Cognitive Therapy For Psychosis Research Articles

Deconstructing emotion regulation in schizophrenia: The nature of abnormalities at the selection and implementation stages.

Difficulties with emotion regulation are observed across psychiatric diagnoses, including psychotic disorders. Past studies using trait self-report indicate that people with schizophrenia (SZ) are less likely to use adaptive emotion regulation strategies and more likely to use maladaptive emotion regulation strategies than controls (CN). However, more recent evidence using ecological momentary assessment (EMA) indicates that regulation effectiveness and adaptiveness may vary across strategies. The present study aimed to systematically understand abnormalities in state-level emotion regulation strategy selection, effectiveness, and adaptiveness in SZ compared to CN using EMA. Participants (n = 50 SZ; n = 53 CN) completed 6 days of EMA surveys assessing emotional experience, emotion regulation, and symptoms. Results indicated that SZ selected interpersonal emotion regulation and avoidance more often than CN, while both groups selected reappraisal and distraction more often than avoidance and suppression. Overall, strategies were effective at reducing negative emotion and adaptive for reducing delusions over time. Reappraisal, avoidance, and suppression all significantly down-regulated delusions over time. Although some selection abnormalities were present in terms of rate of selection and effort exertion, people with SZ select strategies which are effective and adaptive in the short term. The present results have implications for how cognitive therapy for psychosis may target delusions. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Results of a prospective, mixed methods study to assess feasibility, acceptability and effectiveness of TRIumPH (Treatment and Recovery In PsycHosis): an integrated care pathway for psychosis, compared to usual treatment

ObjectivesTo evaluate whether a newly developed care pathway, Treatment and Recovery In PsycHosis (TRIumPH), is feasible, acceptable and effective in meeting National Institute of Health and Care Excellence (NICE) quality...

The evolution of cognitive-behavioral therapy for psychosis.

Cognitive therapy for psychosis has developed over the past 30 years from initial case studies, treatment manuals, pilot randomized controlled studies to fully powered and methodologically rigorous efficacy and, subsequently, effectiveness trials. Reviews and meta-analyses have confirmed the benefits of the interventions. Considered appraisal by government and professional organizations has now led to its inclusion in international treatment guidelines for schizophrenia. Patients consistently ask for access to psychotherapeutic interventions, and it is slowly becoming available in many European countries and other parts of the world, eg, US and the People’s Republic of China. However, it remains unacceptably difficult to access for the vast majority of people with psychosis who could benefit from it. Psychosis affects people in the prime of their lives and leads to major effects on their levels of distress, well-being, and functioning, and also results in major costs to society. Providing effective interventions at an early stage has the potential to reduce the high relapse rates that occur after recovery from first episode and the ensuing morbidity and premature mortality associated with psychosis.

Automatic Word Processing Hypnosis and Cognitive Therapy for Psychosis: A Case Report

Hallucinations are often perceived as auditory and visual experiences emanating from outside the mind and it is this belief by patients that is a powerfully convincing factor in maintaining psychotic symptoms and accompanying distress. One of the main tasks of cognitive therapy for psychosis is to help the person recognize that the hallucinations emerge from within their own mind for some meaningful reason. A change in meaning can change a person’s affective and behavioral responses to hallucinatory phenomena. Automatic Word Processing (AWP) hypnosis is a novel way to help a person realize that the hallucinations they perceive as external and distressful are really internally generated phenomena often based upon his or her life experiences. The case presented here illustrates how AWP hypnosis helped a 13-year-old girl access the internal material that shaped the form and content of visual and auditory hallucinations and interfered with her social and academic functioning.

A Pilot Evaluation of Therapist Training in Cognitive Therapy for Psychosis: Therapy Quality and Clinical Outcomes

Historically, it has been difficult to demonstrate an impact of training in psychological interventions for people with psychosis on routine practice and on patient outcomes. A recent pilot evaluation suggested that postgraduate training in Cognitive Behavioural Therapy for Psychosis (CBTp) increased the delivery of competent therapy in routine services. In this study, we evaluated clinical outcomes for patients receiving therapy from therapists who successfully completed training, and their association with ratings of therapist competence and therapy content. To characterize the therapy delivered during training and to inform both a calculation of effect size for its clinical impact, and the development of competence benchmarks to ensure that training standards are sufficient to deliver clinical improvement. Paired patient-reported outcome measures (PROMS) were extracted from anonymized therapy case reports, and were matched with therapy ratings for each therapist. Twenty clients received a course of competent therapy, including a high frequency of active therapy techniques, from nine therapists. Pre-post effect size for change in psychotic symptoms was large (d = 1.0) and for affect, medium (d = 0.6), but improved outcomes were not associated with therapist competence or therapy content. Therapists trained to research trial standards of competence achieved excellent clinical outcomes. Therapy effect sizes suggest that training costs may be offset by clinical benefit. Larger, methodologically stringent evaluations of training are now required. Future research should assess the necessary and sufficient training required to achieve real-world clinical effectiveness, and the cost-effectiveness of training.

Self-Administered Cognitive Therapy for Psychosis: Untapped Potential or Premature Promotion?

Self-Administered Cognitive Therapy for Psychosis: Untapped Potential or Premature Promotion?

Homework Use in Cognitive Therapy for Psychosis: A Case Formulation Approach

Based upon empirically supported cognitive-behavioral treatment approaches, this paper aims to outline the use of homework to enhance the therapeutic relationship, patient motivation, and skills for managing delusions, hallucinations, and negative symptoms. The nature and timing of homework is outlined for the different phases of treatment. Frequent barriers that emerge during the setting and reviewing of homework are described, followed by strategies to enhance motivation and homework compliance. The paper concludes with a demonstration of how homework is optimized within a case formulation approach for persistent symptoms of psychosis.

