Psychological Treatments for Schizophrenia
Revision note: The specification identifies two psychological therapies used to treat schizophrenia. Family
therapy and cognitive behaviour therapy (CBTp). These two therapies follow on logically from the two
psychological explanations – family therapy as a way of helping family dysfunction and cognitive behaviour
therapy as a way of dealing with the faulty cognitions and dysfunctional thought processing identified by the
cognitive explanations.
The specification also identifies token economy as a way of managing schizophrenia.
Family Therapy
Given that family dysfunction – a negative family climate and poor/abnormal communication were
identified as a cause of schizophrenia and as a key factor in whether schizophrenic individuals
relapse or not, it is unsurprising that family therapy developed as a form of treatment. As the name
implies, a range of family members attend therapy sessions, rather than just the individual with
schizophrenia. Family therapy involves at least 10 sessions over a 3–12-month period. Family
therapy aims to deal with issues such as double-bind statements, but family therapy sessions
mainly attempt to improve the quality of communication and interaction between family members
in families with high levels of expressed emotion. Family therapy aims to provide support for
carers, make family life less stressful and therefore reduce relapse and rehospitalisation.
The key theorist is Fiona Pharoah. She identified a range of objectives of family therapy:
1. Forming a therapeutic alliance between all family members to help care for the person
with schizophrenia
2. Reducing the stress / burden of caring for a family member with schizophrenia
3. Improving the ability of family members to anticipate and solve problems
4. Reducing expressions of anger and guilt in family members and improving the emotional
climate within the family
5. Helping family members achieve a balance between caring for the schizophrenic
individual and maintaining their own lives. Helping them to maintain some degree of
separation when needed.
6. Psychoeducation – providing the schizophrenic individual and other family members with
information about schizophrenia to help them understand schizophrenia better,
improving their attitudes towards schizophrenia and making them better able to deal with
it.
Family therapy includes the schizophrenic individual as far as possible. During sessions
schizophrenics are encouraged to talk to family members and identify what sort of support
they find helpful and what type of communication they find stressful. Family members are
encouraged to listen to each other and openly discuss problems and potential solutions. The
very nature of schizophrenia means that schizophrenic individuals may be suspicious about
others (delusions of persecution) and family therapy aims to combat this.
, Family therapy is usually undertaken as a combination therapy alongside antipsychotic
medication. By reducing stress in this way, family therapy attempts to help schizophrenics who are
in remission continue to comply with their medication and avoid relapse.
Key study: Pharoah et al 2010.
Procedures (A01)
Pharoah et al reviewed 53 studies (meta-analysis) of the effectiveness of family therapy. Studies
were conducted in Europe, Asia and North America. The studies compared the outcomes of family
therapy to “standard” care (antipsychotic medication alone). They concentrated on studies using
randomised controlled trials.
Findings (A03)
Compared to the control group, individuals experiencing family therapy:
✓ Were more likely to comply with medication
✓ Were less likely to relapse and be readmitted to hospital in the 24 months after treatment
However, results were inconsistent in terms of improvement in mental state and social
functioning (holding down employment and living independently). Some studies showed
improvements, others did not.
A03 – Family Therapy
Point Evidence Conclusion
A strength of using family Pharoah et al’s meta- The lower relapse rates
therapy to treat analysis compared the identified in Pharoah’s
schizophrenia is that the effectiveness of family study suggests that family
study by Pharoah et al therapy vs antipsychotics therapy is an effective
suggests that it is an alone in 53 studies. treatment for
effective form of treatment. Pharoah et al found that schizophrenia.
individuals experiencing
family therapy were more
likely to comply with their
medication and less likely
to relapse and be
readmitted to hospital.
Further support for the As Pharoah conducted a The population validity of
effectiveness of family meta-analysis of 53 the data gathered suggests
therapy comes from the studies with a large that it is possible to
methodology used by sample size of patients, the generalise Pharoah et al’s
Pharoah et al. data gathered and findings and conclusions
conclusions reached apply and this further supports
to a significant sample of the effectiveness of family
therapy.
