Comparative Analysis of Treatment Options for Schizophrenia - Essay Example

Running head: Treatment Interventions for Schizophrenia Name Xxxx Course Xxxx Lecturer Xxxx Date xxxx Treatment for schizophrenia This paper presents a comparative analysis of treatment options for schizophrenia. In a nutshell, his is a psychological disorder by which a patient has difficulties in differentiating between real and unreal, having normal emotional responses and think clearly. The paper addresses the difference between the terms effectiveness and efficaciousness as used in the treatment of psychological disorders. This sets a platform by which to comparatively analyse the efficaciousness of two evidence-based treatments for the disorder. It will analyse the efficacy for cognitive behavioural therapy vis a vis behavioural family therapy. Schizophrenia is a complex disabling mental disorder characterised by impairment and disruption of individuals’ normal thought processes, emotions and behaviours. The individuals also have disruptions with regard to seeing, hearing and processing information from the world around them. It affects children and adults, appearing at age five in the former or in teenage years. According to Tsuang, et al. (2011), schizophrenia is tremendously complex in its aetiology and presentation with much of its aspects such as development, origin, pathology and treatment being widely unknown. Indeed, there remains a lack of consensus about what this putative entity exactly means. It has been identified as a clinical diagnosis that has pathognomonic signs and symptoms yet there is yet to be a laboratory test for it. Consequently, the most contemporary approach of this disorder views it as a point on a continuum of abnormal psychological functioning of an individual, rather than perceiving it as a discrete entity (Tsuang, et al., 2011). Its clinical picture of signs and symptoms may be divided into two aspects: positive and negative signs and symptoms. Positive signs and symptoms refer to additional behaviors to the normal human repertoire whereas the negative ones refer to elimination of behaviors from this repertoire. Patients who are schizophrenic will often show signs of delusions, hallucinations, disorganization bizzare agitated behaviour and paranoia. Negative signs include avolition, alogia, anhedonia, attentional problems, negativism, flat or emotional unresponsiveness and catatonic stupor amongst others (Tsuang, et al., 2011; Castle & Buckley, 2008). There exists a myriad of treatments for schizophrenia and other psychological disorders with ranging differences for both efficacy and effectiveness Efficacious vs Effective Treatments In treatment of psychological disorder, there are two aspects by which treatment interventions are evaluated and compared: efficaciousness and effectiveness. There exists a myriad of treatments for schizophrenia and other psychological disorders with ranging differences for both efficacy and effectiveness. Efficacy refers to the potency or the ability of an intervention as assessed in a high control setting such as in research (Bower, 2003). Essentially, evidence-based interventions are tested for efficacy in highly controlled experimental conditions. Any treatment or intervention is efficacious to the extent that a subject in a clinical study is reported to be less dysfunctional or to have improvements than a person who has not received the treatment. Efficaciousness depends on the ability of clinical study to demonstrate internal validity by controlling the patients treated, standardizing treatments, random administration and use of control agents. They may also be referred to as empirically supported treatments given their research or study basis. Effective treatments comprise of the higher level of efficacious results. Essentially, effectiveness is concerned with potency of interventions in normal clinical and routine contexts (Bower, 2003). This is beyond trail stages and emphasizes on external validity and representativeness of the intervention. The improvements are seen over a wide heterogenous and uncontrolled population. As such, a treatment is effective to the extent that patients have significant positive effects from it (Trull, 2005). Numerous studies often report high efficacy for various psychological and pharmacological interventions. Along a continuum, some are least efficacious while other show high potency. However, the high potency does not always result in dependaple effectiveness. The challenge has always been in transforming efficaciousness into effectiveness for evidence-based clinical practice. Rosa-Alcázar, et al., (2008) indicates that despite confirmed results by various meta-analyses, there are studies with inconclusive and diffrential results for effectiveness in behavioral and cognitive approaches. Evidence-based treatments for schizophrenia Schizophrenia has been treated using both pharmacological and psychosocial therapies. Pharmacological interventions entail the use of