Study of the Effectiveness of Psychological Intervention - Essay Example

? Psychological interventions on a psychotic problem The world has had a series of challenges as far as medical health and educationpsychology are concern. As humans struggle through the ever increasing myriad of challenges, one thing they have to content with being that nature provides lots of opportunities, most of which remain unexploited. Conventionally, scientific innovations coupled with extensive research are the answers to all the common problems human beings are made to experience. Therefore, humans should stay on track especially the education and medical professionals for them to unravel the unforeseen emanating health/ psychological problems. In the world, today, one thing that is clear about human problems is that they are either emotional, social economic, or mental. This implies that most of human disorders are either due to the psychological effects or occur due to medical reasons. Health related problems are classified as either physical or mental basing on the nature of occurrences (Fuller, E. 2007). Mental health problems include Psychosis, anxiety, depression, and alcohol while the physical health related problems include diabetes, cancer, and cardiac (Whitney, H. 2005). These two groups have psychological part associated with them. This paper explores the psychological effects associated with these heath problems with utmost concerns being, the application of two different Psychological interventionism in dealing with mental health, or physical health problem. Future interventions for the therapy are also issues to be analysed considering their functions in early interventional service and their prevention of relapse. Much emphasize is put on integration of the psychological therapies into the comprehensive service. Additionally the paper explores the contrast and comparison of the main principles and evidence that is based on the effectiveness of two psychological intervention of psychosis as a mental health condition. Thirdly, paper reflects critically on the results of different types of evidence, the interventions and recommendations for the implementation of the chosen interventions in clinical practice. The most likely questions that need to be responded to, therefore, in this paper are: what are psychological interventions? How effective are the two psychological interventions? How do the two interventions compare and contrast? Given a certain condition like psychosis, how do different types of evidence tell about the condition? What are the recommendations for the implementation of the interventions in clinical practice? Psychosis which is, a condition due to mental health occurs when the mind works abnormally (Xavier, A. 2000). A person affected with this condition is prone to loss of his contact with reality. Such a person is called a psychotic. This condition is given to the severe psychological ailments where by hallucination, impaired insight and delusions do occur. A complex psychological or neurological could be the cause of the alteration of signals as observed in cases of psychosis. In individuals who may appear to be normal, ligarnds that are exogenous can precipitate symptoms of psychosis. In other cases, some antagonistic receptors such as ketamine can lead to psychotic symptoms as observed in schizophrenia cases. In some cases, the prolonged dose of psycho stimulants could change the function of the brain especially for such cases as manic phase in bipolar disorder (Jack, M. 1998). Psycho stimulants, for example, in an individual who is already prone to psychotic thinking, could lead to varied symptoms. This includes delusion beliefs and the persecutory. The psychological demand for therapy for psychosis has to a greater margin been recognized. Recently two of the psychological approaches have come up from the prevailing psychological approaches for effective therapies. The two psychological approaches are so far termed the strongest evidence. These psychological approaches are the family intervention, and cognitive behavioural, therapies. The theoretical perspective of the two approaches is described under a broad bio psychosocial framework that is stress- vulnerable. The summarised effective evidence is derived from the recently made schematic review results of cognitive behaviour therapy (CBT) and family intervention (FI). CBT helps in reduction of symptoms whereas, FI reduces the relapse (Jack, M., 1998). The acknowledgement of Psychosis has increasing considerably. This happens because of varied reasons. To start with, antipsychotic medication is the mainstay of psychological treatment and it leads to massive benefits, promising outcomes, and it is partially effective. Secondly, poor reliance on the antipsychotic medications is something to content. On average, about seventy percent of patients end up not taking the medications according to the doctor’s prescription. Thirdly, a large number of individuals do relapse despite the antipsychotic long term medication. Last but not least, although the medication may better certain symptoms, it does not give impact on a wide range of patients’ concerns in their ailments. Most patients may experience a variety of disabling conditions that might not remedy, especially of a cognitive or a social nature. Two psychological approaches have specifically come up as an effective therapy that has to be considered in the treatment of persons who have schizophrenia. These are the CBT and the FI approaches. The evidence derived from the random controlled trials of these approaches has been reviewed using the meta-analytic process. For instance, in United Kingdom, the evidence that is based on guidelines of the treatment of schizophrenia has been developed. This did review the evidences for the psychological treatment and three psychological approaches. The three are Supportive counselling, psychodynamic therapies, and the psycho education therapy. A close examination of evidences indicates clearly that FI and CBT have a strong evidence base that can be used for effectiveness. Conceptualizing psychosis