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PSYC 441 - FINAL > Psyc 441: lecture 14 Psychological treatment in sz > Flashcards

Psyc 441: lecture 14 Psychological treatment in sz Flashcards

1
Q

Medications are not 100% effective – especially for _______________

A

negative symptoms

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2
Q

What types of antipsychotics have significant side-effects?

A

Both 1st and 2nd generation

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3
Q

What is the reason most people stop medication?

A

Because of the significant side-effects

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4
Q

What are the components of a COMPREHENSIVE TREATMENT?

A
  • Medication (symptoms, side effects)
  • Lifestyle (work, health community)
  • Psychotherapy (counselling, education, drugs, support, cognitive)
  • Social (family, housing, integration)
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5
Q

What are the types of treatment?

A
  • Individual or group CBT
  • Family interventions
  • Neuropsychological and cognitive rehabilitation
  • Social skills and related training
  • Contingency management*
  • Treatment for comorbid disorders

*Contingency management refers to a type of behavioural therapy in which individuals are ‘reinforced’, or rewarded, for evidence of positive behavioural change.

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6
Q

Individual or group CBT can target specific symptoms and reduce specific risk. What are they?

A

1) negative & positive symptoms
2) social skills,
3) relapse & suicide prevention

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7
Q

What is CBT?

hint; the therapy focuses on what and how many sessions etc.

A
  • Therapy focuses on changing maladaptive current thoughts, feelings and behaviors
  • One-on-one treatment
  • 12-30 sessions
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8
Q

When administering CBT to clients with SZ, we may have to account for social and cognitive deficits. Describe the reasons for that and by what means.

A
  • People with SZ may have difficulty recognizing the need for treatment
  • Building rapport may be slower
  • Sessions may need to be shorter
  • People with SZ may need concrete reminders of the information given within a session
  • Treatment may need to be long-term and supportive instead of change oriented
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9
Q

What is the CBT view of psychosis?

A
  • Risk for the disease + environmental factors (stressors) = psychotic symptoms [onset, worsening, relapse]
  • It can be difficult to put your finger on a stressor, it may be a change in the disease
  • It results in thoughts, emotions and actions
  • CBT evaluates the appraisal of those thoughts, emotions and actions
  • CBT focuses on changing it as a way to handle symptoms
  • Negative appraisal = exaggeration of psychotic symptoms
  • Positive appraisal = reduction in psychotic symptoms
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10
Q

WHAT CONTRIBUTES TO BIASED APPRAISALS? (True for all people, but exaggerated in SZ)

A

1) Reasoning styles (ex. jumping to conclusions)
2) Dysfunctional schemas & adverse social environment *
3) Emotion and associated cognitive processes
4) Secondary appraisals (ex. insight on the illness)

*A poor self-concept/self-esteem leads to negative delusions

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11
Q

Define Normal belief confirmation bias

A

People seek evidence that confirms existing beliefs

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12
Q

Define Belief inflexibility

A

Unwilling to consider alternative causes

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13
Q

Define Externalizing attributional style

A

Situation caused by something outside of the individual’s control

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14
Q

Define Jumping to conclusions

A

Rapid acceptance of potentially erroneous beliefs

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15
Q

What are the four REASONING STYLES?

A

1) Jumping to conclusions
2) Externalizing attributional style
3) Belief inflexibility
4) Normal belief confirmation bias

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16
Q

Explain the THE BEADS TASK (Garety, 2005)

A
  • A good example of studying this idea of jumping to conclusions
  • 1 jar of beads ( mostly black, mostly orange beads)
  • Shake up the jars
  • Experimenter picks a beads and ask the patients which jar they picked from
  • People with delusions are more likely to jump to conclusions after only one or two draws.

The findings were:

  • People with delusions consistently jump to conclusions: One-third will even make a judgment after drawing only one bead!
  • People with delusions also consistently rate their certainty as much higher than controls
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17
Q

The Beads task show us that poor decision making is also related to __________

A

poor executive function

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18
Q

How can CBT act on poor executive function in SZ?

A
  • May be difficult to change, but can provide strategies
  • Meta-insight: “I often jump to conclusions that turn out to be wrong. I should think twice, ask a friend, etc”

Notes: CBT for psychosis, we not always be able to change the cognitive side of someone with SZ, but we can try to provide strategies.
Meta-insight is to learn that often I jump to conclusions…I dont have to change my style but perhap i should think twic etc.
*CBT is about about modifying as opposed to changing. **

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19
Q

What are the three steps for cbt for sz work?

A

1) Introduction to the treatment
2) Assessment of symptoms
3) Identification of goals

20
Q

Introduction to the treatment

A
  • How therapy works
  • Why therapy might be helpful
  • What are the person’s expectations about therapy? - Have they had treatment before?
21
Q

Assessment of symptoms

A
  • What are the major symptoms? How severe are they?

- Which symptoms are distressing the person, impairing their function?

22
Q

Identification of goals

A
  • What does the person want to change?
  • What does the therapist see as important to change?
  • These may not always be the same
23
Q

What is collaborative empiricism? And what does it entail?

