...CBT for Psychosis Introduction Psychosis (Psyche – Greek for the mind or soul; -osis referring to abnormal condition) is a general umbrella term for mental states traditionally characterised by a loss of contact with reality, during which sufferers may experience episodes of hallucinations and delusional thinking, distorted thoughts or behaviours, even personality changes. Current criteria for diagnosis includes experiencing one or more symptoms such as delusions, hallucinations, disorganized speech, disorganized or catatonic behaviour, negative symptoms; disturbed social cognition and functioning, bizarre behaviour, emotional labiality (American Psychiatric Association, 1994). Traditionally treatment and conceptualisation of psychotic symptoms has been more the domain of psychiatry. The use of ‘psychosis’ as a term first emerged towards the end of the 1800’s as a new label for ‘madness’ and as a way of classifying illness of the mind. It wasn’t until the mid 1900’s there was a shift in the perception of psychosis and possible psychological processes contributing to psychotic experiences. Bentall (1993) further supported this by writing about understanding psychotic symptoms based on an individuals’ presenting distress/ difficulties rather than focusing on a medical model of psychosis treatment. Though Aaron Beck in the development of the cognitive approach to emotional disorders did explore the idea of adapting a cognitive model to psychosis in a paper in 1952, “Successful...
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...Psychosis - CBT Word count: 4898 Content Introduction Referral letter Theoretical perspectives * Formation of paranoia Assessment * Assessment tools and baseline measures * Individual belief ratings * Management of risk Case Formulation Treatment Plan & Interventions Evaluation Critical review References Appendix 1 – Assessment Summary (diagrammatic) Appendix 2 – Formation of paranoia Appendix 3 – Risk assessment and management Appendix 4 – Letters Appendix 5 – Judging by appearances a behavioural experiment Confidentiality statement The name and other identifiable information relating to this patient have been changed to maintain confidentiality. Introduction This case study describes the CBT assessment, formulation and treatment of delusions of persecution and associated paranoid beliefs. Referral Letter Roger, a 29 year old single man was referred to the Psychological Therapies Department. The letter noted that he had had one inpatient admission three years previously due to paranoia and risk of suicide. He was currently being supported by community mental health services. A differential diagnosis of Delusional Disorder – Paranoid Type, (ICD 10- F22.0) and Paranoid Personality Disorder (ICD 10 – F60.0) as defined by the ICD 10 manual (World Health Organisation, 1992) was indicated. Theoretical perspectives Delusions are irrational beliefs, held with a high level of conviction, that are resistant to change even when the...
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...The author of this work is currently employed as a community psychiatric nurse whose remit is to work with those clients with serious and enduring mental illness, the majority of whom have a medical diagnosis of schizophrenia and related psychosis. Over the past 10 years there's been a growing movement towards diverse treatments for schizophrenia other than the acknowledged role of medication as a treatment modality (Birchwood and Tarrier 1993). Developments in psychological theory have led to a number of innovative psychological treatments drawn from human experimental psychology such as behavioural and social psychology and cognitive science. Therapies based on cognitive behavioural theory have been rapidly developing, initially for the so called ‘neurotic disorders’ but in recent years evidence has accumulated to suggest that these cognitive behavioural approaches can be effective for those people suffering from psychosis ( Williams 1995). The aim of this assignment is to explore the basis of Cognitive Behavioural Therapy and review its’ therapeutic application to schizophrenia. Cognitive Behaviour Therapy (CBT) is an evolutionary paradigm that came about a from the merging of the established paradigm of behavioural therapy and contemporary cognitive therapy (Clarke and Fairburn 1997). Behavioural therapy historically focused on anxiety, phobic and obsessional disorders. Treatments were aligned to the learning theories of Pavlov and Skinner,...
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...Introduction Regardless of whether the psychosis is functional or organic, consciousness may be constructed from input from our senses, however when experiencing psychosis symptoms such as hallucinations and delusions, may provoke the experience of stimuli such as hearing voices or visual disturbances that are not rooted in reality. There is some evidence that psychotic symptoms may be provoked or aggravated by emotional distress, the negative relationship between negative affect and psychotic symptoms, therefore, supports the use of psychological therapies, such as Cognitive Behavioural Therapy (CBT) and Family Intervention (FI) in ameliorating psychotic symptoms. As such we should consider our choice strategy when targeting psychotic symptoms,...