in a stress-vulnerable framework offers a positive rationale for action. These vulnerable factors are cognitive biases, biological factors that are of genetic or neuro-development origin and emotional difficulties like low esteem and the social anxiety (Hatfield, B. 1993). These stressing elements, for example, hostile environment, psychoactive drugs, stressful events in life, do tamper with not only the cognitive process but also the emotional process. This, therefore, precipitate changes; depression, difficulties in information processing and hallucinations. These disturbing changes are interpreted by a patient, and the result of the meaning of the interpretation to the self leads to psychotic symptoms and processes that are similar to this maintain psychosis. The treatment and experiences and consequence of psychosis provide more maintaining factors like the reluctance to medication, a mood that is depressed and hopelessness. It is, therefore, apparent how the psychological therapy would be suit for addressing the vulnerability factors, stress and beneficial in treating psychosis. Cognitive Behavioural therapy draws two sources. That is the stress-vulnerability model of psychosis and cognitive therapy or theory for emotional disorders. CBT central focus is on the experience of psychosis. Its focus is on the symptoms and individual attempts in the understanding of the symptoms. Its main objective is to help a patient come to the realization of the psychosis that is less distressing, and that assist a patient in prevention of reoccurrence or the managing of the unwanted experiences and in the development of a full and satisfactory life. In style, this approach is an inquiring and collaborative approach that has goals of working with individuals in order to obtain a shared understanding. The therapy context entails identification of main beliefs and a review of evidence for the beliefs, establishing thinking biases and getting a relation of the thoughts to the mood and the behaviour of an individual. A psychotic person is encouraged to attempt new methods of thinking or behaving in exercises that are between sessions. Standard cognitive therapy approaches, however, are modified in order to take care of the individual needs of persons with psychosis and to be moved to the psychotic cognitive model and the stress-vulnerable framework. Some of these modifications may include: Taking a relatively long time in the initial therapy stages, so that those people who may appear to be suspicious can be engaged, and having flexible session time and length, so that the sessions are not perceived to be stressful. In psychosis, CBT is administered as a therapy that is structured and has singularly limited time, despite the flexibility. Studies give out approximately twenty sessions that can be offered weekly up to a fortnight in a period of nine months. It also ranges from about 10 to 30 sessions in a period of three months to a period of two years. CBT is not only administered alongside other medications or services, but also to individuals who do not take part in medications or services. It is also incorporated in the package of care. Family intervention, on the other hand, is a psychological approach that also deals explicitly with the stress- vulnerable model of psychotic (Woolis, R. 1992). This approach is derived from pioneer work of Leff, Vaghn and Brown in the identification of roles of the aspect of a family’s emotional atmosphere, for example, hostility, expressed emotion and criticism in relapse contribution. The main objective of FI is to reduce the relapse risk in a vulnerable person, by changing a possible source of stress. In this respect, a family include those who have an emotional connection to a psychotic person. In the discussion of FI, the basic assumptions are specified and conluded. These are: Schizophrenia is a biology origin illness in a model of stress-vulnerability. Family is presumed to be an invaluable ally in care, formation of a therapy alliance with an individual’s family is also essential, emphasis is on collaboration and openness, family has needs and strength and FI approach are offered along other medical interventions. The main objective of FI is to improve an individual’s family atmosphere and also to reduce relapse. It involves components like providing information on psychosis, improvement and coping with the psychotic patient by identification of problems and solutions, and giving help to the family members so that they can communicate positively. Some family interventions aim at reduction of distress that is felt by the care givers. In such cases, a family is seen with no identified patient. Other FI involve communication training that employs psychodynamic principles. The frequency and the duration within which FI is delivered are variable. Family intervention is given for one year though this may be ranging from few months up to three years. Evidence based on effectiveness. `Cognitive Behavioural Therapy. The cognitive, behavioural, trials that are random, and controlled, were reported in 1990 for the first time and the evidence base of the research, though small is developing rapidly (Nasar, S. 2001). Meta analysis of the eight controlled trials was reported. All patients in the trial were given antipsychotic medications, and the objective of the trial was to show unresponsive medication symptoms. These studies were conducted in UK, USA and Israel. Symptoms The review of Schizophrenia guideline discovered that CBT leads to reduced symptoms during the treatment and at the nine to twelve month follow-up (Wegkamp, P. 2004).. This finding did apply when the comparison of CBT and psychological intervention and comparison of CBT and usual treatment was made. Relapse and suicide. There was remarkably little evidence to establish whether CBT could lead to a reduction in suicide, having minimal cases of suicide reported. Apart from this, there was minimum evidence that could determine whether CBT could reduce relapse although there were some evidence that CBT could reduce relapse if it is administered for a longer duration