Cognitive Behavior Therapy in First-Episode Psychosis With a Focus on Depression,Anxiety, and Self-Esteem

Although several reviews show that cognitive behavioral therapy (CBT) is an effective treatment for patients with chronic psychosis, the effects of CBT on patients with a first-episode psychosis are less clear. Patients undergoing a first-episode psychosis are unique in that not only are they struggling with the symptoms of the disease, but also the realization of the diagnosis. Understanding how the disease will impact their lives with respect to changes in social goals, roles, and status can also lead to depression, anxiety and low self-esteem. The main aim of the present study is to describe two clinical cases in order to demonstrate the application of CBT in first-episode psychosis patients in an early stage of their psychosis. The two cases are individuals who were in an ongoing CBT trial for first-episode psychosis patients with symptoms of social anxiety, depression, and low self-esteem. Individual case formulations based on these symptoms were developed. Psychoeducation, normalizing, evaluation of negative automatic thoughts and dysfunctional schematic beliefs, and focusing on the negative consequences of safety behavior were the main treatment targets in attempting to improve the patients’ symptoms and functioning. Both patients showed improvement in depressive symptoms, self-esteem, and general functioning. The cases described suggest that treatment designed to target depression, anxiety, and self-esteem in patients with first-episode psychosis could have potential beneficial effects; specific studies of this approach are recommended.     

饥无食寒无衣则乱无治:社会保障感受与不道德行为的关系

从社会心理学的角度探索社会保障感受与不道德行为的关系,及焦虑在其中的作用。用三个实验对假设进行检验,实验1和实验2探索社会保障感受对不道德行为的影响; 实验3则进一步探索焦虑在其中的作用。回归分析表明,社会保障感受可显著预测人们的不道德行为,社会保障感受越低人们的不道德行为越多; 焦虑在其中起中介作用,低社会保障感受会促进焦虑的产生,继而增加不道德行为。研究从社会心理学角度探索并证实了社会保障感受引发不道德行为的微观心理机制,拓宽了社会保障的伦理道德价值研究视域,为未来从社会心理学的角度研究社会保障与伦理道德的关系提供了可资借鉴的思路。     

Integrating Psychotherapeutic Processes with Cognitive Behavioral Procedures

There has been a recent focus on the processes that underlie intervention delivery for children and adolescents throughout the Cognitive-Behavioral Therapy (CBT) literature. Certain process variables have been associated with treatment outcome among youth receiving CBT. Data for these process variables including: the therapeutic alliance or therapeutic relationship, child and parent involvement, other child and therapist variables, and issues of diversity, are reviewed. Based on this data, specific clinical recommendations are made. The treatment relationship as a very important process (VIP), and the facilitation of CBT so that it is real and relevant to youth are emphatically discussed. Process issues in modular CBT are identified. Ultimately, genuine collaborative empiricism and guided discovery preserve the therapeutic relationship as a VIP, and foster the customization of therapeutic tools and the treatment trajectory.     

Therapeutic Relationship

This article addresses the important role of the therapeutic relationship in cognitive-behavioral therapy (CBT). As has been noted from the inception of CBT, there are critical features of both the therapist and the relationship that optimize the likelihood of therapeutic success, and this article briefly describes these features. It is further argued that a successful therapeutic relationship in CBT is not static but is flexible and adaptive both across and within clients, as their needs and concerns vary. A positive therapeutic relationship is viewed within CBT as a necessary but insufficient condition for change, as the relationship serves as a foundation upon which interventions are scaffolded, but that the client’s response to various interventions itself shapes the interactions between therapist and client. Finally, it is argued that the key therapeutic ingredients of CBT are largely teachable, and the article provides several suggestions to promote an effective therapeutic relationship in CBT.     

Bidirectional semantic interference between action and speech

Research on embodied cognition assumes that language processing involves modal simulations that recruit the same neural systems that are usually used for action execution. If this is true, one should find evidence for bidirectional crosstalk between action and language. Using a direct matching paradigm, this study tested if action-languages interactions are bidirectional (Experiments 1 and 2), and whether the effect of crosstalk between action perception and language production is due to facilitation or interference (Experiment 3). Replicating previous findings, we found evidence for crosstalk when manual actions had to be performed simultaneously to action-word perception (Experiment 1) and also when language had to be produced during simultaneous perception of hand actions (Experiment 2). These findings suggest a clear bidirectional relationship between action and language. The latter crosstalk effect was due to interference between action and language (Experiment 3). By extending previous research of embodied cognition, the present findings provide novel evidence suggesting that bidirectional functional relations between action and language are based on similar conceptual-semantic representations.     

