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Center for Recovery-Oriented Cognitive Therapy (CT-R) | Research Findings

Recovery Extends to All


CT-R Research Findings Summary

Theory

  • Extensive research suggests that connection with others is a fundamental human need [1] that is very commonly unmet amongst those given a diagnosis of serious mental illness [2].
  • Beck ’s cognitive model [3] provides a keen roadmap for understanding the many challenges that can impede a person’s desired life [4][5] also Beck, Himmelstein, Grant); it also is a useful guide for how the person flourishes.

Science of Beliefs

  • The idea for defeatist beliefs. We learned from providers that negative symptoms (difficulty in accessing motivation, being able to socialize, and experiencing pleasure) were especially challenging. We asked individuals why they didn’t do the things they used to succeed at or enjoy, and they said, “Why try, I’m only going to fail,” and “I can’t do it anymore.” We labeled these statements defeatist beliefs and we proposed that the beliefs protect the person from failure, but they also lead to inaction, which keeps them from living the life they want.
  • A study showing defeatist beliefs impede desirable living. We assessed negative symptoms, defeatist beliefs, and real-world functioning. We also administered a battery of tests for attention, memory, and executive functioning. We found that defeatist beliefs were linked to factors that lead to people not living a fuller lifer life [6].
  • The idea for asocial beliefs. When we asked individuals about the reasons they have do not tend to socialize, they would say that they prefer to be by themselves. However, a discussion of their aspirations often revealed they wanted friends and partners. We termed asocial beliefs statements such as, “People sometimes think I am shy when I really just want to be left alone.”
  • A study showing asocial beliefs impede desirable living. The asocial beliefs predicted future socializing, but current socializing did not predict future beliefs [7]. Asocial beliefs protect the person against rejection and disappointment.
  • Defeatist and social beliefs independently impede community participation. We found that to the degree defeatist beliefs or asocial beliefs are higher, access to motivation is lower, leading to less engagement in community activities that matter [8].
  • Defeatist beliefs, work and socializing. In an exciting study conducted by investigators in Indiana, decreased levels of defeatist beliefs lead to people having more success at work, and also more success socially – in other words, getting more of the life they want [9].
  • Sources of challenges cognitive performance. In a review paper, we show that factors – motivation, stress, negative beliefs, etc. — which contribute to poor test performance for anyone, also contribute to poor test performance for people with serious mental health conditions [10]. These are factors that can be addressed psychosocially.
  • We have a lot of evidence at this point showing that beliefs are critical for understanding how people with serious mental health challenges are not getting the life they want.

Empirical Validation

  • Translating science to practice. We developed Recovery-Oriented Cognitive Therapy as an active approach that operationalizes recovery by targeting these beliefs.
  • Active Clinical trial of CT-R. We recruited people with elevated negative symptoms, randomly assigned them to continue their standard treatment in the community or to receive weekly CT-R. Active treatment could last up to 18 months.
  • End of treatment effect for CT-R. At the end of the 18 months of treatment, people in the CT-R condition, as compared to those in standard treatment, showed improved functional outcomes – they had enhanced access to motivation, and their positive symptoms decreased [11]. In real-world terms, the change experienced by the typical person in CT-R meant going from spending each day smoking cigarettes and watching TV to making friends, volunteering, starting to go back to school, starting to date.
  • Follow-up gains maintained in CT-R. After six months receiving no CT-R, the people in the CT-R condition still had greater daily functioning, greater motivation, and less positive symptoms. They changed their perspectives about themselves, others, and the world in a lasting way that continues to develop.
  • Recovery extends to everyone. Another important result from this study was that people who received the diagnosis 20, 30, or 40 years ago still showed improvement by the end of the treatment period, it was just slower [12] than those who had received the diagnosis earlier. Nobody is too severe or has been affected too long to get better and get the life they want.

Next Steps

  • Positive beliefs. One of our big discoveries is the importance of positive beliefs [13] in how people improve and flourish in the life of their choosing.
    • We are developing new scales and validating them.
    • Conducting experience sampling studies to track these beliefs in everyday life.
    • Positive beliefs as mechanisms of CT-R.
  • Research the adaptive mode
    • Performance correlates of activation of the adaptive mode.
    • Biological substrates.

References

  • [1] Baumeister, R.F., & Leary, M.R. (1995) The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117(3), 497-529.
  • [2] Patel, R., Jayatilleke, N., Broadbent, M., Chang, C.-K., Foskett, N., Gorrell, G., . . . Stewart, R. (2015). Negative symptoms in schizophrenia: a study in a large clinical sample of patients using a novel automated method. BMJ Open, 5(9).
  • [3] Beck. K. et al (In Press). Clinical and functional long-term outcome of patients at clinical high risk (CHR) for psychosis without transition to psychosis: A systematic review. Schizophrenia Research.
  • [4] Beck, A.T. (in press) A 60 Year Evolution of Cognitive Theory and Therapy. Perspectives on Psychological Science.
  • [5] Beck, A. T., Himelstein, R., & Grant, P. M. (2017). In and out of schizophrenia: Activation and deactivation of the negative and positive schemas. Schizophrenia research, 203, 55-61.
  • [6] Grant, P. M., & Beck, A. T. (2009). Defeatist beliefs as a mediator of cognitive impairment, negative symptoms, and functioning in schizophrenia. Schizophrenia Bulletin, 35(4), 798-806.
  • [7] Grant, P. M., & Beck, A. T. (2010). Asocial beliefs as predictors of asocial behavior in schizophrenia. Psychiatry Research, 177(1-2), 65-70.
  • [8] Thomas, E. C., Luther, L., Zullo, L., Beck, A. T., & Grant, P. M. (2017). From neurocognition to community participation in serious mental illness: the intermediary role of dysfunctional attitudes and motivation. Psychological Medicine, 47(5), 822-836.
  • [9] Reddy, F., Reavis, E., Polon, N., Morales, J. & Green, M. (2017b). The Cognitive Costs of Social Exclusion in Schizophrenia.Schizophrenia Bulletin, 43, S54-S54.
  • [10] Beck, A.T., Himelstein, R., Bredemeier, K., Silverstein, S. M., & Grant, P. (2018). What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors. Psychological Medicine, 1-10.
  • [11] Grant, P.M., Huh, G.A., Perivoliotis, D., Stolar, N.M., & Beck, A.T. (2012) Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia. Arch Gen Psychiatry. 69(2)121–127
  • [12] Grant, P.M., Bredemeier, K., & Beck, A.T. (2017) Six-month follow-up of recovery-oriented cognitive therapy for low-functioning individuals with schizophrenia. Psychiatric Services, 68(10), 997-1002.
  • [13] Grant, P.M., Perivoliotis, D.,Luther, L., & Bredemeier, K. (2018) Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery-oriented cognitive therapy. Psychological Medicine, 261-268.