Dr David Kingdon: Future Directions for Research on CBT in Psychosis

David Kingdon, MD, professor of mental health care delivery, University of Southampton, outlined some future avenues for research on the use of cognitive behavioral therapy (CBT) in psychosis, including the benefits of “worry periods” and studies on sleep.

What are some future directions for research on CBT in psychosis?
Well, there’s been some very interesting developments in terms of just treatments, so one study we’ve been involved with, with Dan Freeman at Oxford, is looking at worry in psychosis and paranoia. It’s obvious when you think about it that people who are paranoid are very worried about what’s happening to them. So using the sort of techniques that have been used with worry in anxiety, in generalized anxiety disorder, has been shown to be really effective. Helping people understand why you worry, how it could be helpful, but how it can also be negative. Beginning to develop some problem solving for it.

Also, and I think we were very surprised that patients really took to this, but having a worry period. So talking with patients about, you know, why worry all day? It doesn’t get you anywhere. Why not select a period during the day, half an hour or so, in which you’re going to do your worrying and then you’re going to leave it behind. And I have to say, we were very skeptical that this might help, but in fact patients have taken to it very well. A paper was published in the Lancet, 2015, and showed really quite significant effects not just on worry, but on quality of life and conviction in the beliefs. So it’s a simple 6-session intervention that’s helpful. There’s also work going on on sleep, because we know sleep exacerbates psychotic symptoms, and again psychological treatments can help with that.

And probably the most important is also on how we can see that these techniques are made most available. It does seem that some of them need continuing boosting. So we did a study on clozapine patients who had CBT, had persistent symptoms. What we found was a really good outcome at the end, but when the therapy stopped, the effect began to reduce. And just as if you’d stopped clozapine, you’d expect the effect to reduce, we also need to have ways of maintaining that, probably using community care workers, community nurses and others in that.
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