CBT for Schizophrenia E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 512

Veröffentlichungsjahr: 2012

Beschreibung

Informed by the latest clinical research, this is the first book to assemble a range of evidence-based protocols for treating the varied presentations associated with schizophrenia through Cognitive Behavioural Therapy

• Deals with a wide range of discrete presentations associated with schizophrenia, such as command hallucinations, violent behaviour or co-morbid post-traumatic stress disorder
• Covers work by the world's leading clinical researchers in this field
• Includes illustrative case material in each chapter

Leseprobe

Contents

About the Editor

List of Contributors

Preface

Acknowledgements

1 CBT for Psychosis: An Introduction

Introduction

Schizophrenia

Cognitive Behavioural Models of Psychosis

CBT for Psychosis

Assessment within CBT

The Evidence Base for CBT for Psychosis

2 Cognitive Therapy for Reducing Distress and Harmful Compliance with Command Hallucinations

Introduction

Clinical Trial Evidence

The CTCH Model

The Trial Protocol

Case Example: Marcus

Agreeing and Setting Therapy Goals in CTCH

Limitations and Future Directions in CTCH

3 CBT for Post-Traumatic Stress Disorder and Psychosis

Introduction and Current Evidence-Base

The Protocol

Session Structure

Monitoring

Protocol Content

Presentation

Discussion

Acknowledgements

4 CBT for Individuals at High Risk of Developing Psychosis

Who is at Ultra-High Risk of Developing Psychosis?

What are Attenuated Psychotic Symptoms?

Clinical Interventions for Individuals at Ultra-High Risk

Our Trials

The Cognitive Model of Psychosis

The Treatment Protocol Used in the Trial

Case Example: ‘At-Risk’ Client with Attenuated Paranoia and Thought Broadcasting

5 CBT for Medication-Resistant Psychosis: Targeting the Negative Symptoms

Toronto Clinical Trial for CBTp

Implications of the Toronto CBTp Trial

The Cognitive Model of Negative Symptoms

The CBT Approach to Negative Symptoms

Treating Secondary Negative Symptoms

Treating Primary Negative Symptoms

Targeting Low Expectancies for Pleasure

Targeting Low Expectancies for Success

Targeting the Impact of Stigma

Targeting Perception of Low Resources

Summary

6 The Challenge of Anger, Aggression and Violence when Delivering CBT for Psychosis: Clinical and Service Considerations

Introduction

Substance Use, Schizophrenia and Violence

Anger, Schizophrenia and Violence

Implications for Interventions

Engagement

Useful Assessments

Formulation in Preparation for Intervention

Intervention

Identifying the Focus for Therapy

Strategies for Working with Anger

Working with Environmental Issues

Consolidating Progress and Use of the ‘Staying Well Manual’

7 CBT for Relapse in Schizophrenia: A Treatment Protocol

Introduction

Relapse as a Manifestation of Affect Dysregulation

CBTp and Relapse Prevention

Overview of CBT for Relapse

Therapist Style

Assessment and Engagement

Formulation

Explaining Beliefs

Early Signs Monitoring

Targeted CBT

Conclusions

8 CBT to Address and Prevent Social Disability in Early and Emerging Psychosis

The Problem

Specific Characteristics of a Multisystemic Cognitive Behavioural Approach: The Need to Weave in Systemic and Assertive Case Management Practice in Delivering CBT to Promote Social Recovery

Research Evidence

Future and Ongoing Trials

Time Use as the Primary Outcome

A Cognitive Behavioural Model of Social Disability in Psychosis as Avoidance

Social Recovery Cognitive Behavioural Therapy (SRCBT)

Assessment and Formulation of an Individual’s Problems

Behavioural Strategies

Problems Associated with Depression

Managing Emotions, Intrusions, and Psychotic Experiences while Undertaking Activity

Assessment and Management of Social Anxiety

Problems with Paranoia, Voices and Anomalous Experiences

Conclusion

9 Group Cognitive Behavioural Social Skills Training for Schizophrenia

Model of Functional Outcome in Schizophrenia

Group Cognitive Behavioural Social Skills Training (CBSST)

CBSST Clinical Trials

Clinical Assessment

Group Member Inclusion

CBSST Protocol

Clinical Application of CBSST

10 Brief Acceptance and Commitment Therapy for the Acute Treatment of Hospitalized Patients with Psychosis

Overview of ACT for Psychosis

What is ACT?

