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Cognitive Behavioral Therapy for Psychosis: Unders ...
Presentation and Q&A
Presentation and Q&A
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Welcome to today's webinar. I'm Amy Cohen, an Implementation Scientist and SMI Psychological Treatment Expert for SMI Advisor, as well as an Associate Research Psychologist at UCLA. I'm pleased you are joining us for today's SMI Advisor webinar titled Cognitive Behavioral Therapy for Psychosis, Understanding the Basics. The Clinical Support System for Serious Mental Illness is an APA and SAMHSA initiative devoted to helping clinicians implement evidence-based care for those living with serious mental illness. Working with experts from across the SMI clinician community, our interdisciplinary effort has been designed to help you get the answers you need to care for your patients. Now, I'd like to introduce you to the moderator for today's webinar, Dr. Ken Duckworth. Dr. Duckworth serves as the Medical Director for the National Alliance on Mental Illness. He is double board certified in adult and child adolescent psychiatry and is a distinguished fellow of the American Psychiatric Association. Welcome, Ken. Thank you so much. And the National Alliance on Mental Illness is delighted to partner with the APA and SAMHSA on this important project. Today, we're delighted to have Dr. Sarah Kopelovich, who's a psychologist at the University of Washington who holds an assistant professorship in the department and a full professorship in Cognitive Behavioral Therapy for Psychosis. Dr. Kopelovich is also the Director of Training for the Northwest Mental Health Technology Transfer Center at UW, which is a SAMHSA funded training and technical assistance center. Cognitive Behavioral Therapy for Psychosis is of great interest to the NAMI community and, of course, to the professional community as we continue to learn about the power of psychosocial interventions. Thank you, Dr. Kopelovich. We appreciate you. Thank you so much, Dr. Duckworth and Dr. Cohen for those fabulous introductions. I'm thrilled to be joining you all today to provide an overview of CBT for psychosis in this one-hour webinar. This is an important topic for me as someone who's committed to changing the culture of care for psychotic spectrum disorders, both in mainstream mental health settings and what have really become our clinical frontiers in the United States, our forensic or correctional and primary care settings. My goal is to orient folks to CBT for psychosis and to really sell you on this idea that CBT for psychosis is an intervention that's aligned with recovery principles and recovery-oriented systems of care. Our learning objectives for our one-hour webinar, I want everybody to be able to come away from this webinar able to articulate the primary goals of a course of CBT for psychosis or CBTP as I'll be calling it, to have a foundational understanding of the theoretical principles of CBTP, to be able to list the stages of treatment. Then I'll provide you with a number of resources at the end of this webinar where you can pursue additional training or education. I start all of my trainings, all of my presentations with this quote from an American psychiatrist and schizophrenia researcher. Schizophrenia is in fact the single biggest blemish on the face of contemporary American medicine and social services. When the social history of our era is written, the plight of persons with schizophrenia will be recorded as having been a national scandal. I share this quote not to demoralize us, but really to hold us all accountable to changing the quality of care and for working in whatever capacities we can to align our practices with the National Schizophrenia Treatment Guidelines. In the US, these are the PORT Guidelines, Patient Outcomes Research Team, where CBT for psychosis is listed as one of a handful of psychosocial and psychotherapeutic interventions for schizophrenia. Despite this recommendation, a preliminary survey of the national CBTP landscape back in 2015 suggested only 0.1% of the roughly 300,000 licensed mental health professionals in our country is trained in this intervention. I did some back-of-the-envelope calculations and found that based on these estimates, only 0.3% of the 5 million Americans with a primary psychotic disorder is presumed to have access to CBTP. By way of comparison, recent estimates coming out of the UK in which CBTP is required intervention for anybody with psychosis, about 20% to 35% of individuals with psychosis there are receiving at least one session of CBTP. I'm going to start this webinar by providing a quick overview of cognitive behavioral therapy and then discuss its application to psychotic symptoms. Most people know that cognitive behavioral therapy is a talk therapy that's based on the cognitive model. The cognitive model asserts that our emotional, behavioral, and physiological responses are based not on the situation itself, what happens to us or inside of us, but on the way that we interpret or make sense of that situation. CBT aims to help people identify patterns of thinking and patterns of behaving that are contributing to their distress and impairment and to help clients to deliberately choose to think and behave in ways that lead to more healthful living. There are two key concepts in CBT that often get confused, so I want to just take a moment to clarify them. What I just described in the last slide is the cognitive model where we have a rapid-fire thought or an interpretation, these are called automatic thoughts, that leads to an emotional response and a subsequent behavioral response. This is really important. We have about, on average, 50 thoughts per minute. Some of them are more emotionally salient than others. Some