2018-19 - Conf. 6 - Prof. M. Birchwood - Does CBT for psychosis have a future ?

Description

Intervenant : Prof. Max Birchwood, Professor of Youth Mental Health, Mental Health and Wellbeing, Warwick Medical School, University of Warwick - UK

Thème : Does CBT for psychosis have a future ?

Résumé :
CBT for psychosis developed over 15 years ago initially by changing the coping strategies used by patients to deal with their symtoms; and then introducing the assumptions and techniques which have been so successful in cognitive approach to affective disorders. Meta-analyses of this ‘first generation' of CBT for psychosis shows that the effect size is much less than we initially thought, and their impact on delusions and hallucinations is unclear and the effects do not always endure. Since these pioneerhere has been sea change in our understanding of the nature and origins of psychotic symptoms, including the notion that these experiences run on a continuum; and that the metamorphosis into troubling psychosis takes place in adolescence and involves affective processes. This is why there is so much 'affective co-morbidity' in psychosis—I will argue that it provides one of the engine of psychosis development. I have previously argues that the first generation of CBT trials (including my own) used a 'quasi-neuroleptic model' in their focus on symptoms rather than on distress and behaviour. I will argue that recent evidence on the role of affect dysregulation in the genesis of psychosis has critical implications for the future development of CBT approaches which I will illustrate by reference to our recent MRC COMMAND on commanding hallucinations which has shown a 50% reduction in harmful compliance while not changing the level of psychotic symptoms including voices. I will outline what I believe should be the ‘next generation' of CBT in psychosis including a greater focus on single symptoms, disability, mechanisms and innovative delivery platforms involving new technology.

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