CBT or drugs for treatment of Schizophrenia?

Matt Kenyon 1411

Cognitive Behavioural Therapy (CBT) involves identifying, challenging and modifying delusionary beliefs. The therapy is mainly talk-based and allows the person to actively alter the thought processes which cause their symptoms. In the cognitive aspect they are taught that their delusions are acceptable and normal for 1% of the population. The behavioural aspect involves the formation of hypotheses to challenge beliefs. Evidence is gathered outside of sessions to show the patient that their beliefs are unrealistic, allowing more realistic alternatives to subsequently be generated.

Drug therapy involves typical and/or atypical antipsychotic drugs. These regulate the abnormal levels of Dopamine (DA) at neurons during neural transmission which cause symptoms. Typical antipsychotics release  a substance which binds tightly to receptor sites, preventing excessive levels of DA from binding. Atypical produce a substance to bind more loosely and for a shorter period of time, causing less severe side effects.

Time– On the basis of time, CBT is superior to drugs, because CBT typically takes about 8-12 weekly sessions to complete a programme, whereas drugs take between 6 to 8 weeks just to begin affect. This makes the actual treatment of schizophrenia shorter to take place with CBT. However, drugs could be said to be better because they take virtually no time to take, whereas CBT is a number of hour-long sessions which may not be desirable for people with busy work or school schedules.

Effectiveness – Hollon found that the two therapies have roughly the same effectiveness, though CBT’s lasts for longer. A combination of the two has also been seen to have a higher effectiveness that any one alone. Individual studies have found high effectiveness for drugs (60%-Barlow and Durand) and for CBt (70%-Kingdon and Turkington).

Acceptability – CBT is a lot more acceptable for patients than drugs because they play an active role in tackling the underlying cause of their delusions, whereas the use of drugs makes patients passive and helpless without independence from drugs; Davis et al found that during his study of the effectiveness of drugs, patients begged not to take medication due to the undesirable side effects. Children and young teenagers may be better suited to CBT as drugs alter the neurochemistry and other processes due to their side effects.

Side effects – One huge strength of CBT over drugs is that they have no side effects. Drugs have many, and some quite severe effects, however: these range from excessive sweating and nausea to irreversible, Parkison’s-like tremors. This leads to further problems on top of schizophrenia. Though atypical antipsychotics have fewer and less severe side effects because binding is looser, the effects still exist but in CBT do not.


Conclusion? –  Each case is different and the treatment which is best for that individual, given their past history and lifestyle, would be most desirable. However, as a whole it can be seen that CBT is the clear winner, with no side effects and high effectiveness and acceptability. The time taken for therapy sessions is worth it for the control that the patient gains over their condition, empowering and useful for the long-term. Despite this, as CBT tackles the brain’s software and drugs the brain’s hardware, a combination would be the best thing to do for the greatest effectiveness.

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Daniel Kahneman: contributions to psychology

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“Widely regarded as the world’s most influential living psychologist…”

  • He established  a cognitive basis for common human errors that arise from heuristics (simple rules or mental shortcuts which people often use to form judgments, involving focusing on one aspect of a complex problem and ignoring others) and biases (resulting errors of heuristics are called cognitive biases) (Kahneman & Tversky, 1973; Kahneman, Slovic & Tversky, 1982; Tversky & Kahneman, 1974)
  • He developed prospect theory (Kahneman & Tversky, 1979). This is the idea that people make decisions based on the potential value of losses and gains rather than the final outcome, and that people evaluate these losses and gains using certain heuristics. He was awarded the 2002 Nobel Memorial prize in Economics for his work on prospect theory.
  • A small amount of his initial work focused on visual perception and attention; his first publication in the journal Science was entitled “Pupil Diameter and Load on Memory” (Kahneman & Beatty, 1966).
  • A large contribution to hedonic psychology has been made through his work. Hedonic psychology is the study of “what makes experiences and life pleasant or unpleasant. It is concerned with feelings of pleasure and pain, of interest and boredom, of joy and sorrow, and of satisfaction and dissatisfaction. It is also concerned with the whole range of circumstances, from the biological to the societal…”
  • Kahneman developed the notion of the focusing illusion (Kahneman & Schkade, 1998; Kahneman, Krueger, Schkade, Schwarz & Stone, 2006) to explain in part the mistakes people make when estimating the effects of different scenarios on their future happiness (also known as affective forecasting). The “illusion” occurs when people consider the impact of one specific factor on their overall happiness, they tend to greatly exaggerate the importance of that factor, while overlooking the numerous other factors that would in most cases have a greater impact.

