scholarly journals Cognitive Restructuring and Graded Behavioural Exposure for Delusional Appraisals of Auditory Hallucinations and Comorbid Anxiety in Paranoid Schizophrenia

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Pawel D. Mankiewicz ◽  
Colin Turner
Keyword(s):  
Psychosocial Functioning ◽  
Psychological Treatment ◽  
Paranoid Schizophrenia ◽  
Cognitive Restructuring ◽  
Behavioural Therapy ◽  
Auditory Hallucinations ◽  
Successful Implementation ◽  
Subjective Data ◽  
Comorbid Anxiety ◽  
Behavioural Experiments

The prevalence of diagnostic comorbidity between psychosis and anxiety disorders has been found to be considerable. Cognitive models of psychosis suggest that anxiety does not arise directly from positive symptoms of schizophrenia but rather from an individual interpretation of such experiences. In the United Kingdom, cognitive-behavioural therapy for psychosis (CBTp) has been recommended within clinical guidelines as a psychological treatment of choice for those diagnosed with schizophrenia. However, despite empirical evidence supporting CBTp, the treatment provision remains infrequent and not routinely available. This case describes a successful implementation of CBTp. Sixteen sessions were delivered to a 40-year-old male with diagnoses of paranoid schizophrenia and comorbid anxiety, focusing primarily on cognitive restructuring of paranoid appraisals of auditory hallucinations and behavioural experiments employed progressively via graded exposure to anxiety-inducing stimuli. Standardised measurements, behavioural frequency sampling, and subjective data indicated a considerable reduction in both paranoia and anxiety. Also, the client’s psychosocial functioning improved substantially. This report indicates that the treatment may help those with experiences of psychosis and comorbid anxiety reach a significant improvement in their quality of life and offers an encouraging and innovative perspective on direct engagement with the content of paranoia and voices at the onset of therapy.

Cognitive Restructuring and Graded Behavioral Exposure for Persecutory Paranoia and Agoraphobic Anxiety in Complex Psychosis

2019 ◽  
Vol 18 (2) ◽  
pp. 143-158
Author(s):  
Pawel D. Mankiewicz
Keyword(s):  
Behavioral Therapy ◽  
Paranoid Schizophrenia ◽  
Cognitive Restructuring ◽  
Cognitive Behavioral ◽  
Successful Implementation ◽  
Behavioral Models ◽  
Subjective Data ◽  
Severe Mental Ill Health ◽  
Cognitive Behavioral Models ◽  
Behavior Frequency

Cognitive behavioral models of psychosis assert the notion of cognitive mediation, in which threat-oriented subjective misinterpretations of anomalous experiences lead to increased levels of emotional distress. Thus, paranoid appraisals of auditory hallucinations often result in hypervigilance and associated anxiety. The prevalence of diagnostic comorbidity between psychosis and anxiety disorders has been shown to be considerable. Among the evidence-based psychological treatments for complex mental ill-health, Cognitive Behavioral Therapy for psychosis (CBTp) has been supported with particularly promising research outcomes. Yet, despite such encouraging empirical data, the treatment provision often remains insufficient, predominantly among individuals with more acute presentations. Likewise, literature demonstrating the actual utilization of CBTp with complex psychoses appears above all relevant to the daily clinical practice in the specialism of severe mental ill-health. This methodologically rigorous case study describes a successful implementation of CBTp undertaken with a socially withdrawn individual diagnosed with paranoid schizophrenia and comorbid agoraphobic anxiety disorder. The intervention focused on cognitive restructuring of paranoid appraisals of voices and graded behavioral exposure to anxiety-inducing stimuli. Standardized measurement, behavior frequency sampling, and subjective data were utilized to evaluate the outcomes, indicating a considerable reduction in both paranoia and associated anxiety, and an overall improvement in the client’s behavioral and interpersonal functioning. The article highlights the importance of direct intellectual engagement with the content of paranoia, alongside methodically facilitated graded behavioral exposure and response prevention in the treatment of severe, socially debilitating psychoses with comorbid mood disorders.

scholarly journals Cognitive Strategies for Management of Social Anxiety: A Comparison of Brief Cognitive Restructuring and Mindfulness Interventions

2021 ◽  
Author(s):  
Leorra Newman
Keyword(s):  
Social Anxiety ◽  
Psychological Treatment ◽  
Cognitive Strategies ◽  
Cognitive Restructuring ◽  
Cognitive Change ◽  
Behavioural Therapy ◽  
Cognitive Approach ◽  
Cognitive Behavioural ◽  
Active Pursuit ◽  
Maladaptive Beliefs

