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Cognitive Behavioral Therapy for Persistent Psychosis

It is estimated that between 25 and 50 percent of the individuals affected by schizophrenia continue to experience delusions, hallucinations and other symptoms to varying degrees, despite taking antipsychotic medications as prescribed. Research from the United Kingdom has shown that when a form of Cognitive Behavioral Therapy (CBT) adapted for persistent psychotic symptoms (CBT-p) is used in combination with antipsychotic medication, symptoms can be reduced and/or function can improve.

Specifically, CBT-p has shown positive results in the following areas:

  • reducing the symptoms of schizophrenia spectrum disorders,
  • improving medication adherence,
  • promoting recovery,
  • reducing relapse rates and
  • decreasing the duration of hospital stays, should re-hospitalization be required.
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    However, despite its effectiveness, CBT-p is not routinely used in mental health practice sites in the United States. CBT-p requires specialized training and few clinicians have been trained in the practice, creating a barrier to its widespread use.

    The BeST Center is engaging with national and international experts to implement this BeST practice.

    The Thought Record, a newsletter for those using a range of CBT-p Interventions

    Please click here to read the  first edition of The Thought Record, the BeST Center's newsletter for the ever-growing number of professionals using Cognitive Behavioral Therapy for Persistent Psychosis and High-Yield Cognitive Behavioral techniques for Psychosis to improve the lives of people affected by schizophrenia spectrum disorders.

    Connections: Health•Wellness•Advocacy Team Implementing a Spectrum of CBT-p Services

    The Intensive Outpatient Behavioral Health (IOBH) Team at Connections: Health•Wellness•Advocacy and the BeST Center at NEOMED are implementing a spectrum of Cognitive Behavioral Therapy for Persistent Psychosis (CBT-p) interventions with clients who have schizophrenia spectrum disorders. Each member of the team completed intensive training and participates in ongoing individual and group follow-up and feedback related to their use of CBT-p interventions.

    The IOBH  team is the first to use an integrated approach to implementing a full spectrum of CBT-p services that range from lower-intensity to higher-intensity. The team worked to develop processes for making referrals, reviewing cases and obtaining outcomes data. Rebecca Roberts-Martin, Ph.D., PCC-S; leads the Intensive Outpatient Behavioral Health treatment team; Dorothea Galloway, M.S.W., L.I.S.W.-S, is the administrative lead for the program; and the BeST Center’s Consultant/Trainer for CBT-p, Harry Sivec, Ph.D., provided initial training and has been involved in the ongoing development of the program.

    Community Support Services' Teams Implementing High-Yield Cognitive Behavioral Techniques for Psychosis

    Members of the Assertive Community Treatment team at Community Support Services, pictured above, completed a training curriculum in  High-Yield Cognitive Behavioral techniques for psychosis (HYCBt-p) and they are now using this approach with clients with schizophrenia spectrum disorders. The team is led by Deborah A. Betts Moore, MSW, LSW, and the BeST Center's Harry Sivec, Ph.D., provides ongoing training and support to the team as they implement HYCBt-p. Two additional Community Support Services teams, the Forensic Assertive Community Treatment Team led by Ragan Leff, LSW, and the Northwest Regional Team led by Denise Cunningham, MA, PCC, NCC, have also been trained in HYCBt-p and use these techniques to assist clients.

    In addition, members of all four Northeast Ohio FIRST early identification and treatment of psychosis teams have completed training in HYCBt-p.

    BeST Center Staff Members’ Practice Review Published in Psychotherapy

    PRACTICE REVIEW: Cognitive Behavioral Therapy for Psychosis in Clinical Practice by Harry J. Sivec, Ph.D., and Vicki L. Montesano, Ph.D., Northeast Ohio Medical University, appears in Psychotherapy, 2012, Vol. 49, No. 2, 258–270. To read the practice review, please click here.

    Implementing a Range of Cognitive Behavioral Therapy Interventions for Persistent Psychotic Symptoms Conference

     

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    The BeST Center offered a conference, Implementing a Range of Cognitive Behavioral Therapy Interventions for Persistent Psychotic Symptoms, on March 15.  For an agenda for the conference, please click here.

    Cognitive Behavioral Therapy for Persistent Psychosis

    As part of its initial exploration, the BeST Center engaged with national and international experts on CBT for psychosis (CBT-p) and developing plans to implement this BeST practice. One of our consultants was Peter J. Weiden, M.D., a psychiatrist who is conducting NIMH-funded research on CBT approaches to help with medication acceptance, and already had extensive experience with bringing CBT approaches to the United States. For more information about Dr. Weiden's work, please visit this link.

    CBTp Douglas Jeremy and Mark.jpgIn August 2010, two internationally known experts on the use of CBT-p, Douglas Turkington, M.D., and Jeremy Pelton, a senior nurse therapist, “crossed the pond” and came from the United Kingdom to Northeast Ohio to share their expertise. They led a day-and-a-half long, filled-to-capacity workshop sponsored by the BeST Center  on August 12 -13, 2010. For copies of the materials from Insight CBT Partnership that were discussed at this conference, please click here.

    High-Yield Cognitive Behavioral techniques for Psychosis Case Manager Research and Demonstration Project

    The BeST Center and Insight CBT Partnership collaborated to develop specific techniques from CBT-p that can yield positive results as part of routine clinical care and support. These techniques are called High-Yield Cognitive Behavioral techniques for Psychosis (HYCBt-p), and they can be delivered by clinical as well as non-licensed direct care staff and others.

    During the week of February 6-11, 2011, the BeST Center and Insight CBT Partnership offered a 40-hour High-Yield Cognitive Behavioral Techniques for Persistent Psychosis training session for case managers.  In addition, there were shorter, more tailored sessions for supervisors, counselors, social workers, psychiatrists and assessors who were engaged in conducting research to determine the impact of High-Yield Cognitive Behavioral techniques for Psychosis delivered by case managers on client symptoms of schizophrenia. Community Support Services’ case managers applied High-Yield techniques with selected clients, and they received clinical supervision in these techniques from Senior Nurse Therapist Jeremy Pelton (via SKYPE) and BeST Center Associate Director  Dr. Vicki Montesano.

    Case Manager

    The BeST Center and its partners conducted two research studies related to High-Yield Cognitive Behavioral techniques for Psychosis. The first study  measured the impact of these techniques on clients’ positive and negative symptoms of schizophrenia, personal and social performance and personal perceptions of recovery. A qualitative study measuring the impact of the techniques on case managers’ perceptions of people with schizophrenia spectrum disorders was also completed.

    For more information about the use of CBT-p for persistent psychosis, please contact Lon Herman, M.A., BeST Center Director, at 330.325.6695 or lherman@neomed.edu.

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