instance, would work by addressing these irrational beliefs and working through them logically, which also works for other positive symptoms such as hallucinations and delusions.
Typically, CBT follows the following format:
CBT adopts the ABC model:
CBT then works on disputing these irrational beliefs through reality testing, normalisation, and critical analysis.
The coping strategy enhancement (CSE) model is an alternative and focuses on the patient developing coping strategies. This is seen through education and rapport training and symptom targeting.
Overall, CBT usually lasts anywhere from 6 to 12 weeks.
CBT, Flaticon
Family therapy focuses on the people around the patient, involving them in the treatment process. Research has shown that many relapses in schizophrenia tend to occur after a patient has returned to their family environment. There are multiple reasons why this is the case.
This is typically due to expressed emotions (EE), stress, guilt, and an overall lack of education or ignorance about the disorder. Families are not perfectly attuned to every possible mental health disorder out there, so until it directly affects them, no one will truly know about these issues (and even then, it requires a lot of time, patience, and effort to understand mental health).
Family therapy usually involves the following format:
Education typically involves:
Compromise and negotiation
Communication skills training
Being family-centred focused, not just focused on the patient.
Family tree, Flaticon
Token economies (TES), also developed in the 1960s, involve a behavioural based reward system that encourages 'good behaviours' and discourages 'bad behaviours'. It is primarily based on the concept of operant conditioning.
In schizophrenic patients, it focuses on maladaptive behaviours that prevent a patient from adapting to new situations, treating both positive and negative symptoms of schizophrenia. Although TES has fallen out of fashion (with the fall in institutionalisation), it does employ some well established psychological theories.
TES usually involves the following process:
Overall, primary reinforcers give power to the secondary reinforcers.
TES is catered specifically to the patient (so their wants and needs can be directly addressed and influence their behaviour).
Token economy, Flaticon
As with all treatment plans, psychological therapies have their strengths and weaknesses. Let's assess the effectiveness of psychological therapies for schizophrenia.
The following can be considered strong points of psychological therapies:
Concerning CBT, Kuipers et al. (1997) investigated the effects CBT had on psychosis (as it had positive effects on those with depression). 60 participants with at least one positive symptom (who also had issues with medication) were randomly allocated to either a CBT and standard care condition (n = 28), and a control group with a standard care only condition (n = 32).
Over nine months, they found significant improvement for those receiving treatment compared to standard care only. There was a low dropout rate and high satisfaction, and CBT had a 50% treatment response compared to 31% of the control group.
They concluded CBT for psychosis could improve symptoms.
Concerning family therapy, Pharoah et al. (2010) found that from data (randomised and quasi-randomised) on families with members affected by schizophrenia, family therapy reduces the rate of relapsing in those with schizophrenia, including the rate of hospitalisation.
Concerning token economies, McMonagle and Sultana (2000) found that, when comparing a token economy system to standard care, it has an effect on the negative symptoms of schizophrenia, although had little to no effect on other areas. They did, however, state that whether this is reproducible and long-term is up for debate and requires more research.
The following can be considered the weak aspects of psychological therapies:
CBT is mostly used alongside drug therapy for schizophrenia in psychology, suggesting that it is not a cure-all, robust therapy. It needs help, and implying CBT is enough alone is ignoring the biological basis of schizophrenia. It also has been shown to have a short-term effectiveness rate, as when studies analysed the rate of relapse compared to the standard care, CBT had a similar or the same rate of relapse.
Family therapy, similar to CBT, does not address the biological aspect of the disorder, and instead focuses mostly on the nurture side of the debate. Blame can be placed on the family environment, which may incite more feelings of guilt and stress.
Token economies have ethical issues, as they are essentially withholding freedoms from patients and demanding they are earned back purely through a reward system. Is it ethically acceptable to restrict this right from patients? As well as this, it is only applicable to those willing to work for their rewards. If a patient doesn't want to or is too ill to engage in the behaviours, token economies would be useless or even cruel for them.
What type of therapy works best for schizophrenia?
This is up for debate, as both biological therapies for schizophrenia in psychology and psychological therapies have their strengths and weaknesses. We cannot conclusively say one is perfect for schizophrenia. However, cognitive behavioural therapy combined with drug therapy has shown promising results.
This is up for debate, as both biological and psychological therapies have their strengths and weaknesses, so we cannot conclusively say one is perfect for schizophrenia. However, cognitive behavioural therapy combined with drug therapy has shown promising results.
Psychological therapies help schizophrenia by addressing dysfunctional thoughts and helping a patient logically work through them, which is also transferrable to everyday life (it can be practised outside of a therapy session). It also allows patients to reflect on their behaviours and potentially address their social circle and family life.
In terms of the psychological factors of schizophrenia, this could be referring to the imbalance in dopamine and serotonin (the neurotransmitters affecting the person's brain with the disorder). Ultimately, this results in positive symptoms (hallucinations, delusions of grandeur) and negative symptoms (alogia, depression, lack of motivation).
Interventions can come in the form of family therapy, group therapies, and general counselling sessions.
Yes, primarily when used in combination with drug therapies. Although, whether it has long-term effects is still up for debate.
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