of them lead to behavioral changes. Those are the ones that we really want to hone in on in CBTP. Where those thoughts come from leads to our second concept, which is the cognitive triad. This is this idea that certain automatic thoughts are based on these deeper, more rigid, and ingrained sets of beliefs, which are called core beliefs or schemas. We have three types of core beliefs, views about the world or other people, views about ourselves, and views about the future. I'm going to come back to core beliefs toward the end of this webinar, because when we do CBTP, our hope is to give people a different relationship with themselves and with their thoughts by using our targeted behavioral and cognitive strategies. I think most people on this call have a good handle on what psychosis is, but we can really think of psychosis as a set of symptoms in which the individual's experience is at odds with the experience of others within their culture. Hearing things that others don't hear, holding beliefs that are resistant to disconfirmation that others don't share. Traditional conceptualizations of psychotic phenomena have really rested in this idea that they are both outside the norm of the typical human experience and, by definition, psychologically not understandable or relatable. In CBTP, we think of psychosis instead as lying on a continuum with non-psychotic phenomena. Each of us is susceptible to slipping into psychotic and psychotic-like experiences under the right set of circumstances and vulnerabilities. There's a cross-national analysis that was led by John McGrath at the University of Queensland. They found that about 14% of people in the general population reported psychotic experiences often or very often. This, of course, contrasts with the prevalence of schizophrenia, which is only 1% to 2% of the population. What that means then is that if we're each susceptible to or have these psychotic or psychotic-like experiences, then perhaps it's not the experience itself that's pathological. It's the frequency, the intensity, and the consequences of these experiences to the individual. That has big implications for how we treat psychosis. We're looking to help the person reframe these experiences and to empower them to feel more control over these experiences. An example I like to give to really drive that point home is if I hear voices and Dr. Duckworth hears voices and our voices say the exact same thing. They say, don't leave the house today, you're going to die. I believe, oh my God, the voice knows I'm going to die. I'm going to feel really scared and I'm probably not going to leave the house. When I don't leave the house, of course, I don't die. It reinforces this belief that the voice really knows what it's talking about. I should really listen to it. If Dr. Duckworth has the belief, I've heard you say that before and I haven't died yet. I'm not buying into the fact that you know everything that you say or everything you say is true. Then their distress and disability is going to be far less. It really is the belief about these experiences that the person has that determines the distress that they feel and of course, how they choose to respond. That's what we're focused on in CBT for psychosis. Before I address the question of really what is CBT for psychosis, I want to ask the question, why? Why CBT-P? We know that medication management is the frontline treatment for schizophrenia spectrum disorders, but we also know that between 50 to 80 percent of individuals diagnosed with schizophrenia experience persistent and distressing psychotic experiences despite adequate medication management. The other piece is that medications don't affect the beliefs that mediate recovery. Beliefs like people with schizophrenia don't get married and have children. Why would I bother going out? Nobody's going to understand what I'm saying or want to hang out with me anyway. These voices are never going to stop. The need for additional treatment strategies is paramount, particularly those that shift these recovery incompatible beliefs. Not surprisingly, CBT-P focuses on psychotic and related symptoms, typically mood symptoms, that cause distress and dysfunction. We aim to help individuals become aware of, again, of those thoughts and behavioral patterns that aren't working so well for them. I want you to think about CBT-P as an umbrella rather than a specific protocol. I know we have a lot of psychiatrists on the webinar today. We can analogize this to a class of antipsychotics, and then under that class, we have a lot of different kinds of medications. We here with CBT-P have a class of psychotherapy that can have many variants. I kind of put up on the screen just a few, and even these are buckets. We have low-intensity protocols. We have formulation-based or high-intensity CBT-P protocols. We have group CBT-P. Then we have a whole host of symptom-specific interventions, like specifically for voices or specifically for paranoid ideation. I'm going to talk a little bit about some of the underlying principles so that you can see we're not in the Wild West here. Even though we've got a lot of different variants, we still have some guidance as far as what are the core elements of CBT-P. Our main goal is to reduce distress and improve functioning and well-being. I think this is a really important point. The goal of CBT-P is not the amelioration of symptoms, which is more a biomedical approach. It is addressing the distress and dysfunction associated with those symptoms. Getting back to my comments earlier, it's that distress and dysfunction that's driving the psychopathology, not the experiences themselves of hearing voices or having suspicious thoughts. Ultimately, we want the person to use skills and supports to help them achieve the goals that are