Lecture 2 - Psychosis

Question 1

What is psychosis?

Answer 1

Term to indicate “loss of contact w/ reality”, characteristic complaints of several mental health problems (diagnoses on schizophrenia-spectrum)

Question 2

How have psychosis treatments been in the past?

Answer 2

Not widely investigated/accepted until 1990s

Seen as fundamentally diff from neurosis, symptoms not seen as understandable in psychological terms, lack of therapeutic optimism in treatment of “schizophrenia”, poor results in early trials, neuroleptics seen as only option

Question 3

What are potential therapies for psychosis now?

Answer 3

Rogerian/person-centred therapy, psychoanalytic therapies, CBT, family therapy, interventions to reduce substance misuse

Question 4

How is CBT for psychosis?

Answer 4

Application + adaptation of basic principles to understand distress + impairment caused by psychotic experiences

National Institute for Health and Care Excellence (NICE) defines as where service users: 1. Establish links between thoughts, beliefs, perceptions, feelings in relation to current/past symptoms/functioning
2. Re-evaluate beliefs/perceptions/reasoning relating to target symptoms
3. Involve development of alternative ways of coping with symptoms, reduction of distress + improvement of functioning

Question 5

What are 4 basic CBTp strategies?

Answer 5

1. Formulating (assessment to identify thoughts/feelings/behaviours linked to problem/symptom targeted + help client to see how they interact to maintain problem —> create shared understanding of how problem developed + how to resolve)
2. Normalisation (challenging stigma + correcting common misconceptions by providing accurate info + views of psychosis)
3. Improving coping
4. Strategies to change unhelpful thoughts/beliefs/appraisals

Question 6

What are 5 myths about psychosis?

Answer 6

1. People w/ psychosis are dangerous – no evidence that those w/ psychosis are more dangerous/violent than general pop, often victim
2. Psychosis is diagnosis for life + no recovery – not necessarily for ever, many have single episode that never occurs again (30%), some experience more than one episode eve after long periods of symptom free (30%), minority have ongoing (<25%)
3. People w/ psychosis unable to work – might be times where distress is so much that it interferes w/ ability to function
4. Psychosis always causes distress + people always need treatment – many experience unusual beliefs/hear voices but not distressed, some make sense of it, viewed positively in some cultures
5. Psychosis always consequence of brain disease – can be brought about from lack of sleep, sensory deprivation, substances, stressful events, bereavement, trauma `

Question 7

How do we improve coping?

Answer 7

Review strategies w/ them + encourage to experiment w/ new coping strategies

Aim to increase coping strategies + provide respite + encourage sense of control

eg. understanding psychosis, responding differently, reduce arousal/distress

Question 8

How do we challenge unhelpful beliefs?

Answer 8

Negative beliefs about it can lead to bad consequences/strong distress + impairment

Use Socratic questioning in sessions, counterevidence

Question 9

What evidence is there for CBTp?

Answer 9

Over 50 RCTs examining efficacy for those in multiple stages (first episode, acute, at risk of relapse, treatment resistant, groups)

CBT can be effective on its own even in those not taking antipsychotic medication

NICE recommends CBT offered as first line treatment across continuum

Appraisals of events not events themselves determine behaviours/thoughts/feelings/distress