Fostering coping as a mechanism of symptom change in cognitive behavioural therapy for psychosis

Targeting metacognitive change mechanisms in acute inpatients with psychotic symptoms: feasibility and acceptability of a modularized group intervention

Emerging evidence suggests the usefulness of psychological interventions targeting metacognitive change mechanisms in patients experiencing psychosis. Although many of these patients are treated in acute psychiatric contexts, only few studies have adapted such interventions for acute inpatient settings. The present study aimed to assess the feasibility, acceptability, and preliminary clinical outcomes of a novel modularized group intervention focusing on different aspects of metacognitive change mechanisms. In particular, the intervention aims to reduce patients' acute symptoms by enhancing cognitive insight and to relieve distress via cognitive defusion (i.e. coping). A sample of 37 participants with acute psychosis received up to nine sessions of the intervention. Baseline and post-intervention assessments were conducted for general psychopathology, psychotic symptoms, global functioning, and symptom distress. Measures of change mechanisms were assessed before and after the respective treatment module. Participants' experiences were explored in feedback questionnaires and interviews. Recruitment, retention, and attendance rate met the pre-set feasibility benchmark of 80%. The intervention was well received by participants, who emphasised the group's clear structure, positive atmosphere, and helpful contents. Response rates were high and linear mixed models revealed significant medium-to-large time effects on all clinical outcomes. As expected, increase in hypothesised change mechanisms cognitive insight and decrease in cognitive fusion was found. However, the uncontrolled design limits interpreting clinical effects. The study provides evidence that an intervention based on a metacognitive model is feasible and acceptable for acute inpatients with psychosis. Positive results on clinical outcomes and change mechanisms warrant further exploration in a randomized controlled trial.

Mindfulness on Daily Life Coping in People Experiencing Psychosis: A Randomized Controlled Trial

Background/Objective

Cognitive Behavior Therapy for psychosis (CBTp) is a recommended treatment for psychoses whose effect is mediated by coping. Mindfulness (MBI) have shown positive effects in psychosis. This study examines the hypothesis that combining CBTp+MBI could improve coping with day-to-day life in psychosis better than CBTp alone in people attending a public community rehabilitation center.

Method

Fifty-six outpatients were recruited and randomly allocated either to CBTp or CBTp+MBI. Measures comprised PANSS interview and COPE Inventory. Data were analyzed using a repeated measures ANOVA and RCI calculation.

Results

There were no statistical differences between groups at pre-treatment. Significant statistical differences were found for the interaction Treatment x Time in Mental disengagement (F = 5.65, p = .021, η² = .102), Acceptance (F = 7.69, p = .008, η² = .133), and Suppressing competing activities (F = 4.62, p = .037, η² = .085).

Conclusions

MBI promotes specific coping styles in people who experience psychosis that otherwise are not improved with CBTp. Only the MBI group improved acceptance of the presence of the stressor and reduced mental disengagement from the context. The intervention is feasible and effective for public healthcare settings.

Application of functional analytic psychotherapy to manage schizophrenia

INTRODUCTION

Cognitive behavioral therapy (CBT) and third-wave CBT approaches have been shown to ameliorate symptoms of schizophrenia. However, this study uses the functional analytic psychotherapy which focuses on the environmental causes of behavior which includes the client's present environment as well as his history of past interactions with it, to bring about a change in the client and reduce the symptoms. This therapy has never been used earlier with patients having schizophrenia in India; therefore, it was taken up for this study.

METHODOLOGY

A pre-post design with control group was used in the present study. Ten patients were taken. Positive and Negative Syndrome Scale for measuring symptoms of schizophrenia, Schizophrenia Quality of Life Scale for assessing quality of life, Coping Response Inventory-Adult form for assessing coping skills, Apathy Evaluation Scale-Clinician Version for assessing apathy, Family Adaptability and Cohesion Evaluation Scale for assessing perceived interpersonal relationship were used for assessment pre- and postintervention. Fifteen sessions were done with each patient within a period of 10 months at the rate of one session per week. Chi-square test, Wilcoxon signed-rank test, and Mann-Whitney U-test were used for the analysis of data.

RESULTS

Significant improvements were found in positive symptoms, general psychopathology, approach coping mechanisms, psychosocial and motivation domains in quality of life, and perceived cohesion in family among the patients postintervention.

CONCLUSION

Functional analytic psychotherapy is an effective method for treating patients having schizophrenia with the application of its specifically modified rules for use with patients having psychosis.