Therapeutic alliance and weight gain during cognitive behavioural therapy for anorexia nervosa

This study examined the relationship between therapeutic alliance and primary symptom change (weight gain) during CBT for anorexia nervosa. The aims were threefold: (1) to establish the strength of the therapeutic alliance across the treatment, (2) to determine whether early therapeutic alliance is associated with the completion of CBT for this client group, and (3) to determine the direction of the relationship between therapeutic alliance and weight gain. Adult outpatients (N = 65) with a diagnosis of anorexia nervosa (or atypical anorexia nervosa) completed a measure of alliance at session six and at the end of treatment. Weight was recorded at the start of treatment, session six and at the end of treatment. The strength of the alliance was consistently high in the sample. However, early therapeutic alliance was not associated with either the likelihood of completing treatment or subsequent weight gain. In contrast, both early and later weight gain were associated with the strength of subsequent alliance. These findings indicate that it might be advisable to focus on techniques to drive weight gain rather than rely on the therapeutic alliance to bring about therapeutic change.     

Cognitive-Behavioral Therapy for Individuals Recovering from a First Episode of Psychosis

Schizophrenia is one of the most devastating psychiatric illnesses. There has been a tremendous worldwide research and clinical effort into early intervention for psychosis. However, despite significant improvement in symptoms after a first episode, there is no corresponding quality improvement in function for many individuals. Thus, increased attention has been given to psychological intervention in particular cognitive behavioral therapy (CBT) with the hope of enhancing functional recovery. Outcome trials of CBT for schizophrenia are promising and other work in CBT suggests this may be a viable psychological intervention for this population. This paper will review the need for a CBT approach after a first episode of psychosis and describe a modular CBT approach for this population. This approach addresses adaptation as well as both functional and symptomatic outcome, an approach which parallels the theoretical shift in CBT that occurred in the last decade.     

Challenging the omnipotence of voices: group cognitive behavior therapy for voices

The present study examines the impact of group based cognitive behavior therapy (CBT) for drug resistant auditory hallucinations, or voices. In particular it assesses treatment effect on beliefs in a voice's omnipotence and control. Twenty-two participants entered one of five 8-session CBT groups. Measures of omnipotence, control, process measures, and symptoms of anxiety and depression were completed at assessment, and first and last group sessions. The groups achieved a significant reduction in conviction in beliefs about omnipotence (df 2, P = 0.002) and control (df 2, P = 0.001). There were no affective changes. Certain participants showed important spontaneous changes in behavior. Process measures suggested that participants valued the groups and benefited from them. These results are promising and the treatment may prove a useful addition to existing psychological interventions.     

Inseminated female mice (Mus musculus) investigate rather than avoid novel males that disrupt pregnancy, but sires protect pregnancy

Experiment 1 replicated the Bruce effect, showing pregnancy termination in CF1 strain female mice (Mus musculus) housed underneath novel heterogeneous strain (HS) males. In a 4-arm maze in Experiment 2, inseminated CF1 females approached novel HS males more often than CF1 sires or unfamiliar CF1 males. In Experiment 3, inseminated females showed random nesting sites when housed continuously underneath 4 compartments containing the sire, a novel CF1 male, a novel HS male, and no stimulus. In Experiment 4, when inseminated females were housed with or without the sire below novel HS males, the sire's presence decreased female interaction with novel males and mitigated the Bruce effect. Inseminated females do not reliably avoid males that disturb pregnancy unless the sire is immediately present.     

Cognitive Behavioral Therapy Across the Stages of Psychosis: Prodromal, First Episode, and Chronic Schizophrenia

Since the early 1990s, cognitive behavioral therapy (CBT) has been increasingly used as an adjunctive treatment for psychotic disorders. This paper describes the CBT of three cases, each at a different stage of psychotic disorder: at-risk mental state, first-episode psychosis, and chronic psychotic disorder. For the at-risk mental state, treament focused on anxiety and social phobia, whereas the treatment of first-episode psychosis focused on the development of a shared formulation of the factors leading to and maintaining psychotic symptoms. For the chronic case, treatment emphasized the possibility of improving strategies to prevent symptoms from interfering with life goals. The potential contribution of CBT to improve outcomes in psychotic disorders beyond those obtained through traditional pharmacotherapy is discussed.     

