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Objectives: Formulation is considered a fundamental process of cognitive behavioural therapy for psychosis (CBTp). However, an exploration into the personal impact of different levels of case formulation (CF) from a service user (SU) perspective is lacking, particularly for those experiencing a first episode of psychosis. Design: This Big Q qualitative design used semi‐structured interviews. Methods: Reflexive thematic analysis (TA) was used to analyse 10 participant interviews. NVivo 12 computer‐assisted qualitative data analysis software aided data organisation and analysis. Results: One overarching theme 'CF – A vehicle for change?' was developed as a pattern of shared meaning across the data set. Three main themes related to the overarching theme: (1) Vicious cycles: 'I never really thought about it being me maintaining the problems' (including one subtheme – Self‐empowerment: 'Only you can make the changes for yourself'); (2) Early life experiences: 'My experiences have shaped the person that I am, therefore, it's not my fault' (including one subtheme – Disempowerment: '[My] core beliefs have been damaged'); and (3) Keep it simple: 'Don't push it too far over the top in case it becomes like spaghetti'. Conclusions: Maintenance formulations may be experienced as self‐blaming, but also self‐empowering, which may help to facilitate change. Longitudinal formulations may be experienced as non‐blaming, but also disempowering, which may inhibit change. Simple CF diagrams may also facilitate change, whereas overly complex CFs may inhibit change. How CBTp therapists might look to improve the impact of different levels of CF for service users (SUs) in first episode psychosis (FEP) are described. [ABSTRACT FROM AUTHOR]

Objectives: Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). Design: Case series. Methods: A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6‐month intervention window. Participants were assessed four times over a 12‐month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental‐health and recovery measures. Results: Sixteen participants engaged in the intervention and were included in last‐observation‐carried‐forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post‐traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. Conclusions: The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. Practitioner points: Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma.Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices.Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation. [ABSTRACT FROM AUTHOR]

People with psychotic symptoms are reported to have a characteristic reasoning style in which they jump to conclusions (JTC). The aims of this research were threefold. The first was to establish how prevalent this style is in people with first-episode psychosis. The second was to examine the specificity of JTC to delusions. The third was to examine explanatory factors that may account for the JTC style. This was investigated by attempting to replicate, with a large sample, previous studies indicating that JTC is associated with specific psychotic and non-psychotic symptoms and processes. Seventy-seven service users were recruited from a first-episode service and completed measures of reasoning and psychotic and non-psychotic symptomatologies. A well-established criterion was used to compare the JTC performance of those people with and without JTC. JTC was present in over 40% of the sample, which is consistent with previous studies of people with long-standing psychotic symptoms. Unlike previous research, no strong associations were found in relation to symptoms and other processes. JTC is a phenomenon common in many people in first-episode services. In this large cohort sample, no clear associations with symptoms or other psychological processes were evident. Hence, the reason people JTC is still unclear. [ABSTRACT FROM AUTHOR]

Objective: To consider the characteristics of first episode psychosis in older adults in a county in North East England. Method/Design: The present study used a naturalistic design to compare individuals aged 65 years and over with those under 65, with a first episode psychosis. Data were collected on demographics, diagnosis at presentation and hospital admissions in the first year. Results: Almost a quarter of all patients were aged 65 years or older. The older group were admitted later on after presentation, but with longer average hospital stays (p < 0.01 ), compared to the younger group, with no difference in the use of the Mental Health Act. Late onset schizophrenia (40-59 years) and very late onset schizophrenia-like psychosis (60 + years) formed a considerable proportion of patients. Conclusions: There is a substantial proportion of older people with first episode psychosis, with a significant use of hospital bed days. There are large gaps in services for this group who often do not have the same access to those offered to younger people, e.g. Assertive Outreach or crisis teams, access to Clozapine and CBT. Ageism exists in all forms; the elderly are doubly disadvantaged in view of their age and mental illness. In view of the Age Discrimination Act (2006) the elderly functionally ill group of patients should be entitled to the same level of care and equal access to services as younger people. More attention and interventions need to be focused on this overlooked group. © Crown copyright 2009. Reproduced with the permission of Her Majesty's Stationery Office. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia are at high risk of suicide. Cognitive behavior therapy (CBT) has been shown to reduce symptoms in schizophrenia. This study examines whether CBT also changes the level of suicidal ideation in patients with schizophrenia compared to a control group. Ninety ambulatory patients with symptoms of schizophrenia resistant to conventional antipsychotic medication were randomized to CBT or befriending. They were assessed using the Comprehensive Psychopathological Rating Scale, including a rating of suicidal ideation at baseline, post intervention, and after 9 months. Post-hoc analysis revealed that CBT provided significant reductions in suicidal ideation at the end of therapy, and sustained at the follow-up. Further research is required to substantiate these findings and determine the process and mechanisms through which this reduction is achieved. [ABSTRACT FROM AUTHOR]