Revision note: The specification identifies two psychological therapies used to treat schizophrenia. Family
therapy and cognitive behaviour therapy (CBTp). These two therapies follow on logically from the two
psychological explanations – family therapy as a way of helping family dysfunction and cognitive behaviour
therapy as a way of dealing with the faulty cognitions and dysfunctional thought processing identified by the
cognitive explanations.
The specification also identifies token economy as a way of managing schizophrenia.
Family Therapy
Given that family dysfunction – a negative family climate and poor/abnormal communication were
identified as a cause of schizophrenia and as a key factor in whether schizophrenic individuals
relapse or not, it is unsurprising that family therapy developed as a form of treatment. As the name
implies, a range of family members attend therapy sessions, rather than just the individual with
schizophrenia. Family therapy involves at least 10 sessions over a 3–12-month period. Family
therapy aims to deal with issues such as double-bind statements, but family therapy sessions
mainly attempt to improve the quality of communication and interaction between family members
in families with high levels of expressed emotion. Family therapy aims to provide support for
carers, make family life less stressful and therefore reduce relapse and rehospitalisation.
The key theorist is Fiona Pharoah. She identified a range of objectives of family therapy:
1. Forming a therapeutic alliance between all family members to help care for the person
with schizophrenia
2. Reducing the stress / burden of caring for a family member with schizophrenia
3. Improving the ability of family members to anticipate and solve problems
4. Reducing expressions of anger and guilt in family members and improving the emotional
climate within the family
5. Helping family members achieve a balance between caring for the schizophrenic
individual and maintaining their own lives. Helping them to maintain some degree of
separation when needed.
6. Psychoeducation – providing the schizophrenic individual and other family members with
information about schizophrenia to help them understand schizophrenia better,
improving their attitudes towards schizophrenia and making them better able to deal with
it.
Family therapy includes the schizophrenic individual as far as possible. During sessions
schizophrenics are encouraged to talk to family members and identify what sort of support
they find helpful and what type of communication they find stressful. Family members are
encouraged to listen to each other and openly discuss problems and potential solutions. The
very nature of schizophrenia means that schizophrenic individuals may be suspicious about
others (delusions of persecution) and family therapy aims to combat this.
, Family therapy is usually undertaken as a combination therapy alongside antipsychotic
medication. By reducing stress in this way, family therapy attempts to help schizophrenics who are
in remission continue to comply with their medication and avoid relapse.
Key study: Pharoah et al 2010.
Procedures (A01)
Pharoah et al reviewed 53 studies (meta-analysis) of the effectiveness of family therapy. Studies
were conducted in Europe, Asia and North America. The studies compared the outcomes of family
therapy to “standard” care (antipsychotic medication alone). They concentrated on studies using
randomised controlled trials.
Findings (A03)
Compared to the control group, individuals experiencing family therapy:
✓ Were more likely to comply with medication
✓ Were less likely to relapse and be readmitted to hospital in the 24 months after treatment
However, results were inconsistent in terms of improvement in mental state and social
functioning (holding down employment and living independently). Some studies showed
improvements, others did not.
A03 – Family Therapy
Point Evidence Conclusion
A strength of using family Pharoah et al’s meta- The lower relapse rates
therapy to treat analysis compared the identified in Pharoah’s
schizophrenia is that the effectiveness of family study suggests that family
study by Pharoah et al therapy vs antipsychotics therapy is an effective
suggests that it is an alone in 53 studies. treatment for
effective form of treatment. Pharoah et al found that schizophrenia.
individuals experiencing
family therapy were more
likely to comply with their
medication and less likely
to relapse and be
readmitted to hospital.
Further support for the As Pharoah conducted a The population validity of
effectiveness of family meta-analysis of 53 the data gathered suggests
therapy comes from the studies with a large that it is possible to
methodology used by sample size of patients, the generalise Pharoah et al’s
Pharoah et al. data gathered and findings and conclusions
conclusions reached apply and this further supports
to a significant sample of the effectiveness of family
therapy.
