Treating Schizophrenia

1. Treating Schizophrenia Using Psychological Therapies

2. Behavioural Therapy • Behavioural treatment for schizophrenia is based on operant conditioning – learning through reinforcement. • Token economies can help encourage people in psychiatric institutions to perform socially desirable behaviours, e.g., getting dressed and making their beds.

3. Token Economies • Token economy programmes can produce significant improvements in self care and desirable behaviour, even with chronic institutionalised schizophrenics. • Ayllon and Azrin (1968) set up a token economy with schizophrenic patients in a psychiatric institution. Patients went from performing 5 chores a day to around 40.

4. Disadvantages • Token economies don’t have high ecological validity- they don’t transfer into the real world. There is nothing to reinforce the desirable behaviours. • Ethical issues- Does it really help the patient? Does it just serve to make their behaviour more acceptable to others? • Superficiality- The patients might only produce desirable behaviour if they’re going to receive a token. • Do we really learn through reinforcement? What about cognition?

5. Strategies of behaviour therapy • Contingency management- Altering the consequences of a behaviour in order to change the frequency of the behaviour. • Contingency contracting- Increasing desired behaviours, and decreasing undesired ones, by drawing up a contract that stipulates rewards and punishments for the relevant behaviours. • Stimulus control- Increasing the likelihood of a behaviour by magnifying the stimuli that promote the desired behaviour and eliminating the stimuli that undercut it. • Systematic desensitisation (Wolpe 1958-anxiety & phobia)- Training a person to engage in behaviour that makes the unwanted behaviour difficult or impossible to perform. Systematic desensitisation eliminates anxiety, as it is difficult to experience anxiety during a state of relaxation.

6. Behavioural family therapy • Families are powerful instruments for effecting change. • Behavioural family therapists seek to bring the powerful array of behavioural treatment techniques to bear on individual problems that seem to occur in the family (Patterson, 1971). • Behaviour training strategies are particularly effective in reducing family tension. The combine education, communication skills training and problem solving methods, alongside drug therapy in long term intervention (Falloon, Boyd and McGill, 1984).

7. Effectiveness of family therapy • Those who receive family therapy function better socially and suffer fewer major exacerbations of schizophrenic symptoms than do those treated with a more traditional individual-oriented approach (Falloon et al, 1985). • Recent studies show that behavioural family treatments results in remarkedly lower relapse rates, fewer rehospitalisations,improvements in the patient’s social functioning, and substantially lower levels of family burden and distress (Bellack and Mueser, 1993) • Family therapy will not always be an option as many patients are estranged from their families or live alone.