CBT, mindfulness, compassion-focused therapy: evidence and beyond Flashcards
What are the four main independent dimensions of delusions to assess?
- Conviction
- Preoccupation
- Distress
- Impact on functioning
What are the ABCs in a CBT assessment?
- Antecedents (internal/external triggers)
- Beliefs (on the content of delusion)
- Consequences (emotional and behavioural)
Which elements should be covered when assessing the voices in psychosis?
- Antecedents: particular situations or mood states
- Beliefs, that the person holds about the voices
- Consequences: how the voices make them feel what they do about it
- What is the content of the voices?
- What do they say (orders, commands)?
- What relationship does the person have with the voices?
When can you start trying to change things in CBT for psychosis?
Once the vicious cycles that maintain the problem are identified
What is the purpose of the individualised case formulation in CBT or psychosis?
Make sense of person’s symptoms
In making sense of voices, which behaviour helps towards breaking the vicious cycle and entering a virtuous cycle?
Don’t believe what the voices say
-> they aren’t so powerful
Which techniques can be used in CBT for psychosis?
- Supportive counselling
- Didactic psychoeducation (on cognitive biases and cognitive model)
- Normalise psychotic experiences
- Reframe beliefs and experiences
- Change thinking biases
- Promote alternative ways of coping
- Reduce emotional difficulties
What are the therapeutic stages of CBT for psychosis?
- Engagement and assessment
- Coping strategies
- Formulation/development of a shared model
- Delusions and beliefs about voices
What characterises the stage of CBT for psychosis during therapy?
- Stages aren’t clear-cut
- You go back and forth between stages
What should you not do in CBT for psychosis?
- Impose your view
- Try to convince the person to see or try new things
- Try to change symptoms no matter what
- Act as an expert on their symptoms
- Say it’s a symptom of mental illness
- Implement CBT techniques at random
- Be inconsistent or interpretative
What are the results of meta-analyses on CBT for psychosis?
Results are more-or-less consistent
- effect sizes are significant BUT modest (similar to medication trials)
- in almost all CBT studies, therapy done in addition to medication
- effect size added on top of medication effect size
What are the factors that lead to overestimation of effect sizes in CBTp trials?
- Lack of blinding
- Exclusion criteria (up to 75% not included)
- Referral bias (from person referring)
- Quality of therapy and supervision in trial conditions is higher compared to real-world
What are the factors that lead to an underestimation of effect sizes in CBTp trials?
- Outcome measures: same severity measures as med trials when CBT changes feelings and behaviours, not symptom severity
- Generic therapy: not addressing idiosyncratic problems (specific to each patient)
- Research is lagging behind therapy (looking at symptom severity instead of specific outcomes)
What are the results from targeted studies on CBT for psychosis?
Larger effect sizes compared to meta-analyses (medium to large)
How do targeted studies on CBTp differ from meta-analyses?
- They don’t just measure broad symptoms
- They focus on particular aspect of the therapy
- They assess what is being changed
- > effect sizes are much larger
