FC19-03 - Advances in cognitive behaviour therapy for psychosis

2011 ◽  
Vol 26 (S2) ◽  
pp. 1917-1917
Author(s):  
D. Kingdon
Keyword(s):  
Negative Symptoms ◽  
Substance Misuse ◽  
Treatment Resistant ◽  
Behaviour Therapy ◽  
The Past ◽  
Cognitive Behaviour ◽  
Clinically Significant ◽  
Randomised Controlled ◽  
Meta Analyses ◽  
Command Hallucinations

IntroductionCBT for psychosis has been developed over the past two decades and is now recommended by most clinical guidelines for schizophrenia internationally.Aims & objectivesTo provide an up-date on advances and controversies in CBT for psychosis.MethodEvidence from recent meta-analyses (including Lynch et al, 2010) and randomised controlled trials will be reviewed. These have generally demonstrated effectiveness in early and treatment-resistant schizophrenia of CBT, and other specific indications, e.g. co-morbid substance misuse, aggressive behaviour, command hallucinations. Treatment is based on engaging the patient in a therapeutic relationship, developing an agreed formulation and then the use of a range of techniques for hallucinations, delusions and negative symptoms.ResultsEvidence of effectiveness in treatment-resistant psychosis remains strong but some areas for intervention remain under-researched. A series of studies are on-going which will provide more information about effective ways of working.ConclusionsCBT is a very important but under-used intervention which can make clinically significant differences to patient's lives.

BATTLING BOREDOM: GROUP COGNITIVE BEHAVIOUR THERAPY FOR NEGATIVE SYMPTOMS OF SCHIZOPHRENIA

2002 ◽  
Vol 30 (3) ◽  
pp. 341-346 ◽  
Author(s):  
Louise C. Johns ◽  
William Sellwood ◽  
John McGovern ◽  
Gillian Haddock
Keyword(s):  
Group Intervention ◽  
Negative Symptoms ◽  
Control Design ◽  
Inclusion Criteria ◽  
Behaviour Therapy ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
The Subject ◽  
Clinically Significant ◽  
Group Cbt

We conducted a pilot group intervention for negative symptoms, particularly targeting avolition/apathy. A baseline control design was used. Six patients were recruited, and four completed the group. The main inclusion criteria were clinically significant negative symptoms, plus associated distress and concern. The group involved 16 sessions, which were cognitive behavioural in approach. The main outcome measures were the Scale for the Assessment of Negative Symptoms, and the Subject Experience of Negative Symptoms Scale. Patients showed a reduction in avolition/apathy, and two patients reported reduced distress. These preliminary results suggest that group CBT is a possible intervention for negative symptoms.

The empirical status of CBT for psychosis: controlled efficacy, indication and therapeutic factors. A systematic review of meta-analytic findings

2011 ◽  
Vol 26 (S2) ◽  
pp. 1475-1475 ◽  
Author(s):  
M. Pfammatter
Keyword(s):  
Negative Symptoms ◽  
Statistical Significance ◽  
Skills Training ◽  
Effect Sizes ◽  
Treatment Motivation ◽  
Long Term Effects ◽  
Behaviour Therapy ◽  
Therapeutic Factors ◽  
Cognitive Behaviour ◽  
Meta Analyses

