Cognitive-Behavioral Therapy for Medication-Resistant Symptoms

Academic Clinical Psychology Unit, St. Thomas' Hospital, London, United Kingdom.
Schizophrenia Bulletin (Impact Factor: 8.61). 02/2000; DOI: 10.1093/oxfordjournals.schbul.a033447
Source: PubMed

ABSTRACT Cognitive-behavioral therapy for psychosis is described. It draws on the cognitive models and therapy approach of Beck and colleagues, combined with an application of stress-vulnerability models of schizophrenia and cognitive models of psychotic symptoms. There is encouraging evidence for the efficacy of this approach. Four controlled trials have found that cognitive-behavioral therapy reduces symptoms of psychosis, and there is some evidence that it may contribute to relapse reduction. Studies that have examined factors that predict treatment response are reviewed. There is preliminary evidence that a good outcome is partially predicted by a measure of cognitive flexibility or a “chink of insight.” People who present with only negative symptoms may show poorer outcome. However, there is no evidence that intelligence or symptom severity is associated with outcome. Implications for selecting patients and for optimal duration of treatment are discussed. Finally, the importance of taking account of the heterogeneity of people with psychosis, so that individual treatment goals are identified, is discussed.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Persistent paranoid symptoms are best understood as having multiple causal mechanisms. An enhanced multidimensional understanding of paranoia may result from the convergence of two distinct measurement paradigms, experimental psychopathology and social cognitive research. This study investigated the role of neurocognitive deficits and emotion misperception bias as they relate to paranoid symptoms at two different time points in a sample of individuals with severe mental illness (primarily schizophrenia spectrum disorders [N=91]) undergoing intensive psychosocial rehabilitation. Before intensive rehabilitation (but after initial stabilization), paranoid symptoms were related to a tendency to misperceive emotion as disgust. The impact of this social cognitive bias was amplified by perseveration (as measured by the COGLAB Card Sorting Task). Perseverative errors were associated with paranoid symptoms at both time points. After 6 months of treatment, there were significant reductions in paranoid symptoms and perseverative errors but no significant changes in emotion misperception biases. This study is one of few to date to evaluate the contribution of both neurocognitive deficits and social cognitive biases to paranoid symptoms. The results demonstrate how social cognitive biases can interact with neurocognitive deficits in expression of paranoid symptoms, and how these relationships change during treatment.
    Schizophrenia Research 05/2004; DOI:10.1016/S0920-9964(04)00127-6 · 4.43 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Suppose I am a blind man, and I use a stick. I go tap, tap, tap. Where do I start? Is my mental system bounded at the handle of the stick? Is it bounded by my skin? Does it start halfway up the stick? Does it start at the tip of the stick? (Bateson, 1972:459; Form, Substance and Difference) One of the most amazing capacities of the human mind is its ability to go beyond its boundaries. The well-known example of the "blind man" by Gregory Bateson helps us understand how our mind is able to expand its potentiality thanks to the use of a tool. This famous example demonstrates two specific features that characterize the relationship between the human mind and the use of tool. From a neuropsychological point of view, the tool is integrated in near space, extending it to the end point of the instrument. From a phenomenological point of view, we are present in the tool because we can use it in an intuitive way to realize our intentions. As Riva and Mantovani suggested, there is also another type of relationship between mind and technology, namely the second-order mediated action. In this case, the subject uses the body to control a distal tool that controls a different one to exert an action upon an external object. An example of a second-order mediated action is what happens with Virtual Reality (VR): I use my body to move an avatar (a distal tool) to exert an action upon an external object (a virtual environment). On one side, the outcome of this process further extends the space of action. From an experiential viewpoint, when interacting in a virtual space, we are also present in the distal virtual environment. On these theoretical bases, it is clear what makes VR development distinctively important is that it represents more than a simple technology in different domains of human society. In recent years, the field of VR has grown immensely. Practical applications for the use of this advanced technology encompasses many fields, from personnel training supported by interactive 3D images in industrial centers, to the use of interactive virtual environments for marketing purposes. One of the newest fields to benefit from the advances in VR technology is medicine and healthcare. Impressive advances in technology, coupled with a reduction in the economic costs have supported the development of more usable, useful, and accessible VR systems that can uniquely target a range of physical, psychological, and cognitive clinical targets and research questions. The aim of the book Virtual Reality-Technologies, Medical Applications, and Challenges is twofold: (1) to provide a critical overview of the most interesting medical applications of VR technologies and (2) to reflect on the future challenges in this growing field.
    Psychology Research Progress 01/2014; Nova Science Publisher Inc.., ISBN: 978-1-63321-933-5
  • Source

Full-text (2 Sources)

Available from
May 22, 2014