Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis

University of British Columbia Department of Psychiatry Vancouver BC Canada; University of British Columbia Ph.D., Assistant Professor of Psychiatry 828 West 10th Avenue, Room 214 Vancouver BC V5Z 1L8 Canada
Journal of Contemporary Psychotherapy 01/2006; 36(1):51-58. DOI: 10.1007/s10879-005-9006-5

ABSTRACT CBT for psychosis has recently been called a best practice, suggesting that studies have demonstrated its efficacy with many populations. Community settings are encouraged to implement best practices such as CBT yet many factors can make the implementation of CBT challenging. Issues such as clinician resistance, setting, as well as client variables (refusal, denial of symptoms, etc.) come into play. Examples of successes and challenges of a community based study of CBT groups for first episodes will be described. The strategies used to overcome these challenges and the successes of the program will be presented.

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    ABSTRACT: Cognitive behaviour therapy (CBT) has become a treatment of choice for several schizophrenia spectrum disorders. This chapter traces the development of CBT from early attempts at thought stopping to more recent developments of cognitive therapy specialized for psychosis. CBT strategies have drawn on information processing biases such as threat bias, attentional bias, reasoning bias, data gathering bias, externalizing bias, lack of agency, and intention initiation. Meta-analytic reviews of the efficacy of CBT in psychosis have shown strong effect sizes when compared with no treatment but less strong when compared to supportive therapy, and proportions of clinically significant change have often not persisted between CBT and comparison therapies at follow-up. Although current CBT programs share common theoretical foundations and follow a similar format of preparation, restructuring and reality testing, experimental findings and clinical strategies differ for specific spectrum disorders. In addition, CBT programs have been tailored to specific stages of development, such as early onset or relapse prevention. There is also a trend towards limiting the targets of CBT intervention to focus on alleviating specific features such as emotional distress, or level of beliefs, or degree of preoccupation, rather than addressing core beliefs. Further challenges for CBT include improving access to and treatment delivery of CBT to diverse populations and through diverse professions. There have recently been attempts in UK and elsewhere to set up pyramid training and to encourage community settings to implement best practices. Alternative treatment delivery involves group formats and new technologies including computer and teleconferences following step care models. KeywordsCognitive behaviour therapy-Psychosis-Positive symptoms-Negative symptoms-Clinical trials-Treatment delivery
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    ABSTRACT: Despite national guidelines recommending cognitive-behavioural therapy (CBT) and family intervention (FI) in the treatment of schizophrenia, levels of implementation in routine care remain low. The present study investigates attitudinal factors amongst community mental health team (CMHT) staff affecting guideline implementation. CMHTs were audited to measure the capacity and delivery of CBT and FI, and semi-structured interviews were conducted with staff from the teams. Methods. Four CMHTs were audited, and five care coordinators from each team were interviewed. A purposive approach to sampling was used to represent the range of professional training of care coordinating staff. Data were analysed using thematic content analysis. Positive views towards guidelines were evident, although tempered by specific implementation issues. Employing simple psychological interventions and approaches as part of the care coordinating role also emerged as highly valued by staff. Severe workload, time pressure and the need for specialist staff were crucial barriers to implementation. Pessimistic views of recovery for clients with psychosis were also apparent and may affect implementation. Staff attitudes and knowledge are an important area of research when examining guideline implementation and require further study. Key themes that have emerged could inform future training agendas and should be considered when developing guideline implementation strategies for the updated 2009 guidelines.
    Clinical Psychology & Psychotherapy 01/2011; 18(1):48-59. · 2.59 Impact Factor
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    Journal of Mental Health 08/2012; 21(4):327-31. · 1.01 Impact Factor


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May 21, 2014