important to them and that will build a life worth living to them. Here are principles that I mentioned. Much of these principles, in fact, all of them are based on the work of Anthony Morrison and Sarah Barrett in their 2010... This is a Delphi study where they polled the experts on what are the critical ingredients in CBT for psychosis. And so, these features really enable practitioners to maximize treatment efficacy and adherence to the model. First and foremost, not surprisingly, it's based on the cognitive model of emotional disorders. What that means is that this is theory and model-driven. Our work with folks is based on validated theories that we then tailor to the individual through the use of a cognitive behavioral formulation to really try to understand what's contributing to the maintenance of this person's psychotic and mood symptoms. It also means that CBT-P is more than a collection of techniques. We're not just throwing CBT skills at the wall and seeing what sticks. Again, we're really guided by our personalized formulation. The second is that CBT-P is educational and collaborative. There's a couple things packed in here. We do provide recovery-oriented psychoeducation using the client's own language, meeting them where they're at. We work together to agree on our treatment targets and then set out on the ways in which those treatment targets can be achieved. It's time-limited. Typically, for a high-intensity formulation-based CBT-P, we're looking at about 24 sessions, preferably weekly, so about a six-month treatment course, give or take. This time-limited format really requires explicit, concrete, and attainable goals, which both parties agree to. We agree that this is appropriate for the number of sessions that we have. The fourth is that CBT-P relies on a trusting, empathic relationship between the client and the therapist. That is an absolute prerequisite. In addition, the therapist must be careful to avoid both collusion and confrontation in order to maintain the therapeutic relationship. Oftentimes, that requires a great deal of skill. The fifth one is that cognitive therapists primarily use the Socratic method. That's to say, instead of providing our own answers to the client's questions or offering alternative explanations, we ask these curious, non-judgmental, open-ended questions that help clients provide their own answers. That's a process called guided discovery. We ask lots of questions in CBT-P. We typically start out with peripheral questions like, how does that work that others are able to read someone's mind? How does someone come by this kind of a talent? What might someone use that talent for? Then progressively shift into more personalized questions. What made you think that this was happening to you? When did that first occur to you? What was going on at that time? What did it feel like in your body? What else might have accounted for that? These Socratic questions become a vehicle for something called collaborative empiricism. It's a bit of psycho jargon here, but collaborative empiricism basically is a systematic process where the therapist and the client are working together to develop insights into what kinds of behaviors and thinking styles are more or less helpful to the person. Maybe even forming a better understanding of where these unhelpful thoughts that keep popping up, where they come from. CBT-P is structured both within and across settings. Within a session, we have a very predictable routinized format, agenda setting. We review home practice, all the elements of a standard CBT session. We tend to see a correspondence between these structural elements and clinical improvement. That being said, as with any manualized treatment, it's really incumbent on the clinician to breathe life into the manual, to really make sure that we are making these sessions feel natural, supportive, warm, and empathic. Then the structure also pertains to the overall arc of the treatment course, which I'll present later on. CBT-P is solutions oriented. We use change strategies, or in the case of third wave CBT, we may use mindfulness, acceptance, or compassion strategies to relieve the distress and enhance functioning. Then finally, therapist assumptions are a core principle. The therapist should believe that recovery is possible, that it is possible to experience psychotic symptoms without feeling distressed, that delusions can be understood. Therapist beliefs and expectations do influence people's response to CBT-P. I'd point you to this 2016 article by Allison Brabin and colleagues that speaks to that point. We got a little bit more to cover in terms of theory, and then we're going to jump into the evidence base. Typically, schizophrenia spectrum disorders are seen as thought disorder. From a cognitive behavioral perspective, we think about this as disordered or maladaptive thinking. This comes from Aaron Beck's original theory about the cognitive specificity hypothesis. What this essentially says is that the way that we think our cognitive content is associated with specific psychological disorders. In other words, when we look at the content of thoughts of individuals with depression, we see depressogenic thoughts. In anxiety disorder, we see ruminative worry thoughts. The idea here is that the thinking styles that are ingrained, that are driving the particular kind of distress that we call depression or social anxiety disorder, or whatever it is, and that this extends to psychotic disorders as well. So the content of hallucinations and delusions are based in some way on reality. They distort or extend that reality. And they are based on those core beliefs I talked about earlier. And it turns out that these core beliefs are quite relatable to all of us. So I'm gonna show you guys what I call my cognitive