Group CBT for Psychosis: Application to a Forensic Setting

Transcription

1 Group CBT for Psychosis: Application to a Forensic Setting Diane Hoffman-Lacombe M.Ps., C.Psych. Raphaela Fleisher M.S.W., R.S.W. Provincial HSJCC 2013 Conference November 25, 2013

2 Responding to my unhelpful thoughts allowed me to do problem solving, and I developed a plan that definitely improved the day. The problem didn t go away, but my response to the problem changed. Dr. Judith Beck

3 Background CBTp Group at The Royal Referrals & Criteria Goals of CBTp Group Sessions Outline CBTp Strategies Forensic Considerations CBTp Practice Group Evaluation Summary References Questions & Feedback Objectives

4 Background CBTp Curson et al found that medication alone was inadequate in managing up to 25 60% of patients with schizophrenia Dr. A. Beck noted that CBT had enjoyed support for treatment of a range of psychiatric and psychosocial difficulties. In 2009 N.I.C.E. recommended CBT as a standard of care for people who suffer from schizophrenia. Studies to date focused on individualized CBT interventions rather than group interventions Royal Ottawa Hospital has been promoting both individual and group CBT approaches for people who suffer from schizophrenia.

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6 CBTp Group at The Royal Schizophrenia Program (February 2010); knowledge, training & experience; manual; research grant (Dr. N. Wright) -intra-discipline collaboration -inter-program collaboration Forensic Program Champlain (September 2010); manual, evaluation, consultation, training, inter-discipline collaboration

7 Referrals Referrals (posters, pamphlets, meetings & presentations) Consult with treatment team Intake Pre-group screening & Orientation Sessions

8 Criteria Diagnosis of schizophrenia / schizoaffective disorder Presence of positive & negative symptoms Treatment with anti-psychotic medication Willingness & ability to participate in group

9 Goals Decreasing symptoms / distress (+ sx) Finding meaning (making sense of hallucinations & delusions) Improvement to negative symptoms Normalize through psycho-education Enhancing recovery / quality of life

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11 participants learn Strategies to manage symptoms Coping tools and techniques Education about the illness Normalize emotions and experiences; give another way to look at their experience

12 Sessions Outline 1 Intro to CBT Group (goals & pleasant activities) 2 CBT: what it can do for you (the CBT triangle and the ABC model) 3 Negative symptoms & getting active 4 Thoughts that get in the way of getting active 5 Thinking errors: noticing my thoughts & checking them out 6 Checking out troubling automatic thoughts 7 & 8 Voice hearing & other hallucinations 9 CBT Strategies for troubling thoughts & hallucinations 10 CBT Strategies: advantages & disadvantages and finding meaning 11 CBT Strategies: behavioral experiments 12 CBT Strategies for paranoid beliefs 13 CBT Strategies for unusual ideas & beliefs 14 Shifting Core Beliefs: Feeling Good About Yourself 15 & 16 Wellness Plan & CBT after the group 17 Booster Session (3 months after group)

13 CBT for Psychosis Group -- What is CBT? Checking our thoughts -- THOUGHTS EMOTIONS BEHAVIOURS

14 The ABC Model Activating Event Beliefs Consequences Event or Situation Thoughts 1) Feelings Troubling thought example 2) Behaviors Voice says: You are a loser I can t do this I will fail 1) Sad 2) Stay at home Balanced thought example Voice says: You are a loser Maybe the voice is wrong The voice is a symptom 1) Confident 2) Go out

15 Forensic Considerations Therapeutic Alliance / Relationship Team Communication Risk Management -risk assessment (HARM) -individual care plan

16 CBTp Practice Group What is CBT Practice Group Context & Background What we do in the group Common Issues / Participants Experience Future plan for this group

17 CBT is About Deciding Which Path To Take

18 What is CBT Practice Group Gives participants a chance to seek different perspectives on an issue, a problem, CBT or coping strategy. Feel a sense of belonging and helps to normalize thoughts, feelings, and behaviours Reinforces CBT strategies and methods previously learned

19 Context & Background Participants are graduates of the 16 week CBT for psychosis program. Participation in this program is voluntary Participants are both inpatient and outpatient Forensic clients Ongoing team collaboration maximizes benefits to participants.