A series of meta-analyses points to the benefits of cognitive behaviour therapy (CBT) in the treatment of psychosis. However, there are discrepancies in the controlled efficacy of CBT for psychosis depending on the targeted treatment goal or the control condition applied. This raises questions about its indication and therapeutic ingredients.The findings of all existing meta-analyses were integrated. Relevant meta-analyses were identified by searching electronic data bases. In order to compare their findings the reported effect sizes were transformed into a standard effect size measure. Moderator analyses were performed regarding different treatment goals and controls. Furthermore, therapeutic components were related to outcome by calculating weighted mean correlation effect sizes in order to identify essential therapeutic factors. The statistical significance of the effect sizes was determined by computing 95% confidence intervals. Homogeneity tests were applied to examine the consistency of the effects and component-outcome relations.The integration of meta-analytic findings demonstrates considerable differences in the controlled efficacy: CBT for psychosis has long-term effects on persisting positive and negative symptoms, but no effect on acute positive symptoms and limited benefits as an early intervention. Moreover, the advantages compared to non-specific supportive therapies are moderate. Component-outcome relations indicate that cognitive restructuring and coping skills training represent key therapeutic factors. However, component control designs also point to the importance of the therapeutic alliance and motivational processes for therapeutic change. Thus, there is a need to promote analyses of the determinants of a helpful therapeutic relationship and enhanced treatment motivation of people suffering from psychosis.

scholarly journals Is self-guided internet-based cognitive behavioural therapy (iCBT) harmful? An individual participant data meta-analysis

2018 ◽  
Vol 48 (15) ◽  
pp. 2456-2466 ◽  
Author(s):  
Eirini Karyotaki ◽  
Lise Kemmeren ◽  
Heleen Riper ◽  
Jos Twisk ◽  
Adriaan Hoogendoorn ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Behavioural Therapy ◽  
Individual Participant Data ◽  
Behaviour Therapy ◽  
Significant Deterioration ◽  
Cognitive Behavioural ◽  
Cognitive Behaviour ◽  
Individual Participant ◽  
Clinically Significant ◽  
Randomised Controlled

AbstractBackgroundLittle is known about potential harmful effects as a consequence of self-guided internet-based cognitive behaviour therapy (iCBT), such as symptom deterioration rates. Thus, safety concerns remain and hamper the implementation of self-guided iCBT into clinical practice. We aimed to conduct an individual participant data (IPD) meta-analysis to determine the prevalence of clinically significant deterioration (symptom worsening) in adults with depressive symptoms who received self-guided iCBT compared with control conditions. Several socio-demographic, clinical and study-level variables were tested as potential moderators of deterioration.MethodsRandomised controlled trials that reported results of self-guided iCBT compared with control conditions in adults with symptoms of depression were selected. Mixed effects models with participants nested within studies were used to examine possible clinically significant deterioration rates.ResultsThirteen out of 16 eligible trials were included in the present IPD meta-analysis. Of the 3805 participants analysed, 7.2% showed clinically significant deterioration (5.8% and 9.1% of participants in the intervention and control groups, respectively). Participants in self-guided iCBT were less likely to deteriorate (OR 0.62, p < 0.001) compared with control conditions. None of the examined participant- and study-level moderators were significantly associated with deterioration rates.ConclusionsSelf-guided iCBT has a lower rate of negative outcomes on symptoms than control conditions and could be a first step treatment approach for adult depression as well as an alternative to watchful waiting in general practice.

Do people with schizophrenia display theory of mind deficits in clinical interactions?

2004 ◽  
Vol 34 (3) ◽  
pp. 401-412 ◽  
Author(s):  
R. McCABE ◽  
I. LEUDAR ◽  
C. ANTAKI
Keyword(s):  
Theory Of Mind ◽  
Mental Health Professionals ◽  
Negative Symptoms ◽  
Experimental Studies ◽  
Chronic Schizophrenia ◽  
Mental States ◽  
Behaviour Therapy ◽  
Cognitive Behaviour ◽  
Clinical Interactions ◽  
Therapy Sessions

