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Cognitive Behavioural Therapy and Family Interventions for Psychosis.

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Cognitive Behavioural Therapy and Family Interventions for Psychosis Helen Healy, David Reader and Kenny Midence INTRODUCTION Psychosocial treatments for schizophrenia are not new in the research literature. Psychological treatments have been previously used in the treatment of schizophrenia. For example in terms of behaviour therapy, operant approaches such as token economy programmes were used in the 1960s and 1970s to improve the behaviour of patients in long stay hospitals. However, the evidence suggests that the clinical gains were limited and did not generalise beyond the therapeutic setting and also did not address delusional convictions (Alford 1986; Himadi et al 1991). Other psychological treatments for schizophrenia can be traced to early work devoted to studying the impact of the social environment on mental illness. A plethora of early studies focused on the role of the family environment in the maintenance of schizophrenia which in turn led to the concept of expressed emotion (Brown et al 1972; Brown & Rutter 1996). Family interventions were first developed as a method for reducing levels of expressed emotion among relatives and are now recognised as a significant aspect in the treatment of schizophrenia. This approach marked a paradigmatic shift in the way family members were viewed by clinicians and has led to efforts to improve communication between clinicians and carers. Recent years have seen such cognitive approaches expanded to interest in interventions that combine the principles of cognitive and behavioural approaches. However, despite all the research available providing evidence of their effectiveness, these approaches are not widely available in routine clinical practice (Slade & Haddock 1996). It is now clear, however, that psychosocial interventions are necessary to help patients cope with their condition, and improve their quality of life. These interventions are also beneficial to relatives, and are effective in improving the quality of the family environment (Penn & Mueser 1996). Psychosocial interventions are aimed at empowering patients, and, as Slade & Haddock (1996) ...read more.


All of the trials have been conducted in the UK, whereas none of the recent trials have taken place in the US. It is uncertain whether the results found would generalise to a different culture such as the US with a predominance of many ethnic minorities. Schizophrenia is associated with a number of cognitive deficits such as difficulty in concentrating, problem solving and other attentional deficits. Such impairments have significant implications for the success of cognitive behavioural therapy and there has been a long held view that psychotic patients are not amenable to cognitive therapy. Lack of insight is another reason that is also posited for their failure to engage. The results of other meta - analyses (Cormac et al 2002, Gould et al 2001) clearly demonstrate that this is not the case. For example Garety et al (1997) found that cognitive variables were not related to treatment response. Nevertheless given the nature of cognitive behaviour therapy, a certain degree of insight and willingness to disclose symptoms are necessary prerequisites to engage in cognitive therapy (Chadwick et al., 1996). Thus those patients who are more severely deluded and suffering from marked negative symptoms of depression and withdrawal may not benefit from such a psychological approach. This hypothesis is supported by findings from Garety et al (1997) where he found that a greater insight did predict a better outcome among patients randomised to CBT therapy. Identification of therapeutically relevant factors is very important in order to be able to implement them in clinical practice. A recent study by Andres et al (2003) investigated the significance of coping as a therapeutic variable for the outcome of purely psychoeducational and behavioural therapy in schizophrenia. They demonstrated that better outcomes in terms of psychopathology and social outcome was best predicted by the patient's mastery of active problem focused strategies, levels of cognizance about the disorder, and levels of social functioning. ...read more.


New Directions for Mental Health Services 53:33-41 Smith J, Birchwood M 1990 Relatives and patients as partners in the management of schizophrenia: the development of a service model. British Journal of Psychiatry 156:654-660 *Smith T E, Bellack A S, Liberman R P 1996 Social skills training for schizophrenia: review and future directions. Clinical Psychology Review 16(7):599-617 Tarrier N 1996 Family interventions for schizophrenia. In: Haddock G, Slade P D (eds) Cognitive-behavioural interventions for psychotic disorders. Routledge, London, pp 212-234 Tarrier N, Barrowclough C 1995 Family interventions in schizophrenia and their long-term outcomes. International Journal of Mental Health 24(3):38-53 Tarrier N, Harwood S, Yusopoff L, Beckett R, Baker A 1990 Coping strategy enhancement (CSE): a method of treating residual schizophrenic symptoms. Behavioural Psychotherapy 18:283-293 Tarrier N, Lowson K, Barrowclough C 1991 Some aspects of family interventions in schizophrenia. II: ?nancial considerations. British Journal of Psychiatry 159:481-484 Tarrier N, Beckett R, Harwood S, Baker A, Yusopoff L, Ugareburu I 1993 A trial of two cognitive-behavioural methods of treating drug-resistant residual psychotic symptoms in schizophrenic patients, I: outcome. British Journal of Psychiatry 162:524-532 Trower P, Bryant B, Argyle M 1978 Social skills and mental health. Methuen, London Vaccaro J, Liberman R, Wallace C J, Blackwell G 1992 Combining social skills training and assertive case management: the social and independent living skills program of the Brentwood Veterans Affairs Medical Center. New Directions for Mental Health Services 53:33-41 Annotated further reading Fadden G 1998 Family intervention. In: Brooker C, Repper J (eds) Serious mental health problems in the community: policy, practice and research. Bailliļæ½re Tindall, London This chapter provides a comprehensive and up-to-date review of the research literature on family intervention. Nelson H 1997 Cognitive behavioural therapy with schizophrenia. Stanley Thornes Publishers, Cheltenham This is an excellent book for anyone who wants to develop an understanding of CBT in the management of psychosis. *Haddock G, Slade P G 1996 Cognitive-behavioural interventions for psychotic disorders. Routledge, London ...read more.

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