Schizophrenia is defined as a mental condition in which a person shows two or more of the symptoms like delusions, hallucinations, disorganised speech, grossly disorganised or catatonic behaviour and negative symptoms, for at least six months. And schizophrenia can easily be mistaken with other similar mental disorders like schizophreniform, schizoaffective disorder and schizophrenia spectrum. Schizophrenia is considered as one of the domain of the schizophrenia spectrum whereas schizoaffective disorder is distinct from schizophrenia because of presence of mood swings between extremes of elevated mood and depression in schizoaffective disorder. Similarly, schizophreniform is distinguished from schizophrenia by the duration of presence of psychotic symptoms or in other words by duration of presence of symptoms being less than 6 months in case of schizophreniform (American Psychiatric Association, 2016).
Schizophrenia can impair social, occupational, educational aspects of a person`s life and also affects the overall health and wellbeing along with self-care. Early diagnosis and management of the illness can help reduce the risk of suicide which has been found to be extremely high in patients with schizophrenia due to inability to cope with the psychological changes affecting the interpersonal, academic or occupational functioning. Furthermore, development of schizophrenia is classified into three stages; prodromal phase, acute phase and continuous symptoms and are manifested by negative symptoms, positive symptoms and resistance to conventional antipsychotic medications, respectively (Katie Evans, Debra Nizette, and Anthony O`Brien, 2016, p.340-365). This essay will discuss about two non-pharmacological treatment options for schizophrenia; Cognitive Behaviour Therapy (CBT) and Family Intervention, with major focus on CBT and less focus on family interventions.
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Cognitive Behavioural Therapy (CBT) is gaining more popularity these days because of its advantages over the antipsychotic medications and their associated severe adverse effects such as weight gain, blank mask-like expressions, drooling, akathisia, tardive dyskinesia, etc., which are also found to be the main reason behind medication non- compliance in patients with schizophrenia.CBT acknowledges the fact that recovery from schizophrenia is supported by emphasis on the topic of living well by building personal resources and skills, identifying personal strengths or developing a positive identity. CBT is a scientific approach and has number of assumptions and principles which enforces the overarching principle that cognition causally influence emotional experiences and behaviours (Stefan G. Hofmann, Gordon J.G. Asmundson, 2017). CBT`s principles are believed to have been derived from behavioural, cognitive and social learning theories which are associated with exposure therapy, constructivism theory and social learning theory, respectively. Behavioural interventions like cognitive training have been found effective for individuals with cognitive deficits as a major symptom of schizophrenia and have significantly reduced the impact on their social and occupational functioning (Stefan G. Hofmann, Gordon J.G. Asmundson, 2017). CBT helps to direct thoughts and perception of an individual in such a way that the behaviour of individual is changed to adjust the symptoms of the illness and prevent it from recurring in future. Therefore, CBT helps to develop positive habits which may or can influence their symptoms and drives the focus from illness towards the strengths and abilities of the person, which ultimately helps to improve the self-esteem and goal achievement of recovery. Identifying what are the stressors and triggers of distress or manifestation of symptoms and developing coping mechanism or ways to avoid them is taken as a crucial theme while developing care plan under CBT and person-centred care and recovery-orientated practice are also considered. During a study on CBT-based adherence intervention with a PE-based psychotherapy among patients early in their course of illness, CBT has been found out to be more effective intervention to address medication adherence in early phases of schizophrenia. (Peter Weiden, Douglas Turkington, Jennifer Beaumont, Marko Mihailovic, 2019). Studies conducted on effectiveness of CBT have concluded that CBT is not the first-line treatment for schizophrenia but can contribute as enforcement on prevention of relapse and can produce or magnify the therapeutic implications if used along with other pharmacological treatment options. For example; weight gain due to side effect of antipsychotic medications can be acknowledged and managed properly with development of compensatory behaviours like regular exercise, scheduled eating habit, etc., which ultimately prevents or reduces the risk of medication non-adherence (Carmen Valiente, Regina Espinosa, AlmudenaTruchartAlmudenaTrucharte, JuanNieto, LeticiaMartínez-Prado, 2019).
Despite of these advantages, CBT however has been proven to be ineffective against negative symptoms of schizophrenia such as apathy, lack of emotion, poor or nonexistent social functioning, etc., and CBT has also been found to be not that effective but somehow significant in prevention of transition into psychosis in those patients who were at high risk (Jauhar, S., Laws, K., & McKenna, P. (2019). Therefore the efficacy of CBT in treatment of schizophrenia still remains as a subject that needs further research on.
