Strengths-based delivery

What is strengths-based delivery?

The strengths-based delivery approach is a person-centred approach that supports commitment to individual development and growth. The approach favours a low case manager load, low supervisor to case manager ratio, and structured weekly group supervision to ensure adherence to the principles of the model. Strengths assessment and personal recovery plans are developed in collaboration between service users and practitioners. Interventions are tailored to meet individual needs, with an emphasis on existing resources, such as supported employment, supported housing, supported education, and supported recreation.

What is the evidence for strengths-based delivery?

Low quality evidence suggests no differences in symptoms, quality of life or functioning between strengths-based delivery models of care and standard care, assertive community treatment or traditional community treatment. Review authors conclude that as the number of trials is low, and more trials are required.

 

June 2016

Mindfulness

What are mindfulness and acceptance therapies?

Mindfulness and acceptance therapies involve intentional and non-judgmental focus of one’s attention on emotions, thoughts and sensations that are occurring in the present moment. The aim is to open awareness to present experiences, whether positive or negative, allowing thoughts and voices to come and go without reacting, and accepting oneself and the experience. This may help alleviate the distress associated with symptoms by focusing on how people relate and respond to their psychotic experiences, rather than identifying and directly challenging thoughts and beliefs about these experiences.

What is the evidence for mindfulness and acceptance therapies?

Moderate to high quality evidence suggests a small effect of improved general symptoms with mindfulness or acceptance therapies when compared to treatment as usual, but not when compared to active control conditions. There was a small effect for depression symptoms, and a medium-sized effect for mindful awareness, and no effects for positive or negative symptoms, hallucination-related distress, or functioning and disability. There was also no effect of individual acceptance therapies.

 

August 2018

Animal-assisted therapy

What is animal-assisted therapy?

Animal-assisted interventions use trained animals to help improve physical, mental and social functions in people with schizophrenia. It is a goal-directed intervention in which an animal that meets specific criteria is an integral part of the treatment process, which usually involves pharmaceutical and psychosocial treatment components. It has been shown to improve outcomes for people with autism-spectrum symptoms, medical difficulties, and behavioural problems.

 

What is the evidence for animal-assisted therapy?

Low quality evidence is unable to determine the benefits of animal-assisted therapy for people with schizophrenia. Review authors report that it has potential for improving symptoms with few adverse effects.

 

May 2016

Treatments for mothers with schizophrenia

Why do mothers with schizophrenia need specialised treatments?

Mothers who have been diagnosed with schizophrenia face challenges in accessing and maintaining treatment programs, particularly when inpatient care is required. Mothers with dependent children may be less likely to seek treatments for their illness due to a fear of losing custody of their children, or due to difficulties in finding alternative care should hospitalisation be required. They may also find it difficult to properly adhere to any treatment programs due to the demands of childcare. Mothers have been shown to be particularly at risk of relapse in the months immediately following child birth and specialised programs could help to support them and their babies during this time.

What is the evidence for treatments tailored to mothers with schizophrenia?

Low quality evidence is unclear as to the benefits of specialised programs tailored to mothers with schizophrenia who have dependent children. Review authors conclude that such interventions are lacking and that flexible treatment approaches that incorporate support networks including childcare and family involvement are highly recommended.

Also see the parenthood topic and the pharmaceutical treatments during pregnancy and breastfeeding topic.

April 2016

Therapeutic relationship

What are therapeutic relationships?

The therapeutic relationship refers to the relationship between a patient and a clinician. Many patients consider it to be the most important component of care, and therefore it should influence how well patients engage with services, and how well they show improvements from therapy.

What is the evidence for therapeutic relationships?

Low quality evidence is unable to determine any associations between therapeutic relationships and hospitalisation rates, symptoms or functioning. Review authors conclude that there is some, but not overwhelming evidence that good therapeutic relationships predict good outcomes, but that methodologically rigorous research is required to properly assess these associations.

 

June 2016

Nidotherapy

What is nidotherapy?

Nidotherapy is a psychological therapy that aims to identify and alleviate problematic areas affecting a person’s life and surroundings. While typical psychological therapies aim to create changes within a person’s actions, emotions, or thoughts, nidotherapy instead aims to make changes to a person’s environment and life situation, with the goal of enabling improvements in quality of life, relationships, mental health and self-esteem.

What is the evidence for nidotherapy?

Low quality evidence is unable to determine the effectiveness of nidotherapy for social functioning or mental health. Review authors conclude that until further research is conducted, nidotherapy should be considered an experimental therapy for schizophrenia.

 

June 2016

Monetary incentives

What are monetary incentives?

Monetary incentives have been proposed as a form of positive behavioural reinforcement, given as a reward for the implementation of target behaviour. In the real world this can include employment or living allowances, but they can be items of lower value that have greater symbolic significance. At the lowest end these incentives become valueless tokens (see the token economies topic).

What is the evidence for monetary incentives?

Low quality evidence is unclear as to the benefits of monetary incentive programs.

 

June 2016

Token economies

What is a token economy?

A token economy is a behavioural therapy utilising non-monetary ‘tokens’ as a reward to reinforce target behaviours. These tokens have no intrinsic value but can be exchanged for various goods or privileges. Token economies were used widely for schizophrenia in the 1960’s and 1970’s, targeted specifically at negative symptoms such as poor motivation or attention, and social withdrawal. More recently token therapies have largely been replaced by social and life skills training, and cognitive skills training.

What is the evidence for token economies?

Low quality evidence is unable to determine the benefit of token therapy. Review authors conclude that the token economy approach may have good effects for negative symptoms but it is unclear if these results are reproducible, clinically meaningful, or maintained beyond the treatment programme.

 

June 2016

Distraction techniques

What are distraction techniques? 

Distraction techniques are a form of coping skill, taught during cognitive behavioural therapy. These techniques are used to distract and draw attention away from the auditory symptoms of schizophrenia, such as auditory hallucinations (e.g. voice-hearing) and intrusive thoughts. These approaches are not a stand-alone intervention for schizophrenia, but rather a strategy for coping with illness symptoms, used in conjunction with ongoing pharmaceutical and psychological therapies. There are three key ‘distraction’ approaches: cognitive distraction, behavioural distraction, and physiological distraction, though techniques can overlap. Cognitive distracters can include reading aloud, humming, as well as voice mastery (e.g. replying to the voices, responding only to pleasant voices, or describing hallucinations aloud). Behavioural distracters are largely social, with the person making a conscious effort to interact with other people to change focus and remove attention from the voices. Physiological techniques can include relaxation strategies, doing exercise, using an earplug in the dominant ear, and playing music.

What is the evidence for distraction technique approaches?

Moderate to low quality evidence suggests no benefit of distraction technique programs over health promotion programs for symptoms or study retention.

 

May 2016

Shared decision making

What is shared decision making? 

Shared decision making aims to support patients during specialist mental health treatment, encouraging patients to be active in the decision making process for their pharmacological and psychoeducational treatment options, by keeping them informed and involved. Shared decision making interventions often utilise a decision-making tool, involving the patient in the decision making process in conjunction with nursing support, ensuring that they understand the clinical problem, exploring patients’ worries, fears and expectations, discussing potential treatment options and ensuring the implications of these options are understood, and providing opportunities to review decisions.

What is the evidence for shared decision making?

Low quality evidence is unclear as to the benefit of shared decision making for improving patients’ inpatient treatment experience. Review authors conclude that there is no evidence of harm of shared decision making, and that there is an urgent need for further research in this area.

 

June 2016