CBT for Schizophrenia: Evidence-Based Interventions and Future Directions by Craig Steel

Author:Craig Steel
Language: eng
Format: mobi, pdf
ISBN: 9780470712054
Publisher: Wiley-Blackwell
Published: 2012-07-31T21:00:00+00:00

CBT for Relapse Prevention in Schizophrenia

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In this example the therapist decided to address the belief that all thoughts

should be controlled and provides some explanation of the difference

between voluntary (e.g. planning a shopping list) and involuntary thoughts

(e.g. negative automatic thoughts or intrusive thoughts in reaction to

stress). Information could be provided and discussed on the frequency of

intrusive thoughts in the general population, and the role of thought sup-

pression in producing rebound. A behavioural experiment investigating

the effects of thought suppression was conducted within the session by

asking the individual construct an image of a banana in their imagination

and then to avoid thinking about bananas. Once the belief that all thoughts

should be controllable is addressed, the belief that ‘If I do not control my

thoughts, then I will become unwell’ can be addressed. At this point the

therapist offered an alternative transformed belief, and as with the former

belief (If I do not control my thoughts, I will become unwell), the therapist

works with the individual to identify the advantages and disadvantages of

this belief with respect to self and relapse.

Testing transformed beliefs

During the process of relapse individuals adopt a range of behavioural

strategies aimed at increasing safety, preventing relapse or increasing

control. For example common signs associated with early relapse include

suspiciousness and vigilance, withdrawal and avoidance, use of alcohol

and drugs. However, these ‘safety behaviours’ may result in the accelera-

tion of relapse, thus confirming individuals’ beliefs concerning their

helplessness, or the inevitability of relapse.

Behavioural experiments provided an ideal methodology of intervention

during this process. Behavioural experiments enable the individual to

achieve a behavioural change (e.g. implementing a coping skill), which

results in a cognitive change (beliefs concerning self or illness). Behavioural

experiments can be conducted within session and between sessions.

Furthermore behavioural experiments can also be graded according to

difficulty. During CBTrp behavioural experiments are targeted on the devel-

opment of alternative behaviours practised across a number of situations

beginning with coaching within session, to applying between sessions and

in vivo . In this example the therapist had begun with the belief that ‘If I do

not control my thoughts, then I will become unwell’ and with the individual

had transformed this to ‘If I can ignore unwanted thoughts, I will feel better’.

As behavioural interventions were implemented and practised, these

changes are consolidated through the review and examination of individuals’

beliefs concerning the control, stigma, shame, and/or fear associated with

illness. The therapist aims to assist the individual in accommodating new

information gained during intervention into pre-existing assumptions

concerning illness, in comparison with the beliefs tested during treatment.

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Andrew I. Gumley

Conclusions

There remains a major challenge to researchers and clinicians alike. The

evidence for CBT in the prevention of relapse is limited unless CBT is

dedicated to the prevention of relapse. We learned a lot about relapse

prevention through our participants’ stories. In particular they described

significant problems in relation to the emotional adaptation to their

experiences. For many, this was linked to feelings of fear of recurrence,

shame about psychosis, feelings of defectiveness and undeservedness. In

this context, relapse could be understood as a major source of threat and

trauma. It was apparent when faced with the immediacy of a potential

recurrence that many participants felt overwhelmed by the surge of

emotion and sources of help (e.

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