Transcript Schizophrenia: Psychological Treatments File

What do we need to know?
0 What are they?
0 What do they do?
0 Are they effective?
0 Are they appropriate?
Behavioural Therapy (and it’s sub
types)
0 What do we know about behavioural therapy?
0 What two concepts is it based around?
0 Behavioural therapies are not used as widely as
biological treatments. Why might his be?
Token Economy
0 This type of therapy is mainly used on patients who
are institutionalised and is a method of helping them
to manage / control their impulses and behaviour.
0 Patients are given coloured counters which can get
them privileges like cigarettes and watching TV.
Allyon and Azrin 1968
0 Female patients with schizophrenia had been
hospitalised for an average of 16 years and were
rewarded for actions like making their beds /
brushing their hair.
0 On average the number of ‘good’ acts increased from 5
to over 40 with the introduction of token based
rewards such as TV and extra canteen trips.
Paul and Lentz 1977
0 Used a token economy with patients hospitalised with
long-term schizophrenia.
0 Patients developed social skills and work related
skills. They became better at self care and their
symptoms appeared reduced.
0 What made these results even more interesting was
concurrently the drug doses of these patients was
reduced.
0 After 4 ½ years 98% of patients in the token economy
half been released compared to only 45% of those
who had been given no specific treatment.
Dickerson, Tenhula and GreenPaden 2005
0 Reviewed 13 studies of token economies, benefits
were reported in 11 of these.
0 It was noted that token economies are beneficial
when used in conjunction with drug therapies and
psycho social therapies.
Are Token Economies
Effective?
0 They were one of the earliest forms of psychological
treatment to actually show positive effect.
0 They seem reasonably effective in patients where all
else has failed and do seem to increase the frequency
of ‘good’ behaviours amongst patients.
But…
0 Good behaviour quickly ceases when the rewards go
away which makes this therapy hard to transpose into
the outside world.
0 Hallucinations, disorganised speech and delusions
have not been shown to improve from this therapy.
0 It has been argued that patients in token economies
merely mimic ‘normal’ behaviour and do not actually
believe it…
0 It is hard to quantitatively measure improvements in
an ecologically valid fashion…
Are Token Economies
Appropriate?
0 Negative symptoms include catatonic states and lack
of motivation, Token economies provide the
motivation to improve these kinds of symptoms and
can be a powerful tool.
However…
0 ‘Desired’ behaviours are decided in most cases by the
hospital or institution, what are the ethical concerns with
this?
0 Token economies cannot control positive symptoms so
well or focus on the biomedical explanations of the
condition.
0 In reality not many patients with schizophrenia actually
live in institutions anymore… It is hard to create token
economies in the real world as we cannot have sufficient
control in the environment.
0 The effects of token economies are relatively short term
and artificial. The dot seem to translate well to the ‘outside
world’ and so the benefits may not necessarily last…
Exam Tips
0 How effective and appropriate are treatments across
ALL the symptoms.
0 Consider the patients level of functioning when
assessing this…
0 How effective is the treatment in regard to relapse
rates?
0 What is the motivation from patients to use the
treatment / the drop out rates?
0 Can the treatment be fully understood?
0 Ethical issues surrounding the treatment