How to Develop Collaborative Empiricism in Cognitive Behavior Therapy: Conclusions From the C&BP Special Series

In this concluding commentary, we reflect on the component parts of the special series (see Kazantzis, Cronin, Dattilio, & K. S. Dobson, 2013--this issue, for the introductory article) in order to reconstitute the “whole” concept of collaborative empiricism in CBT. Each contribution of the special series clearly acknowledges that collaboration and empiricism are imperative for effective CBT, as well as to further elucidate these concepts in a range of central and timely therapeutic contexts. The articulation of the component elements of collaboration and empiricism is discussed as an important contribution, and one that assists in distinguishing central features and clarifying differences between collaboration as defined in CBT. A second important theme of the special series is the further specification of the construct of empiricism as it relates to the practice of CBT. The special series provides clarification for the role of collaborative empiricism in therapeutic processes of case formulation, in-session structure, and self-monitoring to assist in assessment, as well as in the use of core techniques such as exposure, work for specific clinical groups such as psychosis, and adaption of the work in a manner that is respectful and responsive to the client’s culture, preferences, and abilities. Case examples illustrate the importance of relying on the client’s experience, rather than general principles or logic, and the use of the client’s experience both specifically and explicitly, and as a measure for the evaluation of therapeutic interventions.     

A preliminary exploration of predictors of outcome and cognitive mechanisms of change in cognitive behaviour therapy for psychosis in people not taking antipsychotic medication

BackgroundCognitive behaviour therapy (CBT) has been shown to be effective in an open trial for people with psychotic disorders who have not been taking antipsychotic medication. There is little known about predictors of outcome in CBT for psychosis and even less about hypothesised mechanisms of change.Method20 participants with schizophrenia spectrum disorders received CBT in an exploratory trial. Our primary outcome was psychiatric symptoms measured using the PANSS. Secondary outcomes were dimensions of hallucinations and delusions, self-rated recovery and social functioning, and hypothesised mechanisms of change included appraisals of psychotic experiences, dysfunctional attitudes and cognitive insight. We also measured patient characteristics that may be associated with outcome.ResultsT-tests revealed that several of the hypothesised mechanisms did significantly change over the treatment and follow-up periods. Correlational analyses showed that reductions in negative appraisals of psychotic experiences were related to improvements on outcome measures and that shorter duration of psychosis and younger age were associated with greater changes in symptoms.ConclusionsCBT based on a specific cognitive model appears to change the hypothesised cognitive mechanisms, and these changes are associated with good outcomes. CBT may be more effective for those who are younger with shorter histories of psychosis.     

Attentional coding of categorical relations in scene perception: evidence from the flicker paradigm

The purpose of the present investigation was to determine whether the positions of objects in a scene are coded relative to one another categorically (i.e., above, below, or side of; Experiment 1) and to determine whether spatial position in scene perception is coded preattentively or only under focused attention (Experiment 2). In Experiment 1, participants viewed alternating versions of a scene in which one of the objects in the scene changed its categorical relationship to the closest object in the scene, changed only its metric relationship to the closest object in a scene, or appeared and disappeared. Participants were faster at detecting changes that disrupted categorical relations than at detecting changes that disrupted only metric relations. In Experiment 2, this categorical advantage still occurred even when participants were cued to the location of the change. These results suggest that categorical spatial relations are being coded in scene perception and that attention is required in order to encode spatial relations.     

支付与报复：成本形式对第三方惩罚的影响

第三方惩罚不仅对惩罚成本的数量敏感,也对成本形式敏感。在保持成本数量相等的情况下,不同形式的惩罚成本会对第三方惩罚的频率产生不同影响。相较支付形式,当惩罚成本采取报复形式时,被试的第三方惩罚频率显著下降。进一步的实验表明,惩罚频率的变化并非因为不同的成本形式所隐含的风险水平有所差异,而是因为被试对不同的成本形式赋予了不同的主观价值。进一步探索更多形式的惩罚成本是未来研究的重要方向。     

The attentional blink reflects retrieval competition among multiple rapid serial visual presentation items: tests of an interference model

When people respond to a target (T1) in a rapid serial visual presentation stream, their perception of a subsequent target (T2) is impaired if the intertarget stimulus onset asynchrony is between about 100 and 500 ms. Three experiments supported the interference model's (K. L. Shapiro, J. E. Raymond, & K. M. Arnell, 1994) claim that this attentional blink reflects competition for retrieval among multiple items in visual short-term memory. Experiments 1 and 2 revealed that items appearing during the blink are named as T2 on an above-chance proportion of trials when T2 must be identified. Experiment 3 demonstrated that both the size of the blink and sensitivity to T2 reflected the number of items competing for retrieval as T2; such competition, moreover, occurred at a conceptual or categorical level rather than at a purely visual one. The relationship between the interference and alternative models of the attentional blink is discussed.     