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...evaluate and, most importantly, persuade the client to adopt alternative, healthier, ways of coping; ways that offer less immediate relief, but which do not trap the person in a diminished quality of life. By explaining breakdown in terms of coping with intolerable affect, this approach, developed and evaluated in an acute hospital setting (Durrant, Clarke & Wilson 2007), enables us to offer more adapted skills for coping with affect as the solution. This 'third wave Cognitive Behavior Therapy (CBT)' approach (Hayes, Strosahl, & Wilson, 1999) takes seriously the discontinuities in human information processing (Teasdale & Barnard 1993) and employs mindfulness to manage them. The coping mechanisms considered are: • Mindfulness • Arousal management techniques • Emotion Regulation skills (Linehan 1993a & b) • Skills for coping with relationships with self and others, including a compassionate mind based approach to self esteem. • Coping with psychosis. Many of these techniques are already familiar in...
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...However, it could not draw firm conclusions on whether this association was fundamental. many people with schizophrenia smoke cannabis, and it is unclear why so many do, and if the consequences are harmful or useful. It is unclear what are the best ways to help people cut or stop smoking cannabis. Cannabis is the most common illegal drug in the world. Cannabis, which is usually smoked or eaten to give a sense of well-being, but in large quantities and can cause mental illness or psychosis. Clinical evidence suggests that people with schizophrenia are usually the result of cannabis misuse, on the other hand there are people with schizophrenia who use cannabis, arguing that it helps reduce their symptoms and the side effects of antipsychotics (Hamilton,...
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...Schizophrenia 6/17/2014 A. Hallmark features and diagnostic criteria of schizophrenia 4 1. Introduction 4 2. Defining schizophrenia - Hallmark characteristics 4 2.1 Loss of contact with reality 4 2.2 Hallucinations 4 2.2.1 Auditory hallucinations 4 2.2.1 B. Other hallucinations 5 2.3 Delusions 5 2.3.1 Delusions of persecution: 5 2.3.2 Delusions of grandeur: 5 2.3.3 Delusions of control: 5 2.3.4 Delusions of thought broadcasting and thought insertion and thought withdrawal: 5 2.3.5 Delusions of reference: 6 2.3.6 Other Delusions 6 2.4 Disorganised speech 6 2.4.1 Loosening of associations – 7 2.4.2 Problems with attention – 7 2.4.3 Neologism – 7 2.5 Disorganised or catatonic behaviour 7 2.6 Negative symptomology 7 2.6.1 Apathy and indifference 7 3. Diagnostic criteria – DSM5 classification 8 3.1 Characteristic symptoms 8 3.2 Social and/or occupational dysfunction 8 3.3 Duration 8 3.4 Schizoaffective and mood disorder exclusion 9 3.5 Substance and general medical condition exclusion 9 3.6 Relationship to a previously diagnosed developmental disorder 9 B. Living positively with schizophrenia 10 1. Understanding schizophrenia and its symptoms 10 2. Approaches to treating schizophrenia 10 2.1 Psychotherapy 11 2.1.1 Positive living psychotherapy 11 2.2 Group therapy 11 2.3 Cognitive behavioural therapy 12 2.4 Assertive community treatment (ACT): 12 2.5 Family...
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...Cognitive behavioral therapy (CBT) is a psychotherapeutic approach that addresses dysfunctional emotions, maladaptive behaviors and cognitive processes and contents through a number of goal-oriented, explicit systematic procedures. The name refers to behavior therapy, cognitive therapy, and to therapy based upon a combination of basic behavioral and cognitive principles and research. CBT is thought to be effective for the treatment of a variety of conditions, including mood, anxiety, personality, eating, substance abuse, tic, and psychotic disorders. Many CBT treatment programs for specific disorders have been evaluated for efficacy; the health-care trend of evidence-based treatment, where specific treatments for symptom-based diagnoses are recommended, has favored CBT over other approaches such as psychodynamic treatments.[1] CBT was primarily developed through an integration of behavior therapy (the term "behavior modification" appears to have been first used by Edward Thorndike) with cognitive psychology research, first by Donald Meichenbaum and several other authors with the label of cognitive-behavior modification in the late 1970s. This tradition thereafter merged with earlier work of a few clinicians, labeled as Cognitive Therapy (CT), developed by Aaron Beck, and Rational Emotive Therapy (RET) developed by Albert Ellis. While rooted in rather different theories, these two traditions have been characterized by a constant reference to experimental research to test hypotheses...
