Psychosocial Treatments for Schizophrenia
Successful treatment of schizophrenia depends on a regimen of both drug and psychosocial support therapies. While antipsychotic medication can help control the symptoms of psychosis associated with schizophrenia, it cannot help the person find and maintain a job, establish effective social relationships, increase their coping skills, or teach them to communicate well with others. Poverty, homelessness and unemployment are often associated with this illness, but effective treatment can prevent this. If the person finds appropriate treatment and complies with it, they can make a full recovery. However people coping with the onset of first episode schizophrenia require all the support their family, community and treatment team can provide.
Psychotherapy and Psychoeducation
Therapy for schizophrenia focuses on improving cognitive functions such as:
- Social skills
- Uncovering and modifying negative self-appraisals
- Coping with persistent symptoms
- Managing stress
While psychotherapy is not the treatment of choice for a person with schizophrenia, it is useful as an adjunct to medication, helping the person to adhere to medication, learn social skills, and support and encourage activities in their community. This can include education, modelling appropriate behaviour, limit setting, and reality testing. Supportive group therapy can be especially helpful in decreasing social isolation and increasing reality testing (retrieved from http://www.mentalhelp.net/).
Cognitive Behaviour Therapy
Cognitive behaviour therapy (CBT), which was originally developed to treat depression and anxiety by targeting maladaptive beliefs and behaviours thought to initiate and maintain distress, has been recently applied to the treatment of psychosis, in particular delusions and hallucinations. Research shows a demonstrated effect with medication-resistant delusions and hallucinations and other acute symptoms. In these cases, CBT has been shown to reduce distress, hospital admission time, and relapse rates (Kingdon & Turkington, 1994).
CBT is primarily used to develop coping strategies for dealing with symptoms. The aim of CBT with psychosis is to gradually promote flexibility in interpreting delusional beliefs and to generate and test alternative explanations, thereby significantly reducing distress and disability resulting from symptoms.
This approach considers delusional beliefs and beliefs about hallucinatory experiences as being on a continuum with normal beliefs, subject to the same biases and processes of evidence, and therefore changeable. In this way, CBT can be useful in acute stages of illness, rather than only when other treatments have failed. However establishing a collaborative and trusting therapeutic relationship can take time (Tarrier, Yusupoff & Kinney, 1998).
This type of treatment is aimed at engaging families as active participants in treatment and improving their coping capacities. It encourages the family to convene a family meeting whenever an issue arises in order to determine the exact nature of the problem, to list and consider solutions, and to select and implement an agreed solution. Family treatments target such issues as:
- Education about the disorder
- Communication and problem solving
- Agreeing on and pursuing goals without becoming emotionally over involved
- Utilising resources in the community
Supportive family therapy can reduce relapse rates to below 10%, whereas patients who do not receive this treatment typically have a relapse relate of approximately 50 to 60% (retrieved from http://www.mentalhelp.net).
Social skills training
Even though symptoms are successfully controlled my medication, one way of helping to improve functional outcomes is through social skills training. Individuals who suffer from Schizophrenia often have poor interpersonal skills.
Social skills training aims at enabling client to acquire skills that they may need in their every day-today functioning such as employment skills, communication skills, relationship skills, personal hygiene skills and skills in managing the disorder’s symptoms and medications. Clients get to practice their new learnt skills through role playing with the therapist before moving to natural settings. Individuals who receive social skills training are less likely to relapse and need hospital treatment (Kurtz & Muesser, 2008; Butcher, Mineka and Hooley, 2007).
Relapse prevention planning occurs following hospitalisation in order to educate the person and their family to recognise early warning signs of schizophrenia and prepare for high risk situations (Phillips, Yuen, Pantelis & McGorry, 2002). A plan of action is decided and agreed upon that will be followed if early warning signs become apparent.
This assists the person to avoid moving from a prodromal phase into the onset of acute symptoms. Education about the illness and identification of the person’s particular triggers for relapse, combined with specific coping strategies and the inclusion of the person’s social network, appears to assist in the prevention of relapse.
This is often carried out by a case manager in the community who helps the person make plans for the future. The case manager also ensures the person has access to community services they may need and provides support and encouragement for resuming life in the community.
The aim of is to prevent new cases of the disorder from ever developing. Research conducted in the past decade indicates that schizophrenia is due to a genetic predisposition and environmental stressors early in a child’s development (during pregnancy and birth, and/or early childhood) which lead to subtle alterations in the brain that make a person susceptible to developing schizophrenia (http://www.schizophrenia.com).
Improving obstetric care of women with schizophrenia and first degree of relatives of individuals with Schizophrenia known as primary intervention may help prevent future development of the disorder (Butcher, Mineka & Hooley, 2007).
Successful prevention encompasses both successful identification of who is at high risk and successful treatment (Doskoch, 2000). The secondary prevention involves early intervention with people that are at most risk of schizophrenia. The challenge however is accurate identification of such individuals due to current flawed screening tests (Butcher, Mineka & Hooley, 2007).