How Does ACT Differ from Traditional CBT?

Research Related to ACT for Psychosis

Clinical Implications

ACT for Psychosis Treatment Protocol

Session Summaries

Case Illustration

Conclusion

11 Improving Sleep, Improving Delusions: CBT for Insomnia in Individuals with Persecutory Delusions

Introduction

Developing CBT for Psychosis

The Insomnia Intervention Protocol

A Clinical Example from the Pilot Study

Summary

12 Compassion Focused Group Therapy for Recovery after Psychosis

Theoretical Background

Practical Considerations

Treatment Protocol

Conclusion

Index

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Library of Congress Cataloging-in-Publication Data

CBT for schizophrenia : evidence-based interventions and future directions / edited by Craig Steel.pages cmIncludes bibliographical references and index.

ISBN 978-0-470-71206-1 (cloth) – ISBN 978-0-470-71205-4 (pbk.)1. Schizophrenia–Treatment. 2. Cognitive therapy. I. Steel, Craig, editor of compilation.RC514.C5782 2013616.898–dc23

2012032289

A catalogue record for this book is available from the British Library.

Cover image: Close-up of Meadow Goatsbeard seed head © Radius Images/Corbis.Cover design by Simon Levy Associates.

About the Editor

Craig Steel is a Senior Lecturer based at the Charlie Waller Institute of Evidence-Based Psychological Treatments, School of Psychology and Clinical Language Sciences, University of Reading, UK. Since he gained his PhD from the Institute of Psychiatry, London in 1998 he has been an active clinician and researcher within the area of cognitive behavioral interventions for schizophrenia. He has extensive experience within clinical trials including as a trial therapist, clinical supervisor, and as principal investigator. He has published numerous experimental and clinical research articles.

List of Contributors

Max Birchwood,School of Psychology,University of Birmingham, UK.Christine Braehler,Institute of Health and Wellbeing, University of Glasgow, UK.Simon Burton,Norfolk and Waveney Mental Health Foundation Trust, UK.David Fowler,Norwich Medical School,University of East Anglia, UK.Daniel Freeman,Department of Psychiatry,University of Oxford, UK.Paul French,Greater Manchester West Mental Health Foundation Trust, UK.Brandon Gaudiano,Alpert Medical School,Brown University, USA.Paul Gilbert,Mental Health Research Unit, University of Derby, UK.Jennifer Gottlieb,Department of Occupational Therapy,University of Boston, USA.Eric Granholm,VA San Diego Healthcare System &Department of Psychiatry, University of California,San Diego, USA.Andrew Gumley,Institute of Health and Wellbeing, University of Glasgow, UK.Amy Hardy,Department of Psychology, Institute of Psychiatry, King’s College London, UKJanice Harper,NHS Greater Glasgow & Clyde, UK.Gillian Haddock,School of Psychological Sciences, University of Manchester, UK.Jason Holden,Department of Psychiatry, University of California, San Diego, USA.Jo Hodgekins,Norwich Medical School, University of East Anglia, UK.Rebecca Lower,Norfolk and Waveney Mental Health Foundation Trust, UK.Alan Meaden,Birmingham and Solihull Mental Health Trust, UK.Anthony Morrison,School of Psychological Sciences, University of Manchester, UK.Kim Mueser,Department of Occupational Therapy,University of Boston, USA.Elissa Myers,Department of Psychiatry, University of Oxford, UK.Neil Rector,Department of Psychiatry, University of Toronto, Canada.Nicola Smethurst,Greater Manchester West Mental Health Foundation Trust, UK.Ben Smith,North East London NHS Foundation Trust, UK.Helen Startup,South London and Maudsley NHS Trust, UK; Department of Psychiatry, University of Oxford, UK.Craig Steel,School of Psychology and Clinical Language Sciences, University of Reading, UK.Ruth Turner,Norfolk and Waveney Mental Health Foundation Trust, UK.Jon Wilson,Norfolk and Waveney Mental Health Foundation Trust, UK.