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...type of therapies used for the treatment of Schizophrenia. The remainder of this paper discusses the rationale uses of these therapies and the effectiveness for Schizophrenia. SCHIZOPHRENIA 3 Schizophrenia The key features of the disorder, including its symptoms Schizophrenia is a disorder that is characterized by unorganized thinking and odd perceptions that dysfunction in major activities within a person’s life. These sometime include withdrawals from society; they have delusions and also hallucinations. They also may not be able to show emotion, feel pain, pleasure. They also have a lack of facial expression. They suffer from depression, mania and paranoia. Schizophrenia is the main example of psychosis. Psychosis is a disorder that people suffer from, they become irrational and they have lost contact with reality. This disease affects the brain and the system affected is the psychic-emotional system. The term schizophrenia means “split mind” but in actuality Schizophrenia does not mean a split personality. In schizophrenia a person may act like they have two different personalities but what they are experiencing is a condition known as dissociative identity disorder. A schizophrenic may experience unusual...
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...What causes addiction, and what is the best approach to counteract it? One contemporary view on the main causes of addiction is positive reinforcement. While there are many factors that contribute to both chemical and physical addiction, including psychosis, a disruptive childhood, or cognitive impairment, positive reinforcement is the major underlying characteristic that envelops an individual’s substance addiction (Osher, 1989). Though the reasons for compulsive drug self-administration varies widely, most, if not all users of drugs do so to avoid negative feelings including anxiety, depression, angst and fear (Goldsmith, Holzer & Manderscheid, 1998). Positive reinforcement is a concept first described by psychologist B. F. Skinner in his theory of operant conditioning. Skinner introduced reinforcement to the law of effect (Thorndike, 1905) in psychology, stating that behaviour that is reinforced is likely to be repeated and strengthened, while behaviour that is not reinforced will likely be extinguished (McLeod, 2007). Positive reinforcement refers to the rewarding and confident emotions that drug users experience when self-administering drugs or other substances. This theory highlights that the common denominator of a wide range of addictive substances is their ability to cause psychomotor activation (Wise & Bozarth, 1987). This view is related to the belief that all positive reinforcers activate a common biological mechanism, with one of the most common components...
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...Stress “Stress is the body’s nonspecific response to a demand placed on it.” Selye (1956) Stress is not a reaction to any one specific thing or situation, it can manifest at any time. Some stress is good for us; a certain level of pressure can help you prepare for such things as work and day to day challenges. Although over an extended period of time, stress can cause physical and psychological harm. Selye describes these types of stress as eustress and distress. Stress is both a biological and psychological reaction to a given situation or threat. The stressor triggers the ‘fight or flight’ response. Once we judge a situation as being stressful, the hypothalamus is activated, and our body releases hormones such as adrenalin, which increase our heart rate and blood pressure so that more oxygen and glucose can get to the muscles. We also breathe faster and sweat more to cool these muscles down. All of these reactions prepare you to take action to deal with a possible threat, Cannon (1932). Over a prolonged period of time, it is not difficult to see the negative effect this response can have on the body. For example hypertension which raises the risk of stroke, myocardial infarction and kidney failure. The body’s immune system is also suppressed making it more vulnerable to infection. There is some evidence that prolonged stress may lead to insulin dependent diabetes in people who are prone to the condition, as it brings about changes in blood sugar levels. According...
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...CBT is a type of psychotherapy a type of psychotherapy in which negative patterns of thought about the self and the world are challenged in order to alter unwanted behavior patterns or treat mood disorders such as depression. CBT focuses on current issues and symptoms of patients. It takes around 12-20 weekly sessions, combined with daily practice exercises designed to help the patient to use new skills on a day-to-day basis. It is a very useful in dealing with emotional problems. There are 2 aims of CBT, the first one is to identify and correct faulty cognitions and unhealthy behaviors. When getting CBT, a patient is asked to do cognitive restructuring. It encourages patients to think about which thoughts are linked with depressed feelings and help patients to correct them. Cognitive restructuring uses the idea that people’s interpretations and inferences about the things that happen to them affect their thinking and behavior as a basis. Cognitive process can be distorted but as they are able to access to consciousness, a person can change them. So, when a depression patient focus too much on their failure, therapist would try to refocus his attention to something he did well. CBT is based on cognitive therapy which is constructed by Beck. He suggests that there are six patterns of faulty thinking which may lead to depression. They...