triad cheat sheet for delusional beliefs. This comes from a book called Cognitive Therapy for Schizophrenia by Aaron Beck, Paul Rector, Neil Stoller, and Paul Grant. And it's in one of the appendices. And if you look at the type of delusion, you can see the theoretical cognitive triad for that type of belief. So if we look at the paranoid delusions, which are our most common type of delusional belief, you can see that the view of the self is vulnerable, inferior, defective, socially undesirable, that other people are powerful, threatening, that they mean us harm, and the view of the future is uncertain. And think about, paranoia oftentimes, we might see somatic beliefs tied to that paranoia. Somebody has poisoned me, I can feel it. And you can see a very similar theme in the cognitive triad under the somatic types of delusions. And so this is so helpful, right? So we can start to develop a formulation about what is underlying even seemingly bizarre beliefs. And I think at the same time, it helps us as clinicians to really buy into the possibility of recovery when we see these themes that we're so used to dealing with in clients with non-psychotic disorders, or we even see these themes in ourselves, right? So I wanna briefly touch on the cognitive model of psychosis and how it informs our approach in CBT. And I think this model, this diagram that was put out in a 2001 article by Philippa Garrity and colleagues, really does a nice job of outlining the development and maintenance of positive symptoms. And essentially what it says is that commonly psychotic symptoms precede through cognitive and affective changes. So there's a few important pieces I wanna highlight here. One piece is what we see occurring in the top two boxes on the left. This is basically our stress vulnerability model that we as clinicians hear about over and over again, right? We know that we have these nomothetic risk factors for psychosis, and then we typically have a trigger and that trigger might be a negatively valence stressor, like a trauma, bereavement and incarceration, or it could be a positively valence stressor, like leaving home for the first time or getting married. And this leads to emotional and positive changes. So the most common emotional change we see is anxious arousal. And anxious arousal is directly linked to uncertainty, poor concentration, and really judging ambiguous experiences as potentially harmful. Think about you're walking down the street late at night, you're already kind of really anxious about something that's happened earlier, and it's dark and those shadows that you're seeing are taking the form of a person. And that sound that you heard in the background might be a gunshot, right? So you're already appraising these stimuli as threatening. At the same time, we're seeing at this stage cognitive and perceptual disturbances. So the individual here is trying to make sense of these anxious feelings and these cognitions that something's not right, something malevolent is going on, and in doing so they come to view these anomalous experiences, let's say a voice that's whispering their name as external to themselves. This interpretation is critical because as we've already discussed with our cognitive model this interpretation predicts distress. So this appraisal doesn't come out of nowhere, right? We have those core beliefs that we talked about that inform our appraisal. So we've got that down in that dotted box, dysfunctional schemas of self and world based on earlier life events. And it's heavily influenced by cognitive biases that decades of research has shown are more prevalent among people who experience psychotic spectrum disorders, things like jumping to conclusions, theory of mind deficits, attributional biases, social cognition deficits. And these factors turn out to also influence whether these psychotic symptoms will persist over time. So there also are maintaining factors. So in CBT for psychosis, this isn't a picture of me, this is a picture of grandma CBTP and she is giving psychosis the old one-two punch. So one is that we attempt to reduce the person's vulnerability to psychotic experiences. And there's a lot of different ways that we can do that. We can work to increase the consistency with which they're taking their medications. We know that there's a high sensitivity to stress. So we'll wanna work with folks in terms of stress management to reduce overall levels of kind of consistent anxiety levels or feelings of being overwhelmed. We wanna gradually increase meaningful pleasurable activities and reduce isolation. And preferably we want these activities both to make the person feel competent and confident, but also can it meet the function of the beliefs that they're holding in some way. Avoiding drugs and alcohol is always helpful and then treating related disorders that might be inflaming the psychosis. And then the second thing that we'll do is we'll wanna try to use cognitive and behavioral strategies or teach cognitive behavioral strategies once a psychotic experience occurs to help cope with that distress and also to create a new relationship with that experience. So let's say a concern is that they're being poisoned. So we wanna try to kind of look at that concern together and facilitate something called reattribution. Could it have been that the sensation in your stomach was a sign of anxiety rather than a sign that you were poisoned? We wanna teach people to recognize reasoning biases and explore alternative explanations, cognitive restructuring, those all rely on good use of Socratic dialogue, engage in reality testing, using coping skills when needed, problem solving as needed medication, and then exposure is our most powerful intervention for anxiety. I wanna spend a few minutes talking about the evidence