For more information about CBT family informed caring
For more information about CBT family informed caring please visit: Our NAMI Marin Website at https: //www. namimarin. org/ or Professor Turkington’s website at https: //www. turkingtonpsychiatry. co. uk TPL © © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
These materials were conceived and developed in a partnership between Dr. Douglas Turkington and NAMI Marin Presented by: Hosted by: TPL Dr. Douglas Turkington NAMI Marin © © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
This program is made possible by a generous grant from the Marin County Board of Supervisors TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
How can we make sense of a delusion? TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Key caring principles The delusion might be true to some degree (and your loved one has a right to believe it), there is always a seed of truth at the heart of the delusion. Let’s find the seed! It’s good to ask about the delusion and its consequences. Learn more about the subject and show an interest but don’t collude. Step back into a Befriending style if needed. Try to help with anxiety, sadness, anger etc. See if asking an expert is acceptable a Priest, computer programmer or Police officer) Test it out in a gentle way. TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved (e. g.
Secondary delusion Delusional perception Types of Delusions of reference Delusional memory Primary systematised delusion Capgras delusion Somatic delusion TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Simple delusions Be friendly Ask peripheral questions Gather pertinent general information Ask Socratic Questions Introduce doubt Generate alternative explanations Draw a pie chart TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Simple delusions Do an easy behavioural experiment Follow up with a more challenging experiment Redraw the pie chart Support the patient in the new belief TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Be friendly (Columbo not Sherlock Holmes) Could it be true… or partly true? Curiosity and respect. Ready to validate any true statement linked to the delusion…find some truth! Open to persuasion Open to the evidence Normalize TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Example David TPL David believed that a satellite was taking the thoughts out of his mind and broadcasting them. He was preoccupied and distressed. He had auditory hallucinations, social withdrawal and poor self care. © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Peripheral and other questions TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Strategies Compare it to something…. . do you mean like telepathy? Can we read up about telepathy? Use a diary Write down the evidence Other possibilities…could it be a meteor, aircraft, NASA space station? Is there a pattern? Does it have a trigger? How could we check if thoughts were going out to the people in the street? Support any new belief. TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
How can we make sense of voices? TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Unprocessed traumas Unresolved conflicts The range of voices humans hear… Spiritual voices Intuitions and creative impulses Positive voices Critical and command voices Healing voices TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Western beliefs about voice hearing Voices are a sign of madness Voices are inherently dangerous Voices are supernatural Voices are uncontrollable TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Amygdala functions TPL Triggers your emotions X 15 faster than conscious awareness. In coordination with the insulae respond rapidly to negative emotions such as grief, anger, shame, guilt and envy. Rapidly activates the sympathetic nervous system (‘fight or flight’). Access lifelong trauma memories Can be inhibited by prefrontal cortical input. Rapid access from olfactory and all other sensory inputs. Processes memories Processes emotions © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
CBT good response case. CBT and f. MRI (Emotional Paradigm) 32 -YEAR-OLD LADY WITH SCHIZOPHRENIA AND PERSISTENT AUDITORY HALLUCINATIONS (9 months CBT) 1ª RM 31. 8 % REDUCTION ACTIVATION TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved 2ª RM
Key caring principles Appreciate the perceived reality and uniqueness of the voice hearing experience. Explain the human brain quite easily hallucinates and can recover Ask if they quieten down at times Ask if you can share the experience by the voices being written down Ask if your loved one recognizes the voice or if the identity is known. Ask if the voices tell the truth? Start to become more assertive with them and do activities Have an appointment with them for 15 minutes each day TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Voice diaries Are very useful Trigger memories that voices might be talking about Point out possible coping strategies and triggers Draw any image that is present Should not be too complex TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Voices can recede/ become less stressful… Within therapy On their own With a change of attitude (e. g. selective listening) With a medication change After a life event TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Case example Linda heard voices that told her to cut herself as she was useless…. her parents kept encouraging her not to do so… which made the voices worse… the home situation was becoming increasingly frantic with high expressed emotion… TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Question and Answer session TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Exercise: Tom 42 years Believed he heard the voice of the devil giving him commands and telling him he was evil. . . he spent long hours praying and was too frightened to sleep or mix with other people… How can we help care for him? TPL © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
Resources TPL www. treatingpsychosis. com © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
For more information about CBT family informed caring please visit: Our NAMI Marin Website at https: //www. namimarin. org/ or Professor Turkington’s website at https: //www. turkingtonpsychiatry. co. uk TPL © © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
These materials were conceived and developed in a partnership between Dr. Douglas Turkington and NAMI Marin Presented by: Hosted by: TPL Dr. Douglas Turkington NAMI Marin © © 2020 NAMI Marin and Turkington Psychiatry Limited. All Rights Reserved
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