psychosocial interventions
The purpose of this assignment is to offer a critical review of the evidence base for psychological interventions in the management of psychosis. ... This model offers a formulation of psychotic illness, which recognises that an individual has unique biological, psychosocial and social elements. ... Psychological interventions have been developing as a treatment for mental health problems for more than thirty years (Haddock and Slade 1996, Tredget 2001). ... Once a comprehensive assessment of an individual’s experiences has been undertaken, a range of psychological interventions are possible. Different research approaches, which all have validity, have been applied to test the efficacy of psychological interventions. ... Focusing and self monitoring have also shown to be useful interventions in reducing voice hearing (Haddock and Slade 1996). ... Hartman and Cashman (1983) identified the importance of medication in conjunction with psychological interventions to treat delusions. More recent studies have confirmed the effectiveness of psychological interventions in the treatment of delusions (Kuipers et al 1997, Garety et al 2000). ... Interventions which may be utilised to address negative symptoms include the adaptation of the environment to improve safety and support, using goal setting and problem solving strategies to increase activity and responsibility and social skills training (Haddock and Slade 1996, Sensky et al 2000, Gamble and Brennan 2000). ... -7- In relation to outcome, there have been numerous attempts to research and clarify the efficacy of psychological interventions in the management of psychosis. ... Positive effects of psychological interventions were also found by Svensson et al (2000) even at two year follow up after treatment. This finding was acknowledged by Garety et al (2000) in their review of studies: cognitive behavioural interventions were found to be particularly effective when they are a component part of an eclectic treatment strategy. The study results do vary in terms of reported success of psychological interventions for psychosis. ... In 2001, for example, Cunningham et al evaluated the impact of psychological interventions for schizophrenic patients at risk of relapse. ... While it is generally accepted across the available literature that psychological interventions are effective in the management of psychosis, it is evident that further work is required to understand why not all service users are helped by this approach (Garety et al 2000). ... For evidence based psychological interventions to be extensively used in everyday settings, further research and a shift in the culture of practice environments is required (Baker 2000, Brooker 2001). ... Currently, a minority of the professional workforce have received adequate training to deliver psychological interventions as a treatment approach (Gournay 2000). ... Some studies (Drury et al 1996, Persaud and Marks 1995), found that the use of psychological interventions for psychosis facilitated engagement with services. ... In relation to the author’s own area of clinical practice, that of older adults with mental health problems, there is a paucity of research which investigates the efficacy of psychological interventions. ... Therefore, if individuals can be identified, then there is obvious scope to -10- develop the same range of psychological interventions which are of such value to younger patients. ... Alongside the provision of psychological interventions, the effective treatment of psychosis in older people requires competent medication management. ... In practice, therefore, the development of treatment approaches which are integrated to include psychosocial interventions and medication management should aim to minimise disability and maximise functioning. ... Services which offer psychological interventions, therefore, should be accessible to all, without eligibility criteria related to age. ... If psychological interventions are accepted as improving engagement with services (Drury et al 1996, Garety et al 2000), then the benefits can be translated to all age groups. ... -12- The purpose of this assignment has been to review the use of psychological interventions used in the management of psychotic symptoms. As described, the use of the stress vulnerability model to frame psychological interventions is well supported by the evidence based literature (Zubin and Spring 1977, Haddock and Slade 1996, Gamble and Brennan 2000). ... In the longer term, however, it is suggested that the routine practice of psychological interventions can improve treatment outcomes and reduce costs (Brooker 2001).