base for CBT-P. Most people don't realize that there have been about 50 randomized clinical trials, over a dozen meta-analyses and four systematic reviews now that support the conclusion that CBT-P is an important adjunctive treatment to pharmacotherapy for individuals with schizophrenia spectrum disorders. CBT-P is not a panacea. We don't have a panacea yet for schizophrenia, but overall we do see clinically significant improvement in the small to moderate range on hallucinations and delusions. And to put those effect sizes into context, those are comparable effect sizes that we see for clozapine, which is 0.49, risperidone, which is 0.25, and olanzapine, which is 0.21 compared to first-generation antipsychotics. Unlike with medications though, we do tend to see that gains are maintained over a follow-up period. We find that negative symptoms tend to also respond, but here we see less dramatic improvements in the small effect sizes. And there is an indication for individuals at clinical high risk for psychosis that it could prevent or delay transition to psychosis. So it is indicated an important adjunctive to psychopharmacology. I wanna say, CBT for psychosis has been challenging to study for two reasons, two kind of main reasons. One is that schizophrenia spectrum disorders are a extremely heterogeneous cluster of syndrome. And so when we have these studies, particularly when we're looking at them in group form, like in a meta-analysis, we're comparing people that have very, very different presentations. Some are predominantly negative symptoms, some have delusions and voices. There's just so many different ways that it could manifest. And then the other reason is that CBT for psychosis is itself heterogeneous. Remember, we're talking about a category of protocols. And so it's been very, very difficult to study this. And I think this has led to claims that CBT-P is oversold. And this was a commentary paper in which Peter McKenna argued that it's oversold and Dr. David King reported that he disagreed with that position. We have another response paper by Kim Muser and Shirley Glynn saying, in fact, CBT-P is undersold and outlying their rationale for that claim. We have some meta-analyses claiming there's no evidence in well-controlled trials. And we have meta-analyses that say there are good effects for hallucinations, medication-resistant symptoms and active comparator treatment. And then of course we have studies that are looking at our clinical outcomes. And looking at the indicators of clinical response as a 50% reduction in symptoms. And we have others that are researchers that are saying, what are really important are our recovery outcomes. How are these symptoms impacting functional recovery? So not easy, but as this sort of battle is fought out within the meta-analyses, we are still seeing an overwhelming indication, I would say for individuals who are in psychosis risk states, individuals experiencing a first episode of psychosis, multi-episode and medication-resistant psychosis. So really indicated across the illness continuum. So I wanna go now into what does the arc of the treatment look like? There is a systematic approach to delivering CBT for psychosis. As part of my work as a CBTP trainer, I'll often review full sessions of clinicians who are just learning to administer CBTP. And one of the most common mistakes I hear clinicians making is jumping right into problem-solving mode, right into those interventions. And it comes from such a good place. We all wanna help our clients. And oftentimes there are really pressing issues that are weighing in. Like we have a client who's at risk of losing his housing because he's screaming at the voices all night. Or a client who's been capitulating to command auditory hallucinations. Or an individual on a forensic inpatient facility whose behavior is leading him to lose a level and the staff are kind of at their wit's end. And so we want to do good and we wanna get these interventions to folks who are in need or maybe even in crisis. But there are some brief interventions that we can front load. For the most part, we do our clients a service by adhering to the structure of the treatment course. Okay, so let's go through that. Oh, let me just say a minute about this. This is super important. So it is critical that we connect natural supports, family, friends, significant others throughout the treatment course. And this is something that's not done enough among any of our, I think among any of our providers, but it really needs to be done in a deliberate way in a course of CBT for psychosis. Of course, it has to be with the permission of the client. Do not reserve this to the end of the treatment. We don't bring in natural supports when we're doing relapse prevention planning. We really wanna bring in natural supports often and throughout the treatment. And typically I'll do this by reserving a few minutes, maybe 10, 15 minutes at the end of the session to allow the client to tell their loved one what they learned, what they're working on, and then to make a plan together for how they're gonna practice that together in between sessions. Okay, the engagement stage is, there's really this strong focus on really getting to know the person. And so David Kingdon and Doug Turkington, who wrote one of our seminal texts on cognitive therapy for schizophrenia, call this stage the befriending stage. Our agendas are a little bit less explicit. We're really learning about what's important to the client, their goals, their values, their interests, what's happening right now. And Pat Deegan, who is a clinical psychologist, who is just at the fore of the recovery movement, has a really nice way of framing this. She says, we move from what's the matter with you to what matters to you. And I just love