Hasson + Gaag + Kapur papers Flashcards
Agreement and shared understanding are very important for effective psychotherapy, why is this a challenge for clients with psychosis?
As their can be a difference in narratives (regarding a range of things) between the client and the therapist
What are three specific barriers/challenges in psychotherapy for psychosis?
part of IMM by Hasson
- Different narratives about the mental health system
- Differing levels of client insight and therapist theoretical perspectives (may not see psychosis as an illness)
- Stigma and self-stigma (therapist may accidentely impose stigma/ppl with psychosis often internalize stigma)
Intersubjective Metacognitive Model by Hasson? Specifically, the three important factors to help therapeutic relationship in psychosis?
- Intersubjectivity: Therapy should be viewed as a collaborative, mutual process of meaning-making rather than imposed by one part
- Metacognition
- Empathy: helps bridge the gaps between stigma and differing perspectives
How do Hasson’s metacognition and empathy help overcome barriers?
- It doesn’t force the medical-model narrative, and instead leaves room for the client’s narrative = fostering of metacognitive abilities
- Empathy & validation are pretty self-explanatory lol (therapeutic relationship, intersubjectivity, etc.)
What is the at risk mental state (ARMS) concept?
Gaag paper
- Identification for people that present attenuated (lowkey) psychotic symptoms or brief intermittent psychotic symptoms, often coupled with social withdrawal and reduced functioning
- ARMS is heterogeneous and frequently co-occurs with PTSD, depression, anxiety, substance misuse & histories of childhood trauma
CBT for ARMS? Gaag paper
CBT is effective for preventing or delaying the onset of psychosis in ARMS individuals by:
- Normalizing experiences
- Promoting psychoeducation
- Targeting cognitive biases/distortions (and challenging appraisals)
How does CBT targeting cognitive distortions/challenging appraisals help with ARMS?
These biases and appraisals can develop into full blown psychotic experiences, which CBT aims to prevent
Future directions (Gaag) for interventions targeting ARMS?
- Integration of interventions that address comorbidities is necessary
- Improvement in social functioning remains a significant unmet goal > CBT should broaden its targets beyond psychosis prevention
Focus of the Hasson paper?
Addresses the unique challenges psychotherapists face in establishing therapeutic agreements and shared meaning when working with clients diagnosed with psychosis + possible ways to overcome said barriers
Kapur paper focus?
Offers a unified theoretical framework integrating the biological, phenomenological, and pharmacological aspects of psychosis in schizophrenia, focusing particularly on dopamine’s role in mediating motivational salience
Dopamine and psychosis?
Kapur
Dopamine dysregulation is central to psychosis, specifically in the aberrant assignment of salience to internal and external stimuli (making ordinary events feel extraordinarily important)
How does aberrant salience affect people with psychosis?
Kapur
Aberrant salience disrupts a person’s normal processing of reality and contributes to the development of delusions and hallucinations
Meaning of aberrant and salience? What does the combination mean in the context of Kapur’s psychosis paper?
Respectively:
- distorded/abnormal
- important/significant
- Assignment of inappropriate/exaggerated importance to otherwise ordinary things
The aberrant salience concept in the context of psychosis & dopamine? How can delusions/hallucinations be explained through this?
Kapur
- Referring to how dopamine dysfunction leads individuals to attribute heightened meaning or significance to irrelevant stimuli
- Delusions emerge as the cognitive attempt to make sense of these confusing experiences
- Hallucinations reflect direct experiences of internally generated aberrant salience
How do antipsychotics work?
- Dampen aberrant salience by blocking dopamine transmission (reduction in psychotic symptoms)
- Therapeutic effects take time > reduction of aberrant salience is gradual
How do antipsychotics help in therapeutic recovery?
Antipsychotics give a platform for recovery; it doesn’t directly erase psychosis, but reduces aberrant salience intensity, enabling patients to reinterpret reality
Clinical implications of Kapur’s model of psychosis?
- importance of pharmacological + psychological treatments as antipsychotics alone do not resolve cognitive distortions
- Long-term maintenance of meds is crucial since discontinuation often leads to the re-emergence of aberrant salience and psychotic symptoms
