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Cognitive-Behavioral Therapy for Psychosis (CBTp)
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Cognitive Behavior Therapy (CBT) is a system of psychotherapy grounded in social learning theory and experimental psychology. CBT is focused on addressing the interaction between dysfunctional thoughts, feelings, and problematic behaviors in persons suffering with a wide range of emotional and mental health problems. At the core of CBT conceptualization is the ABC model in which an activating event (“A”) triggers a belief (“B”) about the activating event, which in turn results in unhealthy emotional and behavioral consequences (“C”).
Cognitive Behavior Therapy for Psychosis (CBTp) is a well-researched variant of CBT that was develop to target psychotic symptoms, in particular delusions and hallucinations in individuals suffering from schizophrenia. CBTp is a collaborative and structured therapy that relies heavily on a problem-solving approach and is focused on the here and now. It involves having patients test and refine the beliefs and experiences (“B”) underlying their psychotic symptoms leading to newly developed view of their environment and experiences, and an improved emotional and behavioral functioning.
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The treatment includes comprehensive assessment for individuals diagnosed with schizophrenia or related disorders. In addition to treatment targeting specific psychotic symptoms (hallucinations and delusions), emphasis is placed on identifying experiences and stressors that may trigger and/or exacerbate such symptoms. Treatment may also focus on other difficulties including anxiety, depression, low self-esteem, relational difficulties, and job related difficulties. CBTp is typically applied in conjunction with psychopharmacological treatment. For further information or to schedule a consultation feel free to contact me. My practice is conviniently located in midtown Manhattan. LIST OF SELECTED RESEARCH PAPERS ON COGNITIVE BEHAVIOR THERAPY FOR PSYCHOSIS (CBTp): Turkington D, Kingdon D, Weiden PJ: Cognitive behavior therapy for schizophrenia. American Journal of Psychiatry 2006; 163:365-373.
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Treatment of Sub-Threshold Psychotic Symptoms:
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Studies of individuals who went on to develop psychosis indicate that many started experiencing worrisome changes in their thinking, mood, and/or behavior on average 5 years prior to the onset of psychosis (Klosterkotter et al., 2001). Such symptoms may include:
• Being socially isolated or withdrawn.
• Changes in perception.
• Suspiciousness of others.
• Development of unusual ideas or behaviors.
• Difficulties thinking clearly or organizing thoughts and speech.
• Loss of interest in usual activities or lack of motivation and energy.
• Worsening personal hygiene and grooming.
These symptoms may develop relatively early in life (from childhood to young adulthood) and may lead to increasing difficulties in relationships, school, and/or work. In some individuals, these symptoms may represent the early stages (“prodromal symptoms“) of a psychotic disorder which will develop over time, while in others the symptoms may fade with time or remain mild, without progression to psychiatric illness.
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Identifying and treating such sub-threshold symptoms early may prevent greater disruption in the individual’s ability to live life as fully as possible (i.e., to enjoy friends and family, think clearly, and be able to study and/or work). During treatment with CBTp patients are encourged to test and refine the beliefs and experiences underlying their sub-threshold psychotic symptoms, leading to a newly developed view of their environment and experiences and an improved emotional and behavioral functioning.
In individuals with sub-threshold symptoms the possible aims of treatment may be: 1) improvement in sub-threshold symptoms; 2) prevention of social decline or stagnation; and 3) potentially preventing or delaying progression to psychiatric illness.
LIST OF SELECTED RESEARCH PAPERS ON TREATMENT OF SUB-THRESHOLD PSYCHOTIC SYMPTOMS USING CBTp:
Bechdolf A, Phillips LJ, Francey SM, Leicester S, Morrison AP, et al. : Recent approaches to psychological interventions for people at risk of psychosis. European Archives of Psychiatry and Clinical Neuroscience, 2006; 256: 159-173.
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Morrison AP, French P, Walford L, Lewis SW, Kilcommons A, Green J, Parker S, Bentall RP: Cognitive therapy for the prevention of psychosis in people at ultra-high risk: randomized controlled trial. British Journal of Psychiatry 2004; 185:291-297
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McGorry PD, Yung AR, Phillips LJ, et al. : Randomized controlled trial of interventions designed to reduce the risk of progression to first-episode psychosis in a clinical sample with sub-threshold symptoms. Archives of General Psychiatry 2002; 59:921-928
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