of time; approximately duration of more than three months (Nasar, S. 2001). Other outcomes. CBT was realized that it was better the adherence to medication and, therefore, improve insight. There were also some evidences that it could lead to improvement of social functioning. Delivery methods. Some established evidence claimed that cognitive behavioural, therapy that is administered for a long period of time could be effective in the reduction of symptoms (Hatfield, B. 1993). It was also noted by reviewers that there was a stronger evidence for treating people who have symptoms that do persist than for treating people in the first severe phase of the schizophrenia’s episode. Family Intervention. A meta-analysis of output data obtained from eighteen random controlled trials of family interventions that involved about one thousand four hundred and sixty seven patients who had been diagnosed with schizophrenia. Some studies were conducted two decades ago. This study took into account the average age of individuals as thirty one years, with thirty one percent of the individuals being women. In the thirteen trials, the average number of admissions was 2.7. In this study, a different type of outcomes that was targeted by family interventions was reported. A report on suicide, readmission, family outcomes, medication adherence, and relapse was also given out. Readmission and relapse. It was discovered that there were strong evidences that family intervention reduces the rate of relapse, during the treating and during the follow-up activities that are approximately fifteen months after the end of the family interventions (Jack, M. 1998). Some evidence showed that family intervention is extremely effective in the reduction of relapse in cases where patients have symptoms that do persist and for patients who had recently relapsed. Other outcomes. Certainly, there were no any differences in the suicide rate between control treatments and family interventions. Some evidence was found that, adherence to medication is increased by family intervention and family interventions, on the other hand, reduces the care burden of family members, if this is given to single family (Woolis, R. 1992). However, there were minimum evidences that indicated that family intervention could decrease the psychotic symptoms. Delivery methods. The guideline report that analysed different delivery methods of Schizophrenia showed out stronger evidences of prevention of relapse if a long duration program or a large number of sessions are used (Miller, R., 2002). There was also strong evidence for the prevention of relapse, especially when the service user was part of the sessions. Systematic reviews demonstrate that, cognitive, behavioural therapy, and family intervention, under the research trial conditions, is remarkably effective for some major outcomes (Schiller, L. 1996). Following the principles of the two approaches, cognitive behavioural approach reduces the symptoms where as family intervention reduces the relapse rate. Both the two approaches do display some evidences for the benefit of some other certain outcome under given condition (Canto, S. 1998). For instance, cognitive behavioural, therapy is for relapse, social functioning, medical adherence, and insight, while family intervention is for the relative’s burden of care and medication adherence. The evidence that concerns cognitive behavioural therapy is to a greater extend, a United Kingdom based. It relates to those persons who have persisting symptoms, where as the evidence base of family intervention is international, and it is mainly obtained from persisting and relapsing groups of symptoms. Interventions. Early intervention. Evidence reviews have raised many questions. To start with, there are questions which of the parents would benefit from these methods. Considerable interest in treating and establishing early identification of persons with psychosis has increased globally. Having been stimulated by the pioneer works of McGorry in Melbourne, Australia, a movement that is the worldwide has come up to establish services that can be employed in early psychosis (Brooke, K. 2004). This include; early identification and treatment of persons with psychosis and treating persons with diagnosable psychosis at an early stage. Interventions in groups that have a higher risk, that were identified by being a psychotic individual’s first degree relative are a research base currently. Many CBT trials that are geared towards prevention of the psychosis transition, including or not including the antipsychotic medication doses, are in place. Reports that were made earlier do suggest that CBT intervention alone could delay the psychosis transition to a number of persons (Miller, R. 2002). In UK, for example, the first services that were set up incorporate the psychological approach like social and vocational programmes. The place of CBT and FI in these services is not clear. Evaluation of specialized services like those administered for early psychosis is still at an earlier age, without any trial episodes of services that are integrated though published will prove to be difficult (Steele, K. 2002). However, there have been some published trials of CBT and FI in the early psychosis of community service (Weiden, K. 1999). Trials that concern first treatment episodes did not yield positive findings. A study was carried out on the CBT approach, where one had a focus in the inpatient stay, while the other in the community follow-up, in which some patients were given episode services that were specialized, only showed temporary and modest benefits. However, a pilot study on CBT and FI considering the first episode patients who were in the adolescent inpatient, suggest some benefits that are clear in reducing symptom from CBT and the improvement of the social function of (FIAlda, A. 2005). Another study of an approach of individual psychosocial with FI, in both the cases of community and inpatient care follow-up phases, could not establish a specific benefit for reduction of relapse from family intervention. The principal reason that made