that. So our goals for this session are to establish therapeutic rapport and alliance and engagement and to instill hope in meaningful recovery. And I would say that hope piece is our most important agenda item for session number one. In the assessment stage, our goal is to identify a shared understanding of the problems and the goals of treatment, to establish a baseline by which we can measure our progress through the treatment course, and then to develop formulation by which we'll guide the intervention. And the emphasis here is placed on understanding the first episode in detail. That can oftentimes hold the key to current belief. And if that's not possible, we focus on the most recent occasion in which there was a marked increase in symptoms. But this is a really critical piece to our formulation-based CBTP. We also use structured measures to monitor a response to treatment and to help the client build insight into the fact that what he or she does affects how he or she feels. That's the kind of insight that helps this intervention stick. In the intervention stage, we select and teach cognitive and behavioral interventions selected on the basis of that case formulation. And so I've listed some kind of buckets of our behavioral strategies and our cognitive strategies here. Overall, our goals here are to increase independent skill use, so not just using the skills because it was assigned for home practice, but because they needed to or wanted to. To reduce distress and to make progress towards our treatment goals. And then finally, in the relapse prevention stage, we have a few goals. One is to continue to shape independent skill use by using fewer clinical prompts. So we wanna see that the person is starting to use these skills independently and that they can start to generalize the skills too. So that they're using it in different settings and they're using them for different problems. So that strategy that was helpful for the voices is also helpful for dealing with anger, insomnia, et cetera. And then we wanna revisit that formulation to build on the insights there and we wanna summarize the changes that have been made that were helpful. And we wanna plan for relapse. So we do our clients a huge service by helping them to identify early warning signs and triggers and then making a plan for how they and their clinical and natural support teams will respond. So before ending this webinar, I wanna leave you with some resources that will be helpful for you, for your clients and for loved ones and caregivers. I highly recommend the overcoming series. Everything on this slide, I think is fabulous and I use in my own clinical practice and recommend to my trainees. And I don't get any royalties from any of these. I just genuinely think these are all fantastic resources. There are several books I would recommend to build your library. All of these on these slides, I think are really considered seminal in terms of teaching how CBT-P is done. And that treating psychosis book in the bottom right-hand corner integrates our third wave CBT approaches. If you're interested in learning more or finding a CBT-P trainer, there's a couple of resources I wanna share with you. The first is a newly formed group in North America called the North America CBT for Psychosis Network. We just officially launched in November with our website. We have an option where you can become a member where you'll receive all sorts of updates on CBT-P and have access to the network. We also have a resources tab where you can get additional learning resources. And we hope to get a directory of trainers in the U.S. and in Canada soon. If you would like some additional resources for clinicians, family members, or individuals experiencing psychosis, I would direct you to my lab's website, the Evidence-Based Practices for Adults Lab at the University of Washington. And our link is there. And so I just wanna thank you guys all for investing the time to learn a bit about CBT for psychosis today. I hope I've whet your appetite for CBT-P and perhaps painted a picture of how CBT-P can advance the culture of care for psychotic disorders in the U.S. from a palliative model to a rehabilitative model. Thank you so much for that very informative presentation, Dr. Kapelovich. My pleasure. Thank you.
Video Summary
In this video, Dr. Sarah Kopelovich provides an overview of Cognitive Behavioral Therapy for Psychosis (CBT-P). She discusses the theoretical principles of CBT-P, its application to psychotic symptoms, and the evidence base supporting its effectiveness. Dr. Kopelovich emphasizes the importance of understanding the cognitive model of psychosis, which suggests that psychotic symptoms are based on distorted or maladaptive thinking patterns. She outlines the main goals and principles of CBT-P, including its focus on reducing distress and improving functioning, its educational and collaborative approach, and its use of the Socratic method and cognitive restructuring. Dr. Kopelovich also highlights the need for a trusting and empathic therapist-client relationship and the importance of connecting individuals with natural supports throughout the treatment process. She describes the four stages of CBT-P, which include engagement, assessment, intervention, and relapse prevention. Dr. Kopelovich concludes the webinar by providing a list of recommended resources for further learning.
Keywords
Cognitive Behavioral Therapy for Psychosis
CBT-P
Psychotic symptoms
Cognitive model of psychosis
Socratic method
Therapist-client relationship
Relapse prevention
Funding for SMI Adviser was made possible by Grant No. SM080818 from SAMHSA of the U.S. Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement by, SAMHSA/HHS or the U.S. Government.
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