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...Foundations of Psychology Karen Johnson PSY 300 January 25, 2014 Foundations of Psychology There are many ideas regarding why humans think, have the feelings or behave the way that they do. According to Kowalski and Western (2009) psychology is “the scientific investigation of mental processes, (thinking, remembering, and feeling). There are four major schools of thought in psychology and each has its own theory on the subject, though all have influenced mankind’s understanding of psychology. Each of these perspectives takes on a different theory of the causes and various psychological disorders with unique approaches to treatment. Freud started the psychodynamic approach, he theorized that people have “powerful motives that underlie their conscious intentions” (Kowalski & Western, 2005, p. 8). The psychodynamic approach includes all the theories in psychology that see human functioning based upon the interaction of drives and forces within the person, particularly unconscious, and between the different structures of the personality. According to The Interpretation of Dreams, “It inaugurated the new practice of psychoanalysis, and impacted society and culture in the interpretation of literature and art.” Freud’s belief that dreams are highly symbolic, containing both secret and unhidden meanings as well as underlying, unconscious thoughts. Dreams he suggested are our unconscious wishes in disguise. As stated in Psychopathology of Everyday Life, “By discarding...
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...Schizophrenia All over the globe people suffer from schizophrenia. It occurs in all societies regardless of race, religion, class or culture. According to the National Institute of Mental Health, (NIMH) the prevalence of schizophrenia is 1.1% of the world’s population. This means 51 million people worldwide are affected. Approximately 2.2 million people in the United States, roughly six to twelve million people in China and 250,000 in Britain are living with schizophrenia. Schizophrenia affects men and women. It is usually diagnosed by behavior around the ages of 15-25. Men usually exhibit symptoms earlier than females. People that live in the city have a higher incidence of schizophrenia than people in the country. According to research immigrants such as people from the Caribbean living in the United Kingdom have a greater rate of schizophrenia than the native people of that area. (Fearon,. Et al. 2006) Some researchers speculate that this is due to changed environmental and social factors. The loss of social or family support and change in cultural environment has been thought to trigger biological stressors. Schizophrenia is one type of psychotic disorder, schizoaffective and schizophreniform are other types. Schizoaffective disorder is characterized by psychotic symptoms and significant mood disturbances. Schizophreniform disorder has the same criteria as Schizophrenia but the episode lasts from one to six months and there is no deterioration...
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...Mood DISORDERS Mood DISORDERS are defined by the presence of mood EPISODES Types of Mood DISORDERS • depressive (major depressive disorder, dysthymia) • bipolar (Bipolar I/II disorder, cyclothymia) • secondary to GMC, substances, medications _ mood EPISODES represent a combination of symptoms comprising a predominant mood state • types of Mood EPISODES: major depressive, manic, mixed, hypomanic MOOD EPISODES Major Depressive Episode (MDE) A. at least 5 of the following symptoms present for 2 weeks, one of which must be either depressed mood or loss of interest • M ood - depressed • S leep - increased or decreased (if decreased, often early morning awakening) • I nterest - decreased • G uilt/worthlessness • E nergy - decreased or fatigued • C oncentration/difficulty making decisions • A ppetite and/or weight increase or decrease • P sychomotor activity - increased or decreased • S uicidal ideation B. symptoms do not meet criteria for mixed episode C. symptoms cause significant social or occupational impairment/distress D. exclude if substance-induced or due to a GMC E. symptoms not better accounted for by bereavement (a constellation of depressive symptoms meeting criteria for a MDE appearing within 2 months of the death of a close relative) Manic Episode A. a period of abnormally and persistently elevated, expansive, or irritable mood lasting at least 1 week (or less if hospitalized) B. during this period three of the following symptoms (four if mood is only irritable; mnemonic...
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