Psychosocial Treatment for Schizophrenia For most people with schizophrenia, the combination of psychopharmacological and psychosocial interventions improves outcomes. The most recommended therapy for schizophrenia then is a combination therapy-medication and psychosocial intervention. Several psychosocial treatments have demonstrated efficacy. Both CBT and family intervention will be reviewed. Psychosocial treatments should be tailored to the needs of the patient. It is critical for persons with schizophrenia and their families to be provided with education about their illness.
Cognitive-behavioral therapy (CBT) for schizophrenia draws on the principles and intervention strategies developed for anxiety and depression. Links are established between thoughts, feelings, and actions in a collaborative and accepting atmosphere Agendas are set but are used more flexibly than in traditional CBT. Therapy generally lasts between 12 and 20 sessions, but can go longer or shorter depending on the patient’s needs.
Phases in CBT for Schizophrenia/psychosis Assessment-Allow the patient to express their own thoughts about their experiences. Rating scales can be used to monitor progress. Share results with the patient as well as thoughts on cause and maintenance of symptoms. Engagement- Draw the patient’s understanding of their situation and ways of coping. Therapist should show empathy towards patient’s perspective and distress and state that they can work together to develop useful explanations. Warmth, genuineness, humor, and empathy are important to use.
Sessions of CBT Cognitive conceptualiztion, including relationship of behavior to automatic thoughts. Goal setting Normalization is critical to help make psychotic experiences less debilitating. This includes educating the patient that others can have unusual experiences which can in turn reduce their anxiety. Evaluate the automatic thoughts together with the patient. However, do not challenge the psychotic symptoms (delusions). Develop alternative explanations and coping strategies. Help the patient develop rational thoughts about their symptoms (delusions, hallucinations.)
Family Intervention Early family therapists investigated the role of the family in the development of schizophrenia in one of the family members. This helped establish family therapy in the field. Early explanations for the development of schizophrenia in a family member have been found to be overly simplified or incorrect (double-bind theory). Schizophrenia eventually came to be known as a biological disorder however family work is still considered to be critical in helping the family with with communication and emotional issues and to provide psychoeducational information that helps the family cope with the disorder.
Psychoeducational Family Therapy Family therapy for families dealing with schizophrenia avoids blaming the family or trying to change dysfunctional family dynamics. The focus of the family therapy is on helping all family members, including the schizophrenic, overcome obstacles to family functioning. This includes addressing expressed emotion and improving nonjudgmental communication. Family therapists teach coping skills to families. They validate families for the stress they experience daily and that makes them vulnerable to dysfunctional family functioning. Families are offered support as they learned how to handle the stress and strain on the family and thus reduce the likelihood of relapse.
In recent years, briefer inpatient hospitalization stays have become the norm for patients with schizophrenia. Patients are often discharged while only in partial remission from their psychotic symptoms. The patient and their families are left to cope with continued symptomatology and problems with reentry into the home and everyday life. Therefore, outpatient family therapy programs also have a psychoeducational focus, which deal with education about the disorder, medication, strategies for coping, and how to avoid relapse.
Combining medication management and a family psychoeducational intervention offers families a therapeutic package aimed at reducing family stress and preventing symptomatic relapse in the schizophrenic member. When family members are not being blamed for the development of the disorder in one of their members it is easier to engage and retain them into treatment programs, thus increasing the likelihood of improved treatment compliance. Their willingness to work with the therapist is also increased if they understand that efforts will help them reduce the family’s level of emotional intensity so that relapse in the schizophrenic might be delayed or reduced in severity.
Medical Family Therapy Because schizophrenia can be considered a chronic disorder, a medical family therapy can also be utilized as an intervention. Medical family therapy consists of a coordinated effort by an interdisciplinary team to treat a disorder. The focus is helping families to cope better with a chronic illness, manage medication, communicate better with providers, and accept that the illness may not be cured. This model for family therapy replaces the traditional medical model that focuses exclusively on a sick individual receiving care to one in which the family becomes a key component to the caregiving system. It seeks to draw out the family’s strengths so as to enhance coping. Therefore, both psychosocial factors and biological interventions play an important role in improving outcomes for the family member with schizophrenia and the family.