Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms.

King's College London, Institute of Psychiatry, Department of Psychology, PO Box 77, London SE5 8AF, UK.
Schizophrenia Bulletin (Impact Factor: 8.61). 11/2006; 32 Suppl 1:S24-31. DOI: 10.1093/schbul/sbl014
Source: PubMed

ABSTRACT Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.

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    ABSTRACT: This paper reviews a revolution in our understanding of psychosis over the last 20 years. To a major extent, this has resulted from a process of cross-fertilization between psychosocial epidemiology and cognitive behavior therapy for psychosis (CBT-p). This encouraged complementary strategies for the acquisition and analysis of data. These include the use of a range of dependent variables related to psychosis, and the exploitation of data from cross-sectional and longitudinal epidemiological surveys, virtual reality experiments, experience sampling methodology, and treatment trials. The key element is to investigate social and psychological measures in relation to each other. This research has confirmed the role of the external social world in the development and persistence of psychotic disorder. In addition, several psychological drivers of psychotic experiences have been identified. There is now persuasive evidence that the influence of social factors in psychosis is significantly mediated by non-psychotic symptoms, particularly mood symptoms and other attributes of affect such as insomnia. Psychotic symptoms are also driven by reasoning biases such as jumping to conclusions and belief inflexibility, though little is known about social influences on such biases. It is now clear that there are many routes to psychosis and that it takes many forms. Treatment of all kinds should take account of this: the dependence of CBT-p on a detailed initial formulation in terms of psychological processes and social influences is an example of the required flexibility. Individual mediators are now being targeted in specific forms of CBT-p, with good effect. This in turn corroborates the hypothesized role of non-psychotic symptoms in mediation, and attests to the power of the approaches described. • 70 • 1. A sea-change in our understanding of psychotic disorder? In the last 15 to 20 years there has been a revolution in our understanding of psychosis. It is now acknowledged that there are clear continuities between psychosis and attributes widely distributed in the population. Partly as a result of this new realization, there has been a large accumulation of scientific evidence suggestive of the processes underlying the emergence of psychotic symptoms and, hence, of psychosis itself. This has been aided by the parallel development and elaboration of cognitive behavioral treatments for psychosis (CBT-p).
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    ABSTRACT: ZET İşitsel varsanılar, şizofrenide ve diğer psikotik bozukluklarda sık görülen belir-tilerdendir. İşitsel varsanıların sıklığı ve bu belirtileri deneyimleyen kişiler üzerinde yarattığı sıkıntı, kişiyi bu seslerin kontrol edilemez ve baş edilemez olduğuna inandırmaktadır. Bu durum umutsuzluğa ve çaresizliğe kapılmaları-na, kendilerine ya da başkalarına zarar vermelerine yol açabilmektedir. Ayrıca seslere harcadıkları zaman ve bu belirtilerle meşguliyetleri nedeniyle bu kişile-rin sosyal ve mesleki işlevselliklerinde belirgin azalma olmaktadır. İşitsel varsanılar temelde içsel uyaranların dışsal kaynaklara atfedilmesine neden olan düşünceler, yani kişilerin iç konuşmalarıdır. Bu iç konuşmalar temel kendini izleme süreçlerindeki bozulma nedeniyle hatalı olarak yorumlanmaktadır. Bu noktada uygulanacak olan bilişsel davranışçı tekniklerin bu bilişsel zorlukların giderilmesi; işitsel varsanıların yarattığı duygu, davranış ve bedensel tepkilerin anlaşılması ve bu belirtilerle baş edilmesi için yararlı olabileceği düşünülmek-tedir. Bu yazıda, işitsel varsanılara yönelik bilişsel-davranışçı teknikleri daha ayrıntılı biçimde tanıtılması ve bu belirtileri yaşayan kişilerin tedavisindeki kullanımının geniş biçimde ele alınması hedeflenmiştir. Anahtar Sözcükler: şizofreni, işitsel varsanılar, bilişsel-davranışçı terapi ABSTRACT Auditory hallucination is one of the most common symptoms in schizophre-nia and the other psychotic disorders. The frequency of the auditory hallucinations and ensuing distress make the individual believe that these voices are not able to be controlled and to be coped. This situation can cause patients to be hopeless and desperate and lead to harm themselves or the others. Furthermore , the time they lose and preoccupation with these symptoms reduce
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    ABSTRACT: Despite a rise in the popularity of cognitive behavior therapy for psychosis (CBTp) over the past 15 years, recent systematic reviews and meta-analyses have concluded that CBTp has only modest effects on psychotic syndrome outcomes and that empirical evidence of its superiority over other psychosocial treatments is poor (Jones, Hacker, Meaden, Cormac, & Irving, 2012; Wykes, Steel, Everitt, & Tarrier, 2008). However, for some time now, some authors prominent in the development of CBTp have argued the primary goals of CBTp not to be global syndrome reduction but the amelioration of emotional distress and behavioral disturbance in relation to individual psychotic symptoms (Birchwood & Trower, 2006). A review of the theoretical and empirical literature related to CBTp reveals broad support for this position. Implications and recommendations for research into the efficacy of CBTp are discussed.
    Journal of Cognitive Psychotherapy 02/2015; 29(1). DOI:10.1891/0889-8391.29.1.45

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