Showing papers by "Max Birchwood published in 1996"

Cognitive Therapy for Delusions, Voices and Paranoia

Abstract: A Cognitive View of Delusions and Voices. The Practice of Therapy and the Problem of Engagement. Delusions: Assessment and Formulation. Challenging Delusions. Voices: Engagement and Assessment. Disputing and Testing Beliefs about Voices. Cognitive Therapy for Paranoia. Challenging Cases and Issues. From a Symptom Model to a Person Model. References. Appendices. Index.

Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms.

Abstract: BACKGROUND The application of cognitive therapy (CT) to psychosis is currently being developed in the UK. This paper reports a trial of CT in acute psychosis with the objective of hastening the resolution of positive symptoms and reducing residual symptoms. METHOD Of 117 patients with acute non-affective psychosis, 69 satisfied inclusion criteria and 40 proceeded to stratified randomisation. The experimental intervention involving individual and group CT was compared with a group receiving matched hours of therapist input providing structured activities and informal support; routine pharmacotherapy was provided by clinicians blind to group allocation. Patients were monitored weekly using self-report and mental state assessments during admission and over the subsequent nine months. RESULTS Both groups showed a decline in positive symptoms but this was more marked in the CT group (P < 0.001). At 9 months 5% of the CT group, v.56% of the control group, showed moderate or severe residual symptoms. CONCLUSION CT appears to be a potent adjunct to pharmacotherapy and standard care for acute psychosis. Issues concerning internal and external validity of the study and opportunities for further research are discussed.

Cognitive therapy and recovery from acute psychosis: a controlled trial. 3. Five-year follow-up.

Abstract: Background This paper describes the 5-year outcome of a cohort of patients who had received a cognitive therapy intervention during an acute episode of non-affective psychosis. Method Thirty-four out of the original 40 patients who had taken part in a randomised controlled trial of a cognitive intervention were assessed, using standardised instruments completed at entry into the study. In the original trial, half the patients received a cognitive therapy programme (CT group) and the other half received recreational activities and support (ATY group). Results At follow-up no significant differences in relapse rate, positive symptoms or insight between the groups were found, although the CT group did show significantly greater perceived ‘Control over illness’ than the ATY group. For individuals who had experienced a maximum of one relapse in the follow-up period, self-reported residual delusional beliefs and observer-rated hallucinations and delusions were significantly less in the CT than in the ATY group. Conclusion Cognitive therapy applied in the acute phase of a psychotic disorder can produce enduring and significant clinical benefits if experience of relapse can be minimised.

Cognitive therapy and recovery from acute psychosis: a controlled trial. II. Impact on recovery time.

Abstract: BACKGROUND A trial of CT in acute psychosis conducted by the authors has shown a significant impact on the rate and degree of recovery of positive symptoms, the focus of the intervention. This paper seeks to determine whether these effects generalise to other features of acute psychosis including dysphoria, insight and "low level' psychotic thinking which were not directly targeted. METHOD Measures of dysphoria, insight and psychotic thinking were taken over a six-month period following presentation for acute psychosis. Using survival analysis, time to recovery from psychosis using three definitions of increasing stringency was compared between the CT and control group. RESULTS CT was associated with a 25-50% reduction in recovery time depending on the definition used. CONCLUSION The impact of the CT intervention extended beyond positive symptoms to include insight, dysphoria and "low level' psychotic thinking. Nevertheless this kind of "clinical' recovery required a median of 20 weeks to complete. Implications for clinical models of acute care are discussed.

Early intervention in psychosis: opportunities for secondary prevention.

Abstract: A description of an emerging paradigm is presented which places emphasis upon secondary prevention in psychosis. It is argued that the first two or three years following a first episode of psychosis is a crucial period for high-quality psychosocial and biological interventions and a time slot which may influence recovery and long-term outcome. Factors contributing to long-term outcome as possible areas for secondary prevention are reviewed.