Top

Published in:

01-03-2006 | Original Article

Cognitive Behaviour Therapy and Recovery from Acute Psychosis: Case Studies of Two Contrasting Styles

Author: Mike Startup

Published in: Journal of Contemporary Psychotherapy | Issue 1/2006

Abstract

In the North Wales randomised controlled trial of cognitive behaviour therapy (CBT) for acute schizophrenia spectrum disorders, patients who received CBT as an adjunct to treatment-as-usual (TAU) had significantly better outcomes at 12 months than patients who received only TAU. However, patients who were offered CBT but dropped out of treatment early had outcomes that were no worse than patients who stayed in. The explanation for this curious finding might be that the drop-outs and the stay-ins had different but equally valid recovery styles. Two case studies from the trial are presented to illustrate these recovery styles: sealing-over and integrating. Discussion focuses on the idea that, rather than try to alter patients' recovery styles, a more appropriate aim might be to match treatment to the patients' styles.

Amador, X. F., Flaum, M., Andreasen, N. C., Strauss, D. H., Yale, S. A., Clark, S. C., & Gorman, J. M. (1994). Awareness of illness in schizophrenia and schizoaffective and mood disorders. Archives of General Psychiatry, 51 826–836.PubMed

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders (4th edn) (DSM-IV). Washington, DC: APA.

Andreasen, N. C. (1984). Scale for the Assessment of Positive Symptoms (SAPS). Iowa City: University of Iowa.

Andreasen, N. C. (1989). Scale for the Assessment of Negative Symptoms (SANS). British Journal of Psychiatry, 155 (suppl. 7), 53–58.

Birchwood, M., Iqbal, Z., Chadwick, P., & Trower, P. (2000). Cognitive approach to depression and suicidal thinking in psychosis: I. Ontogeny of post-psychotic depression. British Journal of Psychiatry, 177 516–521.PubMedCrossRef

Birchwood, M., Smith, J., Cochrane, R., Wetton, S., & Copestake, S. (1990). The Social Functioning Scale: The development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. British Journal of Psychiatry, 157 853–859.PubMed

Drury, V., Birchwood, M., Cochrane, R., & MacMillan, F. (1996a). Cognitive therapy and recovery from acute psychosis: a controlled trial. I. Impact on psychotic symptoms. British Journal of Psychiatry, 169 593–601.PubMed

Drury, V., Birchwood, M., Cochrane, R., & MacMillan, F. (1996b). Cognitive therapy and recovery from acute psychosis: A controlled trial. II. Impact on recovery time. British Journal of Psychiatry, 169 602–607.PubMed

Fowler, D., Garety, P., & Kuipers, E. (1995). Cognitive Behaviour Therapy for Psychosis: Theory and Practice. Chichester, UK: John Wiley & Sons.

Garety, P. A., & Freeman, D. (1999). Cognitive approaches to delusions: A critical review of theories and evidence. British Journal of Clinical Psychology, 38 113–154.PubMedCrossRef

Gaudiano, B. A. (2005) Cognitive behavior therapies for psychotic disorders: Current empirical status and future directions. Clinical Psychology: Science and Practice, 12 33–50.CrossRef

Gould, R. A., Mueser, K. T., Bolton, E., Mays, E., & Goff, D. (2001). Cognitive therapy for psychosis in schizophrenia: An effect size analysis. Schizophrenia Research, 48 335–342.PubMedCrossRef

Harrow, M., MacDonald, A. W., Sands, J. R., & Silverstein, M. L. (1995). Vulnerability to delusions over time in schizophrenia and affective disorders. Schizophrenia Bulletin, 21 95–109.PubMed

Jackson, H., McGorry, P., Henry, L., Edwards, J., Hulbert, C., Harrigan, S., Dudgeon, P., Francey, S., Maude, D., Cocks, J., & Power, P. (2001). Cognitively oriented psychotherapy for early psychosis (COPE): A 1-year follow-up. British Journal of Clinical Psychology, 40 57–70.PubMedCrossRef

Johnson, M. K. (1988). In T. F. Oltmans & B. A. Maher (Eds.) Delusional beliefs. New York: Wiley.

