What does the therapist ASSESS before starting a CBTp intervention?
- PSYRATS to assess positive psychotic symptoms
- Semi-structured interview to understand individual variation in psychotic symptoms, like:
- –Belief about symptoms
- –Emotional reactions
- –Antecendets consequences and context of psychotic symptoms
- –Coping strategies patients already uses
What therapeutic strategies might help a therapist forge a workable relationship with a client with schizophrenia?
- Therapist encourgated to be client centered
- Open collaborative style
- Create safe context
- Acknoledge and respect differences in perspective
“Agree to disagree” - Expliticity acknowledge dysfunctional thoughts client might have about therapist, address by making unambiguous statement
How does the CBTp model conceptualize psychotic symptoms/emotions/cognitions/behaviors?
There is a trigger ( ex no sleep for 3 days)
Which leads to critical voices
Leads to Appraisal (e.g. the devil is talking to me
Leads to Behavior (e.g. self harm or social withdrawl)
Leads to Emotions (e.g. sadness or shame)
Goes back to the beginning (critical voices)
- genetic vulnerabilities
Other psychological symptoms
What are the intervention strategies used in CBTp?
- Emphasis on coping not curing
- Increased activity levels
- Social enagement and disengagement
- Belief modification
- Socratic question (e.g what evidence supports this belief? What alternative might exist? etc.
- ABC or SORC Assessment
- Goal Setting
- Cognitive restructuring
- Relaxation training
- Homework
What are the general findings regarding empirical support for CBTp?
- Meta-analyses of 19 controlled trials have shown that CBTp at least moderately effective in treating positive, symptoms compared to TAU (Tarrier and Wykes, 2004)
- Updated meta-analysis found CBTp also effective for treating positive symptoms, negative symptoms, social functioning and depression (Wykes et al., 2007)
- Good evidence that CBTp reduces positive symptoms in chronic, partially remitted patients (Tarrier, 2008)
Equivocal evidence that CBTp speeds recovery in acutely ill patients (Lewis et al, 2002) - Relapse reduction effects for standard CBTp are disappointing but a form of CBTp focused on relapse reduction is promising (Tarrier & Wykes 2004)
- CBTp promising in one prevention study, in which patients got CBTp during a prodromal period (Morrison et al, 2004)
NEWER Studies
- CBTp in early psychosis in younger adolescent/young adult patients (ages 14 and up) improved psychotic symptoms and self-concept (Marois et al, 2011)
- Low intensity CBTp (16 sessions) demonstrated to significantly reduce psychosis, depression and improve functioning (Hazell et al, 2016)
- Culturally sensitive CBTp helped with positive and negative symptoms compared to TAU (Habib et al, 2015)
- Rathod et al (2013) found statistically significant improvement in psychotic symptoms, and high satisfaction with treatment in minority ethnic groups in UK.
What are the intervention strategies used in CBTp?
attention switching
Patient changes the focus of their attention form one subject exp. To another
Ex. focus on external stimuli or remember a positive scene from patient’s own previous experience
What are the intervention strategies used in CBTp?
Attention narrowing
Restrict range of content of attention; focus on a smaller piece of experience more intensely
What are the intervention strategies used in CBTp?
Modified self-statements and internal dialogue
Patient rehearses these statements out loud in treatment, makes the statements more and more quietly until their are internalized
What are the intervention strategies used in CBTp?
Reattribution
Patient coahed to generate alternative statement and then practice them in therapy sessions
What are the intervention strategies used in CBTp?
Awareness training
- Become aware of/monitor symptoms
- Particular focus on onset of positive symptoms
- Accept experiences, but don’t react to them
What are the intervention strategies used in CBTp?
De-arousing techiques
Useful because agitation and arousal can function as both antecedents and consequences to psychotic symptoms
What are the intervention strategies used in CBTp?
Can include
- Sitting quietyly
- Breathing exercises
- Quick relaxation
What are the intervention strategies used in CBTp?
Increased activity levels
activity scheduling
- Useful if patients is vulnerable to psychotic symptoms during periods of inactiivty
What are the intervention strategies used in CBTp?
Social engagement and disengagement
- For some, social interactions serves to distract and provide source for rationalizing maladaptive thinking
- INstead of social WITHDRAWL, PATIENTS may be taught to briefly disengage if over stimulated
- Functional disengagement: not conversing or lowering their gaze temporarily
What are the intervention strategies used in CBTp?
Belief modification
- Schizophrenic individuals may need more prompting from therapist
- Goal is to use belief modification to self regulate
- Patients are encouraged to
- —-Question their beliefs
- —-Examine inconsistensies in their beliefs
- —-Look at whether “omnipotent”voices have ever been incorrect
