Cognitive Behavioural Therapy for Psychosis

cognitive Behavioural Therapy for PsychosisA literature re bewitch in chronological decree from past 5 yearsIntroductionThe blanket term mental hygiene covers a multifaceted pluralistic enterprise in which a hurl of therapies is required to meet a affected roles various needs (Holmes J 2002). The National Service Framework cites cognitive doings therapy as being the psych some otherwiseapeutic method of quality for conditions that include depression, eating disorders, fright disorder, obsessive-compulsive disorder, and deliberate self harm. (Rouse et al. 2001)Literature reviewThe first member we shall consider is a letter to the editor of the BMJ by vanguard Meer (R 2003). It is relatively unusual since it is a clinician referring to clinical matters which are both intuitive and learn based. The author refers to the fact that many psychiatrists and related healthcare professionals actually empty talking ab start the content of psycho symptoms. The generally accepted r ationale being that these are diagnostically of no entailment and therefore therapeutically irrelevant. Van Meer contrasts this view with the basic concepts of cognitive demeanour therapy. He suggests that in his experience, the patient actually often pass on want to talk about issues that are primeval to their experience and are distressed when they are kept out of the conversation. He suggests that this is one of the reasons why cognitive conduct therapy is popular with insane person patients is that they have the opportunity to discuss with sympathetic professionals the significance of their experiences and this is cap adequate of natural endowment them a mechanism of dealing with what may be otherwise unexplainable to them. This publication is selected because of its counterintuitive thrust to support cognitive behaviour therapy against the mainstream of modern clinical psychiatric practice and is written by an experienced practising clinician. This field of honor of con sideration is given a further twist with a contrastive insight from Moorhead (S 2003). He agrees that psychiatric professionals tend to try to avoid date with psychotic patients on the subject of their psychosis and thereby unwittingly add to the prejudice that blights the lives of race who live with psychosis . He points, very succinctly, to the fact (and cites Brabban A et al. 2000) that the central tenet of cognitive behaviour therapy is that the therapist should endeavour to show a clear linkage between personal experience, core beliefs ( strategys), and emergence of psychotic symptoms. The significance of this publication is that it is unusual insofar as it outlines the benefit of cognitive behaviour therapy for the staff as much as the benefit for the patient, by suggesting that staff trained in the techniques of cognitive behaviour therapy are able to empathise on a much deeper level with the patient and this, in itself, has a remarkable remoralising effect of developin g a substanceful grounds of the psychotic phenomenon with a patient. This point is echoed in the discussion of the Craig authorship.The Craig paper (Craig T K J et al. 2004) is a carefully constructed, but hard reported, randomised controlled trail of the current efficacy of specialised care modalities for cases of other(a)ish psychosis. (Vickers, A. J et al. 2001). It is presented here as a case employment in critical analytic thinking. The hinderances were delivered in two multitudes. The accounting entry cohort was allocated to a monetary standard care group (the control) or the intervention group (specialised care group). both(prenominal) sets of treatment were delivered by the community mental health teams. The outcomes for both groups were rate of relapse or readmission to hospital. (Friedman GD. 1994)We present this paper to illustrate a greens problem with this type of streamlet. On first appreciation, it demonstrates the fact that the intervention group did b etter than the control group. The difficulty in critical analysis comes in trying to decide which of the treatment modalities actually produced this ripe effect. (Mohammed, D et al. 2003)The entry cohort was quite impressive for a study of this type with 319 presenting with psychotic illness over an 18 month completion and 144 of these merging the inclusion criteria. 94% of these were remained in the trial over the 18 months of happen up.We note that, although the programme of interventions did include cognitive behaviour therapy, it also include other treatment options such as low dose untypical antipsychotic regimens, cognitive behaviour therapy based on manualised protocols, and family counselling and vocational strategies based on established protocols (Jackson H et al. 1998). From the point of view of our considerations here, on the one hand the results appeared to be good insofar as the study showed that the intervention group had fewer readmissions to hospital in the stu dy period and also they had fewer psychotic relapses (although this was of low statistical significance). On the other hand the paper tells us that all patients had medication and the ultimate choice of treatment pathway was