The relativity of time perception produced by facial emotion stimuli

We systematically examined the impact of emotional stimuli on time perception in a temporal reproduction paradigm where participants reproduced the duration of a facial emotion stimulus using an oval-shape stimulus or vice versa. Experiment 1 asked participants to reproduce the duration of an angry face (or the oval) presented for 2,000 ms. Experiment 2 included a range of emotional expressions (happy, sad, angry, and neutral faces as well as the oval stimulus) presented for different durations (500, 1,500, and 2,000 ms). We found that participants over-reproduced the durations of happy and sad faces using the oval stimulus. By contrast, there was a trend of under-reproduction when the duration of the oval stimulus was reproduced using the angry face. We suggest that increased attention to a facial emotion produces the relativity of time perception.     

Delusional disorder and delusions: is there a risk of violence in social interactions about the core symptom?

Delusional disorders are rare, but psychoses with prominent and persistent delusions are less so. A small but significant association between psychosis and violence is often mediated by delusions in such illnesses. Traditionally, delusions have been viewed as “incorrigible”, but there is evidence that they change over time. During development of a scale for measuring delusions, it was found that people who acted violently on their “most important” delusion were more likely to have modified that belief after a mild form of challenge to it. When cognitive–behaviour therapy (CBT) is used for schizophrenia, attempts to modify psychotic symptoms are generally included. Could studies of CBT provide further information about possible risks of social interactions about delusions? In the UK, 2000 people with schizophrenia have been in randomized controlled trials of CBT with a goal of symptom modification. These studies were examined for evidence of violence during the treatment. There was none. Given the period prevalence of violence among people with psychosis, this is surprising. In these studies, however, both challenge to delusions and change in them was minimal and in the context of a safe clinical relationship. Challenge to delusions may, however, occur in a variety of social situations. There are no systematic data on lay challenge to them, but it seems likely that some in the sufferer's social circle will do so vigorously. Relatives, friends, and acquaintances are the people most vulnerable to the most serious violence by someone with psychosis. Study of how people interact in these circumstances and whether their interactions are relevant to modification of delusions would be worthwhile. Could those close to a sufferer learn skills for responding to such pathological beliefs that could be protective against violence, perhaps derived from the principles of CBT?. Copyright © 2006 John Wiley & Sons, Ltd.     

Can Cognitive‐Behavioral Therapy Be Optimized With Parent Psychoeducation? A Randomized Effectiveness Trial of Adolescents With Major Depression in Puerto Rico

This is a longitudinal randomized control trial on the impact of adding a parent psychoeducation intervention (TEPSI) as part of cognitive‐behavioral therapy (CBT) for adolescents with Major Depressive Disorder (MDD) in a Puerto Rican sample. We tested the efficacy of adding 8 group sessions of TEPSI to 12 sessions of individual CBT on reducing depressive symptoms, MDD diagnosis, and improving family functioning. Participants (n = 121) were randomized to individual CBT with or without TEPSI. No main group effects were found for most patient domains including depression symptoms, as well as presence of adolescent's MDD diagnosis at posttreatment. Results did show a main effect of CBT over time for depression symptoms, suicide ideation, family criticism, and the presence of MDD diagnosis decreasing from pre‐ to postintervention. A year post treatment, almost 70% of adolescents in both conditions (CBT and CBT + TEPSI) remained in remission. A main effect was obtained for treatment in the adolescent's perception of familism and family emotional involvement. The primary hypothesis that family psychoeducation would optimize CBT for depression in adolescents was not supported. Both conditions yielded similar clinical end points. The culturally adapted CBT was found effective with Latino/a adolescents showing clinically significant improvements from pretreatment to posttreatment and remained stable at a 1‐year follow‐up. Regarding family outcomes, adolescents in CBT + TEPSI remained stable from pretreatment to posttreatment on family emotional involvement, while adolescents in CBT‐alone showed an increase. The implication of these findings is discussed.