An interacting cognitive subsystems model of relapse and the course of psychosis

Abstract

This paper outlines a theoretical analysis of current psychological conceptualizations of psychosis that draws on Teasdale and Barnard's (1993) Interacting Cognitive Subsystems (ICS) model of depression. The ICS model differs from Beck et al.'s (1979) model of emotional disorders in that it specifies two qualitatively different levels of meaning. These different levels of meaning play a different role in the production, maintenance and modification of emotion, and indeed, also recognize the distinction between`intellectual' belief and emotional' belief. Intellectual beliefs are at the level of specific propositional meaning: they have a truth value which can be assessed and they are not directly influenced by sensory information such as voice tone, arousal and body state, or visual stimuli. Given this, propositional meaning does not have a direct link to the production of emotion. Rather the link to emotion is an indirect one, through the activation of more generic and holistic affect-related schematic models. These latter schematic models are hypothesized to have implicational meaning, and correspond to schematic models derived from emotive experiences. In consequence they do not have a specific truth-value and they reflect contributions from a wide variety of sources, including multiple patterns of specific meanings, and patterns of direct sensory input. This ICS perspective proposes that integration of these two levels of meaning can facilitate the psychological conceptualization of the initiation, acceleration, and maintenance of positive psychotic symptomatology during relapse. This theoretical analysis is illustrated by the use of a case study, which describes the process and application of ICS to facilitating recovery from acute psychosis. This paper also provides a detailed discussion of the implications of this analysis for future research and psychological therapy. In particular, ICS has relevance for tracing the evolution of schematic beliefs during the early episodes of psychosis, which are hypothesized to have a bearing on the future course of psychosis. This has implications for the further development and expansion of psychological treatments for relapse and recovery from psychosis.

Cognitive Processes during Acute Psychosis: The Role of Heightened Responsibility and Catastrophic Misinterpretations

“…This supports the hypothesis that inflated responsibility beliefs could be both a trait vulnerability factor and also be exacerbated as a state factor in acute psychosis, contributing to the development and/or maintenance of positive psychotic symptoms. These results provide support to Gumley et al's (1999) suggestion that responsibility beliefs may be an important variable to consider in psychotic crisis. Cognitive processes shown to be significant in psychosis such as attribution and confirmatory bias, a tendency to jump to conclusions and to make overconfident judgements (Garety and Hemsley, 1994; Garety et al, 1991; Peters et al, 1999), may all contribute to exaggerated sense of responsibility; while other cognitive deficits such as impaired reality testing (Bentall and Slade, 1985) may be contributing to the sense of impending threat.…”

A Randomized Controlled Trial of Relapse Prevention Therapy for First-Episode Psychosis Patients: Outcome at 30-Month Follow-Up

“…37 For example, perhaps the intervention increased anxiety, or rational concern, regarding relapse, which mediated increased avoidance of goal attainment, consistent with cognitive models of relapse. 38 We would concur with Lilienfeld that replication is required to definitively draw this conclusion. 37 Against this interpretation, is that the reduction in functioning in the RPT group was only apparent at the 30-month time point, and there is no previously published evidence to support this conclusion, so we believe this is unlikely.…”

Qualitative investigation of targets for and barriers to interventions to prevent psychosis relapse

“…Not only are they unpleasant in their own right, they may contribute to the development of psychosis. Two existing cognitive models of psychosis relapse [ 34 , 35 ] propose that dysphoric early signs (e.g. anxiety, depression, arousal, insomnia) are responses to internal or external events resembling the early stages of previous episodes and that, as such, they can be causal factors rather than just inert epiphenomena of imminent relapse.…”