Cognitive-Behavioral Therapy for Medication-Resistant Symptoms

Academic Clinical Psychology Unit, St. Thomas' Hospital, London, United Kingdom.
Schizophrenia Bulletin (Impact Factor: 8.45). 02/2000; 26(1). DOI: 10.1093/oxfordjournals.schbul.a033447
Source: PubMed


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.

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Available from: Elizabeth Kuipers
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    • "Interventions may extend beyond conventional psychological therapies. A focus on how internalised stigma is handled, encouraging social participation and preventing isolation is important for wellbeing and symptomatic recovery in the long-run (Garety et al., 2000, 2001; Pyle and Morrison, 2013; Wood et al., 2014a). Hence, mental health services need to consider practical ways of minimising patients′ social exclusion, for example by encouraging service-user led self-help groups and by employing service-user advisors, and by developing robust anti-stigma policies that apply to all staff. "
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    ABSTRACT: This study aimed to examine how stigma impacts on symptomatic and subjective recovery from psychosis, both concurrently and longitudinally. We also aimed to investigate whether self-esteem and hopelessness mediated the observed associations between stigma and outcomes. 80 service-users with psychosis completed symptom (Positive and Negative Syndrome Scale) and subjective recovery measures (Process of Recovery Questionnaire) at baseline and 6-months later, and also completed the King Stigma Scale, the Self-Esteem Rating Scale and the Beck Hopelessness Scale at baseline. In cross sectional regression and multiple mediation analyses of the baseline data, we found that stigma predicted both symptomatic and subjective recovery, and the effects of stigma on these outcomes were mediated by hopelessness and self-esteem. When the follow-up data were examined, stigma at baseline continued to predict recovery judgements and symptoms. However, self-esteem only mediated the effect of stigma on PANSS passive social withdrawal. Self-esteem and hopelessness should be considered in interventions to reduce the effects of stigma. Interventions that address the current and long-term effects of stigma may positively affect outcome for people being treated for psychosis.
    Full-text · Article · Sep 2015
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    • "This involves modifying the content of anomalous beliefs identified as being associated with distress and dysfunction such as delusions and other symptom-related cognitions that may lead to distress, e.g. the belief that hallucinated voices have the power to harm the patient. The major techniques for weakening such beliefs include challenging the evidence for them, generating alternative explanations, identifying irrational or inconsistent elements and constructing reality testing experiments [4,5]. "
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    ABSTRACT: Background Cognitive behavior therapy for psychosis has been a prominent intervention in the psychological treatment of psychosis. It is, however, a challenging therapy to deliver and, in the context of increasingly rigorous trials, recent reviews have tempered initial enthusiasm about its effectiveness in improving clinical outcomes. Acceptance and commitment therapy shows promise as a briefer, more easily implemented therapy but has not yet been rigorously evaluated in the context of psychosis. The purpose of this trial is to evaluate whether Acceptance and Commitment Therapy could reduce the distress and disability associated with psychotic symptoms in a sample of community-residing patients with chronic medication-resistant symptoms. Methods/Design This is a single (rater)-blind multi-centre randomised controlled trial comparing Acceptance and Commitment Therapy with an active comparison condition, Befriending. Eligible participants have current residual hallucinations or delusions with associated distress or disability which have been present continuously over the past six months despite therapeutic doses of antipsychotic medication. Following baseline assessment, participants are randomly allocated to treatment condition with blinded, post-treatment assessments conducted at the end of treatment and at 6 months follow-up. The primary outcome is overall mental state as measured using the Positive and Negative Syndrome Scale. Secondary outcomes include preoccupation, conviction, distress and disruption to life associated with symptoms as measured by the Psychotic Symptom Rating Scales, as well as social functioning and service utilisation. The main analyses will be by intention-to-treat using mixed-model repeated measures with non-parametric methods employed if required. The model of change underpinning ACT will be tested using mediation analyses. Discussion This protocol describes the first randomised controlled trial of Acceptance and commitment therapy in chronic medication-resistant psychosis with an active comparison condition. The rigor of the design will provide an important test of its action and efficacy in this population. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12608000210370. Date registered: 18 April 2008
    Full-text · Article · Jul 2014 · BMC Psychiatry
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    • "Frequently, the SST intervention is applied in a group format, which allows the participants to practise with others, but the intervention can also be delivered in an individual format (Hogarty et al., 1991; Liberman & Eckman, 1989). According to Penn et al. (2004), the number individual psychotherapy approaches for schizophrenia are increasing, particularly those approaches based on cognitive-behavioural models (Garety, Fowler, & Kuipers, 2000). Individual psychotherapy approaches may better target patients' social needs and goals and can place greater emphasis on interpersonal context and the social consequences of symptoms (Tarrier & Calam, 2002). "
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    ABSTRACT: Social skills training (SST) intervention has shown its efficacy to improve social dysfunction in patients with psychosis; however the implementation of new skills into patients' everyday functioning is difficult to achieve. In this study, we report results from the application of a virtual reality (VR) integrated program as an adjunct technique to a brief social skills intervention for patients with schizophrenia. It was predicted that the intervention would improve social cognition and performance of patients as well as generalisation of the learned responses into patient's daily life. Twelve patients with schizophrenia or schizoaffective disorder completed the study. They attended sixteen individual one-hour sessions, and outcome assessments were conducted at pre-treatment, post-treatment and four-month follow-up. The results of a series of repeated measures ANOVA revealed significant improvement in negative symptoms, psychopathology, social anxiety and discomfort, avoidance and social functioning. Objective scores obtained through the use of the VR program showed a pattern of learning in emotion perception, assertive behaviours and time spent in a conversation. Most of these gains were maintained at four-month follow-up. The reported results are based on a small, uncontrolled pilot study. Although there was an independent rater for the self-reported and informant questionnaires, assessments were not blinded. The results showed that the intervention may be effective for improving social dysfunction. The use of the VR program contributed to the generalisation of new skills into the patient's everyday functioning.
    Full-text · Article · Sep 2013 · Journal of Behavior Therapy and Experimental Psychiatry
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