drugs whereas psychological interventions involve attempts to change an individuals feelings, thoughts and behaviors. Medications have been a mainstay intervention for the condition. Cognitive behavioral therapy has received much attention in evidence-based practice especially due to its wide use in treating depression, anxiety and other psychological disorders such as eating disorders, and phobias (Allen & Dalton, 2011; Cuijpers, et al., 2008). Essentially, it aims at modifying a patient’s non-adaptive thoughts, processes, and beliefs by recreating the link between the thought and emotional processes and self monitoring of thoughts, as well as teaching the patient on how to deal with distress (Addington & Lecomte, 2012). A cognitive approach would be a reasonable approach since the disorder is associated with cognitive baises that are related to hallucinations and delusions. It helps the patient to develop self healing mechanisms by retraining their cognitive processes evaluate problematic thoughts and subsequently cultive positive adapative responses. Its theoretical approach is based on the cognitive model which posits that a patient’s perception of self, the world and the future get distort negatively influencing emotions and behavior leading to maladaptive processes. This approach has high efficacy in dealing with psychotic symptoms. However, for it to have optimal efficacy and effectiveness in schizophrenia, it is required that the model and therapy are adapted to the special needs of schizophrenic populations (Marcinko & Read, 2004). In the cognitive therapy the model is collaborative between the patient and the therapist. Essentially, the therapist socializes the patient into the model using Socratic type of questioning and guided discovery. There are short and active sessions in which the patient and therapist establish the problems and develop behavioral techniques used along cognitive restructuring techniques. These techniques revolve around set goals and homework assignment, as well as regular feedback. This takes several stages :engagement, assessment, tracing of beliefs, elicit metacognitions, symptom normalization and establishment of alternative mechanisms, hallucinations reattribution and treament of negative symptoms (Marcinko & Read, 2004). Numerous meta-analyses have reported high efficacy of this intervention. However, compared to other supportive therapies and standard care, there are still variability on its ability to adequately address all positive and negative symptoms. There are often dangers of relapse. In addition, it requires that the clinician or therapist be highly skilled and experienced (Jones, et al., 2004). This is due to low compliance related to compromised cognitive functioning and psychosocial factors surrounding a client. As such, it remains scarce in day-to-day practice owing to restricted availability of suitable therapists. Finally, the application of CBT is not even in its effectiveness, but rather on the questions of when, to whom and in which modality it should be offered (Addington & Lecomte, 2012). This intervention closely compares with another common psychosocial approach: behavior family therapy (BFT) often considered as standard care model. It is widely advocated for its benefits and involvement of family support and social remodeling. BFT approaches the disorder with a functional focus of maladaptive problems and interactions sequences. This is unlike the cognitive behavior therapy whose basis is essentially the cognitive elements of actions. The functional approach views the psychotic problems as being resultant from ineffective reinforcement patterns between or amongst family members. Further, a reference to schizophrenia is specific to punishment density often leading to negative emotions. This mostly has effects on children although there are numerous case of adults. Whereas this intervention may be used in its own entity, it is mostly combined with other interventions. It will often involve development of family support through family psycho-education (Dixon, et al., 2000). Psycho-education teaches skills to family members which enable them to be effective in managing the illness and give aqequate support. It is emphatic on behavioral changes within the home environment. As such the therapist structures it in a way there is consistent collaboration in the family with commitment to compliance in homework and tasks. Family interventions are preferred for several reasons. Firstly and similar to cognitive interventions, there is reduced dependence on medical drugs. Psychotic disorders have prominent social and cognitive elements which may not be dealt with by drugs. Drugs stimulate specific somatic processes. However, compared to cognitive behavioral therapy, BFTs have high social outcome ratings. Full social recovery is more difficult compared to clinical aspects of schizophrenia (Falloon, 2003). BFT has the potential to ensure full social recovery since it is based on the very social system