psychological intervention not to find clear benefit is that a big proportion of the participants of the trial is improving with the medication. This additional benefit is considerably subtle and extraordinarily difficult to be detected. Alternately the benefit may not give out additional benefit in this particular stage, and resource has to be targeted towards the unique needs sub-groups. Relapse prevention. A group that experiences some repeated relapses is a second group that needs to be considered. This intervention is in contrast to those patients who have persisting symptoms that are stable. Such individuals have taken part in FI and CBT studies, and the evidence does suggest that these patients who have symptoms that persist have benefited from the two approaches (Noble, D. 1995). The patient obtained different outcomes that lead to the reduction of relapse and reduction of symptoms. The people who are at a higher risk of getting relapses have gone through a selection for family intervention studies. No cognitive, behavioural studies, for this group have been published. However, a recent report on such a study demonstrated a significant relapse reduction with the intervention of CBT that was designed for this reason. These reports together with evidences that are systematic do suggest a reduction of relapse with the administration of CBT, therefore, raising the relative benefits of CBT and FI in the reduction of relapse. Targets and other groups for intervention. There may be a group of other individuals with psychosis that the psychological intervention may of benefit for them. Many beneficial applications of the therapies are going through a development. Research shows that the benefits for the relevant group of individuals who have a dual diagnosis, did obtain it from a combination of FI, CBT and motivational interviewing approaches (Christopher, D. 2003). This is a contrast to a focus which was made on a particular sub-group, where by some cognitive behavioural, therapy approaches were targeted on specific outcomes. For instance, higher rates of post-traumatic disorders and traumas in individuals with psychosis have piloted an advanced CBT for the symptoms of PTSD in psychotic individuals; have proved to be promising and feasible. Different, specific, targets, where by CBT has been proved to be beneficial are insight and medication adherence. One other aspect that is still being developed is treating persons with depression and low self esteem due to psychosis. Dissemination and training. This is another intervention that is tremendously influential in helping persons with psychosis. FI and CBT were developed initially by qualified psychiatrists and clinical psychologists. It was developed considerably with the experienced clinical practice, research and therapy in psychosis (Lefley, J. 1993). Considering research trials that have established efficiency, the required intervention had to follow therapy manuals and the required supervisions have been intensive. These approaches have widely been disseminated a number of mental health officials who have trained backgrounds have continued this work. Some formal courses have been established in some countries though there is no clear agreement on the training required. Moreover, available evidence shows that training alone is less sufficient in ensuring the effective implementation. It is also extremely prominent in ensuring that the staffs have a chance of seeing patients and at the same time receiving skilled supervision. In comparison with CBT, FI has been established to be effective for relatively lengthy periods of time and many countries are attempting to do the dissemination of the FI into their routine practice (Adamec, C. 1996). Apart from the practical difficulties, in the delivery of interventions, another reason is that the family may have changed the nature of the family in other countries. Considering the urban settings like the countries in the North Europe, there is increasing evidence about the fragmentation of individual’s family ties. Europe studies on care of persons who have mental illness about two thirds of the people in Northern Europe do live alone (Alda, A. 2005). Family intervention can be administered by family members who do live together, if there are close in contact, but this cannot be said to be applicable when there is less care giving and contact. It is due to this reason that some cultures, individual therapies may be practical in many ways. Recommendations. Evidences ascertain that, FI are of benefit when it comes to reducing relapse to an individual with psychosis (Nymous, E. 2005). On the other hand, CBT is appropriate in reducing symptoms. The new application and different benefits as suggest the current research; both approaches will play a leading activity as a psychosis for the future Preston, D. 2000. Treating the ever changing early intervention field and substance misuse is among the many crucial areas that need to be developed. Apart from these, other targets that are used for these two approaches need not be neglected. For example, the prevention of relapse and treatment of trauma and depression should be put into consideration. Other relevant elements of therapy, provision of the social activity, medication, working programme and leisure activities should be emphasised in order to reach the achievement of the interventions. FI and CBT will fulfil the objectives of bettering the outcomes of persons with psychosis effectively, only when they are well integrated into the comprehensive services. References Aaron, T., 2007. Schizophreniac: Cognitive Theories, Research, and Therapy. New York: Guilford Press. Adamec, C., 1996. How to Live With a Mentally Ill Person: A Handbook of Day-To-Day Strategies. New York: John Wiley & Sons. Alda, A., 2005. Never Have Your Dog Stuffed : And Other Things I've Learned. New York: Random House. Brooke, K., 2004. I Think I Scared Her: Growing Up With Psychosis. New York: Xlibris Corporation. Canto, S., 1998. Childhood Schizophrenia. New York: The Guilford Press. 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