Schizophrenia
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Psychological treatments
Treating schizophrenia
Non-drug-based therapies
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Behavioural
Psychodynamic
Cognitive-behavioural
Family therapy
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Behavioural therapies
Reinforcing coherent/non-delusional speech
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Some success e.g. Nydegger (1972) - apparent
reduction in hallucinations, delusions
May be that patients learn not to talk about
symptoms rather than symptoms actually reduced
Results do not generalise well to non-clinical
situations
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Behavioural therapies
Token economies
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Early successes, esp. with negative symptoms
May be due to better organisation/more positive
staff behaviour, not reinforcement
Changes may not last
Ethical/human rights problems
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Psychodynamic therapies
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Traditional psychoanalysis not likely to be
effective
Rosen (1946) suggested ‘direct analysis’
involving:
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Brutal confrontation of patient’s problems
Regression to childhood
Therapist becomes a substitute parent/nurturer
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Psychodynamic therapies
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Success claimed by Rosen and others
Drake & Sederer (1986) suggest some
therapies actually harmful esp. when they
involve:
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A close relationship
Regression
High levels of emotionality
These lead to longer hospitalisation &
worsening of symptoms
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Cognitive therapies
CBT strategies to challenge & help modify
delusory beliefs
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Identify delusions
Challenge evidence on which delusions are
based
Design ‘experiments’ to test reality of this
evidence
Chadwick & Lowe (1993) – significant
reductions in delusions in 10 out of 12
patients
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Cognitive therapies
Normalising strategies where patient is taught
to understand the nature of schiz. symptoms
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Challenge ‘catastrophising’ beliefs about
schizophrenia
Help patient feel that symptoms are
understandable and ‘normal’
Helps 70% of patients although other 30%
may deteriorate (Kingdon & Turkington, 1996)
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Family therapies
Aimed at reducing ‘expressed emotion’ in the
family environment through:
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reducing negative interactions
Increasing understanding of schiz. symptoms
Tackling feelings of guilt & anxiety
Hoped to prevent relapse in patients following
release
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Family therapy
Some success:
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Lower relapse rates compared with individual
therapy (12% vs. 50%; Falloon et al, 1985)
As effective as social skills training (both 20%
relapse) but most effective when both combined
(<10% relapse rate; Hogarty et al, 1986)
Follow-up data suggest that relapse is
delayed, not prevented
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