The gold standard psychological treatment for social anxiety disorder (SAD), one of the most common anxiety disorders, is cognitive-behavioural therapy (CBT), incorporating cognitive restructuring to target maladaptive beliefs thought to maintain SAD. Recent evidence suggests that mindfulness- and acceptance-based approaches, emphasizing nonjudgmental awareness without active pursuit of cognitive change, may also be effective. The goal of the current study was to examine the mechanisms by which each cognitive approach affects symptoms. Eighty-seven adults with elevated social anxiety were randomized to receive training in one of the strategies or to a control condition in which participants completed assessments only. Participants self-reported similar decreases in symptoms after 1 week of practice, and these improvements were mediated by increases in decentering and decreases in maladaptive beliefs across condition. These results suggest greater overlap between modalities than theory might predict. Implications for clinical practice, including brief treatments and the role of assessment, are reviewed.

scholarly journals Cognitive Strategies for Management of Social Anxiety: A Comparison of Brief Cognitive Restructuring and Mindfulness Interventions

2021 ◽  
Author(s):  
Leorra Newman
Keyword(s):  
Social Anxiety ◽  
Psychological Treatment ◽  
Cognitive Strategies ◽  
Cognitive Restructuring ◽  
Cognitive Change ◽  
Behavioural Therapy ◽  
Cognitive Approach ◽  
Cognitive Behavioural ◽  
Active Pursuit ◽  
Maladaptive Beliefs

The gold standard psychological treatment for social anxiety disorder (SAD), one of the most common anxiety disorders, is cognitive-behavioural therapy (CBT), incorporating cognitive restructuring to target maladaptive beliefs thought to maintain SAD. Recent evidence suggests that mindfulness- and acceptance-based approaches, emphasizing nonjudgmental awareness without active pursuit of cognitive change, may also be effective. The goal of the current study was to examine the mechanisms by which each cognitive approach affects symptoms. Eighty-seven adults with elevated social anxiety were randomized to receive training in one of the strategies or to a control condition in which participants completed assessments only. Participants self-reported similar decreases in symptoms after 1 week of practice, and these improvements were mediated by increases in decentering and decreases in maladaptive beliefs across condition. These results suggest greater overlap between modalities than theory might predict. Implications for clinical practice, including brief treatments and the role of assessment, are reviewed.

scholarly journals CBT for OCD: habituation or cognitive shift?

2014 ◽  
Vol 7 ◽  
Author(s):  
Lottie Morris ◽  
Jim Nightingale
Keyword(s):  
Psychological Treatment ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Exposure And Response Prevention ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Cognitive Behavioural ◽  
Behavioural Experiments ◽  
Cognitive Shift ◽  
Intrusive Cognitions

AbstractCognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is recommended by NICE as the psychological treatment of choice for obsessive compulsive disorder (OCD). Twenty-five percent of OCD patients refuse ERP, and many psychologists advocate formulation-driven cognitive therapy, including ERP, as opposed to ERP alone. However, a recent meta-analysis suggested there is insufficient evidence to suggest ERP is improved by cognitive methods. This paper proposes to contribute to this debate by providing a detailed description of the treatment of a patient with intrusive cognitions of a sexual nature, who was treated successfully using behavioural experiments designed to test cognitions, rather than ERP. This is, arguably, the way in which most cognitive behavioural therapists would work with someone with OCD. However, this approach is not reflected in the literature at present. The authors report the patient's feedback that therapeutic change was brought about through cognitive shift, as a result of the formulation-driven behavioural experiments.

scholarly journals Validation of an algorithm for semiautomated surveillance to detect deep surgical site infections after primary total hip or knee arthroplasty—A multicenter study

2020 ◽  
Vol 42 (1) ◽  
pp. 69-74
Author(s):  
Janneke D. M. Verberk ◽  
Stephanie M. van Rooden ◽  
Mayke B. G. Koek ◽  
David J. Hetem ◽  
Annelies E. Smilde ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
High Probability ◽  
Surgical Site Infections ◽  
Data Interpretation ◽  
Routine Care ◽  
Successful Implementation ◽  
Subjective Data ◽  
Essential Information ◽  
Total Hip ◽  
Healthcare Associated

