This is a 16/16 essay on the psychological treatments for schizophrenia, including CBT (in particular CBTp) and token economy. This essay includes two AO1 paragraphs and follows with four evaluation (AO3) points.
Discuss psychological treatments for schizophrenia (16)
One psychological treatment for schizophrenia is cognitive behavioural therapy which is a combination of
cognitive therapy (a way of changing maladaptive thoughts and beliefs) and behavioural therapy (a way of
changing behaviour in response to these thoughts and beliefs). Cognitive behavioural therapy for psychosis
(CBTp) particularly focuses on tackling schizophrenia and the basic assumption is that people often have
distorted beliefs, which influence their feelings and behaviours in maladaptive ways. For example, someone
with schizophrenia may believe their behaviour is being controlled by someone else. Delusions are thought
to result from faulty interpretations of events, and CBTp is used to help the patient identity and correct these
faulty interpretations. CBTp usually proceeds through assessment, engagement, the ABC model,
normalization, critical collaborative analysis and developing alternative explanations. The first stage
(assessment) is when the patient expresses his or her thoughts about their experiences to the therapist and
realistic goals for therapy are discussed. Normalisation includes the therapist normalizing the patients’
behaviours, by telling them that many people have unusual experiences such as hallucinations and delusions
under many different circumstances (e.g. in situations of extreme stress) and this reduces anxiety and
isolation for the schizophrenic. This makes the patient feel less alienated and stigmatised. The final stage of
CBTp involves developing alternative explanations. This is when the patient develops their own alternative
explanations for their previously unhealthy assumptions. If the patient is not forthcoming with alternative
explanations, new ideas can be constructed in cooperation with the therapist.
Another method of treatment for schizophrenia is token economy. This is a form of therapy where desirable
behaviours are encouraged by the use of selective reinforcers. The tokens are paired with rewarding stimuli
and so become secondary reinforcers because they are associated with real rewards. The patient then
engages in ‘target’ behaviour or reduces inappropriate ones. The patient is then given tokens for engaging in
these desirable behaviours such as dressing themselves. The patient is able to trade these tokens for access to
desirable items or other privileges (primary reinforcers).
A strength of CBTp is that there is evidence for its effectiveness. For example, a study collected participants
with schizophrenia and either placed them in standard care or standard care with CBTp. It was found that
50% of those using standard care with CBTp improved with only one worsening in contrast to 31% of
patients only receiving standard care with three worsening and one committing suicide. This evidence
strongly suggests that CBTp is an effective form of treatment for schizophrenia and this study increases the
validity of the treatment. However, it could be argued that a more idiographic approach is needed when
treating schizophrenic patients. This is because 31% of patients receiving standard care alone still improved,
indicating that standard care is not significantly worse than using CBTp. This could be due to individual
differences – some people may respond better to drug treatment (standard care) alone rather than therapy,
meaning the effectiveness of CBTp is limited.
However, a limitation of CBTp is that there is a lack of availability when it comes to being offered the
treatment. Despite being recommended by the NICE as a treatment for people with schizophrenia, it is
estimated that in the UK, only one in 10 of those who could benefit from this form of therapy get access to
it. This figure is even lower in some areas of the country. A survey found that in the North West of England
of 187 randomly selected patients diagnosed with schizophrenia, only 13 (7%) had been offered CBTp.
Additionally, of those who are offered CBTp, a significant number either refuse or fail to attend therapy,
thus limited its effectiveness even more.
A limitation of token economy as a treatment for schizophrenia is that it is less useful for patients living in
the community. Although the token economy has shown to be effective in reducing negative symptoms, it
has only really been shown to work when in a hospital setting. Corrigan argues that there are problems
administrating the token economy method with outpatients who live in the community. Within a psychiatric
ward setting, patients receive 24-hour care and so there is better control for staff to monitor and reward
patients appropriately. However, patients living in the community only received treatment for a few hours a
day, so therefore the token method could not be used within a 24-hour period, meaning it lacked
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