Psychological Interventions for psychosis

Question 1

What are the findings of Linscott and van Os?

Answer 1

80% of PE remit
Of those that don’t, only 7% develop psychosis.

4% report distress, and 8% no distress

Question 2

What is the major focus of Psychological approaches?

Answer 2

Experiences, Belief and Behaviours that cause DISTRESS.

Question 3

How does CBT tackle distressing experiences like psychosis?

Answer 3

Individual formulation: considering: What has caused difficulties and how they are being maintained. Furthermore, we look at the appraisal of events.

Question 4

How is the appraisal stage significant in AH?

Answer 4

The beliefs regarding the voice will dictate if it is distressing, not the content or the presence.

Question 5

What could CBT change and what could it not change?

Answer 5

It could change:

Appraisals of events
Social environment
Thinking and reasoning bias
How one responds to their experinece.

But can’t change:

Actual psychosis experience

Question 6

What three elements should CBT involve?

Answer 6

Being flexible as you work with individual

Collaborative: Work together

Driven by their desire to change

Question 7

What are the goals fro CBT in psychosis?

Answer 7

Not about cure, about management

Emphasise engagement

Bring about change

Individual formulation because:
Heterogeneity of symptoms and severity
Secondary symptoms

Question 8

What are the three most popular third wave approaches?

Answer 8

Acceptance and compassion: Goals despite struggles

Mindfulness based CT: Mindfulness and breathing

Compassion Focused Therapy: Self soothe

Question 9

What are the four dimensions of delusions?

Answer 9

Conviction
Distress
Preoccupation
Impairment

Question 10

According to CBT what elements should we focus on when assessing voices?

Answer 10

Antecedents: Situations and Moods that trigger
Beliefs: about the voice
Consequence: behaviours and emotions

Also: Reasoning basis
What the voices say?
Nature of voices
Relationship to voices

Question 11

What are themes of voices?

Answer 11

Omnipotence

Intention:
Benevolence vs Malevolence

Response: Engage or resist

Question 12

How do we intervene in the vicious cycle in psychosis?

Answer 12

At each stage there is a exit option:

Antecendent: Instead of avoiding you can challenge

Thoughts: Are the thoughts the only option

Belief: challenge beleif

Emotions: Awareness and changing of physiology

Question 13

What are the stages in CBT therapy?

Answer 13

Engagement and Assessment
Coping strategies
Formulation
Delusions and Beliefs about voices

Potentially also: Unhelpful Assumptions
Social exclusion
Risk of relapse

Question 14

What have the results for meta-analysis found with regards to CBT and psychosis?

Answer 14

Significant but modest results
CBT is done in conjunction with medication

Best results:
TR patients
Stable patients with symptoms
1-1 and individual formulation

Question 15

What things can lead to an overestimation of effect size in CBT?

Answer 15

Lack of blinding
Exclusion criteria
Referral bias
Quality of therapy

Question 16

What things could lead to underestimation of effect size in CBT?

Answer 16

Outcome measures of symptoms not distress (targeted studies better)

Generic therapy not 1-1

Research lags behind therapy

Question 17

How do we know CBT works in real life?

Answer 17

In the PICUP clinic symptoms, depression and anxiety only reduce after therapy and at follow up.

CBT shown to reduce fear processing in the brain, related then to reduced symptoms.

Also: Patients have very high satisfaction levels for CBT 59%