PSY71 - CBT & Psychosis

PSY71 - CBT & Psychosis - Historical Factors...

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1 Historical Factors Discouraging CBT for Schizophrenia Schizophrenia too severe Biological model of disorder Schizophrenics not seen as active in own treatment Modifying delusions as potentially harmful Limited generalizability of early token economy- based interventions Factors Encouraging CBT for Schizophrenia 30 – 50% experience residual symptoms Patients develop their own coping strategies Suboptimal medication adherence in 55% outpatients Promising results of large controlled trials Therapeutic Alliance Be attuned to how patient is perceiving you and your office Develop strategies to respond to paranoid beliefs about you “Agree to disagree” Create a problem list Therapeutic relationship may be the only source of contradictory information to negative core beliefs
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2 Psychoeducation Stress-vulnerability model of schizophrenia Decatastrophize schizophrenia Normalize psychosis Normalize aggressive/obscene thoughts Thoughts Behavior Physical Emotion •Nobody likes me •The world is dangerous •People want to hurt me •Isolation •Avoidance •Hypervigilance •Fatigue •Panic •Pain “Cognitive-Behavioral” aspects Principles of CBT Symptoms are maintained by appraisal and behavior Distortions are amenable to cognitive and behavioral approaches
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3 I could have been a great doctor—better than you!
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