A cognitive investigation of schizophrenic delusions
ABSTRACT Delusions have traditionally been regarded as unmodifiable false beliefs. Both Freud (1911) and Jaspers (1968) argue that there is a unidirectional relationship between a delusional belief and consensually validatable realtiy: the delusion structures reality in accordance with the delusion's demand. In contrast, we postulate that there is a bidirectional interaction between the delusion and external events. We believe that external events might modify the rigid belief when there is a dramatic incongruity between specific beliefs and selected events. The following investigation was motivated by a desire to understand more clearly how some overtly delusional patients come to lose their delusions during the course of treatment for schizophrenia. Do delusions simply melt away under the influence of major tranquilizers, or does the delusional patient play some active part in assessing the validity of this belief?
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ABSTRACT: We studied three characteristics or dimensions of delusions in schizophrenia patients living in the community, including their influence on work and community functioning. The 149-patient sample included 57 delusional schizophrenia and nonschizophrenia outpatients, 50 nondelusional outpatient controls, and 42 delusional inpatient controls. The data indicated the strength and prominence of acute-phase psychopathology on characteristics of delusions, with large significant differences in intensity of delusions between the acute inpatient phase and the postacute inpatient and outpatient phases. Contrary to some views, the data indicate that the overall presence of any delusions in general, and the various dimensions of delusions, both influence work performance and community functioning, with the greater part of the variance due to the presence of delusions in general. Despite their outpatient status, delusional outpatients showed surprisingly poor self-monitoring about whether others would regard their delusional ideation as unrealistic. Schizophrenia and affectively disordered patients with high emotional commitment to their delusions showed significantly poorer work functioning and were significantly more likely to be rehospitalized (p < 0.05), indicating the important impact on functioning of patients' feelings of immediacy and urgency about their unrealistic beliefs.Schizophrenia Bulletin 01/2004; 30(1):147-61. DOI:10.1093/oxfordjournals.schbul.a007059 · 8.61 Impact Factor
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ABSTRACT: Cognitive behavior therapy has been demonstrated in a number of randomized controlled trials to be efficacious for the treatment of psychosis. Emerging evidence suggests the usefulness of related mindfulness/acceptance-based approaches for this population. The current study was designed to replicate and extend previous findings by Bach and Hayes (2002). Psychiatric inpatients with psychotic symptoms were randomly assigned to enhanced treatment as usual or enhanced treatment as usual plus individual sessions of Acceptance and Commitment Therapy (ACT). Results revealed greater improvements in the ACT group at post-treatment on clinician-rated affective symptoms and global improvement, and self-rated distress associated with hallucinations and impairment in social functioning. Overall large effect size improvements were demonstrated in both groups pre- to post-treatment, with medium effect sizes differences between groups favoring the ACT condition. In addition, significantly more participants in the ACT condition reached clinically significant improvements in overall symptoms at posttreatment. At 4-month follow-up, 45% of participants in the ETAU only group had been rehospitalized compared to only 28% of those in the ACT group. Results suggested that believability in hallucinations mediated the relationship between symptom frequency and distress. Improvement in believability of hallucinations over time was only observed in the ACT condition, and change in believability predicted change in associated distress after controlling for change in frequency of hallucinations. Results are viewed as largely consistent with the findings of Bach and Hayes and warrant future investigations with larger samples. Future research should continue to investigate possible mechanisms of action in effective psychosocial treatments for psychosis.
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ABSTRACT: Too few research studies that identify effective therapeutic methods for treatment of psychotic depressions are available. A few studies indicate that cognitive therapy reduces symptoms and may provide prophylaxis in outpatients with moderately severe depressions. Cognitive theory provides a conceptual framework for developing techniques to treat more severely depressed patients. Specific obstacles in the psychotherapy of this group include negatively biased recall of current and past events; difficulties in forming a therapeutic alliance; memory and concentration deficits; hallucinations; delusions; and somatic complaints. This paper presents preliminary attempts to develop and apply cognitive change techniques to some of these difficulties. The role of medication in combination with psychotherapy, the identification of depressions requiring psychotheeapy, and the development of methods specific to psychotherapy with psychotic depressions and promising areas in need of further investigation.The American Journal of Psychoanalysis 02/1980; 40(2):99-121. DOI:10.1007/BF01254804