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Ingredients of cbt for persecutory delusions: expert consensus and experimental manipulation of safety behaviours
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Dissertation
Ingredients of cbt for persecutory delusions: expert consensus and experimental manipulation of safety behaviours
2010
Overview
Over the last decade, CBT has been found to be an effective alternative to medication for people with psychosis. Although consensus around the essential elements for CBT has been reached (Morrison & Barratt, 2010) the study also highlighted the idiosyncratic nature of the principles of CBT to the presenting problem and suggested consensus around specific CBT strategies may differ amongst experts if the symptom was specified, for example, persecutory delusions or hallucinations. A randomised case series was designed to investigate whether entering a feared situation and dropping safety behaviours led to a greater reduction in distress and belief in feared outcome ratings than exposure alone for people experiencing persecutory delusions. Over five sessions, participants were invited to complete assessment measures, develop a case formulation and complete two ten minute behavioural experiments involving exposure alone and exposure with dropping safety behaviours. In total, 5 participants completed all the assessment data and 3 participants completed the final experiment. As hypothesised, all participants reported a feared outcome associated to their persecutory ideation and all participants reported safety behaviours associated to their feared outcome. Study two employed a Delphi methodology to seek consensus amongst experts on the essential elements of CBT for persecutory delusions. The experts were invited to rate statements over three stages, covering many principles such as assessment, formulation, change strategies, homework, therapist assumptions and relapse prevention. Overall, 82 statements were rated as essential or important for CBT for persecutory delusions by > 80% of the panel, with 20 statements reaching a consensus of 100% at stage two. People experiencing persecutory delusions do report using safety behaviours and the safety behaviours are associated with a feared outcome. Although no conclusions could be drawn as to whether dropping safety behaviours produced a greater reduction to distress and belief, people are open to experimenting with dropping their safety behaviours.
Publisher
ProQuest Dissertations & Theses
Subject
