Introduction to Treatments and Therapies
Welcome to one of the most important parts of Clinical Psychology! Once a person has been diagnosed with a disorder—whether it is Schizophrenia, Unipolar Depression, or Anorexia Nervosa—the next step is finding a way to help them manage their symptoms and improve their quality of life. In this chapter, we will look at biological treatments (like drugs) and psychological therapies (like CBT and Family Therapy). Our goal is to understand how these treatments work and, more importantly, how effective they really are.
1. Treating Schizophrenia
Schizophrenia is a complex disorder, so treatments often focus on managing "positive" symptoms like hallucinations and "negative" symptoms like social withdrawal.
A. Drug Therapy (Biological Approach)
The primary biological treatment for schizophrenia is antipsychotic medication. These drugs are designed to balance neurotransmitters in the brain, specifically dopamine.
How they work:
1. Typical Antipsychotics: These are the "older" generation of drugs (developed in the 1950s). They work by acting as antagonists in the dopamine system, blocking \(D_{2}\) receptors in the brain's synapses. This reduces dopamine activity, which helps calm down positive symptoms like delusions.
2. Atypical Antipsychotics: These are the "newer" drugs (developed in the 1990s). They also block dopamine receptors but also act on other neurotransmitters like serotonin. They are often preferred because they carry a lower risk of some movement-related side effects.
Quick Evaluation:
Strengths: Drug therapy is highly effective at reducing acute symptoms and allows many patients to live in the community rather than in a hospital.
Weaknesses: They often come with severe side effects (like tremors or weight gain), and they do not "cure" the disorder—they only manage the symptoms. Some patients may stop taking them because of the side effects, leading to a relapse.
B. Family Therapy (Social/Psychological Approach)
Family therapy is based on the idea that the home environment can influence a patient’s recovery. Specifically, it aims to reduce Expressed Emotion (EE).
How it works:
The therapist works with the patient and their family members to improve communication and reduce stress. The process includes:
- Psychoeducation: Teaching the family about schizophrenia so they understand it is a biological illness, not the patient's fault.
- Reducing Stress: Helping family members lower levels of criticism, hostility, or over-involvement (High EE).
- Problem Solving: Teaching the family how to deal with practical problems and crises together.
Key Takeaway: Family therapy doesn't just help the patient; it supports the whole family unit, making it less likely that the patient will need to go back into the hospital.
2. Treating Unipolar Depression
If you or a school chooses Unipolar Depression as the "other disorder," these are the two treatments you need to know.
A. Drug Therapy: Antidepressants
The most common biological treatment for depression is the use of SSRIs (Selective Serotonin Reuptake Inhibitors).
How they work:
In people with depression, serotonin (a neurotransmitter linked to mood) may be too low. Normally, serotonin is released into the synapse and then reabsorbed by the sending neuron. SSRIs block this "re-uptake." This means there is more serotonin available in the synapse to stimulate the receiving neuron, which helps improve mood over time.
B. Cognitive Behavioural Therapy (CBT)
CBT is a "talking therapy" that focuses on the link between thoughts (cognition) and actions (behaviour).
How it works:
The therapist helps the patient identify irrational or negative thoughts (e.g., "I am a failure"). The patient is then encouraged to challenge these thoughts using evidence from their real life. A common technique is behavioural activation, where the patient is encouraged to take part in activities they used to enjoy to break the cycle of lethargy and sadness.
Don't forget: CBT requires a lot of effort from the patient. It isn't a "quick fix" like a pill, but it provides skills that the patient can use for the rest of their life.
3. Treating Anorexia Nervosa
If you or your school chooses Anorexia Nervosa as the "other disorder," these are the two treatments required by the syllabus.
A. Drug Therapy
There is no specific "anorexia pill," so drug therapy usually focuses on treating the symptoms or co-morbidities (other disorders that happen at the same time, like anxiety).
How it works:
- Antidepressants (SSRIs): Often prescribed to help with the depression or OCD-like rituals that frequently accompany anorexia.
- Antipsychotics (e.g., Olanzapine): Sometimes used in low doses to help reduce the "distorted body image" or to help the patient feel less anxious about eating and weight gain.
B. Cognitive Behavioural Therapy (CBT-E)
For eating disorders, therapists often use CBT-E (Enhanced), which is specifically designed to treat the patterns seen in anorexia.
How it works:
The therapy usually happens in stages. First, the therapist focuses on the importance of regular eating and weight gain. Then, they move on to addressing the over-evaluation of shape and weight. The patient learns to stop seeing their self-worth purely through the lens of their body size and develops better ways to cope with stress.
4. Professional Standards: The HCPC Guidelines
No matter which treatment is being used, all practitioners in the UK (and many abroad) must follow the Health and Care Professions Council (HCPC) guidelines. These ensure that treatments are safe and ethical.
Key standards include:
- Confidentiality: Keeping patient information private.
- Competence: Only providing treatments that the therapist is actually trained to give.
- Conduct and Ethics: Behaving in a professional manner and maintaining boundaries with patients.
Summary and Revision Tips
Common Mistake to Avoid: When answering an exam question about "Drug Therapy," make sure you specify which drug is for which disorder. Don't just say "drugs"—use terms like antipsychotics for schizophrenia and SSRIs for depression.
Quick Review Box:
- Schizophrenia: Treated with Antipsychotics (Biological) and Family Therapy (Social).
- Depression/Anorexia: Treated with Drug Therapy (SSRIs/Antipsychotics) and CBT (Cognitive).
- The Goal: Most modern clinicians suggest a "combination" approach is best, using drugs to stabilize the patient so they are well enough to engage in talking therapies.
Memory Aid: Think of CBT as "Catch it, Check it, Change it." Catch the negative thought, check if it’s true, and change it to a healthier one!