Preface

The development of evidence-based psychological interventions for schizophrenia has been rapid. The first clinical trials were taking place in the United Kingdom in the early 1990s, and within 10 years the evidence base had grown to the point that CBT for psychosis was becoming a routine part of mental health services.

During the past 10 years clinical researchers have moved on from the core application of CBT for the positive symptoms of psychosis. A growing number of research groups have developed protocols aimed at specific phases, symptoms or co-morbidities within this group. The momentum within these developments has reached the point where there is sufficient material to form the basis of the current book. Each chapter highlights an intervention that is embedded within the context of the relevant evidence base. The aim is to enhance access to the protocols used within research trials, and therefore to optimize clinical outcome.

Craig Steel, June 2012

Acknowledgements

This book is the dissemination of a large number of clinical trials, which will have included hundreds of people diagnosed with a psychotic ­disorder. Each person will have signed up to be part of a research project and to undertake detailed assessments without any guarantee of immediate ­therapy. It is hoped that this book will help to increase other peoples’ access to the products of those trials.

Needless to say this book is a combined effort from a wide range of ­contributors. Each one is highly valued and I am indebted to them for their hard work and patience. There are also a number of people I have worked with who have not contributed directly, but have provided inspiration to me, and the field as a whole. These include Christine Barrowclough, Paul Bebbington, Philippa Garety, David Hemsley, Elizabeth Kuipers, Emmanuelle Peters, Nick Tarrier and Til Wykes.

There are also those at home who have provided their own special kind of encouragement and support, Kerry, Frankie and Joss.

1

CBT for Psychosis: An Introduction

Craig Steel and Ben Smith

Introduction

Many readers of this book will recall a time when the predominant view within psychiatry was that talking therapies were not recommended for people diagnosed with schizophrenia. The past 10 years have seen a rapid expansion of an evidence base that has overturned this traditional view. Cognitive behavioural therapy (CBT) for schizophrenia is now recommended as part of routine clinical practice within a number of ­countries, including the United Kingdom and the United States. One consequence of this rapid rate of change is the need for widespread dissemination of this psychological intervention. Attempts have been made to meet this need through the publication of a number of treatment manuals, as well as an increase in the availability of training events.

The evidence base of CBT for schizophrenia was first developed through a generic intervention aimed at the relatively stable ‘medication-resistant’ group. However, as those readers who are trained clinicians will be aware, a diagnosis of schizophrenia is associated with a wide range of presentations. Consequently there have been recent developments within distinct protocols aimed at specific presentations and phases of the disorder. The aim of this book is to bring together these recently developed evidence- based protocols.

Although the interventions described within this book have key differences, which have been developed for specific target groups, they all rely on the basic engagement skills that are required when working with ­individuals diagnosed with a psychotic disorder. This chapter therefore aims to cover generic information, which will form the background to all following chapters. The chapter will cover four main areas: (i) a brief introduction to the symptoms associated with schizophrenia, (ii) the generic cognitive model of schizophrenia, (iii) generic clinical skills required when adopting CBT for schizophrenia, and (iv) a brief review of the evidence base of CBT for schizophrenia.

Schizophrenia

Schizophrenia is the most commonly diagnosed form of psychotic disorder. The most common symptoms are hallucinatory experiences and delusional beliefs. These are often referred to as the ‘positive’ symptoms of schizophrenia. The vast majority of CBT protocols for psychosis are aimed at these positive symptoms.

Hallucinations

Hallucinations are frequently considered to be sensory perceptions of stimuli that are not really there. While auditory hallucinations are the most common form, and have received the most attention from clinical researchers, they may occur within any sensory modality. Although the perceived auditory stimuli may be of general noises or music, they are most often in the form of a voice, or voices. They may be judged to originate from either inside the head or outside the head, may be experienced as male, female or alien voices, and there may be either single or multiple voices. The type of communication originating from the voice may come in many forms including ‘voices commenting’ in which the perceived voice makes frequent comments on the actions and thoughts of the voice hearer and ‘command hallucinations’ in which the voice-hearer is given direct instruction on how to act (see Chapter 2).