The relationship between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive therapy for psychosis

Objective. This paper examines the relationships between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive–behaviour therapy (CBT) for psychosis. Method. 29 patient and therapist dyads completed patient and therapist versions of the California Psychotherapeutic Alliance Scale (CALPAS) at session 3 and 21 at session 9. The level of patient homework compliance was rated by therapist and patient, using visual analogue scales, at therapy sessions 3 (29 dyads) and 9 (20 dyads). The Positive and Negative Symptoms of Schizophrenia (PANSS) scale was used to measure psychotic symptoms pre- and post-treatment. Patient suitability for the treatment was measured at session 3, using the Suitability for Short-Term Cognitive Therapy Scale. Results. Only two of the specific hypotheses were supported. There was no significant agreement between patients and therapists on the quality of the therapeutic alliance at session 3, but by session 9 two (patient commitment and working strategy consensus) of the four sub-scales were significantly associated, although there was little evidence that the quality improved over time. Lower patient suitability and insight at session three predicted a lower therapeutic alliance. Therapeutic alliance predicted level of homework compliance. The only significant predictor of outcome was the PANSS positive symptoms sub-scale pre-treatment score. Conclusions. These results suggest that patients who experience psychotic symptoms can be successfully engaged early in therapy as can those with affective disorders but that therapeutic alliance may not have a direct effect on outcome. Copyright © 2006 John Wiley & Sons, Ltd.

Cognitive therapy for psychosis

The evidence for using cognitive therapy for psychosis is extensive, especially for those with medication-resistant symptoms of schizophrenia. Cognitive therapy involves engaging with the patient and then developing a full clinical assessment into a formulation which links thoughts, feelings and behaviour. A cognitive model of psychosis is constructed which identifies vulnerabilities and relevant stressful events and circumstances. Specific work on symptoms is then possible. Hallucinations are explored in terms of nature and content. Work on reattribution, learning coping strategies and debating content is used. Delusions are discussed; alternative explanations may be explored and the beliefs tested through appropriate exercises. Where conviction is immovable, understanding the contributing factors can provide therapeutic targets leading initially to behaviour change and eventually moderation in conviction. With negative symptoms, gentle examination of their development, the expectations patients have and often the pressure they feel, can allow the patient to develop achievable goals. Cognitive therapy can form part of a comprehensive care plan for patients, alongside medication, social and family management.

The use of imagery in cognitive therapy for psychosis: A case example

There has been a long tradition of studying imagery in relation to psychotic symptoms. Recent studies have suggested that imagery may be involved in the development and maintenance of psychotic symptoms (hallucinations and delusions in particular). Following a review of this literature, including work conducted by the author and colleagues, a case study is used to illustrate the clinical applications of this work. Working with images that were associated with persecutory delusions appeared to contribute to a reduction in distress, preoccupation, and conviction in relation to these beliefs, which were assessed using a standardised measure (PSYRATS). The implications for theory, practice, and future research are considered.

Prevention of functional disorders in primary care/family medicine

The evidence for using cognitive therapy for psychosis is extensive, especially for those with medication-resistant symptoms of schizophrenia. Cognitive therapy involves engaging with the patient and then developing a full clinical assessment into a formulation which links thoughts, feelings and behaviour. A cognitive model of psychosis is constructed which identifies vulnerabilities and relevant stressful events and circumstances. Specific work on symptoms is then possible. Hallucinations are explored in terms of nature and content. Work on reattribution, learning coping strategies and debating content is used. Delusions are discussed; alternative explanations may be explored and the beliefs tested through appropriate exercises. Where conviction is immovable, understanding the contributing factors can provide therapeutic targets leading initially to behaviour change and eventually moderation in conviction. With negative symptoms, gentle examination of their development, the expectations patients have and often the pressure they feel, can allow the patient to develop achievable goals. Cognitive therapy can form part of a comprehensive care plan for patients, alongside medication, social and family management.

Cognitive therapy for psychosis in schizophrenia: an effect size analysis

We conducted a meta-analysis using all available controlled treatment outcome studies of cognitive therapy (CT) for psychotic symptoms in schizophrenia. Effect sizes were calculated for seven studies involving 340 subjects. The mean effect size for reduction of psychotic symptoms was 0.65. The findings suggest that cognitive therapy is an effective treatment for patients with schizophrenia who have persistent psychotic symptoms. Follow-up analyses in four studies indicated that patients recieving CT continued to make gains over time (ES=0.93). Further research is needed to determine the replicability of standardized cognitive interventions, to evaluate the clinical significance of cognitive therapy for schizophrenia, and to determine which patients are most likely to benefit from this intervention.

Cognitive therapy for psychosis: Formulation, treatment, effects and service implications

Cognitive and cognitive behavioural therapies for psychosis involve talking to patients about their symptoms and life predicament, and attempting to make sense of such problems in terms of a cognitive formulation of psychosis. The aim is to engage in collaborative discussions which lead to the fostering of less distressing and more constructive ways of understanding psychosis, and behaviour likely to promote recovery. Recent randomised controlled treatment trials provide strong evidence that such therapies can have a significant impact on the symptoms and problems presented by people with psychosis. This paper outlines the formulation and treatment approach of cognitive behavioural therapy for psychosis, provides a brief review of the findings of recent controlled treatment trials, and addresses issues relating to how cognitive behavioural therapies might be integrated within mainstream mental health services.