AbstractObjective:Surveillance of healthcare-associated infections is often performed by manual chart review. Semiautomated surveillance may substantially reduce workload and subjective data interpretation. We assessed the validity of a previously published algorithm for semiautomated surveillance of deep surgical site infections (SSIs) after total hip arthroplasty (THA) or total knee arthroplasty (TKA) in Dutch hospitals. In addition, we explored the ability of a hospital to automatically select the patients under surveillance.Design:Multicenter retrospective cohort study.Methods:Hospitals identified patients who underwent THA or TKA either by procedure codes or by conventional surveillance. For these patients, routine care data regarding microbiology results, antibiotics, (re)admissions, and surgeries within 120 days following THA or TKA were extracted from electronic health records. Patient selection was compared with conventional surveillance and patients were retrospectively classified as low or high probability of having developed deep SSI by the algorithm. Sensitivity, positive predictive value (PPV), and workload reduction were calculated and compared to conventional surveillance.Results:Of 9,554 extracted THA and TKA surgeries, 1,175 (12.3%) were revisions, and 8,378 primary surgeries remained for algorithm validation (95 deep SSIs, 1.1%). Sensitivity ranged from 93.6% to 100% and PPV ranged from 55.8% to 72.2%. Workload was reduced by ≥98%. Also, 2 SSIs (2.1%) missed by the algorithm were explained by flaws in data selection.Conclusions:This algorithm reliably detects patients with a high probability of having developed deep SSI after THA or TKA in Dutch hospitals. Our results provide essential information for successful implementation of semiautomated surveillance for deep SSIs after THA or TKA.

Treatment barriers, preferences and histories of individuals with symptoms of body dysmorphic disorder

2020 ◽  
pp. 1-14
Author(s):  
Jessica McCausland ◽  
Josephine Paparo ◽  
Bethany M. Wootton
Keyword(s):  
Mental Health ◽  
Best Practice ◽  
Body Dysmorphic Disorder ◽  
Psychological Treatment ◽  
Behavioural Therapy ◽  
Cross Sectional Study ◽  
Treatment Barriers ◽  
Treatment Access ◽  
Cross Sectional ◽  
Treatment Delivery

Abstract Background: Individuals with mental health concerns face many barriers when accessing psychological treatment. Even when patients overcome these barriers, they often do not receive an evidence-based treatment. Although the current literature highlights these issues clearly across psychological disorders, the research is limited in relation to body dysmorphic disorder (BDD). Aim: The aim of this study was to examine psychological treatment barriers, treatment delivery preferences and treatment histories of individuals with symptoms of BDD. Method: A total of 122 participants with clinically significant BDD symptoms (94% female; mean age = 34.19 years, SD = 10.86) completed the cross-sectional study. Results: The most frequently reported barriers to accessing psychological treatment for individuals with BDD symptoms were the cost of treatment (41%) and the belief that the symptoms did not warrant treatment (36%). Although 69% of treatment-seeking participants reported previously receiving cognitive behavioural therapy (CBT) for BDD, only 13% of participants appeared to receive best-practice CBT. The preferred modality of future psychological treatment delivery was face-to-face treatment with a therapist once a week (63%), rather than accelerated or remote treatment approaches. Conclusions: The study suggests that there are significant barriers to accessing CBT for BDD. Reducing these barriers, as well as increasing consumer mental health literacy, is required to improve treatment access and treatment outcomes for individuals with BDD.

Electroconvulsive Therapy in Treatment-Resistant Schizophrenia: a Case Report

2011 ◽  
Vol 26 (S2) ◽  
pp. 1135-1135
Author(s):  
V.M. Barrau ◽  
M. Salinas ◽  
S. Yelmo ◽  
E. Santana ◽  
F. Montiano ◽  
...  
Keyword(s):  
Electroconvulsive Therapy ◽  
Hospital Admissions ◽  
Paranoid Schizophrenia ◽  
Chronic Schizophrenia ◽  
Optimal Number ◽  
Auditory Hallucinations ◽  
Predictors Of Response ◽  
Maintenance Ect ◽  
Controversial Topic ◽  
Null Response

Electroconvulsive therapy (ECT) is born as we know it in the first half of the twentieth century. Although initially introduced as a treatment for schizophrenia, soon proved more effective in affective disorders.Currently this therapy is second choice in the treatment of schizophrenia, representing only 10–20% of ECT treatments.We present a 55 years-old-woman diagnosed with Paranoid Schizophrenia in the adolescence, with several hospital admissions who was sent from sub-acute unit to receive ECT, given the null response to several pharmacological trials. The last, 1,200 mg amisulpride, 650 mg clozapine and 1,000 mg valproate per day, and Zuclopenthixol ampoule every 14 days. She verbalizes poorly structured persecutory, megalomaniac and nihilist delusional ideas, as well as auditory hallucinations which she does not clarify, and thought broadcasting phenomena. After withdrawing this medication and starting treatment with 30 mg haloperidol and 550 mg quetiapine, 14 bifrontotemporal ECT sessions were given.Given the disappearance of persecutory delusional ideas, and the decrease of auditory hallucinations, which she criticizes, the patient was discharged. After 4 months, she is still psychopathologically stable, and receiving maintenance ECT biweekly.ECT, either alone or in combination with conventional antipsychotic drugs, has been shown effective in a certain percentage of patients with acute schizophrenia, particularly in the catatonic subtype and also in schizoaffective disorder. The use and efficacy of ECT in chronic schizophrenia is a more controversial topic.Research should also focus on the determination of optimal number of ECT, the predictors of response and the efficacy of continuation and maintenance ECT.