Other notable contributions:

His contributions have been recognised through a variety of awards including the American Psychological Associstion’s Award for Outstanding Lifetime Contributions to Psychology in 2007.


Sources:

http://www.ted.com/speakers/daniel_kahneman

http://en.wikipedia.org/wiki/Daniel_Kahneman

http://kahneman.socialpsychology.org/

http://www.econlib.org/library/Enc/bios/Kahneman.html

Is day care beneficial for children?

Yes:

  • Multiple studies have found that, after statistically adjusting for the effects of social class and other potential confounders, kids enrolled in high quality child care given by nonrelatives develop slightly better cognitive and language skills—as measured at various points in their lives, all the way up through age 15—than do kids in low-quality care. These beneficial effects are more pronounced for low-income kids than children from more affluent families and for kids in center-based care than other types of care.
  • A study also compared children in child care to children who stayed at home with their mothers for the first three years of their lives, and the ones at home fared somewhere in the middle: They scored better on verbal comprehension tests at age 3 than did kids in low-quality care.
  • Separation-derived stress hormones may have positive benefits on children, including optimal development of brain circuits and emotional resilience.
  • Children who are socialised outside the home are exposed to more infections and end up with better immune systems as a result.
  • Social interaction – It improves a child’s ability to make relationships and attachments, and play with other children. Children are taught how to share; not to hit, push, or bite; and how to take turns.
  • The set routine of a day care centre can prepare a child for beginning school, allowing a greater ability to concentrate and perform better once at school

No:

  • , A study compared children in child care to children who stayed at home with their mothers for the first three years of their lives, and the ones at home fared somewhere in the middle: they scored worse on language tests at age 2 than kids in medium- and high-quality care.
  • A correlation between time spent in day care and behavioural problems reported by teachers has been found by various studies – poorer academic ability in the third grade and being more impulsive at 15 years old
  • The set routine of day care centres: “Staff have to stick to a routine in order to survive day-in, day-out with a rotating set of children. The trouble is, children don’t work this way. They are all different, with their different characteristics and needs” (Cavendish, 2011)
  • Using the Strange Situation Test (designed to measure attachment) psychiatrists have found that infants raised at home who are insecurely attached to their mothers are at higher risk of future psychological problems than are securely attached infants
  • Infants subjected routinely to more than twenty hours a week of nonmaternal care are more likely to show insecure attachment when tested. This insecure attachment is associated with traits such as heightened aggressiveness, noncompliance, and withdrawal in the preschool and early school years.

Conclusion?

Despite the many studies arguing that day care is bad for children, the probabilities found are very low and, of course, cannot be applied to every child or situation. As long as a good-quality day care centre is used with a set structure and not too much ‘TV time’, the benefits of social interaction and relationships outweigh the negatives.


Sources:

Moyer (2013): http://www.slate.com/articles/double_x/the_kids/2013/08/day_care_in_the_united_states_is_it_good_or_bad_for_kids.2.html

Cavendish (2011): http://www.telegraph.co.uk/women/mother-tongue/8758117/Does-day-care-damage-your-baby-One-mothers-view….html

Lambert (2011): http://www.telegraph.co.uk/women/mother-tongue/8758078/Does-day-care-damage-your-baby-The-debate-rages-on….html

Shell (1988): http://www.theatlantic.com/past/docs/issues/88aug/babe.htm