PSY W4 T3 P4

• Delusions are multidimensional constructs that vary among individuals.
• Key dimensions of delusions include conviction, preoccupation, distress, and impact on functioning, which should be assessed.
• The ABCs (antecedents, beliefs, consequences) can help understand triggers, content, and impact.
• "A" (Antecedents) are triggers, which can be internal or external, like situations or anxious feelings.
• "B" (Beliefs) represents the content of the delusions.
• "C" (Consequences) can be emotional and behavioral.
• Assessing reasoning and cognitive biases is important, like jumping to conclusions or personalizing bias.
• Assessment of voices focuses on triggers (situations or mood states), beliefs about the voices, and consequences.
• Important factors about the content of voices include whether the voices are negative, neutral, or positive.
• Listen to if voices give orders or commands.
• Assess the individual’s relationship with their voices is key.
• Main themes linked to voices include omnipotence/omniscience, intent, and responses.
• Intent can be benevolent or malevolent.
• Responses include engaging or resisting the voices.
• Case formulation should lead to making psychological sense of symptoms and should be discussed with the client.
• Identifying vicious cycles is key to starting change.
• The goal is to help people think about and cope with experiences differently, reducing distress.
• A real case example included voices saying, "kill yourself" or "you'll die soon," and noticing strangers' behaviors.
• Appraisals of experiences are crucial, not just the experiences themselves.
• The person may interpret experiences as something strange happening, feeling bad vibes from people that are disguised or evil spirits.
• These appraisals can lead to feelings of anger, anxiety, and depression.
• Behaviors might include making suicide plans to appease the voices, avoiding strangers, or paying attention to body language.
• Individuals may pray or read the Bible and worry a lot.

Example Case: Hearing Voices

• Voice activity includes both bad voices (e.g., "don't eat") and good voices.
• The person believed voices were 100% powerful.
• The bad voices' identity was the man in the police cell, and the voices were people they knew.
• The person felt no control over the voices, with voices holding that if they didn’t comply, his girlfriend would be hurt.
• Emotional consequences included feeling worried, angry, scared, used, and abused.
• Behavioral consequences included obeying the voices, self-harm etc.
• The person would partially eat or try to appease the voices by saying they would comply later.
• Resistance included sometimes eating, pacing, or taking methadone.

Intervention Strategies

• Discuss past experiences and alternative explanations.
• Question thinking and change how they cope.
• Intervene at cognitive, physiological, or emotional levels.
• Instead of avoidance, encourage checking out noises or try to distract from hypervigilance.
• The voices saying “Don’t go to therapy” is an example of making sense of the voices.
• Address voices may lead to stopping action on good things.
• Cognitive restructuring helps to not getting caught in a trap of believing what negative voices say.
• It can involve standing up to the voices and testing their claims.

Therapeutic Techniques

• Use supportive counselling, warmth and empathy.
• Consider didactic psychoeducation on cognitive biases.
• The goal is to normalize psychotic experiences.
• Reframe beliefs and experiences and alter thinking biases to promote alternative ways to cope.
• Reduce emotional difficulties.
• Basic therapy stages include engagement and assessment.
• Start with coping strategies, develop a formulation.
• Follow with work about delusions, beliefs about voices.
• One can then move on to unhelpful views of self/others, social exclusion, and risk of relapse.
• Do not impose your views or try to change symptoms if the person does not want to.
• The person is an expert on their symptoms, so you are NOT an expert on their symptoms.
• Create an alliance, set meaningful and achievable goals, and promote homework.
• Offer structure and understand the person's beliefs and experiences.
• Work on distressing thoughts first.
• Protect and enhance self-esteem, so that you can help discover their own coping methods.