A

Defintion:
Problem-solving the target hallucination or delusion

What does it entail?

  • Non-judgemental, factual approach to symptoms
  • “Socratic” reasoning or questioning, understanding the beliefs, reality testing
  • Alternative interpretations
24
Q

In CBT for SZ, what does developing coping skills entail?

A
  • Anxiety reduction
  • New behaviors
  • Using alternative interpretations in every-day life
  • Concrete reminders, strategies
25
Q

What is the CBT technique for Delusions

A
  • Inference chaining
  • *Peripheral questioning

*“Inference chaining,” in which the personalized meaning of a systematized delusion, is explored to decrease the distress engendered by the delusion.

**To reduce the impact of positive symptoms, “peripheral questioning,” a technique in which the person is queried about the specifics of their delusional beliefs in order to understand how they arrived at his or her conclusions,

26
Q

What are the CBT techniques for hallucinations?

A
  • Normalizing

- Enhancing coping strategies

27
Q

What is the CBT technique for Anhedonia?

A

Mastery and pleasure rating

28
Q

What is the CBT technique for Amotivation?

A

Activity scheduling

29
Q

What is the CBT technique for Affective blunting

A

Social skills training

30
Q

Therefore, the CBT technique to target positive symptoms are ________ and the CBT technique to target negative symptoms are __________

A
  • Alternate explanations to patients

- Behavioral interventions

31
Q

What is the CBT technique for Avolition?

A

Behavioral self monitoring

32
Q

Avolition

A

“Avolition” is a term used to describe the lack of motivation or ability to do tasks or activities that have an end goal, such as paying bills or attending a school function. Avolition occurs most commonly in schizophrenia, depression, and bipolar disorder.

33
Q

Amotivation

A

Amotivation, also known as avolition, is a psychological condition defined as “a reduction in the motivation to initiate or persist in goal-directed behavior”

34
Q

Anhedonia

A

Anhedonia is the inability to feel pleasure.

35
Q

Affective blunting.

A

Emotional blunting is a term sometimes used to describe a person’s limited emotional reactivity. They may not even be experiencing any emotions to feel, and people with emotional blunting may report feeling an unpleasant numbness instead of emotions.

36
Q

What is the “traffic light self rating of symptoms” system?

A
  • Green would be - Can cope with voices
    [ so Focus on school, partner
    Make sure to take medications, eat & sleep]
  • yellow would be - Voices annoying
    [ Check medications, eating and sleeping
    Talk to friends & partner]
  • Red would be - Voices persistent, negative
    [ Get in touch with therapist, Talk to friends & family]
37
Q

What are the benefits of the “traffic light” self rating of symptoms?

A
  • Concrete, easy to remember system
  • Gives person control
  • Can be used for other behaviors, situations
38
Q

What is the efficacy of CBT? (how well does it work)

A
  • Since 2009 in the U.K., CBT has been part of best practices for treatment of schizophrenia
  • But only 10% of service users have access*
39
Q

Discuss the effect size of CBT in comparison to the effect size of antipsychotics.

A

The effect size - how much change you get with CBT has been estimated to be .48 (.5 SD), this is a small improvement but it’s comparable to average effect size of antipsychotics on positive symptoms. So it would mean that they would be as effective as antipsychotics and it’s important for people with SZ to have access to them.

40
Q

CBT Has been shown to be effective compared to _____________

A

to standard treatment and control interventions (be-friending)

41
Q

Effects of CBT last beyond _________

A

the end of therapy

42
Q

CBT may be May be particularly effective for specific problems such as:

A

social skills and for co-morbid drug and alcohol problems

43
Q

CBT for patients not on meds (Morrison, 2012)

  • 20 people with SZ (10 M & 10 F)
  • Not currently on meds
  • Max 26 sessions over 9 mths

What were the Outcome variables?

A
  • Positive and negative symptoms
  • Severity of positive symptoms
  • Change in dysfunctional beliefs (specific CBT mechanism)
  • Adaptive behavior
44
Q

CBT for patients not on meds (Morrison, 2012)

  • 20 people with SZ (10 M & 10 F)
  • Not currently on meds
  • Max 26 sessions over 9 mths

What were the results?

A
  • Specific improvement in appraisal of delusions and hallucinations
  • Greater change was related to better adaptive behavior, shorter duration of psychotic episodes
45
Q

CBT for “ultra high-risk” (UHR) Study:
200 people with sub-clinical psychotic symptoms, family history of SZ and social decline
Standard treatment (ST) or ST plus CBT for UHR

CBT for UHR 
max 26 sessions over 9 mths
18 mth follow-up
Psycho-education on causes of psychotic symptoms
CBT interventions for:
  • “jumping to conclusions”
  • Selective attention to threatening stimuli
  • Confirmation bias: “Everyone is out to get me, so any new person I meet is out to get me too.”
  • Correlation bias: “I heard a dog barking outside and then the power went out. That dog is an emissary of Satan who caused my power to fail.”

What were the results?

A
  • For CBT group fewer people transitioned to psychosis

- At 18-mth follow-up, more people in remission from sub-clinical symptoms

PSYC 441 - FINAL (13 decks)

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