treatments
Psychotherapy
Introduction
Currently, psychotherapy is not the primary treatment for schizophrenia. Medications (antipsychotic agents) are considered to be the principle treatment for this disease, but psychotherapy can be helpful. There is increasing evidence that combining these modalities may represent the most effective solution for addressing all aspects of a patients illness.
A review article1 by Jack E. Scott and Lisa B. Dixon examines the impact of dynamic and supportive psychotherapies (individual and group) and psychosocial skills training on clinical and social outcomes for individuals with schizophrenia. They note that the few controlled trials completed previously exhibit serious methodological problems that make them difficult to generalize. They also note that reality-oriented approaches appear to be superior to dynamic, insight oriented psychotherapies. They also conclude that with psychosocial skills training models, target skills can be trained and maintained over time.
Types of Psychotherapy
Psychotherapy can be categorized as individual, group and family therapy. It can be further divided into a variety of types. They include “Cognitive”, “Behavioral” or a combination of the two, “Cognitive-Behavioral” therapy. Usually considered a part of other therapies, supportive therapy validates the client’s illness and concerns. It also helps the client identify and utilize support from individuals and programs.
Other strategies that can be considered to be other types of therapy include:
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Behavioral Skills Training -
Stress Management Training
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Assertiveness Training
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Communication Skills Training
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Problem Solving Skills
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Individual and Family Education
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Rehabilitation
Cognitive-Behavioral Therapy
Cognitive psychotherapy, when combined with specific behavioral strategies, has been shown to be the most effective form of psychotherapy for treating depression, panic disorder and schizophrenia. Group cognitive-behavioral therapy can also be very beneficial in treating substance abuse disorders. AA (Alcoholics Anonymous) and ALANON meetings are an example of this form of therapy utilized to treat patients with substance abuse and their families.
The underlying theory behind this form of therapy holds that individuals often have unrealistic views and expectations for themselves, the people around them, and the world in general. This is particularly true in schizophrenia, where distorted perceptions and disorganized thoughts alter individuals views. Cognitive therapy challenges these illogical assumptions and helps clients examine and restructure their perspectives.
The behavioral component of cognitive-behavioral therapy encourages clients to alter their behavior where it is inconsistent with recovery or is causing problems in their lives. It is generally a part of most psychosocial rehabilitation programs. There is an emphasis on what behaviors are therapeutic and adaptive. In other words, how behaviors lead to improvement in terms of satisfaction (hobbies or other recreation); how they may lead to improvement related to occupational or social functioning; or how they may assist clients in avoiding specific problems.
Stress Management Training
This modality helps clients devise and employ strategies for reducing or avoiding stress. Situations that are inclined to generate stress may be identified and a plan developed to avoid those situations. When stress can not be avoided, the client may utilize techniques to reduce the stress, such as relaxation techniques or recreation or social diversions.
Assertiveness Training
Clients learn how to stand up for themselves so that they can avoid situations where they may be exploited. Examples may include requests for money or cigarettes. This also allows them to make the most of doctor’s appointment where they may feel intimidated. As they become more assertive, they are better able to relate symptoms and side effects and criticize current treatment, when it does not meet their expectations. In general, it makes them more effective in their dealings with all the professionals who are part of their treatment team as well as family members.
Communication Skills Training
Clients learn how to communicate more effectively by critically examining what has and has not worked for them in the past. They may “role play” certain scenarios with a therapist or within a group until they are able to more effectively verbally deliver questions or statements that are consistent with their goals.
Problem Solving Skills
Clients identify specific problems and formulate new means of solving those problems. The therapist may gently guide them in the right direction or group members may share ways in which they solved the same or similar problems. It is hoped that with time and experience, the client will learn to generalize effective schemes so that they may be used to solve new problems.
Education
Education is utilized for both clients and their families. They each learn about the illness in terms of symptoms, treatments, available resources, and coping. It is especially important to learn about how specific symptoms compromise a person with schizophrenia’s ability to function and about the pitfalls associated with relapse.
Rehabilitation
Rehabilitation involves all of the modalities other than medications that may assist clients to overcome obstacles that impede their progress in the areas of social, occupational, financial, and recreational functioning. Clients develop knowledge and skills related to transportation, money management and socializing.
Self-Help
Self-help can not be underestimated. Whether it consists of reading or other materials the client may make use of or self-help groups, this represents an important resource for anyone with schizophrenia or for their family. Self-help groups provide ongoing support and a sense that other people are struggling with the same problems that an individual or family faces. Groups of families or patients have a stronger voice than one alone may possess. Collectively, they are better able to affect changes in legislation, solicit research and available treatments, and combat the stigma associated with this illness.
Who Is the Therapist?
In virtually all of these instances the “therapist” may be one of any number of individuals. It may be a psychotherapist, a social worker, a psychiatrist or other doctor. It may be an addictions specialist or a nurse. The ACT (Assertive Community Treatment) model makes use of all of these individuals to deliver therapy. The ‘therapist” may also be an individual who is part of a group or the group itself.
1 Schizophrenia Bulletin, 21(4): 621-630, 1995.
(Sources: The author’s knowledge base unless otherwise noted.)
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