RATIONALE FOR CBT
Cognitive behavioral approaches in the treatment of psychosis have become more prevalent in recent years for a number of reasons. Evidence has been available for the past two or three decades regarding the success of these techniques with other forms of psychopathology such as depression, anxiety disorders, and medical problems. Anxiety, depression and low self-esteem have been cited as the most common consequences of psychotic disorders. The observation has also emerged that many patients develop their own coping strategies for reducing the frequency, severity, and disruptiveness of their symptoms. There has also been increasing evidence regarding the influence of social environmental factors on the course of psychosis and the development of stress-vulnerability models to explain these relationships. Research suggests that 20 to 50 percent of persons with psychosis who receive neuroleptics continue to experience difficulties related to their psychotic symptoms.
BACKGROUND INFORMATION
On a clinical level, numerous case reports and several controlled trials of interventions using cognitive-behavioral strategies have demonstrated their efficacy in decreasing ratings of anxiety and depression, symptom severity and frequency, improving social functioning, and reducing hospitalization and relapse rates among patients with psychotic disorders. Such reports have typically been with reference to chronic patients for whom pharmacological interventions have failed to achieve total remission of symptoms.
Given the current evidence for the effectiveness of cognitive interventions with such patients, these may be even more efficacious in helping patients at early stages of psychosis or having prophylactic value in reducing likelihood or severity of future episodes of psychosis.
OBJECTIVES OF CBT
The objectives of individual CBT as provided by the psychologist in this program are as follows:
- To reduce comorbid psychopathology such as anxiety and depression
- To reduce psychotic symptoms
- To improve self-efficacy, self-esteem, and reduce self-stigmatization
These objectives are typically achieved through teaching and practice of cognitive behavioral techniques aimed at:
- Reduction of stress and building of skills for coping with stressors
- Building self-esteem and self-efficacy
- Identifying and coping with triggers for psychosis
- Dsruption of symptoms
- Belief modification
DESCRIPTION OF CBT
Patients are identified through a multidisciplinary review process to require C.B.T. Initially they meet with the Psychologist for one hour on a weekly basis. Under some circumstances sessions may occur twice weekly or be shorter in duration (i.e. if the presenting problem is severe and requires more frequent contact or the cognitive functioning of the patient warrants a shorter appointment). Once some amelioration of the patients presenting problem has occurred and these gains are being maintained, contact is slowly tapered off to biweekly, followed by monthly sessions with the eventual goal of termination. While the exact duration of CBT will vary widely according to psychological, social and cognitive functioning of the patient, most people can expect to spend 6 to 12 months in treatment.
CRITERIA FOR CBT
Patients are referred to Psychology who have completed the 'YES' group and continue to demonstrate a need for intervention regarding mood, anxiety, and adjustment related concerns and/or residual psychotic symptoms, or who are identified as requiring immediate intervention of this nature following completion of their intake assessment and stabilization of their symptoms.
In order for this treatment to produce the greatest benefit for patients, a certain level of cognitive and social skills is required. Patients functioning intellectually below the average range may experience difficulty understanding and utilizing various cognitive techniques. Patients who are acutely psychotic or experiencing pervasive negative symptoms are also likely to receive limited benefit from use of CBT. Research on the use of this therapy has reliably demonstrated that those patients who benefit most are verbal, highly motivated, and able to tolerate some anxiety generated by direct and open discussion of their concerns.
