10. CBT for Psychosis Flashcards
The cognitive element of CBT is about m____ p____ - everything that goes on in your m____ e.g. d____, m____, images, thoughts, a____
mental processes, mind
dreams, memories, attention
The behaviour part of CBT is everything you d___- refers to a____ and i____, what you s____, how you a____, what you do or don’t do
do, action, inaction, say, act
The therapy part of CBT is a “s____ approach to c____ a problem, i____, or i____ condition”
systematic, combating, illness, irregular
The way you think and b____ in r____ to experiences determines d____, f____ and n____
behave, response, distress, function, need
CBT aims to:
1. promote u____ of psychosis
2. reduce d____ and d____
3. promote more p____ responses/adjustment
- understanding
- distress, disability
- positive
Psychological models view delusions as :
1. On a c____ with normal beliefs
2. M____ (involves c____, p____ and d____)
3. Attempts to make s____ of a____ experiences
4. Mediated by a____
5. Involve r____ and a____ biases
6. Influenced by e____ processes
- continuum
- Multidimensional (involves conviction, preoccupation and distress)
- sense, anomalous
- appraisals
- reasoning, attributional
- emotional
Participants’ explanations of Nielsen’s experiment:
1. My hand was controlled by an o____ p____ f____ - I don’t know what it was, but I could feel it
2. I looked to see if there were ____ on my hand, but I couldn’t see any: they were there, but I was d____ about them
- outside physical force
- electrodes, deceived
There were differences in the appraisals of anomalous experiences in diagnosed and undiagnosed pts. The undiagnosed group made more n____, s____ and p____ appraisals for the experiences, while the diagnosed group tended to make p____ appraisals
normalising, spiritual, psychological
personalising (other people)
Paranoid participants have an exaggerated s____-s____ bias (they take c____ for p____ events and b____ others for n____ events). More specifically, they have an e____, p____ a____ style.
self-serving, credit, positive, blame, negative
external, personalising attributional
When people who had hallucinations but were delusion-free at time one were followed up, it was found those with d____ had a f____-fold increase in developing delusions __ years later. This implies e____ are involved at the f____ stage.
distress, four (18.75% vs 4.35%), 4
emotions, formation
Key elements of working with a client in CBTP:
1. E____ is crucial in psychosis (empathy, genuineness)
2. S____ g____ (beliefs and expectations)
3. Take client s____, regardless of c____
4. F____ i____ (be creative, gentle, collaborative, engage with what is d____, not what is a____)
- engagement
- shared goals
- seriously, content
- facilitate intervention, distressing, abnormal
Using CBTp approaches:
1. Continuum of beliefs and experiences –> n____
2. Attempts to explain anomalous experiences –> provide p____ a____
3. Mediated by appraisals, reasoning and thinking biases, behaviour –> r____appraisals and a____ biases/behaviour
4. Influenced by emotional processes –> v____ distress, a____ emotions (esp. a____) and emotional r____
- normalise
- plausible alternatives
- reframe, address
- validate, address, anxiety, responses
All of the Randomised Controlled CBTp Trials (RCT’s) selected in recent meta-anlyses reported s____ r____ and most reported g____ f____ as primary outcomes (mean effect size on positive symptoms: __
symptom reduction
global function
0.4
One key effectiveness issue of CBTp with challenges with e____:
1. Patients with psychosis are often not h____-s____
2. Patients may not view their problems as p____ or m____ health related or requiring therapy
3. Patients’ symptoms may negatively affect e____
4. These factors can lead to e____ d____ and p____ outcomes
engagement
1. help-seeking
2. psychological, mental
3. engagement
4. early disengagement, poorer
A key effectiveness issue of CBTp is the challenge of w____ o____:
1. CBT effects often measured as symptom c____ then focus is on thinking p____, d___ or impact on f____
2. This may affect o____ as what changes may not be what is m____
which outcome
1. change, patterns, distress, function
2. outcomes, measured
A key effectiveness issue of CBTp is challenge of service user’s p____:
1. B____ CBT approaches may have multiple potential t____/g____ for therapy
2. G____ must be s____ and a____ with the patient
3. G____ may d____ from one patient to another
4. Patient g____ may not be what is measured
priorities
1. Broad, targets/goals
2. Goals, shared, agreed
4. goals, differ
5. goals
The service user concept of recovery involves i____ conditions and e____ condition.
I_____ = h____, h____, e____ and c____.