decided by the intervention clinician, so although cognitive behaviour therapy was used, we have no absolute idea of its specialty from this trial. (Green J et al. 1998). All we can say with confidence is that, as part of a total package, cognitive behaviour therapy appeared to have helped to raise to a beneficial outcome for a significant military issue of psychotic patients. A all in all analytical and minimalist approach to this finicky trial could suggest that it is and so possible that cognitive behaviour therapy is actually ineffective per se. other than it served to victuals the patient in closer contact with the clinicians. (Piantadosi S. 1997)In this respect this is an causa of a trial which is seemingly supportive but does not contribute greatly to the evidence baseOn first sight this particular view might be considered pedantic, but it is echoed by Yates (DH 2005) in a letter in the BMJ, where he specifically takes up this very point. He points to the fact that there is very little description of the regimes of cognitive behaviour therapy and the head that its impact can be isolated from the boilers suit effect. He also refers to the fact that a breakdown of the various therapies offered and the degree that each was helpful would have improved the paper tremendously. We have to agree.We will next consider a broad(prenominal) profile paper by Morrison (A P et al. 2004) which has been widely cited. This paper took the pioneering work of Yung (et al. 1996) who identified a gritty bump group of patients who would develop psychosis and studied the effect of cognitive behaviour therapy on the prevention of the development of the clinical state. Morrison et al. identified the fact that other studies (McGorry, P. D et al. 20 02) had demonstrated that it was possible to reduce the incidence of psychosis development with a multifaceted approach, like that of Craig, which included elements of cognitive behaviour therapy. Morrison however, elected to hold back out a study that used cognitive behaviour therapy as a single strand approach in this high risk population. (Leaverton P E. 1995)The results from this study convincingly demonstrated that cognitive behaviour therapy solo significantly cut back the likelihood of making progression to psychosis as delimit on the Positive and Negative Syndrome Scale over 12 months. (Kay, S. R et al. 1987) The authors were also able to demonstrate that cognitive behaviour therapy also reduced the likelihood of a patient being prescribes antipsychotic medication. Other criteria of analysis demonstrated that cognitive behaviour therapy significantly improved the positive symptoms of psychosis in the target population.This is an important study as it is one of the firs t to fork out a reasonably secure evidence base that cognitive behaviour therapy works in the psychotic patient. It also shows that it works in the high risk group and has the possibility of a prophylactic effect by minimising the likelihood of psychotic relapse.A critical analysis would observe that the intervention cohort was comparatively small and a disproportionately small number were entered in the control group (37 and 23 respectively). High risk psychotic patients are comparatively rare and therefore one has to appreciate the serviceable difficulties involved in accumulating a sufficiently large sample to study. (Grimes D A et al. 2002),The last publication that we shall consider is that by Trower (P et al. 2004). It was published at the same time as the Morrison paper and is notable for the fact that, like the Morrison paper it recognises the shortfalls of the previous multi-modality studies and isolates cognitive behaviour therapy in its analysis. It also specifically ta rgets a notoriously treatment-resistant group of psychotics, those who suffer from command hallucinations. (Haddock, G et al. 1999)This was a single blind randomised trial with 38 patients. The trial was mazy in structure but, in essence, it was able to show, with convincing statistical significance that cognitive behaviour therapy interventions alone was able to reduce the patients conformity rate with the psychotic commands. The authors noted that this reduction in compliance was associated with a reduction in levels of both anxiety and depression.In remainder we would like to commend the book by Eisenman (R 2004) The Case Study doorkeeper to Cognitive Behaviour Therapy of Psychosis as a particularly authoritative and clinically useful overview. It cites a number of clinical case studies and analyses them in depth. It supports the view that cognitive behaviour therapy, by attempting to confront the patients distort thinking and allowing them to appreciate their thoughts in a more rational and down-to-earth way, can have beneficial results and it places cognitive behaviour therapy in a clinical context amongst the other, generally accepted modes of psychotherapy. It is not a mates reviewed publication so we shall not consider it further than that.ReferencesBrabban A, Turkington D. 2000The search for meaning detecting congruence between life-events, underlying schema and psychotic symptoms. 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