Cognitive Behavior Therapy (CBT) for Psychosis
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Presented by: Dawn I. Velligan, Ph.D. Professor, Department of Psychiatry Director, Division of Schizophrenia and Related Disorders Meredith L. Draper, Ph.D. Assistant Professor, Department of Psychiatry University of Texas Health Science Center, San Antonio
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Cognitive Behavior Therapy (CBT) for Psychosis
- 1. Cognitive Behavior Therapy (CBT) for Psychosis Basic Tenets and Skills for Interacting with Individuals Experiencing Psychotic Symptoms Dawn I. Velligan, Ph.D. Professor, Department of Psychiatry Director, Division of Schizophrenia and Related Disorders Meredith L. Draper, Ph.D. Assistant Professor, Department of Psychiatry University of Texas Health Science Center, San Antonio Supported by grant # R01 MH082793
- 3. Serious mental illness and the criminal justice system
- 8. A Review of schizophrenia and psychosis
- 12. Partial Compliance and Hospitalization Weiden PJ et al. Psychiatr Serv. 2004;55:886-891. Longest medication gap (days) N=327 N=1710 N=1166 N=1122 6% 12% 16% 22% 0 1-10 11-30 >30 Patients hospitalized (%) Studies with better methodology demonstrate that patients take About 50% of prescribed medication 0 5 10 15 20 25
- 15. Continuum of Experience I’d like to have more money… What would it be like if I won the lottery….I’d definitely buy a boat…a blue ski boat with a wakeboard…. I just woke up and for a moment I really thought I’d won the Powerball - $18M! I am really a millionaire, but a group of Satanists is trying to take all my money… Normal thoughts Imagination Dreams Delusions and hallucinations
- 16. Many people have beliefs others do not profess or understand About 75% Americans profess at least one paranormal belief, according to a 2005 Gallup survey. ESP 41% Houses can be haunted 37% Ghosts/Spirits 32% Telepathy 31% Clairvoyance 26% Astrology 25% Witches 21%
- 19. Zoe Wanamaker (actress) Beethoven (composer) Sir Anthony Hopkins (actor) Brian Wilson (Beach Boys) Joan of Arc (saint and heroine of France) Sigmund Freud (psychoanalyst) John Frusciante (guitarist, Red Hot Chili Peppers) Normalizing: Famous Voice Hearers Slide courtesy of Sara Tai, Clin.Psy.D., University of Manchester
- 20. Winston Churchill, Prime Minister of Britain during the second world war and famous speech maker, suffered from depression, and also heard voices. Winston Churchill is credited as being the greatest of all Britain’s war leaders. During World War II, Churchill's "voices" would tell him to "sit here" or "sit there?" (Funk & Wagnalls Encyclopedia, 1990, "Hallucinations.") Normalizing: Famous Voice Hearer: Winston Churchill http://www.intervoiceonline.org
- 27. Overview of Cognitive Behavioral Therapy for Psychosis
- 31. Stress-Vulnerability Model of Psychosis
- 32. Stress-Vulnerability Model Money Problems Relationship Break-up
- 33. Stress-Vulnerability Model Money Problems Relationship Break-up Assault Substance Use Fight with boss Speeding Ticket This is often the state during an encounter with law enforcement
- 34. Stress-Vulnerability Model Money Problems Relationship Break-up Assault Substance Use Fight with boss Speeding Ticket Medication Family Support Someone to listen Regular Sleep
- 37. 85:15 ratio The Beady Task
- 39. Beads seen before deciding! (Dudley et al., 1997a)
- 45. Responders to 9 months of CBT versus Standard Care 50 31 0 10 20 30 40 50 60 CBT Standard Care Percent Responding Kuipers et al. (2006)
- 46. 35.6 20.5 15.1 36.6 22.9 26.6 10 15 20 25 30 35 40 CBT Active Control Baseline 9 months 18 months Treatment Phase Follow-up Symptoms CBT versus an active comparator treatment Sensky et al., 2002
- 48. Techniques Informed by CBT for Psychosis
- 52. Formulating (Making Sense) Trigger Psychotic Symptom Belief about symptom Consequence Behavior
- 53. Formulating (Making Sense) Fight with Mom about medicine Hear a voice Mom is trying to poison me Fear No sleep Threatens to hurt mom, she calls the police
- 54. Many patients state that the brain disease model degrades and demoralizes them Your brain is defective!
- 59. Normalizing Exacerbation of Psychotic Symptoms Symptoms e.g. hearing voices Worry e.g. ‘ I’m going crazy’ ‘ I’m in danger’ Feel upset, anxious, depressed etc Symptoms get worse
- 64. Delusional Conviction: Coughing means there is a conspiracy against me 90% Convinced that a spell has been placed on me 10% Believe there may be another explanation
- 65. Pie Charts-Discuss Reasons People Cough—Re-rate original belief in light of alternative information Re rate original belief and emotion in light of alternative information
- 67. Ride the Bus-Don’t allow safety behavior
- 68. Ride the Bus-Don’t allow safety behavior
- 69. Ride the Bus-Don’t allow safety behavior
Notes de l'éditeur
- SMI – Bipolar disorder, schizophrenia or MDD-treatment refractory Likelihood of running into someone with SMI as a law enforcement agent/crisis team - high
- N
- A review of schizophrenia
- We will have participants split up into groups of 3 – do the try to speak with someone what a third person is talking in their ear Process what this was like….
- Ask – given their experiences of voice hearing in a safe environment…what must that be like?
- Normalizing begins with the clinician or intervening person’s opinions about these experiences. If you are frightened or judgmental of someone’s experience – particularly in a crisis – this may escalate the situation
- Here is a revised pie chart accounting for more of the contributory factors that led to the company losing money. The pie chart or ratings do not have to add to 360 degrees or 100%. The person may see that there is only 1% left after all the others have been allocated a role. The goal is not to teach them maths. At the end of this process the idea is to demonstrate that there are usually more than one factor involved. The numbers and percentages above are not real. So at the end the question may be “ now that we have reviewed all of the factors that contributed to the company losing money it seems that only about a quarter was down to you. What do you make of this?” Thinking about it now, how much do you think you were to blame? How much do you believe it now? How does this make you feel? Hopefully the person will see that there were a number of factors contributing and that when these are in mind the person does not feel so bad.