www.psychosisrecovery.org cbt for psychosis kate hardy, clin.psych.d post doctoral fellow prodromal...

www.psychosisrecovery.org

CBT for psychosis

Kate Hardy, Clin.Psych.DPost Doctoral FellowProdromal Assessment, Research and Treatment Team (PART), [email protected]

PREP Prevention and Recovery of Early Psychosis


Objectives

• Be able to differentiate between the terms ultra high risk and first episode psychosis

• Have an understanding of CBT in relation to psychosis and the evidence base behind this

• Be able to recognize the key aspects of CBT for psychosis including the reduction of distress rather than the removal of symptoms

• Have reviewed any concerns regarding practicing CBT for psychosis


What is psychosis?

• Positive symptoms

• Negative symptoms

• Disorganized symptoms

• Associated mood symptoms


Psychosis: the early course

very early symptoms psychotic symptoms

The typical course of psychosis

Psychosis

Treatment & Recovery Relapse?

“DUI”

Early Detection & Intervention in the at-risk phase

Early Intervention after onset of psychosis (EIS)

premorbid phase


Phase specific psychological treatments

• AT RISK PHASE – identify symptoms and prevent transition to psychosis

• ACUTE – maintain safety, decrease positive symptoms, decrease associated distress

• RECOVERY - promote medication adherence, identify early warning signs and develop relapse signature


Ethics of intervening in the at risk period

• Use of anti psychotic medication with young people who don’t have a diagnosis of psychosis

• Stigma associated with treating individual for something they don’t yet have


What is CBT for psychosis?

• CBT focuses on reduction of emotional distress (depression, anxiety, trauma etc) through altering cognition and behavior

• In psychosis – focus is on a cognitive model of the formulation and maintenance of positive symptoms

• Also ‘affective disturbance’ influences and maintains this process


What is CBT for psychosis - II

• Focus is still on collaborative approach • Client’s perspective is taken seriously • Shared formulation developed to attempt to

understanding the meaning of psychosis to the individual

• May offer more flexibility in duration of sessions, frequency, goals etc to accommodate difficulties with attention and concentration


CBT, psychosis and distress

• Birchwood et al. (2004) - not all distress in psychosis arises from positive symptoms

• Focusing purely on delusions/hallucinations will not address other sources of distress

• Other sources of distress include post psychotic depression, PTSD, childhood trauma

• Argue that CT should focus on reducing distress and not on reducing symptoms


Deconstructing Schizophrenia

• Psychotic symptoms on a continua

• Questions validity of term ‘schizophrenia’ and proposes that we focus on individual symptoms

• Cognitive processes and biases maintains misperceptions

• Processes and biases amenable to CBT intervention


Clients’ understandings of psychotic experiences

Jim Geekie (2004)

• Research conducted with 13 participants in NZ

• Came from observation that clients he was working with focused on ‘explanatory models’

• Variety of ways in which people understand their experiences

• Welcome opportunity to talk in depth about what experience means to them individually


• Cautions against telling the client what their experience is or what it means – may lead to further invalidation

• Important to recognize that clients want to be active participants in the process of ‘sense making’

• Not undermining the medical profession but encouraging acknowledgement of multiple perspectives

www.psychosisrecovery.org cbt for psychosis kate hardy, clin.psych.d post doctoral fellow prodromal...

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