Similarly, family interventions (FI) are found to be remarkably effective in preventing relapse and reducing the severity of manifestation of symptoms of schizophrenia and therefore recommended along with CBT in current treatment guideline, The National Institute for Clinical Excellence (NICE). (Gillian Haddock, Emily Eisner, Candice Boone , Gabriel Davies, Catherine Coogan, and Christine Barrowclough, 2014). The key elements of FI were found to be common therapeutic factors along with some coping skills training and education on the mental condition and the management option, provided by the family heraist or a mental health nurse or some other relevant health professional and are proved to be effective in promoting cognitive and emotional changes in family members and the carers. Grácio, J., Gonçalves, P. M., & Leff, J. (2018).
Family intervention (FI) may consist of psycho-education, stress reduction, emotional processing, cognitive reappraisal and structures problem solving. A therapeutic relationship is made with the care givers or the family members of the affected one and professionals delivering these interventions must have significant training in delivery of the intervention and must also take into account of the whole family`s preference for either single-family intervention or multi-family group intervention. Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). Although family psycho-educational interventions including FI have an impressive evidence based results in treatment of schizophrenia, challenges in their implementation including the engagement of families is equally prevalent. Understanding the experiences of families regarding the FI is considered as a vital factor that could possibly increase the involvement of family members and help to eradicate the challenges of implementation of FI.
To conclude, anti-psychotic medications are the most preferred and most used treatment of schizophrenia, but because of their side-effects and adherence issues, alternative/supportive methods like CBT and FI are gaining more popularity are being studied and accounted as significant methods in treating schizophrenia.
Reference list
- American Psychiatric Association(2016). Diagnostic and Statistical Manual of Mental Disorder. Retrieved from https://dsm.psychiatryonline.org/pb-assets/dsm/update/DSM5Update2016.pdf
- Evans, K., Nizette, D., & O'Brien, A. (2016). Psychiatric and mental health nursing. Retrieved from https://ebookcentral.proquest.com
- Stefan G. Hofmann, Gordon J.G. Asmundson,The Science of Cognitive Behavioral Therapy,Academic Press,2017,Pages 591-610,ISBN9780128034576,https://doi.org/10.1016/B978-0-12-803457-6.00036-2.(http://www.sciencedirect.com/science/article/pii/B9780128034576000362)
- Peter Weiden, Douglas Turkington, Jennifer Beaumont, Marko Mihailovic, S98. Can CBT-based interventions address medication adherence in early phases of schizophrenia? results from a pilot rct comparing a cbt-based vs. psychoeducation-based intervention, Schizophrenia Bulletin, Volume 45, Issue Supplement_2, April 2019, Pages S343–S344, https://doi.org/10.1093/schbul/sbz020.643
- Carmen Valiente, Regina Espinosa, AlmudenaTruchartAlmudenaTrucharte, JuanNieto, LeticiaMartínez-Prado, 2019). The challenge of well-being and quality of life: A meta-analysis of psychological interventions in schizophrenia. Schizophrenia Research. https://doi.org/10.1016/j.schres.2019.01.040
- Jauhar, S., Laws, K., & McKenna, P. (2019). CBT for schizophrenia: A critical viewpoint. Psychological Medicine, 49(8), 1233-1236. doi:10.1017/S0033291718004166].
- Grácio, J., Gonçalves, P. M., & Leff, J. (2018). Key Elements of a Family Intervention for Schizophrenia: A Qualitative Analysis of an RCT. Family Process, 57(1), 100–112. https://doi-org.wallaby.vu.edu.au:4433/10.1111/famp.12271
- Caqueo-Urízar, A., Rus-Calafell, M., Urzúa, A., Escudero, J., & Gutiérrez-Maldonado, J. (2015). The role of family therapy in the management of schizophrenia: challenges and solutions. Neuropsychiatric disease and treatment, 11, 145–151. doi:10.2147/NDT.S51331
- Haddock, G., Eisner, E., Boone, C., Davies, G., Coogan, C., & Barrowclough, C. (2014). An investigation of the implementation of NICE-recommended CBT interventions for people with schizophrenia. Journal of Mental Health, 23(4), 162–165. https://doi-org.wallaby.vu.edu.au:4433/10.3109/09638237.2013.869571
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