Psychological Therapies PDF

Psychological Therapies In Early Intervention in Psychosis Dr Alice Brooke with thanks to Dr Katherine Hill Hastings Early Intervention Team Learning Objectives • The role of a psychological approach in Psychosis • CBT for Psychosis with worked examples • Family Interventions – what are they and h...

Psychological Therapies In Early Intervention in Psychosis Dr Alice Brooke with thanks to Dr Katherine Hill Hastings Early Intervention Team Learning Objectives • The role of a psychological approach in Psychosis • CBT for Psychosis with worked examples • Family Interventions – what are they and how do they work? Why not just medication? • • • • Treatment resistant symptoms Partially resistant symptoms Where side effects limit doses of medication Service user choice • Comorbidity….anxiety, depression, PTSD Levels of Psychological Interventions CBT for psyc hosi Psychologically s informed work Ethos of Early Intervention Team Overarching Ethos of EIPS teams CB T for psy ch osi Psychologically s informed work Ethos of Early Intervention Team • • • • Hopeful Collaborative Empowering Social recovery prioritised….achieving work, relationships Psychologically informed case management CB T for psy ch osi Psychologically s informed work Ethos of Early Intervention Team • Timeline of events leading to psychosis Relapse signature Early warning signs, crisis plan • Problem solving • Psychoeducation • Self management , advance directives CBT for Psychosis (CBTp) CB T for psy ch osi Psychologically s informed work Ethos of Early Intervention Team Cognitive Behavioural Therapy for Psychosis CBTp • 12-20 sessions • Treatment resistant symptoms • Alternative to medication for distressing symptoms • Aim is to relieve distress and increase function rather than “treat” delusions or “get rid” of hallucinations. CBT model Thoughts Behaviour Feelings Imagine jumping out of a plane….what feelings would you have? Appraisal of a situation Excitement? Heart racing Feel ready for action Butterflies in the stomach Fear? Heart racing Sweating Feel tense Stomach churning So, can we change our thoughts, feelings and behaviours? CBTp works more on thoughts Targets of interventions inappropriate processing of stimuli that would normally be considered irrelevant Dopamine Dysregulation ANTIPSYCHOTIC DRUGS Cognitive Salience Errors Delusions CBT Working on a delusional belief Belief; I am being followed, so I am in danger What happens? anxious, looking for danger so checking cars as they go by. Keep seeing red cars, this reinforces belief that I am being followed by one. Possibly selective attention and jumping to conclusions playing a part. Challenge; sit and record colours cars going past and their registration plate for period of time - Are there more red cars than other cars? - Is it the same car or different cars? How does that then influence belief that being followed by a red car? Knock on effects to behaviour and mood If I am less convinced I am being followed I might be able to go out more …effect on behaviour from changing thoughts I would feel less lonely and depressed….effect on feelings from changing thoughts Seeing red cars everywhere Hiding at home, checking internet for information about terrorism No friends Staying at home Looking up stuff on internet. Selective attention to red cars…. Jumping to conclusions- evidence for worries I am being followed… Because they think I am a bad person who might be a terrorist Feel depressed and anxious that I might be arrested I am an outsider who nobody likes Moved around a lot and struggled to make friends Work on self esteem and negative patterns of thought. Thinking errors: everything always goes wrong for me, if its not perfect, its worthless. Nobody likes me and I am an outsider, so? …people will not trust me and think I am a terrorist. Working in CBT on challenging these thoughts, is there evidence to the contrary? Work on appraisal of meaning of having psychosis It means I’m weak and a failure…. I am not in control and cannot do anything to change that. I’ll never get a job, partner, have a meaningful life……therefore there is no point even trying…. How do we challenge what it means to have psychosis? NICE recommended psychological treatments in schizophrenia CG 178 February 2014 • Offer Cognitive behavioural therapy for psychosis (CBTp) • Offer Family Interventions • Consider Art Therapy • Assess for PTSD, and follow PTSD guidelines Psychological therapies for co morbidities Depression... behavioural activation Bipolar……mood management, relapse prevention Trauma…..trauma related work, EMDR Anger management Anxiety….relaxation, graded exposure work Medication concordance, motivational interviewing Family Interventions What can we offer families? Psychoeducation for families Support for families, friends and family groups. Specific coping strategies Specific psychosis based family intervention Family Therapy • • • • Highly structured therapy 12-16 sessions 2 therapists Ideally patients who have relapsed and are in close contact with family What may sessions look like? • Sharing Information about mental health problems and treatment • Problem solving • Communication skills • Encouraging family members to refocus on own lives rather than the individual with the psychosis. Psychosis CAG family therapy video Psychosis treatment options - Family work – YouTube Art Therapy Art therapy • • • • Negative symptoms (loss of motivation, social withdrawal) Concentration Isolation Self confidence Creative medium to help explore and articulate feelings rather than speaking about them. Safe space and relationship with therapists. What have we learnt? • CBT for Psychosis – a brief understanding • Family Intervention work – an introduction • Treatment for psychosis isn’t solely medication-based • Place the service user and their family at the centre of care