McGlashan, T. H. (1987). Recovery style from mental illness and long-term outcome. Journal of Nervous and Mental Disease, 175681–685.PubMedCrossRef

McGlashan, T. H., Levy, S. T., & Carpenter, W. T. (1975) Integration and sealing over: Clinically distinct recovery styles from schizophrenia. Archives of General Psychiatry, 32 1269–1272.PubMed

Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, F. C., Vidaver, et al. (1998). Trauma and post-traumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66 493–499.PubMedCrossRef

Pilling, S., Bebbington, P., Kuipers, E., Garety, P., Geddes, J., Martindale, B., Orbach, G., & Morgan, C. (2002). Psychological treatments in schizophrenia: I. Meta-analysis of family intervention and cognitive behaviour therapy. Psychological Medicine, 32 763–782.PubMedCrossRef

Rector, N. A., & Beck, A. T. (2001). Cognitive behavioral therapy for schizophrenia: An empirical review. Journal of Nervous and Mental Disease, 189 278–287.PubMedCrossRef

Rossau, C. D., & Mortensen, P. B. (1997). Risk factors for suicide in patients with schizophrenia: Nested case-control study. British Journal of Psychiatry, 171 355–359.PubMedCrossRef

Startup, M., Jackson, M. C., & Bendix, S. (2004) North Wales randomised controlled trial of cognitive behaviour therapy for acute schizophrenia spectrum disorders: Outcomes at six and twelve months. Psychological Medicine, 34 413–422.PubMedCrossRef

Startup, M., Jackson, M. C., & Startup, S. (In press) Insight and recovery from an acute psychotic episode: the effects of cognitive behaviour therapy and premature termination of treatment. Journal of Nervous and Mental Disease.

Tait, L., Birchwood, M., & Trower, P. (2004). Adapting to the challenge of psychosis: Personal resilience and the use of sealing-over (avoidant) coping strategies. British Journal of Psychiatry, 185 410–415.PubMedCrossRef

Tarrier, N., Lewis, S., Haddock, G., Bentall, R., Drake, R., Kinderman, P., Kingdon, D., Siddle, R., Everitt, J., Leadley, K., Benn, A., Grazebrook, K., Haley, C., Akhtar, S., Davies, L., Palmer, S., & Dunn, G. (2004) Cognitive-behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial. British Journal of Psychiatry, 184 231–239.PubMedCrossRef

Thompson, K. N., McGorry, P. D., & Harrigan, S. M. (2003). Recovery style and outcome in first-episode psychosis. Schizophrenia Research, 62 31–36.PubMedCrossRef

Title: Cognitive Behaviour Therapy and Recovery from Acute Psychosis: Case Studies of Two Contrasting Styles
Author: Mike Startup
Publication date: 01-03-2006
Publisher: Springer US
Published in: Journal of Contemporary Psychotherapy / Issue 1/2006
Print ISSN: 0022-0116
Electronic ISSN: 1573-3564
DOI: https://doi.org/10.1007/s10879-005-9002-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Cognitive Behaviour Therapy and Recovery from Acute Psychosis: Case Studies of Two Contrasting Styles

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 1/2006

Cognitive-Behavioral Therapy for Individuals Recovering from a First Episode of Psychosis

Community Implementation Successes and Challenges of a Cognitive-Behavior Therapy Group for Individuals with a First Episode of Psychosis

Effects of Cognitive Behavioral Therapy and Vocational Rehabilitation on Metacognition and Coping in Schizophrenia

Group Cognitive Behavioral Therapy for Delusions: Helping Patients Improve Reality Testing

Cognitive Therapy for Command Hallucinations: Not a Quasi-Neuroleptic

Therapeutic Factors Contributing to Change in Cognitive-Behavioral Group Therapy for Older Persons with Schizophrenia