20 What we do in the group Structure the group in a similar manner as an individual CBT therapy session. Follow a CBT format

21 CBT FORMAT Rate Mood Session Summary Bridge from Previous Session Provide Feedback Agenda Setting Practice (Homework) Review

22 What we do in the group Structure the group in a similar manner as a therapy session unfolds. Follow a CBT format Review CBT techniques, strategies & tools participants may use to assist with distressing thoughts, delusions and hallucinations

23 Strategies Goal Setting Activity Schedules Decentering Meta thinking Thought Records ABC method

24 Common Issues / Participants Experience Low motivation Poor/ineffective decision making Social withdrawal Difficulty in initiating activities Stigma Identity Poverty Housing Interpersonal Relationships Budgeting Criminal/Forensic

25 Future Plans for CBT Practice Group Integrate Mindfulness and Compassion, Acceptance Focused approaches Introduce effectiveness measurement tools for this group Set specific parameters regarding graduating from the group

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27 Evaluation Feedback from participants I used to think that it was outside of me, now I know it is inside me it s all about the thoughts it s how you look at things patience, it takes time Clinical Outcome Measures (pre / post) SCL-90-R, Satisfaction with Life Scale PANSS, PSYRATS, BDI-II, BAI Group Evaluation Clinical Outcome Questionnaire

28 Summary # of groups to date: 6 # of participants to date: 35 # of staff training: 4 New this fall: CBTp (level 1) course for staff (27 participants) Future planning: implementation at FTU January 2014 partnership with schizophrenia program (evaluation) CBTp (level 2) course for staff spring 2014

29 References for Professionals Beck, A. T., Rector, N.A., Stolar, N., & Grant, P. (2009). Schizophrenia: Cognitive theory, research, and therapy. New York: Guilford Press. Beck, J. S. (2011) Cognitive behavior therapy : basics and beyond. New York: Guilford Press. Byrne, S., Birchwood, M., Trower, P., & Meaden, A. (Eds.) (2006). A casebook of cognitive behaviour therapy for command hallucinations: A social rank theory approach. New York: Routledge / Taylor & Francis Group. Gilbert, P. (2010). Compassion-focused therapy. New York: Routledge, Taylor & Francis Group. Kingdon, D. G., & Turkington, D. (2005). Cognitive therapy of schizophrenia. New York: Guilford Press. Meaden, A., Keen, N., Aston, R., Barton, K., & Bucci, S. (2013). Cognitive therapy for command hallucinations: An advanced practical companion. London, UK: Routledge / Taylor & Francis Group. Morris, E. M., Johns, L. C., & Oliver, J. E. (Eds.). (2013). Acceptance and commitment therapy and mindfulness for psychosis. Chichester, UK: Wiley-Blackwell. Nelson, H. (2005). Cognitive-behavioural therapy with delusions and hallucinations : a practice manual. Cheltenham, U.K.: Nelson Thornes. Tarrier, N., Gooding, P., Pratt, D., Kelly, J., Awenat, Y., & Maxwell, J. (2013). Cognitive behavioural prevention of suicide in psychosis: A treatment manual. London, UK: Routledge / Taylor & Francis Group.

30 References for Clients Freeman, D., Freeman, J., & Garety, P. (2008). Overcoming paranoid and suspicious thoughts: A self-help guide using cognitive behavioral techniques. New York: Basic Books. Hayward, M., Strauss, C., & Kingdon, D. (2012). Overcoming distressing voices: A self-help guide using cognitive behavioral techniques. London, UK: Constable & Robinson. Morrison, A. P., Renton, J. C., French, P., & Bentall, R. P. (2008). Think you re crazy? Think again: A resource book for cognitive therapy for psychosis. New York: Routledge / Taylor & Francis Group. Turkington, D., Kingdon, D., Rathod, S., Wilcock, S. K. J., Brabban, A., Cromarty, P., et al. (2009). Back to life, back to normality. Cambridge, UK: Cambridge University Press.

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32 Questions & Feedback

33 Thank you! ext / ext. 6776

34 CBT-p Cognitive Behavioural Therapy for Psychosis CBt-p Cognitive Behavioural Techniques for Psychosis HYCBt-p High Yield Cognitive Behavioural Techniques for Psychosis Level Three (CBT informed practice) CBT-p Cognitive Behavioral Therapy A Licensed Therapist who has completed a certified one year CBT course (or equivalent) prior to specializing in Psychosis Level Two CBTt-p Cognitive Behavioral Techniques A licensed professional (Counselor/Social Worker/Psychiatrist/Psychologist/Nurse) who has a working familiarity of CBT in practice and has engaged in advanced training of CBT for psychosis Level One HYCBt-p High Yield techniques Either a licensed professional (as above) or an unlicensed mental health worker without a working familiarity of CBT in practice and has attended either a workshop or course in High Yield techniques for psychosis