Dr David Kingdon Discusses How CBT Techniques Tailored to Psychosis Can Help Patients Feel Understood

Psychiatrists can use cognitive behavioral therapy (CBT) techniques to help patients with psychosis understand and explore their own beliefs and to develop the therapeutic relationship, according to David Kingdon, MD, professor of mental health care delivery, University of Southampton.

How can CBT techniques be tailored to the specific symptoms of psychosis?
The key things are things like, if they have a paranoid belief, which is that the government has it in for them or the neighbors have it in for them, what CBT will do is it will take that belief, it’ll listen to it—the feelings, the understanding, the way it’s affecting somebody—and they will then weigh up with them how likely it is, how unlikely it is. So it’s really exploring, it’s not challenging the belief, it’s trying to explore and understand it, because quite often there’s been a trigger, there’s been something which has set off that belief, and if the person can go back and re-look at that information, reprocess it, that can be really valuable and work very effectively and helpfully.

It certainly helps the relationship you have with the person, as well. Developing the therapeutic relationship is one of the key things that we try to do, and we know that that can be very difficult in people with psychosis, because they feel very alienated, they feel very different. Being able therefore to help them understand and feel understood is really very important.

Similarly, with voices, they’re very distressing, very disturbing. If you can help people understand them better, and work out ways of managing them better, that we’ve found to be really very effective.

And negative symptoms—the feeling that it’s not worth going on, feeling demoralized, feeling fed up, just feeling very very flat—being able to instill hope by looking towards the future, working out goals they can work with, and understand how negative symptoms can actually be protective sometimes. What people are doing is they’re avoiding situations that they find stressful. If you worry about people talking about you when you go out, an obvious response is don’t go out. So if we could help people understand those beliefs and then begin to test them, that in itself has been shown to be effective.
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