E____ = h____ r____, p____ v____ of h____ and r____ o____ s____
internal, external
internal = hope, healing, empowerment, connection
external = human rights, positive Laue of healing, recovery oriented services
CBT targets are c____ with s____ u____
collaborative, service users
An exploration of the factor structure revealed that the items with the highest loadings could be conceptualised as those likely to yield more i____ c____ and the goals of a more r____ and b____ (coping) nature; whereas those with the lower loadings (with the exception of feeling s____ and s____) were those more reminiscent of c____ outcomes and processes of c____ in CBTp
immediate changes
recovery, behavioural
safe, secure
cognitive, change
A key effectiveness issue of CBTp is which CBT intervention?:
1. There are d____ t____ of CBT - standard CBT is often g____, b____ and f____ driven
2. G____-based behavioural CBT is delivered in a g____ setting and is not p____
3. I____, t____ interventionist-causal CBT is focused on specific m____ maintaining specific s____ and is often b____
4. Some types seem more e____ than others
- different types, general, broad, formulation
- Group, group, personalised
- Intensive, targeted, mechanisms, symptoms, briefer
- effective
Worry periods involve two parts that aim to help patients see that worry is in their c____:
1. Planning a t____ and p____ to worry
2. Planning how to p____ worry until the worry period
control
1. time, place
2. postpone
Worry periods exercise includes boosting times you’re starting to worry with other activities:
1. A____
2. Making c____ with someone
3. Thinking of something d____
4. R____
5. P____ s____
6. __ ways to w____
- Activities
- contact
- different
- relaxation
- problem solving
- 5, wellbeing
Results from a worry period study:
1. Significant reduction in w____
2. Significant reduction in p____ d____
3. Significant improvements in w____, CHOICE, and overall s____
- worry
- persecutory delusion
- wellbeing, symptoms
Self-confidence Pilot Study Results:
Improvements in…
1. Negative s____-b____
2. P____
3. W____
4. CHOICE
5. Positive s____-b____
6. Negative s____ c____
7. S____-e____
8. D____
negative self-beliefs
paranoia
Well-being
CHOICE
Positive self-beliefs
Negative social comparison
Self-esteem
Depression
Pilot study results of treatment of insomnia:
Improvement in…
1. S____
2. P____ d____
3. W____
4. CHOICE
5. O____ s____
- sleep
- persecutory delusions
- wellbeing
- overall symptoms
Symptom change is often measured using PANSS which stands for p____ and n____ s____ s____. PANSS is rated in terms of s____.
Positive and Negative Syndrome Scale
severity
Randomised control trials of psychosis measure different things. This includes PANSS but also:
1. F____
2. M____
3. Q____ of l____
4. P____
5. S____ a____
6. H____
There may be a massive difference in how e____ CBT is seen to be depending on how the outcome is measured
- Function
- Mood
- Quality of life
- Paranoia
- Social Anxiety
- Hopelessness
effective
The Threat Anticipation Model (Freeman et al., 2002) states that there psychosis involves a t____ and the outcome is focused on p____ (specifically the p____ t____ belief). The model involved a number of maintaining factors:
1. S____ disturbance
2. W____
3. Beliefs about s____
4. J____ to c____
trigger, paranoia, persecutory threat
1. sleep
2. worry
3. self
4. jumping, conclusions
Daniel Freeman - Feeling Safe Trial 2021:
1. Targeted c____ mechanisms
2. Patients c____ what they work on
3. A____ therapy
4. Develop new m____ of safety over __ sessions
5. Most e____ psychological d____ therapy
6. Results include significant reduction in p____ d____ conviction and s____
7. … as well as significant improvements in p____, w____, daily activity and q____ of l____
- causal
- choose
- Active
- memories, 20
- effective, delusions
- persecutory delusions, severity
- paranoia, wellbeing, quality of life
SlowMo therapy is a d____ therapy designed for fear of h____ from o____
digital, harm, others
SlowMo is particularly interested in r____ and is a b____ therapy supported by a computer and phone a____
reasoning, blended, app
There are 8 SlowMo sessions:
1. N____ your thoughts
2. N____ your thinking h____
3. Slow down for a m____
4. Slow down: ways of feeling s____
5. U____ a safety s____
6. Slow down: p____ experiences
7. Slow down: p____ the worry
8. Make a h____ of slowing down
- Notice
- notice, habits
- moment
- safer
- use, strategy
- past
- pop
- habit
The SlowMo worries formulation involves:
1. My t____
2. My u____ thoughts
3. I____ on my l____
- Triggers
- Upsetting
- Impact, life
SlowMo feeling safer formulation involves “My s____ thoughts” and involves, not necessarily r____ negative thoughts with alternatives but, s____ positive thoughts
safer
replacing, strengthening
Games on SlowMo where the person is shown a scene and given a decision to decide n____ what is going on or w____ and get more information first engages them to n____ their thinking p____ and show down
now, wait, notice, pattern
After 8 sessions of SlowMo, results found a significant reduction in __/11 measures of p____ as well as an improvement in:
1. W____
2. Q____ of l____
3. W____
4. Negative s____-c____
5. Positive s____-c____
9/11, paranoia
1. wellbeing
2. quality, life
3. worry
4. self-concept
5. self-concept
Three key effectiveness issues with CBT are:
1. S____ of study design - more r____ designs have weaker effects
2. Q____ of meta-analysis - some meta-analyses include therapies like c____ r____ as controls which are not CBT so findings aren’t clear
3. CBT is almost always in t____ r____ psychosis - so studies often asking what’s the a____ benefit on top of m____ in people for whom m____ isn’t working (which is a different question!)
–> very few studies looked at CBT by self as e____ issues with offering CBT but not medication when know someone has psychosis
- strength, robust
- quality, cognitive remediation
- treatment resistant, added, medication, medication, ethical
CBT for psychosis has at least s____ to m____ effects
small to moderate
(see slides for individual effect sizes per section)
