Week 4 Lecture 4 - psychological therapy for psychosis Flashcards
Why the delay in developing talking treatments for psychosis?
- psychological therapies for psychosis not widely accepted as useful until 1990s
- Psychosis was seen as fundamentally different from neurosis.
- Symptoms not seen as understandable in psychological terms
- Lack of therapeutic optimism in the treatment of “schizophrenia” –> Poor results from early trials of psychotherapy, Neuroleptics seen as the only viable treatment option
What are some psychological therapies for psychosis?
- Rogerian/person-centred therapy
- Psychoanalytic therapies
- Cognitive Behaviour Therapy (CBT) –> recommended by NICE
- Family therapy
- Interventions to reduce substance misuse
What is CBTp?
- the application (and adaptation) of the same basic principles of CBT to understand the distress and impairment caused by psychotic experiences
NICE defines CBTp as a psycholgoical intervention where service users …?
- Establish links between thoughts, beliefs, perceptions and feelings in relation to their current or past symptoms and/or functioning
- Re-evaluate their beliefs, perceptions and reasoning relating to target symptoms
- CBTp should involve development alternative ways of coping with the target symptoms, and/or reduction of distress, and/or improvement of functioning
What are some basic CBTp strategies?
1) Formulating (making sense).
2) Normalising psychosis.
3) Improving coping.
4) Strategies to change unhelpful thoughts, beliefs, and appraisals
What is formulating CBTp?
After therapy goals are identified, the therapist carries out an assessment to:
- Identify thoughts, feelings, behaviours that are linked to the problem/symptom targeted
- Help the client to see how these interact to maintain the problem in the present
- Create a shared understanding of how the problem developed and what could be done to resolve it
Often in CBT, therapists use well-established models to formulate difficulties (“templates”).
What is normalisation (CBTp)?
- Challenging the stigma of psychosis.
- Correcting common misconceptions about psychosis, its causes and its consequences.
- Provision of more accurate information.
- Promotion of accurate views about psychosis.
- making the experience understandable –> e.g., as a reaction to trauma
- they are not alone
- psychoeducation
- personal disclosure
True or false
People with psychosis are dangerous
False
- no evidence that people with psychosis are more dangerous or violent than the general population. Violence in psychosis is explained mostly by other factors
- People are more likely to be withdrawn or preoccupied with their own problems
- People with psychosis are much more
likely to be the victim of violence rather
than the perpetrator
True or false
Psychosis is a diagnosis for life and
there is no recovery
False
- Psychosis is not necessarily for ever.
- Many people have a single episode that
never occurs again (about 30%). - Some people experience more than one
episode even after long periods of being
symptom-free (about 30%). - A minority of people have persistent
ongoing symptoms (< 25%)
True or false
People with psychosis are unable to
work
False
- May be times when a person’s distress is such that it interferes with their ability to function, but this is not necessarily so.
- Many people who have experienced or
currently experience symptoms of
psychosis are able to work, have
relationships and manage to function in
their life.
True or false
Psychosis always causes distress and
people always need treatment
False
- Many people experience unusual beliefs or hear voices, but are not distressed by them
- Many people make sense of their experiences in a way they can find helpful
- In some cultures, psychotic symptoms are viewed positively
True or False
Psychosis is always a consequence of a brain disease
False
Psychosis can be brought about by many experiences such as:
- Lack of sleep
- Sensory deprivation
- Substances or activities creating altered states of consciousness
- Stressful events
- Bereavement
- Trauma
What is improving coping (CBTp)?
Coping strategies enhancement consists of:
- Review strategies the client already uses to cope with psychotic experiences, how often/when they are used and how effective they are
- Encourage the client to experiment with new coping strategies
What is the aim of coping strategies?
(1) increase the coping strategies the client can use when facing distressing symptoms
(2) provide some respite
(3) encourage a greater sense of control
What are some examples of coping strategies?
1.) understanding psychosis –> humming, singing, reading
2.) responding differently to symptoms –> acting assertively/ dismiss the voice, “making an appointment” with the voices, respond rationally to the voice content
3.) reduce arousal and distress –> listen to soothing music, mindfulness meditation, relaxation exercises
