✅ L2 - Psychosis

Question 1

What is psychosis?

Answer 1

• Loss of contact with reality.
• Characteristic complaints of several mental health problems, most notably on schizophrenia-spectrum.
• Involves clusters of “symptoms” including positives (hallucinations, delusions) and negatives (flat affect, avolition, lack of interest in social interactions).

Question 2

Why are psychosis and its treatment can be problematic?

Answer 2

1. Psychotic symptoms can cause some individuals (not all populations) distress and reduce functioning.
2. Bio-psycho-social influence on psychosis but most receive only biological treatments (antipsychotics).

Question 3

Why is there a delay in developing talking treatments for psychosis?

Answer 3

A1. Psychological therapies for psychosis not accepted as potentially useful treatments until the 1990s.

2. WHY?
   * Psychosis seen as different from neurosis.
   * Non-understandable symptoms in psychological terms
   * Lack of therapeutic optimism in treating “schizophrenia”.
   * Poor results from early trials of psychotherapy

=> Drugs (antipsychotics) seen as the only viable treatment option.

Question 4

Types of psychological therapies for psychosis?

Answer 4

1. Rogerian/person-centred therapy.
2. Psychoanalytic therapies.
3. Cognitive Behaviour Therapy (CBT).
4. Family therapy.
5. Interventions to reduce substance misuse.

Question 5

Cognitive Behaviour Therapy for Psychosis (CBTp)? What are some strategies for CBTp?

Answer 5

1. Components of CBT:
   - Activating events -> affect thoughts
   - Interaction in Thoughts - Feelings/Emotions - Behaviours (reconsolidate)
2. NICE defines CBTp as a psychological intervention:
   - Establish links from thoughts to symptoms.
   - Re-evaluate their beliefs to symptoms.
   - Developing alternative ways of coping with symptoms.
3. CBTp strategies:
   - Formulating (making sense).
   - Normalising psychosis.
   - Improving coping strategies
   - Changing negative beliefs about psychosis

Question 6

Describe all the steps of CBTp in details?

Answer 6

1. Formulation
   - Set therapy goals
   - Identify thoughts, feelings, behaviours linked to symptoms
   - Shared understanding of how problem developed and how to resolve.
   - Use well-established models to formulate difficulties: (1) Triggers -> (2) Auditory hallucinations -> (3) Misinterpretation of Hallucinatory Experience.
2. Normalisation:
   - Challenge psychosis stigma & misconceptions
   - Promotion of accurate views about psychosis.
   -> psychoeducation
   -> personal disclosure
3. Coping enhancement consists of:
   - Review existing coping strategies
   - Encourage to try new/increase coping strategies
   - Provide respite (rest) and encourage better sense of control.
4. Changing unhelpful beliefs/appraisals of psychotic experiences
   - Negative beliefs about psychosis strongly predict distress and impairment.
   - CBT changed this believe using example strategies
   + Socratic questioning
   + Keep log of recent voice hearing experiences.
   + Evidence/counter-evidence analysis.

Question 7

What are 5 myths about psychosis? [1/2]

Answer 7

1. People with psychosis are dangerous.
   - No evidence
   - More likely to be preoccupied with their own problems
   - People with psychosis more likely to be victim of violence than vice versa.
2. Psychosis is a diagnosis for life and there is no recovery.
   - Psychosis is not forever
   - 30% have 1 episode and gone
   - (30%) >1 episode after long symptom-free period
   - (<25%) persistent symptoms

Question 8

What are the 5 myths of psychosis? [2/2]

Answer 8

3. People with psychosis are unable to work.
   - Not really, unless their distress is too much it interferes with their function
   - Many are able to work, have relationships, and function normally.
4. Psychosis always causes distress and people always need treatment.
   - Many people are not distressed by their unusual beliefs or voices
   - Many make sense of their experiences in helpful way
   - Some cultures view psychotic symptoms positively
5. Psychosis is always a consequence of brain disease.
   - Psychosis can be caused by many experience (e.g. lack of sleep, sensory deprivation, substance uses, stressful events, trauma etc.)

Question 9

Evaluation of CBT for psychosis (is it effective?)

Answer 9

1. > 50 RCTs examined the positive efficacy of CBTp across most “stages” of psychosis.
2. Meta-analyses show that CBTp can alleviate psychotic symptoms, especially positive symptoms.
   => Effective on its own (even in ppl not taking psychotic meds)
3. NICE: CBTp should be offered as a first-line treatment across the continuum of psychosis.
   => Also recommend assessment for trauma and trauma-related therapies.

Question 10

Give a few examples of coping strategies?

Answer 10

1. Understanding psychosis:
   - Humming.
   - Reading.
2. Responding differently to symptoms:
   - Acting assertively / dismiss the voice.
   - Respond rationally to the voice content.
3. Reduce arousal and distress:
   - Listen to soothing music.
   - Mindfulness meditation.
   - Relaxation exercises.
   - Use positive imagery/positive affirmations (self-statements).