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PREP Prevention and Recovery of Early Psychosis Review session Kate Hardy, Clin.Psych.D Post Doctoral Fellow Prodromal Assessment, Research and Treatment Team (PART), UCSF [email protected] www.psychosisrecovery.org Objectives • Socialize a client to the model of CBT for depression and anxiety • Develop formulations for both depression and anxiety • Use the downward arrow technique to explore core beliefs and underlying assumptions • Know how to develop and test out behavioral experiments • Utilize techniques to alter core beliefs (schemas) www.psychosisrecovery.org Case Study • • • • • George – forty year old male Owns a fish and chip shop Married to Sally for 16 years No children Reports being depressed for the last four years www.psychosisrecovery.org Socialization to the model • Tell George about CBT and what to expect from the approach www.psychosisrecovery.org Socialization to the model • Explain link between thoughts, feelings and behavior • Introduce concept of structured sessions • Discuss agenda setting and homework • Contract for number of sessions/reviews www.psychosisrecovery.org Problem list development • Ask about what is currently going on for George • Find out what is on George’s problem list www.psychosisrecovery.org Goal setting and outcome measurement • How can George’s problem list be translated into goals? • How are we going to measure if these goals have been achieved? www.psychosisrecovery.org Formulation – here and now • Can George’s difficulties be formulated in the here and now? www.psychosisrecovery.org Five Areas Model Environment Thoughts Biology behavior Mood www.psychosisrecovery.org Formulation What’s the point? I am no good No one can help me Rumination Stopped things he enjoyed Decreased energy Decreased interest/ motivation Depressed www.psychosisrecovery.org Shop losing money Early experiences, underlying assumptions and core beliefs • Explore George’s early experiences • What core beliefs and underlying assumptions have been formed? www.psychosisrecovery.org Formulate George using cognitive model • Can the information from George be used to develop a formulation from the cognitive model? • How can this be done collaboratively with George? www.psychosisrecovery.org Cognitive Model Early Experiences Core beliefs Underlying assumption Critical incident Activate assumptions Thoughts Feelings Behaviour Physical www.psychosisrecovery.org • Early experiences lead people to develop core beliefs • From core beliefs unhelpful assumptions are generated that organize perception and govern behavior • Critical incident triggers the assumptions • Leading to negative automatic thoughts (NAT’S) which have knock on effect to mood, behavior and physiology www.psychosisrecovery.org Cognitive Model - George Early Experiences Multiple losses Critical time Impact on development Core beliefs bad things happen to me I’m a failure I have to support others Underlying assumption If I have something good it will be taken away Critical incident Shop vandalised Area redeveloped Activate assumptions Thoughts What is the point? I am no good Feelings Behaviour Depressed Low confidence Rumination Stopping things he used to enjoy Physical Loss of energy Loss of motivation www.psychosisrecovery.org Schema Change • • • • • Identify alternative schema Continuum methods Positive data logs Prejudice Model Historical test of schema www.psychosisrecovery.org Interventions – behavioral • What behavioral interventions can we implement? • (clue – think back to the problem list) www.psychosisrecovery.org Behavioral Interventions • Psychoeducation • Activity scheduling and pleasant events scheduling to increase activity • Problem solving techniques www.psychosisrecovery.org Interventions – Cognitive • What cognitive interventions can be used • Again think back to the problem list and goals • Also consider his schema www.psychosisrecovery.org Cognitive Interventions • • • • • • Thought record Challenging negative thoughts Alternative schema Continuum Positive data log Problem solving strategies www.psychosisrecovery.org Challenging negative thoughts – some helpful questions • • • • • Am I getting things out of proportion? What happened the last time I was in this situation? What would other people think in this situation? Are my thoughts predicting the future in an unhelpful way? What is the evidence for and against this thought? www.psychosisrecovery.org Challenging negative thoughts – some helpful questions continued • Am I trying to read other people’s minds? • Is this just another example of my typical negative thinking? www.psychosisrecovery.org Review of the course • • • • What do people like? What don’t people like? What can we do more of? What should we do less of? www.psychosisrecovery.org