Background. Having a ‘theory of mind’ (ToM) means that one appreciates one's own and others' mental states, and that this appreciation guides interactions with others. It has been proposed that ToM is impaired in schizophrenia and experimental studies show that patients with schizophrenia have problems with ToM, particularly during acute episodes. The model predicts that communicative problems will result from ToM deficits.Method. We analysed 35 encounters (>80 h of recordings) between mental health professionals and people with chronic schizophrenia (out-patient consultations and cognitive behaviour therapy sessions) using conversation analysis in order to identify how the participants used or failed to use ToM relevant skills in social interaction.Results. Schizophrenics with ongoing positive and negative symptoms appropriately reported first and second order mental states of others and designed their contributions to conversations on the basis of what they thought their communicative partners knew and intended. Patients recognized that others do not share their delusions and attempted to reconcile others' beliefs with their own but problems arose when they try to warrant their delusional claims. They did not make the justification for their claim understandable for their interlocutor. Nevertheless, they did not fail to recognize that the justification for their claim is unconvincing. However, the ensuing disagreement did not lead them to modify their beliefs.Conclusions. Individuals with schizophrenia demonstrated intact ToM skills in conversational interactions. Psychotic beliefs persisted despite the realization they are not shared but not because patients cannot reflect on them and compare them with what others believe.

scholarly journals Pre-post effect sizes should be avoided in meta-analyses

2016 ◽  
Vol 26 (4) ◽  
pp. 364-368 ◽  
Author(s):  
P. Cuijpers ◽  
E. Weitz ◽  
I. A. Cristea ◽  
J. Twisk
Keyword(s):  
Comparison Group ◽  
Meta Analysis ◽  
Effect Sizes ◽  
Behaviour Therapy ◽  
Natural Processes ◽  
Cognitive Behaviour ◽  
Post Test ◽  
The Difference ◽  
Meta Analyses ◽  
Highly Cited

AimsThe standardised mean difference (SMD) is one of the most used effect sizes to indicate the effects of treatments. It indicates the difference between a treatment and comparison group after treatment has ended, in terms of standard deviations. Some meta-analyses, including several highly cited and influential ones, use the pre-post SMD, indicating the difference between baseline and post-test within one (treatment group).MethodsIn this paper, we argue that these pre-post SMDs should be avoided in meta-analyses and we describe the arguments why pre-post SMDs can result in biased outcomes.ResultsOne important reason why pre-post SMDs should be avoided is that the scores on baseline and post-test are not independent of each other. The value for the correlation should be used in the calculation of the SMD, while this value is typically not known. We used data from an ‘individual patient data’ meta-analysis of trials comparing cognitive behaviour therapy and anti-depressive medication, to show that this problem can lead to considerable errors in the estimation of the SMDs. Another even more important reason why pre-post SMDs should be avoided in meta-analyses is that they are influenced by natural processes and characteristics of the patients and settings, and these cannot be discerned from the effects of the intervention. Between-group SMDs are much better because they control for such variables and these variables only affect the between group SMD when they are related to the effects of the intervention.ConclusionsWe conclude that pre-post SMDs should be avoided in meta-analyses as using them probably results in biased outcomes.

scholarly journals Cognitive behaviour therapy for whom?

1996 ◽  
Vol 2 (1) ◽  
pp. 17-23 ◽  
Author(s):  
Stirling Moorey
Keyword(s):  
Cognitive Behaviour Therapy ◽  
Medical Model ◽  
Behaviour Therapy ◽  
Anger Control ◽  
Diagnostic Categories ◽  
Effective Evaluation ◽  
Cognitive Behaviour ◽  
Behavioural Therapies ◽  
Randomised Controlled ◽  
Challenging Behaviours

In many ways cognitive and behavioural therapies represent the acceptable face of psychotherapy for the general psychiatrist. They are brief, focused, problem-oriented treatments, which take symptoms seriously. They show an affinity for the medical model in their acceptance of diagnostic categories and their commitment to effective evaluation of treatments through randomised controlled trials. The wide applicability of these therapies is also attractive to the general psychiatrist. Cognitive and behavioural techniques are of major importance in the treatment of anxiety disorders, depression, eating disorders, and sexual dysfunctions, and beyond this core group the methods can be applied to enhance coping and change unwanted behaviours in conditions as diverse as cancer, chronic pain, substance abuse, anger control, schizophrenia, and challenging behaviours in people with learning disabilities.

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