Individuals in random community samples not diagnosed as mentally ill report a variety of mental states along a continuum from 'normalcy' to psychosis. The existence of this continuum suggests that in addition to hallucinations and delusions, other more subtle reflections of psychotic thought processes might occur in ordinary mental life. Five transient disruptions of ordinary mental life which may mirror the cognitive processes underlying psychosis are identified. Thought experiments designed to heighten awareness of each of these states are described. The thought experiments aim at helping clinicians 'normalize' psychotic symptoms by locating analogies to psychosis in their own mental life. In addition, a questionnaire was administered to subjects in a random community sample to assess the frequency of the transient disruptions explored in the exercises in the general population. These disruptions appear to be quite common. This would suggest that at least some psychotic symptoms are a pathological expression of psychological processes latent in and widely distributed throughout the general population. [ABSTRACT FROM AUTHOR]

Aims. To explore the relationship between symptoms of anxiety and cognitive behaviour therapy (CBT) in patients with schizophrenia Design. Separate subanalyses of two randomized controlled trials comparing CBT for schizophrenia against befriending in the London Newcastle (LN) study, and against treatment as usual in the insight into schizophrenia (IS) study. Main outcome measures. Assessment of anxiety symptoms using the Brief Scale for Anxiety (BSA) derived from the Comprehensive Psychopathological Rating Scale (CPRS), at baseline, end of therapy and follow-up. Results. In both studies, anxiety symptoms positively correlated with overall psychopathology, hallucinations and depression. In the LN study, patients with persecutory delusions and with distress due to akathisia and incapacity due to abnormal movements scored significantly higher on the BSA. In the IS study, anxiety scores were also positively correlated with; delusions, negative symptoms, relationship problems and problems with activities of daily living, living conditions, occupation and activities. Both subanalyses showed CBT had beneficial effects on anxiety symptoms compared with the control groups. Overall prognosis was found to be better in those with low anxiety in the LN study. Conclusions. CBT improves anxiety symptoms in psychosis. We did not find an association between anxiety symptoms at baseline and outcome of cognitive therapy in this group of patients with schizophrenia. [ABSTRACT FROM AUTHOR]

Patients with schizophrenia have a substantial lifetime suicide risk, especially by violent means. Little published work exists on self-harm (SH) in this population. The goal of this study was to examine whether patients with schizophrenia were also more likely to self-harm in a violent manner. A retrospective analysis performed on method, motive, and suicidal intent in patients with schizophrenia (n = 50) and adjustment reaction (n = 138) who presented with SH over a 3-year period found that there was no significant difference between the two groups in terms of violence of method or suicidal intent. Presence of positive symptoms of schizophrenia was not significantly associated with use of a violent method. This study suggests that the expected pattern of violent SH in schizophrenia is inaccurate and for the majority the acts are of a similar nature to those seen in adjustment reactions. [ABSTRACT FROM AUTHOR]

