Article

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
Journal of Contemporary Psychotherapy 03/2006; 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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Available from: Alicia Spidel
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    • "Psychotherapies, such as cognitive behavioural therapy for psychosis (CBTp), are now being used alongside the psychopharmacological approach in the treatment of the core symptoms of schizophrenia, such as delusions (Barrowclough et al., 2006; Bechdolf et al., 2010; Garety et al., 1994; Granholm et al., 2006; Landa et al., 2006; Lecomte et al., 2003; Lecomte et al., 2008; Spidel et al., 2006). CBTp, whether administered individually or in group settings, aims to identify and actively modify maladaptive delusional beliefs, attitudes and behaviours that are often associated with schizophrenia. "
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    ABSTRACT: Objective: Metacognitive training is an eight-module, group-based treatment programme for people with schizophrenia that targets the cognitive biases (i.e. problematic thinking styles) thought to contribute to the genesis and maintenance of delusions. The present article is an investigation into the efficacy of a shorter, more targeted, single-module metacognitive training programme, administered individually, which focuses specifically on improving cognitive biases that are thought to be driven by a 'hypersalience of evidence-hypothesis matches' mechanism (e.g. jumping to conclusions, belief inflexibility, reasoning heuristics, illusions of control). It was hypothesised that a more targeted metacognitive training module could still improve performance on these bias tasks and reduce delusional ideation, while improving insight and quality of life. Method: A sample of 28 patients diagnosed with schizophrenia and mild delusions either participated in the hour-long, single-session, targeted metacognitive training programme (n = 14), or continued treatment as usual (n = 14). All patients were assessed using clinical measures gauging overall positive symptomology, delusional ideation, quality of life and insight, and completed two cognitive bias tasks designed to elucidate the representativeness and illusion of control biases. Results: After a 2-week, post-treatment interval, targeted metacognitive training patients exhibited significant decreases in delusional severity and conviction, significantly improved clinical insight, and significant improvements on the cognitive bias tasks, relative to the treatment-as-usual controls. Performance improvements on the cognitive bias tasks significantly correlated with the observed reductions in overall positive symptomology. Patients also evaluated the training positively. Conclusions: Although interpretations of these results are limited due to the lack of an optimally designed, randomised controlled trial and a small sample size, the results are promising and warrant further investigation into targeted versions of the metacognitive training programme.
    Full-text · Article · Oct 2013 · Australian and New Zealand Journal of Psychiatry
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    • "Participants received 24 sessions of either treatment, twice a week, for 3 months. Strategies used to conduct groups with first episodes in the community are mentioned elsewhere (Spidel et al., 2006). Each intervention was led by 2 cotherapists of different gender, 1 from the site's mental health team and one from the research team. "

    Full-text · Article · Aug 2012 · Journal of Mental Health
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    • "Participants received 24 sessions of either treatment, twice a week, for 3 months. Strategies used to conduct groups with first episodes in the community are mentioned elsewhere (Spidel et al., 2006). Each intervention was led by 2 cotherapists of different gender, 1 from the site's mental health team and one from the research team. "
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    ABSTRACT: This study aimed at determining the effectiveness of group cognitive behavior therapy (CBT) for recent onset psychosis in comparison with a recognized intervention for individuals with severe mental illness-social skills training. One hundred twenty-nine participants took part in a single-blind randomized controlled trial with repeated measures (baseline, 3 months, and 9 months). Participants were randomized to 1 of 3 conditions: group CBT, group social skills training for symptom management, or a wait-list control group. Both interventions were delivered by mental health staff with minimal training. Both treatments resulted in improvements on positive and negative symptoms compared with the wait-list control group, with the CBT group having significant effects over time on overall symptoms, and post-treatment effects on self-esteem, and active coping skills compared with the wait-list control group and lower drop-out rates than the skills training group. Therapist fidelity was adequate for both treatment conditions. Group CBT for psychosis is a promising intervention for individuals with recent onset of psychosis and their mental health professionals.
    Full-text · Article · Jan 2009 · The Journal of nervous and mental disease
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