International Review of Psychosis Bipolarity CompassionFocused Therapy for
International Review of Psychosis & Bipolarity Compassion-Focused Therapy for Psychosis: empirical review and presentation of a new clinical trial Maria João Martins, Paula Castilho, Célia Barreto Carvalho, Ana Telma Pereira, & António Macedo April, 2015
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW NEW CLINICAL TRIAL Intervention for Psychosis Pharmacological Treatment International Guidelines (e. g. NICE) recommend CBT for all people with a psychosis diagnosis CBT for Psychosis (CBTp): Psychossocial intervention with more empirical evidence Efficacy studies: Moderate efficacy for positive and negative symptoms, functioning, humor and social anxiety (Wykes et al. , 2008) Psychosis Severe Mental Illness Chronic Course Low compliance (behavioral) Negative Symptoms Cognitive Deficits Secondary effects of medication
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW NEW CLINICAL TRIAL Limitations of CBTp • High dropout rates and compliance issues • Patients’ avoidance of emotionally difficult experiences • Absense of consensus regarding benefits in: v Relapse prevention v Quality of life improvement • Difficultie in keeping the focus on positive symptoms after symptom remission/reduction • Unstable improvement regarding insight Contextual Therapies – Third Generation CBT • Focus on context and function of private events (e. g. Thoughts, emotions) instead of focusing on content (absense of content /rationality questioning) • Transdiagnostic approach • Experiential strategies (instead of language-based) – focus on the body and “here and now” • Enphasis placed on quality of life and functioning (instead of symptom relief) • Focus on workability of behavior (utility instead of veracity) Mindfulness-based Cognitive Therapy (MBCT, Teasdale et al. , 1995) Acceptance and Commitment Therapy (ACT, Hayes et al. , 1999) Compassion Focused Therapy (CFT, Gilbert & Procter, 2006)
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW NEW CLINICAL TRIAL Rationale 3 Affect regulation systems Excitement; Motivation; Vitality; Search for Pleasure/Reward Contemtment; Safety; Afiliation; Connection to others Dopamine Opiaces; Oxytocin Soothing System Drive System Threat System Anger; Anxiety; Disgust; Sadness HPA; Cortisol
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW NEW CLINICAL TRIAL Rationale Inbalance “Better Safe than Sorry” Threat-focused Mind • Attention • Thought • Behavior • Emotions Aim: Balamce between the three systems. Being able to activate an alternative system that deactivates/regulates the threat system – The Soothing System. Organizing the mind with a different motivation (instead of a threat-focused and defense. focused motivation) Compassion (motivation directly related with the soothing system)
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW NEW CLINICAL TRIAL Rationale Compassion Flow Compassion: “Basic kindness, with deep awareness of the suffering of oneself and of other living things, coupled with the wish and effort to relieve it” (Gilbert, 2009, p. XIII) Self Others Self How? Using evidence-based strategies (skills training) in order to develop the compassion competencies that activate the Sootyhing System. Examples: Mindfulness training, Breathing Rithms (Soothing breathing rithm), Imagery exercises (compassionate image, compassionate self), behavioral experiments (act as the compassionate self), chair work (talking to multiple selves)
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW CFT FOR PSYCHOSIS: WHY? Psychosis is characterized with processing highly focused on threat Patients with several sources of threat (internal and external) with fewer sources of tranquilization (3 systems inbalance) Patients with high levels of shame, self and others-criticism and stigma CFT FOR PSYCHOSIS Naturally stimulates the Soothing System – a natural regulator of the Threat System (overdeveloped in psychosis patients) Helps people to disengage from a social ranking mentality (focused on other’s pottentialy harmful power) and to activate afiliative, cooperative and self/others care processes. The aim is to develop a “compassionate self” that will wprk as a secure base from which to explore and be envolved with fears, trauma, voices and other experiences usually avoided. NEW CLINICAL TRIAL
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW NEW CLINICAL TRIAL Results • CFT group with improvement regarding social comparison , self-esteem, depressive symptoms, external shame and psychopathology Results • CFT group with improvement regarding negative symptoms; • CFT group with higher levels of positive emotions and psychological recovery Results • CFT group with higher clinical improvement levels when compared to TAU • CFT group with higher compassion levels • In CFT group: improvement in compassion associated with reductions in depressive symptoms and social marginalization.
INTRODUCTION COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW NEW CLINICAL TRIAL COMPASSION-FOCUSED THERAPY: GROUP INTERVENTION PROTOCOL FOR SCHIZOPHRENIA Main Objetive To develop and test the feasability, efficacy and effectiveness of a group format, compassionfocused therapy based intervention protocol for patients with the diagnosis of Schzophrenia. Description Setting 2 Portuguese Hospitals (Aveiro and Coimbra) Type Group-format (maximum 10 participants per group) Periodicity Weekly (1 hour to 1 h 30 sessions) Duration 8 -12 sessions Inclusion Criteria Diagnosis of Schizophrenia Critical period– until 5 after the first episode of psychosis Clinical stabilization (1 month with stable symptomatology and/or medication) Exclusion Criteria Substance Dependence| Substance-induced Psychosis Significant cognitive impairement Active psychotic symptomatology (when impeditive of participation)
COMPASSION-FOCUSED THERAPY INTRODUCTION EMPIRICAL REVIEW NEW CLINICAL TRIAL Referenciation Process -Psychiatrists; Clinical Psychologists -Specific Teams (First Episode Teams; Mental Health Community Teams) Outpatien units; Inpatient units; Specific Teams Clinical Criteria (Exclusion) Contact with Family/Caregivers Family Assessment Moment 1 Explaining the aims of the Study Informed Consent Assessment Moment 1 (1 st Part) Psychopathological Assessment (Clinical Interview) Assessment Moment 1 (2 nd Part) (Processes and outcomes baseline – Selfresponse) N = 60 Randomization Psychoeducation for Family Intervention Group (CFT + TAU) N =30 Control Group (TAU) N=30 Group Intervention Protocol 8 -12 Weekly sessions Family Assessment Moment 2(post-intervention – 1 week) + Qualitative feedback Family Assessment Moment 3 (Follow-up 3 months) Family Assessment Moment 4(Follow-up 6 months) Patient does not want to participate (Exclusion)
INTRODUCTION Self. Compassion towards others Receiving Compassion from others COMPASSION-FOCUSED THERAPY EMPIRICAL REVIEW Psychoeducation (de-shaming) NEW CLINICAL TRIAL Multiple self dialogue Loving. Kindness Meditation Breathing Rithms Intervention Group (CFT + TAU) N =30 Psychotic Experience (e. g. voices/delusion s) as a part of the self Mindfulness Skills Compassionate Self (acting as) Group Emotionregulation
International Review of Psychosis & Bipolarity Thanks for your attention! Compassion-Focused Therapy for Psychosis: empirical review and presentation of a new clinical trial martins. mjrv@gmail. com April, 2015
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