Download Cognitive Explanations for Psychotoc disorders

Cognitive Explanations for Psychotic disorders
Cognitive Treatments for Psychotic Disorders
Learning Outcomes
• Outline the cognitive explanations for Schizophrenia
• Explore the cognitive reasons for Psychotic
symptoms
• Explore and evaluate the scientific model of
delusional thinking
• Assess the effectiveness of cognitive treatments for
Schizophrenia
• Revision tasks
Cognitive Explanation
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Hemsley (1993) suggested schizophrenics cannot distinguish between information
that is already stored and new incoming information. As a result, schizophrenics
are subjected to sensory overload and do not know which aspects of a situation to
attend to and which to ignore.
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When schizophrenics first hear voices and experience any other worrying sensory
experiences, they turn to their friends and relatives to confirm the validity of what
they are experiencing. Some people fail to confirm the reality of these
experiences, so the schizophrenic comes to believe they must be hiding the truth.
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Individuals then begin to reject feedback from those around them and develop
delusional beliefs that they are being manipulated and persecuted.
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Yellowlees et al have developed a curious treatment, where patience watch a
machine that produces virtual hallucinations, such as hearing the television tell you
to kill yourself or one person’s face morphing into another’s. This is to show
schizophrenics that their hallucinations are not real, that disbelieving others is a
consequence of madness.
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The role of biological factors is acknowledged in this explanation – it says that the
condition has always existed, but is worsened by those around them
Evaluation of Cognitive Approach
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Focuses on the current cognitions
Plenty of research into the idea
Influential and popular model
Includes biological and the psychological
Empowers the individual to change
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Ignores the environmental influences
Unscientific
Blaming the individual can make the disorder worse
Is thinking irrational?
Which is the cause? Which is the effect?
Let’s remind ourselves of the Symptoms
(Behavioural Outputs)
• POSITIVE SYMPTOMS – TYPE 1
– Distortion of normal function
Delusions, hallucinations, disorganised speech, under the
control of an alien force, disordered thinking
• NEGATIVE SYMPTOMS – TYPE 2
– Lack of normal function
Apathy, no emotion, flat effect, social withdrawal, Alogia (Lack of Speech)
Maher Model Task
Evaluation
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approach bias
application
deterministic
individual versus situational explanations
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.
Participants
• 90 patients.
– 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
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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.
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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.
Cognitive behavioural
therapy condition
• A normal routine of CBT was used:
– initially engaging with patient.
– examining antecedents of psychotic disorder.
– developing a a reason for the behaviour.
– treatment of other disorders such as depression.
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.
What is CBT?
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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.
The CBT approach to treatment 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
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For example, you may be taught to recognize examples of delusional thinking in
yourself. You may then receive help and advice about how you can avoid acting on
these thoughts.
Most people will require between eight to 20 sessions of CBT over the space of six to 12
months. CBT sessions usually last for about an hour.
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.
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.
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.
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.
Evaluate the research:
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4.
Evaluation of CBT
for Schizophrenia
 Shown to be incredibly effective
 Not very rational to teach patients to see life through rose coloured
spectacles
 Doesn’t work for everybody
Learning Outcomes
• Outline the cognitive explanations for Schizophrenia
• Explore the cognitive reasons for Psychotic
symptoms
• Explore and evaluate the scientific model of
delusional thinking
• Assess the effectiveness of cognitive treatments for
Schizophrenia
• Revision tasks
Homework
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?
• You have a friend that is suffering from stress, which appears to be having
a knock on effect on their behaviour. You have been asked to explain to
them why they might have stress and how and why it is impacting on
their health. They also ask you about what management strategies you
would recommend. Which causes / treatments would you share with
them? Are there any that you would leave out?
Potential Exam Questions
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Describe two explanations one Disorder (10 marks)
Evaluate explanations of Schizophrenia (15 marks)
“Psychologists believe that Schizophrenia can be explained solely by biological factors”
• Discuss this claim with reference to the above quotation. (10 Marks)
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Describe and evaluate at least two issues in classifying or diagnosing schizophrenia (15 marks)
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Explain issues relating to classifying schizophrenia as a mental disorder (10 marks)
Discuss two explanations of schizophrenia from different perspectives in psychology (15 marks)
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Describe the clinical characteristics of Schizophrenia (10 marks)
Explain and evaluate issues relating to the diagnosis of Schizophrenia as a mental disorder (15
marks)
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Discuss the extent to which biological therapies can be used to treat Schizophrenia (15 marks)
Describe and evaluate two psychological explanations of Schizophrenia (15 marks)