in which a patient lives. It has a more prominent community basis than cognitive behavioral therapy with more supportive multi-contextual and multidisciplinary aspects. Essentially, the sessions with the therapist takes place in the family context. More importantly, there is reduced dependence on the therapist subsequently improving the social skills and contextual individualization. Making reference to the functional approach for psychotic disorders, BFT enables the therapist to treat the patient in the context and equally improve the psychosocial settings. Jones, et al. (2004) indicates that some of the main barriers to cognitive behavioral therapy is stigma and inhibiting psychosocial surroundings. BFT is able to deliver more enduring benefits on functional elements thereby reducing relapse. Improvements in clinical and social aspects by BFT imply that there are reduced costs for intensive medical care and social care for the family. Essentially, BFTs augment the other interventions providing important recovery prospects. As such, it has high efficacy and effectiveness in evidence-based practice. (Bower, 2003). These benefits notwithstanding, cognitive behavioral therapy has more potent than BFT owing to suitability. The latter is efficacious only in situations where the patient has close social relations such as family. This works well for children, adolescents and adults in family sytems. However, not all patients have such pyschosocial supports. In addition, BFT is essentially a standard support for other interventions unlike cognitive therapy that can be singly used efficaciously. There is a general consensus on the efficacy of various psychosocial and pharmacological interventions for schizophrenia and other psychotic disorders. However, there are still concerns about their effectiveness in evidence based day-to-day practice due to factors such as cost, ability to amicably deal with all symptoms and signs, side effects. For instance, cognitive-based therapy requires high quality skills and experience on the part of the therapist. This should match a certain level of competency on the part of patient who is usually mentally compromised. The use of drugs is characterized by concerns for costs of drugs, and potential benefits vis a vis risk and side effects. Treatment of schizophrenia is often characterized by high relapse rates with some of the patients remaining symptomatic in spite of functional recovery. As such, literature indicates that it is vital that therapists combine both psychosocial and pharmacological interventions in order to achieve effectiveness. In Jones, et al. (2004), literature supports that cognitive based therapies should be augmented with pharmacologilcal, standard care and other supportive therapies. Antipsychotic drugs are most effective within appropriate social and pychological supports. The social element refers to community-case management in which there are multidisciplinary and multicontextual activities within health facilities in the community (Os & Kapur, 2009). In conclusion, this paper has comparatively studied two treatment interventions for schizophrenia: cognitive behavioral therapy and behavioral family therapy. It has evaluated them on the basis of their efficacy and effectiveness in evidence-based training. Efficacy refers to the extent to which a treatment results in improvements in highly controlled experimental conditions. Treatments are effective to the extent that they result in improvements in large uncontrolled populations in day-to-day clinical practice. Cognitive behavioral therapy at modifying a patient’s non-adaptive thoughts, processes, and beliefs by recreating the link between the thought and emotional processes and self monitoring of thoughts, as well as teaching the patient on how to deal with distress. Behavioral family therapy entrenches a social focus and acts a support for other interventions. Both have high efficacy, although the latter is more effective. Finally, treatment is more effective when treatment interventions are combined. One may combine pharmacologic with psychosocial treatments, as well as other supports. References Addington, J. & Lecomte, T., (2012). Cognitive behaviour therapy for schizophrenia. F1000 Medical reports, 4(6). Allen, S. & Dalton, W., (2011). Treatment of eating disorders in primary care: A systematic review. Journal of Health Psychology, 16(8), pp. 1165-1176. Bower, P., (2003). Efficacy in evidence-based practice. Clinical Psychology and Psychotherapy, Volume 10, pp. 328-336. Castle, D. & Buckley, P., 2008. Schizophrenia. Oxford: Oxford University Press. Cuijpers, P., Straten, A. & Andersson, G., (2008). Psychotherapy for Depression in Adults: A meta-analysis of comparative outcome studies. Journal of Counselling and Clinical Psychology, 76(6), pp. 909-922. Dixon, L., Adams, C. & Lucksted, A., (2000). Update on Family Psychoeducation for Schizophrenia. Schizophrenia Bulletin, 26(1), pp. 5-20. 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