Schizophrenia: Treatments and Therapies

1. Schizophrenia: Treatments and Therapies Drug, Humanistic, Behaviour and Cognitive Therapies

2. 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.

3. 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.

4. 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)

5. 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.

6. 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.

7. 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. The NHS have reported thefollowing side effects which schizophrenic patients have had:-

8. 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.

9. 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.

10. Client-Centred Therapy Contd… • There are three core elements of practice in client-centred therapy: • Empathy: being able to put yourself in the client’s 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.

11. 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

12. 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) Types of Behaviour Therapy

13. 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.

14. 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

15. Family Therapy Videos • Video Clip on Structured Family Systems: http://www.youtube.com/watch?v=91wTCgPa_xw • Video Clip from the BBC 2 Series “The British Family: http://www.bbc.co.uk/programmes/b00q08ft

16. 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.

17. 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.

18. 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'. Who pioneered Cognitive Therapy?

19. 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.

20. 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/cognitivetherapy_000439.htm

21. Summary Chart