1. COGNTIVE Treatment OF SCHIZOPHRENIA
Psychological treatments, such as cognitive behavioural therapy (CBT), can help people with schizophrenia to cope better with the symptoms of hallucinations or delusions. Psychological treatments can also help to treat some of the negative symptoms of schizophrenia, such as apathy or a lack of volition/hedonism (motivation / enjoyment in life).
COGNTIVE Treatment OF SCHIZOPHRENIA
A2 Psychology

2. QUICK QUIZ
Name one researcher that looked at a genetic link in auditory impairments in Sz
Give two criticisms of the cognitive explanation
What are the 3 deficits identified by Frith?
Frith’s model attempts to identify the onset and maintenance of which types of symptoms?
According to cognitive psychologists what is the difference between a normal brain and the brain of a schizophrenic?
In what way does the cognitive explanation agree with the biological explanation?
Explain one way in which cognitive psychologists study the brain.

3. QUICK QUIZ
FARAONE et al Found auditory impairments and suggest there is a predisposing gene for schizophrenia
Two marks for full answers. there are many
Positive - Verbal hallucinations, delusions of control, thought insertion
In a normal brain there is a mechanism that filters incoming stimuli. In a Schizophrenic brain the mechanism malfunctions and lets in too much stimuli,
Agrees with biological view that during hallucinations the brains of people with schizophrenia are producing strange and unreal sensations (triggered biologically)
PET or MRI – 2 marks for full answer

4. Map to Spec – Page 59
3 Content g) For schizophrenia describe and evaluate two treatments. Students must select one treatment each from two different approaches studied from the five in Units 1 and 2.

5. Map to Spec – Page 60
Describe and evaluate one treatment/therapy from each of the following approaches:
i. the Social Approach: either Family Therapy or Care in the Community programmes
ii. the Cognitive Approach: either Cognitive Behaviour Therapy or Rational Emotive Therapy
iii. the Psychodynamic Approach: either free association or dream analysis
iv. the Biological Approach: either the use of drugs (chemotherapy) or electro-convulsive therapy (ECT)
v. the Learning Approach: either the Token Economy Programme or Systematic Desensitisation.

6. What is CBT?
Cognitive behavioural therapy (CBT) is based on the idea that most unwanted thinking patterns, and emotional and behavioural reactions are learnt over a long period of time.

7. The CBT approach to treatment of schizophrenia differs slightly from conventional CBT methods.
The aims of this therapy are as follows:
To challenge and modify delusory beliefs
To help the patient to identify delusions
To challenge those delusions by looking at evidence
To help the patient to begin to test the reality of the evidence

8. An example of a delusional belief
Event
Overhearing someone saying “I know what’s on your mind”
Interpretation
Everyone can read my thoughts
Feeling
Paranoid, scared and believing that others will attack me for my thoughts
Behaviour
Take evasive action – avoiding situations that will bring me into contact with others

9. CBT Techniques
Patients are encouraged to trace back to the origins of their symptoms in order to get a better idea of how they may have developed.
Try to help the patient come up with rational alternatives

10. Long-term Help
The therapist encourages patient to come up with their own coping strategies for when they experience any symptoms
They may then receive help and advice about how they can avoid acting on delusional thoughts.

11. CBT course
Most people will require between 8 to 20 sessions of CBT over the space of 6 to 12 months. CBT sessions usually last for about an hour.

12. This type of treatment has been shown to be effective for reducing the positive symptoms of schizophrenia, for reducing relapse and for enhancing recovery when schizophrenia is diagnosed early.

13. Cognitive Treatment Sensky et al. (2000)
Aim
To compare cognitive behavioural therapy (CBT) with non-specific befriending interventions for patients with schizophrenia
Design
A randomized controlled design.
Patients were allocated to one of two groups:
a cognitive behavioural therapy group.
a non-specific befriending control group.

14. Procedure Participants Patients were allocated to one of two groups.
57 from clinics in Newcastle, Cleveland and Durham and 33 from London. They had diagnoses of schizophrenia that had not responded to medication.
Aged 16–60 years.
Procedure
Patients were allocated to one of two groups.
Both interventions were delivered by two experienced nurses who received regular supervision.
Patients were assessed by blind raters
at baseline.
after treatment (lasting up to 9 months).
at a 9-month follow-up evaluation.
They were assessed on measures including the Comprehensive Psychiatric Rating Scale, the Scale for Assessment of Negative Symptoms, plus a depression rating scale.
Patients continued to receive routine care throughout the study.
The patients received a mean of 19 individual treatment sessions over 9 months.

15. Cognitive behavioural therapy condition
A normal routine of CBT was used:
initially engaging with patient
psycho education
developing a reason for the behaviour
Cognitive and behavioural interventions
treatment of other disorders such as depression
Reducing relapse by planning ahead

16. CBT Strategies Used
Specific techniques for positive symptoms of schizophrenia were used:
critical analysis of beliefs about auditory hallucinations.
patients were helped to change their beliefs.
patients taught coping strategies to deal with the voices.
Delusions and thought disorders were also addressed using cognitive strategies.

17. Befriending condition
The patients had the same time allocation at the same intervals as patients in the CBT condition.
The therapists were empathic and non-directive.
There was no attempt at therapy:
The sessions focused on hobbies, sports and current affairs.

18. Findings
Both interventions resulted in significant reductions in positive and negative symptoms and depression.
After treatment there was no significant difference between the two groups.
At the nine-month follow-up evaluation, patients who had received cognitive therapy showed greater improvements on all measures.
They had improved, while the befriending group had lost some of the benefits.

19. Conclusions
Cognitive behavioural therapy is effective in treating negative as well as positive symptoms in schizophrenia resistant to standard antipsychotic drugs.
Its efficacy is sustained for at least nine months.

20. Evaluation of CBT for Schizophrenia
Shown to be incredibly effective
Allows people to function more normally with symptoms, preventing Learned symptoms from developing.
Can be used in conjunction with other therapies
Improves symptoms, recovery and relapse rates
No side effects
Not very rational to teach patients to see life through rose coloured spectacles
Doesn’t work for everybody
Expensive and time consuming

21. Psychological Treatment; CBT
CBT strategies to challenge & help modify delusory beliefs
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
Normalising strategies where patient is taught to understand the nature of schiz. symptoms
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)

22. Read the Case study and answer the questions on the worksheet

23. Extension Apply your knowledge:
You have a friend that you believe has schizophrenia. You have been asked to explain to them why they might have schizophrenia. They also ask you about which treatments you would recommend. Which explanations / treatments would you share with them? Are there any that you would leave out?

24. Past paper - June 2011
There are many explanations for schizophrenia including biological ones.
Describe one explanation for schizophrenia and compare this with one other explanation. Comparisons include considering similarities and/or differences. (12 Marks)