May 2 – 4, 2011, Cognitive Behavior Therapy Workshop Level II: Personality Disorders and Challenging Problems

Earlier this month, Beck Institute held the first Cognitive Behavior Therapy Workshop Level II: Personality Disorders and Challenging Problems.  In attendance were psychologists, psychiatrists, social workers, councilors, and other professionals from Brazil, Canada, Hong Kong, Sweden, Thailand, and nine U.S. states.  This higher level workshop provided extra training and guidance to professionals that wished to improve their abilities for the benefit of their clients.

Demonstration of Cognitive Behavioral Therapy Techniques

The workshop focused on the use of CBT for challenging problems, anger management, substance abuse, and Axis II disorders.  The Beck Institute faculty used role-plays and discussions to demonstrate the CBT techniques that would be useful with various patients. On day two, Dr. Aaron Beck spoke about research being done currently on the use of CBT with Schizophrenic patients.  Treatments are looking into the negative symptoms of patients and working with them to change their emotions regarding the hallucinations.  Random assignment of medication in Britain has shown that patients, who discontinue use of medication, still improve with CBT.  The workshop attendees were then able to see Dr. Aaron Beck use the techniques he pioneered in two role-plays.  Attendees brought real patient scenarios in front of the group in order to gain insight into treatment. The first role-play was about a lawyer in her late 30’s who went through a recent divorce.  She now has signs of depression, social anxiety, and OCD.  After the role-play, participants noted the following:

  • Dr. Beck followed a pattern of asking questions to elaborate on emotions and beliefs and then providing capsule summaries of the patient’s beliefs in an attempt to narrow in the focus of the problem.
  • Using mental rehearsal as an intervention, the patient would be able to see the rationality, or lack thereof, of her beliefs.
  • After focusing in on the problem, Dr. Beck analyzed the situation and assigned the patient homework (attending a party) that would push her anxieties.

The second role-play was about an unemployed man in his 40’s who has an unstable relationship, little friends, and constantly complains about the way he is treated.  This patient has a history of abuse and shows signs of social anxiety.  Attendees noted the following in Dr. Beck’s approach:

  • Dr. Beck focused on trying to conceptualize the patient’s views.
  • Using gentle interruptions and positive feedback, Dr. Beck was able to give the patient advice without looking like an authority figure.
  • The conversation was always pulled back into that which the patient had control over.

Participants received professional training from Aaron T. Beck, M.D., Judith S. Beck, Ph.D., Leslie Sokol, Ph.D., and Norman Cotterell, Ph.D.

The Relationship between Interpersonal Self-Concept and Paranoia in Patients with Schizophrenia

newstudy-graphic-66x60.jpgA recent study published in Behavior Therapy examined the relationship between interpersonal self-concept and global self-worth, and psychotic and depressive symptoms in patients with psychosis. The participants consisted of 83 patients, all of whom had diagnoses on the schizophrenia spectrum, and 33 healthy individuals. The researchers measured each participant’s global self-worth, interpersonal self-concept, dysfunctional beliefs, positive and negative symptoms, delusions, paranoia, and depressive symptoms.

Results showed that (1) Global self-worth is related more to depression than it is to paranoia, (2) the perception of not being accepted by others is more related to psychotic symptoms, (3) individuals who believe that others evaluate them positively have lower levels of paranoia, regardless of their dysfunctional beliefs levels, and (4) negative self-concept (i.e., not being respected , trusted, loved, and accepted by others) is most closely related to positive symptoms, paranoia, and psychosis.

The significant correlation between dysfunctional interpersonal self-concept, dysfunctional attitudes, and paranoia reinforces the formulation-based cognitive approach to delusions and the importance of eliminating dysfunctional self-concepts. The results of this study suggest that cognitive therapy may be successful in treating persecutory delusions and paranoia by focusing on interpersonal and threat-related self-concepts.

Lincoln, T.M., Mehl, S., Ziegler, M. Kesting, M.L., Exner, C., & Rief, W. (2010). Is fear of others linked to an uncertain sense of self? The relevance of self-worth, interpersonal self-concepts, and dysfunctional beliefs to paranoia. Behavior Therapy, 41, 187-197.

CBT Meta-Analysis Review is Most Downloaded Article in CPR

It looks as if the research efficacy of Cognitive Therapy is becoming more well-known. Clinical Psychology Review is a peer-reviewed journal that publishes substantive reviews of topics relevant to clinical psychology. The most downloaded article from this important journal is The empirical status of cognitive-behavioral therapy: A review of meta-analyses (Volume 26, Issue 1, January 2006, Pages 17-31), authored by Andrew C. Butler, Jason E. Chapman, Evan M. Forman and Aaron T. Beck.

This 2006 review summarizes CBT treatment outcomes for a wide array of psychiatric disorders and includes sixteen methodologically rigorous meta-analyses. Findings are consistent with previous review methodologies and demonstrate the efficacy of CBT for many disorders. Specifically, unipolar depression, generalized anxiety disorder, panic disorder (with or without agoraphobia), social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders all showed large effect sizes. Marital distress, anger, childhood somatic disorders, and chronic pain showed moderate effect sizes.

CBT was also shown to be somewhat superior to antidepressants in the treatment of adult depression and as effective as behavior therapy in the treatment of both adult depression and obsessive-compulsive disorder. Bulimia nervosa and schizophrenia showed large, uncontrolled effect sizes.

Medication-resistant Schizophrenia benefits from adjunct CBT

A recent review in the Journal of Psychiatric Practice found cognitive behavioral therapy (CBT) to be beneficial for medication-resistant symptoms of schizophrenia. This is an important study because persistent symptoms are often disabling, lead to significant distress, and are associated with increased depression, anxiety, and risk of suicide. CBT as part of a treatment protocol with anti-psychotic medications has been shown to reduce these and other symptoms, and to increase adherence to treatment and insight; additionally, the effects are durable and cost effective. Working collaboratively with patients to improve understanding and coping has overall reduced suffering and improved functioning.

Study authors: S. Rathod, D. Kingdon, P. Weiden, D. Turkington

Using Cognitive Therapy to treat Delusions

Dr. Aaron Beck recently responded to an interviewer’s questions about addressing delusions among Schizophrenic patients. One of the central tenets of Cognitive Therapy is that individuals learn to evaluate their thinking and look for evidence that supports and/or contradicts their perceptions. The interviewer asked Dr. Beck how this pursuit of evidence plays out when individuals are having delusions and literally ‘seeing’ objects/people that aren’t really there.

Interviewer: How… do you persuade someone to ignore the evidence of their own eyes and believe you? 

Dr. Aaron Beck: The treatment of delusions and schizophrenia is a very tricky one. One of the definitions of delusions is that they do not yield to corrective feedback from other people. Consequently, attempting to persuade an individual that the delusion is incorrect is obviously self-defeating. There is a whole body of literature on how to address delusions. In brief, questioning the patient like a journalist without indicating disbelief is one way. This tends to get the patient into a questioning mode. Read more

Cognitive Therapy for Schizophrenia

Here’s what Kevin Benbow emailed to us about his experience supervising a clinician with her first schizophrenia patient:

As a clinical supervisor for a small, rural mental health clinic in Arizona I get the opportunity to supervise and train behavioral health technicians.  Such individuals have a wide range of experience and education levels and are allowed to practice under Arizona State law if they receive supervision from a licensed Behavioral Health Professional.

One of these clinicians has been particularly receptive to the cognitive model and has been helping many of her clients identify their automatic thoughts and subsequently test them.  Recently she assessed a client who was subsequently diagnosed with schizophrenia.  She had only weeks before experienced her first psychotic episode.  Read more