Dr David Kingdon on the Principles Underlying the Use of CBT in Psychosis

Cognitive behavioral therapy (CBT) has long been used to help people examine the links among their feelings, thoughts, and behaviors, but the use of CBT has expanded to patients experiencing psychosis, who can learn to cope with delusional beliefs or hearing voices, explained David Kingdon, MD, professor of mental health care delivery, University of Southampton.

What are the principles underlying CBT, both in general and in psychosis?
CBT in general is really about looking at the way that thoughts, feelings, and behavior link together, and working with those, understanding them, so that the person can begin to deal with the issues they have. It may well be that they’re feeling very depressed, the thought they get is “I’m useless; it’s not worth doing anything,” so they don’t go out, so they get more depressed. CBT is really about trying to look at the links between these feelings and thoughts and behavior and seeing if we can change that in a productive way.

Now, psychosis is a relative newcomer to CBT work, although it’s now been 20 or 30 years in which studies have been emerging, that we’ve been involved with and many others. What it involves additionally is looking at the sort of thoughts that people have when they have psychosis. So the delusional beliefs they have, the voices they experience, and the negative symptoms as well which affect their behavior, and working out ways that we can help people with those.

If I take voices, people may hear voices, they may be very confused by the experience, and so what we do is we explore it with them, understand that actually this is somebody talking to them, that’s the experience they’re getting. But they don’t understand how that’s happening, because other people can’t hear those voices; the things the voices are saying are very unpleasant, very often. So we work with them to understand how voices can occur through stress, they can occur through a vulnerability you might have, and there are coping ways that can help with that.

Understanding it’s to do with the person themselves is very helpful in terms of compliance with treatment. If they recognize that it’s not their neighbor that’s the problem, but actually maybe it’s something to do with themselves, doing things like taking medication, getting involved with other people, socializing, can be relevant and they will work with that.

Similarly with a delusional belief, they may have very strong beliefs that worry them, cause them great concern, and those are beliefs which exploring and understanding is something that we find patients really value, and also does help them move on, and move on to other things.
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