An overview of CBT for psychosis

Dr Sarah Swan & Prof. Emmanuelle Peters

Tuesday, 22 November 2022

Introduction

Cognitive Behaviour Therapy for psychosis (CBTp) is an adaptation of standard CBT, informed by research into the psychological mechanisms underpinning psychotic symptoms, and tailored to accommodate the difficulties of people with psychosis. Cognitive models (Birchwood and Chadwick 1997; Freeman, 2016; Garety et al. 2007; Morrison 2001) highlight that it is not unusual experiences themselves which are problematic, but their appraisal as external, personally significant and threatening.Maladaptive coping and safety behaviours also maintain distress and disability. CBTp aims to break these vicious cycles by helping people to understand their psychotic experiences, promote coping and self-regulation, and counter negative appraisals of self and difficulties.

CBTp includes a combination of elements and therapeutic activities (Morrison & Barratt, 2010), and requires a very explicit focus on engagement, with a trusting relationship being a crucial foundation. The specific model used depends on what the primary difficulties are (e.g., delusions, voices, emotional difficulties). Each model emphasises the important role of appraisals of, and responses to, particular experiences, as well as a person’s previous experiences and their beliefs about themselves, the world, and others (Garety & Hardy, 2017). Successful implementation of CBTp involves both skilful application of therapy techniques and adherence to the underlying values and principles of offering hope and a recovery-oriented perspective; listening to and collaborating with the service user; and validating and supporting the ‘making sense’ process of the service user’s experiences (Brabban et al., 2017).


The event will be equivalent to 5.1/2hrs of CPD.

Content

The workshop will provide an overview of Cognitive-Behavioural Therapy (CBT) for psychosis. Specifically, the application of CBT to the symptoms of auditory hallucinations and delusions will be addressed. The morning session will concentrate on engaging and assessing patients; the afternoon session will focus on developing and applying appropriate CBT techniques.

Learning Objectives

The key learning objectives are to (i) become aware of therapeutic styles necessary for working with psychosis patients; (ii) have an understanding of key issues to be covered in the assessment of delusions and voices; (iii) develop an understanding of formulations for individuals with delusions and voices; (iv) learn CBT skills and techniques for changing delusions and voices.

Training Modalities

The workshop will include: didactic content, experiential, Q&A, and video/live role play

Key References


Brabban, A., Byrne, R., Longden, E., & Morrison, A. P. (2017). The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis. Psychosis, 9(2), 157-166.
Garety, P. A., & Hardy, A. (2017). The clinical relevance of appraisals of psychotic experiences. World Psychiatry, 16(2), 140-141.
Johns, L., Jolley, S., Keen, N. & Peters, E.R. (2013) CBT for people with psychosis. In A. Whittington & N. Grey (Eds) The Cognitive Behaviour Therapist: From Theory to Clinical Practice (Wiley) ) (‘How to’ chapter)
Kelly R., Cohen A. & Peters E. (2018) Psychosis. In S Moorey and A. Lavender (Eds) The Therapeutic Relationship in Cognitive Behavioural Therapy. Sage (How to develop and maintain a good therapeutic relationship in CBTp)
Morrison A, P. (2017). A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis: learning from clinical trials. Psychosis, 9, 1-11.

Online materials:
Increasing Access to Psychological Therapies for Severe Mental Illness (IAPT-SMI) competence framework for working with people with psychosis, bipolar disorder, and personality disorder (direct hyperlink is: http://www.ucl.ac.uk/clinical-psychology/CORE/competence_mentalillness.html; shorter link is www.ucl.ac.uk/CORE/)
http://www.psychosisresearch.com/cbt/ OR search for Cognitive Behavioural Therapies for Psychosis at: https://www.e-lfh.org.uk (may need an NHS computer to access this link)

About the presenter

Emmanuelle Peters is Professor of Clinical Psychology at the Institute of Psychiatry, Psychology & Neuroscience (IOPPN), and an honorary Consultant Clinical Psychologist at the South London and Maudsley NHS Foundation Trust, where she is the Director of an award-winning, specialist outpatients psychological therapies service for psychosis (PICuP), which she set up in collaboration with Prof Elizabeth Kuipers over 15 year ago. She has specialized in psychosis for the past 25 years as a clinician, researcher and trainer, and has received awards in each of these areas (BPS Distinguished Contributions to Professional Psychology; Schizophrenia Society Research Excellence Award; King’s College London Supervisor Excellence Award).
Sarah Swan is a Chartered Clinical Psychologist with over 10 years’ experience in psychosis. She has completed further Postgraduate study in CBTp at the IOPPN and has worked across specialist psychosis community and in-patient services delivering CBTp. Sarah is part of the PICuP Clinic at the South London and Maudsley NHS Foundation Trust and currently coordinates Professor Peters’ £1.5million National Institute for Health Research funded randomised controlled trial investigating a novel trauma focused CBTp intervention for people experiencing post-traumatic stress disorder and co-morbid psychosis at the IOPPN. Sarah has provided teaching and supervision for a range of professionals including trainee and qualified psychologists, and professionals from other disciplines undertaking specialist training in CBTp.

Who should attend

This workshop is suitable for delegates who are already familiar with basic CBT principles and techniques.