CBT for Psychosis Flashcards
What are some of the limitations of medication for psychosis?
40% Partial or minimal effectiveness is reported (Kane, 1996)
70% Poor adherence, not taking medication as prescribed (Scott, 1999)
20% People relapse in one year, in spite taking medication (Kane, 1999), influenced by social context, such as the nature of the family environment or life events (Birchwood & Spencer, 1999)
What did a (2004) RCT study by Morrison et al show with regard to CBTp treatment for psychosis?
-Prevents transition to psychosis
-Reduces likelihood of antipsychotic prescribing
-Reduced total PANSS scores
ES -6.52, 95% CI -10.79, -2.25, p= .003
safe and acceptable
What are some of the aims for CBT for psychosis?
Reduce the impact of experiences i.e. reduce distress and improve functioning
Provide an opportunity for making sense of experiences and develop a personalised narrative and psychological formulation of difficulties
Address anxiety, depression, trauma, sleep, worry etc. as identified in relation to psychosis
Address secondary appraisal of illness, issues of stigma, humiliation and loss; promote social inclusion
Address staying well/ relapse issues – longer term change
What did the Turner (2020) et al metal-analysis show?
In conventional meta-analyses, CBTp was superior for hallucinations (g=0.34, P < .01) and delusions (g=0.37, P < .01) when compared with any control
Compared with TAU, CBTp demonstrated superiority for hallucinations (g = 0.34, P < .01) and delusions (g = 0.3)
Compared with AC, CBT was superior for hallucinations (g=0.34, P < .01), but not for delusions although this comparison was underpowered.
What did the (Wykes et al. 2008) study show?
Behavioural emphasis larger effect sizes in RCTs than trials focussing on establishing links between symptoms and past events
What’s the prevalence of insecure attachment (fearful) types in psychosis rates?
Highly prevalent (76%)
Those who have psychosis and insecure attachment types have higher associations with what?
Higher severity of positive symptoms
poorer outcomes
poorer therapeutic alliance and engagement
less adaptive recovery styles
longer hospitalisations
What are the main 3rd wave CBT approaches used to help those with psychosis?
Mindfulness & ACT?
Is CBTp equally effective across ethnic groups?
CBTp meta-analyses often do not mention ethnicity
Browne et al. (2021) meta-analysis: Other-rated* therapeutic-alliance was less predictive of engagement in more ethnically diverse studies
Browne et al. (2021) meta-analysis: Other-rated* therapeutic-alliance was less predictive of engagement in more ethnically diverse studies
What are some of the reason given by young black men as to why they would choose not to access mental health services?
Lack of trust on existing services, fear of not receiving good care, being sectioned…
Not being aware of pathways to receiving psychology
Lack of visibility of Black men receiving or providing therapy, not clear to them if their needs would be met
When asked what services would they like (from a list full of creative ideas)? Surprise finding….one-to-one therapy top rated
What’s the traditional definition of trauma?
Why does Brewin et al (2019) criticise this definition?
“exposure to death, threatened death, actual serious injury, or actual or threatened sexual violence” (Criterion A for PTSD, DSM-5)
… because it overlooks increasing evidence that subjective responses to traumatic events predict PTSD equally or more strongly (Ozer et al 2003)
What types of traumatic events can trigger psychosis-related trauma?
Emotional and physical neglect
Emotional abuse
Sexual abuse
Physical abuse
Loss/ separation
War/ conflict
Accidents/ illness
Discrimination/
victimisation
How common is trauma in psychosis?
49-100% High rates of trauma, particularly multiple childhood victimisation, in psychosis compared to the general population
What kind of racial trauma might people experience?
Racial trauma historical and ongoing impact. For example Black people-compared to White people: 5x likely to have police force against them, 5x more likely to die in childbirth. Racially motivated crimes accounted for 76% of hate crimes in the UK in 2018/19. (Home Office, 2019).
What are some of the impacts of trauma on psychosis?
Increased severity of psychotic, depression and PTSD symptoms
Higher rate of admissions, worse engagement with community services
Other poor outcomes (incl. quality of life, higher prevalence of drug and alcohol misuse, neurocognitive impairment, suicide attempts, housing instability)
