Cognitive Behavioral Therapy and Recovery with Persons in

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Objectives,o In this webinar we will, Describe what we know about first episode psychosis and. Present the state of the science of CBT for people in the. early stages of severe mental illness SMI,Describe Cognitive Behavioral Therapy CBT and its. integration with the Recovery Movement, Explore issues related to the implementation of CBT in real. world settings and,Address participant questions, Do Not Reproduce Without Permission TCreed Ph D June 2014 2. First Episode Psychosis Recovery,and Risk Factors, Do Not Reproduce Without Permission TCreed Ph D June 2014 3.
Recovery from First Episode Psychosis,o Many individuals who experience a first. episode psychosis FEP will reach clinical,o Some recover fully and return to their previous. roles and trajectories1,o 35 70 experience relapse2. o With each relapse the risk of developing,persistent psychotic symptoms and long term. impairment increases3, 1 Bird et al 2010 2 Marshall et al 2005 2 Addington et al 2007 3 Stephenson 2000.
Do Not Reproduce Without Permission TCreed Ph D June 2014 4. Risk of Relapse Delayed Treatment,o Many people experience significant periods of. misdiagnosis and delayed treatment after,onset of symptoms and impairment. o The delay between onset and treatment,increases the likelihood of long term. morbidity and impairment1,1 Dixon et al 2013, Do Not Reproduce Without Permission TCreed Ph D June 2014 5. Risk of Relapse Stress,o Presence of and sensitivity to stress are also.
important predictors of the onset and,recurrence of schizophrenia1. o Our understanding of the exact mechanism is,still evolving but the association between. experienced stress and relapse is well,established. 1 Corcoran et al 2003, Do Not Reproduce Without Permission TCreed Ph D June 2014 6. Risk of Relapse Social Support,o Following an FEP many individuals lose a.
sizable portion of their social network1,o Those with poorer social support are often. slower to recover and may experience ongoing,depression even after recovery from the FEP 1. o However the presence of even a few,emotionally close and positive relationships. can be a strong protective factor related with,lower rates of relapse2. 1 Johnson Meyer Winett Small 2000 2 Jablensky Sartorius Ernberg Anker 1992. Do Not Reproduce Without Permission TCreed Ph D June 2014 7. Risk of Relapse Family Factors, o Families often react to an individual s FEP with.
distress1 which can lead to or exacerbate,unhelpful patterns of interaction in the family. o Increasing family isolation criticism and,hostility in turn increase risk of relapse and. impairment2,1 Boye Bentsen Malt 2002 2 McFarlane 2002. Do Not Reproduce Without Permission TCreed Ph D June 2014 8. Risk of Relapse Disruption of the,o Important developmental transitions often. coincide with onset of FEP creating a,disruption of the individual s trajectory.
o Late adolescence and early adulthood are pivotal. times for development of autonomy,independence individuation. o FEP can threaten the individual s success in these. transitions1,1 Gumley Clark 2012, Do Not Reproduce Without Permission TCreed Ph D June 2014 9. Recovery from First Episode Psychosis,o FEP treatment guidelines include. development of an active relapse prevention,o Insufficient evidence to identify a clear. evidence based practice for people who have,experienced a FEP but CBT is emerging as the.
treatment of choice, o Even less data available about implementation in. real world settings2,1 Lehman et al 2004 2 Dixon et al 2010. Do Not Reproduce Without Permission TCreed Ph D June 2014 10. Cognitive Behavioral Therapy for,People in Early Stages of Severe. Mental Illness, Do Not Reproduce Without Permission TCreed Ph D June 2014 11. CBT What are we really talking,o Cognitive Behavioral Therapy.
o An umbrella term for a wide range of intervention strategies. that focus on changes in behavior thinking and feelings. o Cognitive Therapy, o The original approach developed by Aaron Beck focused on. changes in cognition that lead to changes in feelings and. o Case Conceptualization driven rather than technique or manual. o Cognitive remediation, o Behavioral treatment using drills paper and pencil tasks and. practice to improve cognitive impairment in areas like memory. attention and problem solving,1 van der Gaag et al 2013. Do Not Reproduce Without Permission TCreed Ph D June 2014 12. Is CBT effective for individuals,experiencing Schizophrenia. o All evidence suggests that individuals with,schizophrenia do best with a combination of.
pharmacological and psychosocial interventions1, o Critical to have effective psychological treatments to. complement pharmacology, o CBT is recommended by most schizophrenia treatment. guidelines1 2 3,o More than 30 clinical trials showing benefits. o Most focused on positive symptoms sometimes just a. single symptom a few on negative symptoms and distress. o Functional outcomes examined as secondary outcomes if. 1 PORT Dixon et al 2009 2 APA 2004 3 National Institute for Clinical Excellence 2002. Do Not Reproduce Without Permission TCreed Ph D June 2014 13. CBT for FEP, o Very few published random clinical trials of CBT. for people experiencing an FEP, o One of the most rigorous studies1 showed that CBT.
and supportive therapy improved symptoms over,treatment as usual. Treatment was delivered in just 5 weeks during the most. acute phase, o A second study showed those receiving CBT showed. more rapid improvement2,Effect waned at 1 year, o Group CBT with social skills training was superior to. waitlist for symptoms self esteem coping strategies. and social support3, 1 Lewis et al 2002 a b Tarrier et a 2004 2 Jackson et la 2008 3 Lecomte et al 2008. Do Not Reproduce Without Permission TCreed Ph D June 2014 14. Specialist FEP Programs,o Combine early detection with quick.
commencement of phase sensitive treatment for,individuals and their families1. o May reduce risk of relapse and re hospitalization. compared to standard mental health services2 3,o Implementing multimodal CBT individual family. for relapse prevention within an FEP program,may reduce relapse in the first year compared to. the FEP program alone4, 1 International Early Psychosis Association Writing Group 2005 2 Craig et al 2004 3 Goldberg et al 2006. 4 Gleeson et al 2009, Do Not Reproduce Without Permission TCreed Ph D June 2014 15.
Cognitive Behavioral Therapy and Recovery with Persons in Early Stages of Serious Mental Illness Torrey A Creed Ph D Aaron T Beck Psychopathology Research Center University of Pennsylvania tcreed mail med upenn edu Funding for this webinar is provided by the Substance Abuse and Mental Health Services Administration SAMHSA Do Not Reproduce Without Permission TCreed Ph D June 2014 2

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