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Lecture 9

Lecture 9 CBT for Psychosis.docx

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Neil Rector

PSY343 L9 CBT for PsychosisFirst case study in the CT of psychosisMan with 7year persecution delusion28yo WWII veteranTreatment focused onoDelusional triggersinterpretationsoAlternative evidence gatheringoConstructing alternative less distressing interpretations of experiencesLinking to past expnegative core beliefsoGot better with antipsychotic medicationKey role of appraisals in paranoia Beck 1952Childhood experience oSelfconscious in groupoCheating by fatherselfdevaluating familybroader communitiesCore beliefsoIf conspicuous will be put downoSince we cheated were vulnerablePrecipitationoDemeanedisolatedDelusional misinterpretationsoFBI observingfollowing himThe generic cognitive modelGeneral CBTp strategies defined p12 purpleo FORM WORKING RELATIONSHIP1o PROVIDE STRUCTUREo GUIDED DISCOVERYo COLLABORATIVE EMPIRICISMo IMPROVE REALITY TESTINGo CASE FORMULATIONo NORMALIZE RATIONALEo ACTIVATE QUESTIONING MODEDiathesisstress model of schizophreniaInfluence of appraisal is importantConstitutionaldiathesisforschizophreniaisanabnormalityindopamineDAneurotransmissionStressrelatedincreasesincortisollevelsexacerbatetheabnormalityinDAneurotransmissionthatunderliesvulnerabilitytoschizophreniaresultingintheonsetoftheillnessContent specificity hypothesis of the CBT modeloDisorder vs systematic biasoEach emotional disorder has its own typical cognitive contentoAutomatic thoughts and subjectively perceived emotional states should be positively relatedSymptomspecific cognitive models required for following phenomena1Delusions2Hallucinations3Negative symptoms4Poor insight1 DelusionsDelusional subtypes require distinct cognitive approaches Kimhy et al 2005oFactor analysis of delusional ratingsDelusions of being controlled2
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