Understanding the Barriers to Accessing Symptom-Specific Cognitive Behavior Therapy (CBT) for Distressing Voices: Reflecting on and Extending the Lessons Learnt From the CBT for Psychosis Literature

Hazell, Cassie M.; Greenwood, Kathryn; Fielding-Smith, Sarah; Rammou, Aikaterini; Bogen-Johnston, Leanne; Berry, Clio; Jones, Anna M.; Hayward, Mark

doi:10.3389/fpsyg.2018.00727

Cited by 19 publications

(12 citation statements)

References 39 publications

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“…Further research in this area will be necessary to improve access to, and utility of, psychological therapy for those experiencing psychosis. Additional work by Hazell et al has suggested that symptom-specific treatment may be one route to overcoming the identified barriers (114).…”

Section: Toward Trauma-informed Treatment Options For Individuals Witmentioning

confidence: 99%

Treating the “E” in “G × E”: Trauma-Informed Approaches and Psychological Therapy Interventions in Psychosis

2019

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Despite advances in genetic research, causal variants affecting risk for schizophrenia remain poorly characterized, and the top 108 loci identified through genome-wide association studies (GWAS) explain only 3.4% of variance in risk profiles. Such work is defining the highly complex nature of this condition, with omnigenic models of schizophrenia suggesting that gene regulatory networks are sufficiently interconnected such that altered expression of any “peripheral” gene in a relevant cell type has the capacity to indirectly modulate the expression of “core” schizophrenia-associated genes. This wealth of associated genes with small effect sizes makes identifying new druggable targets difficult, and current pharmacological treatments for schizophrenia can involve serious side effects. However, the fact that the majority of schizophrenia genome-wide associated variants fall within non-coding DNA is suggestive of their potential to modulate gene regulation. This would be consistent with risks that can be mediated in a “gene × environment” (G × E) manner. Stress and trauma can alter the regulation of key brain-related pathways over the lifetime of an individual, including modulation of brain development, and neurochemistry in the adult. Recent studies demonstrate a significant overlap between psychotic symptoms and trauma, ranging from prior trauma contributing to psychosis, as well as trauma in response to the experience of psychosis itself or in response to treatment. Given the known effects of trauma on both CNS gene expression and severity of psychosis symptoms, it may be that pharmacological treatment alone risks leaving individuals with a highly stressful and unresolved environmental component that continues to act in a “G × E” manner, with the likelihood that this would negatively impact recovery and relapse risk. This review aims to cover the recent advances elucidating the complex genetic architecture of schizophrenia, as well as the long-term effects of early life trauma on brain function and future mental health risk. Further, the evidence demonstrating the role of ongoing responses to trauma or heightened stress sensitivity, and their impact on the course of illness and recovery, is presented. Finally, the need for trauma-informed approaches and psychological therapy-based interventions is discussed, and a brief overview of the evidence to determine their utility is presented.

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Section: Toward Trauma-informed Treatment Options For Individuals Witmentioning

confidence: 99%

Treating the “E” in “G × E”: Trauma-Informed Approaches and Psychological Therapy Interventions in Psychosis

2019

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“…In patients with COPD, group CBT reduces patient-reported symptoms, increases exercise therapy, improves QoL, augments adherence to medical treatment and diminishes exacerbations [14, 15]. Despite these benefits, CBT remains underused in COPD patients, partly due to limited access for patients to CBT, and primary care providers not referring patients for CBT due to a paucity of knowledge, excessive waiting time and inadequate provision of psychological services [16, 17]. Furthermore, access to trained CBT therapists in the national health service is scarce.…”

mentioning

confidence: 99%

Nurse-led cognitive behavioural therapy for treatment of anxiety in COPD

Yohannes

2018

ERJ Open Res

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Anxiety disorders are common and debilitating conditions that significantly impair the physical functioning and quality of life (QoL) of patients with chronic obstructive pulmonary disease (COPD). A recent systematic review identified the high prevalence of these disorders in patients with COPD, ranging 6–33% for generalised anxiety, 0–44% for panic disorder, 10–27% for specific phobias, and 5–11% for social phobias [1]. Furthermore, under-recognised or untreated anxiety disorders in COPD patients may reduce the QoL of their caregivers and increase emergency care visits and hospital admissions [1–5]. In 2004, in the European Union, the estimated direct (e.g. hospital admissions and medications) and indirect (e.g. loss of productivity due to absence from work) cost of anxiety disorders exceeded €41 billion per annum [2].

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“…While there is consensus in the literature that CBT can significantly contribute to the effective management of schizophrenia and psychosis, access to this type of therapy is limited. 7,14 Furthermore, there may be a tendency in medical settings to prioritize medication management in dealing with troublesome psychiatric symptoms at the expense of attending to how patients think or interpret their symptoms. The idea of actually focusing on patients' thoughts and interpretations of their symptoms is comparatively new.…”

Section: Discussionmentioning

confidence: 99%

“…9,13 Despite evidence for its clear benefits, the availability of CBT for this population remains restricted. 7,14 Limited access to CBT specialists is an important barrier to its implementation, 15 as are restrictions linked to service management and delivery and to workforce capability and expertise. 16 Intensive case management (ICM) programs can improve access to CBT.…”

mentioning

confidence: 99%

Cognitive-Behavioral Therapy in Intensive Case Management: A Multimethod Quantitative-Qualitative Study

Pomerleau

Demoustier

Krajden

et al. 2022

Journal of Psychiatric Practice

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Cognitive-behavioral therapy (CBT) has been shown to improve clinical outcomes in schizophrenia and severe and persistent mental illness, but access to it remains limited. One potential way to improve access to CBT is to provide it through intensive case management (ICM) teams. A 90-week quality improvement study was designed to assess if CBT could be implemented in ICM teams. Self-selected ICM clinicians (N = 8) implemented CBT with their patients (N = 40). These clinicians attended weekly seminars (36 h total) and group supervision (1.5 h/wk). Patient outcomes for this group were compared with those of other clinicians who did not attend the seminars [treatment as usual (TAU) clinicians (N = 4)] and their patient population (N = 49). Prescore and postscore on the Clinical Global Impressions scale and a quality-of-life scale (Montreal Life Skill Survey) were analyzed for completers in both groups (Clinical Global Impressions scores were analyzed for 25 patients in the CBT group and 29 patients in the TAU group). Weekly session reports by clinicians in the CBT group measured CBT interventions, session focus, and satisfaction with CBT. Qualitative data were obtained from clinicians in the CBT group. After 90 weeks, patients in the CBT group had fewer negative symptoms compared with patients in the TAU group. Our qualitative data describe 2 trajectories of patients: those who improved with CBT and those who did not, and they suggest factors that may impact patient trajectories in CBT. This study suggests that CBT can be used effectively in ICM teams working with patients suffering from severe and persistent mental illness.

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Understanding the Barriers to Accessing Symptom-Specific Cognitive Behavior Therapy (CBT) for Distressing Voices: Reflecting on and Extending the Lessons Learnt From the CBT for Psychosis Literature

Cited by 19 publications

References 39 publications

Treating the “E” in “G × E”: Trauma-Informed Approaches and Psychological Therapy Interventions in Psychosis

Treating the “E” in “G × E”: Trauma-Informed Approaches and Psychological Therapy Interventions in Psychosis

Nurse-led cognitive behavioural therapy for treatment of anxiety in COPD

Cognitive-Behavioral Therapy in Intensive Case Management: A Multimethod Quantitative-Qualitative Study

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