The present work examined the question ‘can cognitive behaviour therapy be successfully adapted to treat schizophrenia and become a recognized adjunct CBT treatment approach by frontline services?’ It was proposed that this was possible, and that a significant barrier to this was the ‘mental set’ of the wider clinical community. Prevailing attitudes of (1) believing that symptoms are not amenable to reasoning and may be made worse on enquiry, (2) patients are too severely disturbed to benefit from a psychological intervention, were related to a strict categorical model of psychopathology, where schizophrenia is viewed as a discrete entity. The premise was put forward that, the realistic benefits of categorical models, i.e. the identification of distinguishing features of a disorder, specific treatment approaches, and relatively homogeneous groups for research, have caused undue emphasis to be placed on identifying differences disorders. In consequence considerably less attention has been paid to scientific evidence showing important similarities across disorders. To protect against the error of unable to see the wood from the trees a preliminary descriptive continuum model of psychopathology was proposed to supplement existing categorical models. Analysis of the literature showed considerable support for a continuum model and the legitimacy of adapting traditional cognitive behaviour therapy approaches for use with schizophrenic patients. Reports of successful cognitive behaviour therapy interventions, particularly with positive symptoms suggest that patients can improve with this adapted approach and that the wider clinical community should be encouraged to assist its further development through research and training initiatives. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Objective Cognitive therapy (CT) has been used in anorexia nervosa, but little is known about its effectiveness. A randomized controlled trial was undertaken comparing dietary advice (DA) with cognitive therapy in the outpatient treatment of AN. Method Thirty-five patients were randomly allocated to either cognitive therapy (n =25) or dietary advice (n =10). There were no significant differences in the groups pre-treatment. Twenty sessions of cognitive therapy or dietary advice were offered. Results At 6 months 23 cognitive therapy patients remained engaged whereas all the dietary advice controls dropped out. Cognitive therapy patients showed significant changes in Body Mass Index (p =0.001), Eating Disorder Inventory Scores (p =0.035), Beck Depression Inventory Scores (p <0.0001) and Locus of Control of Behaviour Scores (p =0.017). Conclusions Significant improvements were observed in patients allocated to cognitive therapy, but not in those allocated to dietary advice on an intention to treat analysis. Cognitive therapy has advantages of promoting engagement and facilitating recovery. Copyright © 1999 John Wiley & Sons, Ltd and Eating Disorders Association. [ABSTRACT FROM AUTHOR]

A single case study is used to explore the therapeutic factors contributing to symptom reduction in a 48-year-old woman with a 29-year diagnosis of ‘chronic schizophrenia’. Eight sessions of cognitive therapy were given and progress followed up over two years. The therapy was based on a model accounting for the function, thematic content and psychological maintaining mechanisms of the hallucinatory experience, which was collaboratively constructed and combined with standard cognitive-behavioural techniques. This increased the client's understanding of and control over her functional auditory hallucinations and her secondary delusional interpretation of these as ‘telepathic’ communication from Cod. The CPRS, self-report and observed behaviour showed marked symptom reduction, reduced distress and increased self-esteem and self confidence. The therapy is described in detail, as a basis for discussion of the specific and non-specific factors contributing to this outcome. [ABSTRACT FROM AUTHOR]

Four unselected patients with drug-resistant delusional disorder were individually treated with eight sessions of cognitive therapy plus a booster session every month up to 1 year. All patients improved on a global measure of delusional severity (the GSDS), and showed a marked reduction in belief conviction. Related psychopathology as measured on the Comprehensive Psychopathological Rating Scale (CPRS) also markedly improved and all the gains were maintained at 1-year follow-up. Improved compliance with medication was achieved with half of the patients, and contributed to the improvement gained. [ABSTRACT FROM AUTHOR]

Cites studies on the relationship between trauma and psychosis. Ways in which traumatic experiences may confer vulnerability to psychosis via cognitive and behavioral processes; Role of trauma on the onset and content of psychotic symptoms; Prevalence of trauma in people who have psychotic experiences associated with distress.

Presents a case study of the therapeutic action of the stimulant modafinil in chronic fatigue syndrome (CFS) in a 33-year-old man. Clinical history of the patient; Effectiveness of cognitive behavioral therapy and graded exercise therapy in treating CFS; Resutls of studies of the neuroendocrinology of CFS.