Cognitive-Behavioural Therapy

2020 ◽  
Author(s):  
Hassan Majeed ◽  
Charles Stanfa ◽  
Donna Sudak
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Activation ◽  
Behavioral Therapy ◽  
Cognitive Restructuring ◽  
Behavioural Therapy ◽  
Cognitive Behavioral ◽  
Case Examples ◽  
Psychiatric Illnesses ◽  
Empirically Supported ◽  
Cognitive Behavioural

Cognitive-behavioral therapy (CBT) is an empirically supported psychotherapy shown to be effective and durable for the treatment of a variety of psychiatric illnesses. It is problem focused and conceptually driven. Cognitive restructuring, behavioral activation, exposure, and developing good action plans for out-of-session practice are tools that benefit patients for a lifetime. The purpose of this review is to provide an overview of the literature that supports the use of CBT, introduce the key elements of the therapeutic approach, and illustrate them with case examples. The structure of the session and the CBT approach to the therapeutic alliance are highlighted in the text.  This review contains 23 tables, and 59 references. Key words: Cognitive-behavioral therapy, cognitive restructuring, collaboration, behavioral activation, exposure

Psychological Treatment of Chronic Auditory Hallucinations: Two Case Studies

1993 ◽  
Vol 21 (4) ◽  
pp. 335-346 ◽  
Author(s):  
Gillian Haddock ◽  
Richard P. Bentall ◽  
Peter D. Slade
Keyword(s):  
Case Studies ◽  
Future Development ◽  
Marked Reduction ◽  
Psychological Treatment ◽  
Auditory Hallucinations ◽  
Behavioural Treatment ◽  
Cognitive Behavioural Treatment ◽  
Cognitive Behavioural ◽  
The Future ◽  
Behavioural Strategies

Two cases involving the cognitive-behavioural treatment of hallucinations are described. In both cases, a focusing strategy was used with a view to enabling patients to reattribute the nature and meaning of their experiences. One patient showed a marked reduction in the frequency and content of his voices. The second patient showed little change. The implications of observations made during therapy for the future development of cognitive-behavioural strategies for use with psychotic patients are discussed.

scholarly journals Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: an instrumental variable analysis

2015 ◽  
Vol 45 (11) ◽  
pp. 2365-2373 ◽  
Author(s):  
L. P. Goldsmith ◽  
S. W. Lewis ◽  
G. Dunn ◽  
R. P. Bentall
Keyword(s):  
Therapeutic Alliance ◽  
Effect Size ◽  
Instrumental Variable ◽  
Structural Equation ◽  
Psychological Treatment ◽  
Causal Effect ◽  
Controlled Trial ◽  
Behavioural Therapy ◽  
Psychological Treatments ◽  
Symptomatic Outcome

BackgroundThe quality of the therapeutic alliance (TA) has been invoked to explain the equal effectiveness of different psychotherapies, but prior research is correlational, and does not address the possibility that individuals who form good alliances may have good outcomes without therapy.MethodWe evaluated the causal effect of TA using instrumental variable (structural equation) modelling on data from a three-arm, randomized controlled trial of 308 people in an acute first or second episode of a non-affective psychosis. The trial compared cognitive behavioural therapy (CBT) over 6 weeks plus routine care (RC) v. supportive counselling (SC) plus RC v. RC alone. We examined the effect of TA, as measured by the client-rated CALPAS, on the primary trial 18-month outcome of symptom severity (PANSS), which was assessed blind to treatment allocation.ResultsBoth adjunctive CBT and SC improved 18-month outcomes, compared to RC. We showed that, for both psychological treatments, improving TA improves symptomatic outcome. With a good TA, attending more sessions causes a significantly better outcome on PANSS total score [effect size −2.91, 95% confidence interval (CI) −0.90 to −4.91]. With a poor TA, attending more sessions is detrimental (effect size +7.74, 95% CI +1.03 to +14.45).ConclusionsThis is the first ever demonstration that TA has a causal effect on symptomatic outcome of a psychological treatment, and that poor TA is actively detrimental. These effects may extend to other therapeutic modalities and disorders.

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