Release Date: September 2005 www.MGHCME.org Cognitive Behavioral Approaches in Schizophrenia RELEASE DATE: SEPTEMBER 2005 SM symposium COURSE MATERIALS Please photocopy as necessary! This educational activity “Cognitive Behavioral Approaches in Schizophrenia” was recorded during the MGH-PA live symposium, Module 3: Psychosis, offered in various cities September through November 2005. Participants who have already received continuing education credit for participating in the live symposium cannot receive credit for this educational activity. This course guide is designed to be used in conjunction with the educational activity titled “Cognitive Behavioral Approaches in Schizophrenia” (EDA# 510-4009-05) by PRIMEDIA Healthcare. PRIMEDIA Healthcare is a division of PRIMEDIA Workplace Learning. The MGH-PA curriculum is supported through unrestricted educational grants from the following Charter Member Supporters and Enhancement Supporter: Platinum: Cephalon, Inc. Gold: Janssen Pharmaceutica Silver: GlaxoSmithKline and Wyeth Pharmaceuticals Enhancement: Bristol-Myers Squibb Company MGH-PA1Release Date: September 2005 www.MGHCME.org This page left blank intentionally. 2Release Date: September 2005 www.MGHCME.org Cognitive Behavioral Approaches in Schizophrenia STATEMENT OF NEED A mounting body of empirical evidence supports the efficacy of cognitive-behavioral approaches combined with antipsychotic medication in improving psychotic symptoms, negative symptoms, medication adherence, and distress. Despite the inclusion of cognitive-behavioral therapies as a “best practice” for schizophrenia, few centers in the U.S. are trained in the implementation of cognitive behavioral techniques with this population. LEARNING OBJECTIVES Upon completion of this activity, the participant should be able to: 1. describe CBT interventions used to reduce psychotic symptoms. 2. construct a simple model of how cognitions and behaviors might contribute to the maintenance of psychotic symptoms and associated distress. 3. describe CBT interventions used to promote medication adherence. TARGET AUDIENCE The target audience for this activity includes physicians, especially psychiatrists, nurses and pharmacists. CE CREDIT INSTRUCTIONS Successful completion of this CE activity (EDA #510-4009-05) includes the following: • View the presentation and review the course materials. • Complete the appropriate CME/CE application and activity evaluation form. • Score a 70% or above on the post-test. • Submit forms to address indicated for processing. Participants will receive a CE statement of credit within 4 weeks following receipt of the CME/CE application and activity evaluation form. There is no fee for participation in this activity. The estimated time for completion of the activity is 60 minutes. 3Release Date: September 2005 www.MGHCME.org DISTINGUISHED FACULTY CORINNE CATHER, PhD Corinne Cather is a cognitive behavioral psychologist for the Massachusetts General Hospital Schizophrenia Program in Boston. In addition, she is a clinical fellow in psychiatry at Massachusetts General Hospital under the auspices of Harvard Medical School. Dr. Cather earned her undergraduate degree in biopsychology at Hamilton College in Clinton, NY and her doctorate in clinical psychology from Rutgers University where she received specialized training in cognitive behavioral therapy (CBT) and health psychology. She completed an internship at UMDNJ (formerly Rutgers) and a post-doctoral fellowship at the MGH in the Schizophrenia Clinical and Research Program with Donald Goff, M.D. Dr. Cather’s research interests include the development and implementation of CBT to residual symptoms, medication adherence, and substance use disorders in individuals with schizophrenia spectrum disorders. She is currently working on modifying these approaches for use in first episode and early psychosis. She has authored empirical and review papers on CBT for psychosis together with training clinicians nationwide in CBT approaches and techniques. Dr. Cather has received a National Alliance for Research on Schizophrenia Young Investigator Award for the cognitive-behavioral treatment of negative symptoms in schizophrenia, is the site principal investigator for a NIMH-funded study on social skills training and health care management in elderly individuals with major mental illness, and is the project manager for a NIMH-funded study of behavioral family treatment for substance use disorders co-occuring with major mental illness. She also collaborates with Dr. Evins to offer smoking cessation interventions to individuals with schizophrenia and consults on behavioral techniques to promote weight loss in individuals with major mental illness. Dr. Cather is on the speaker’s bureau of Eli Lilly and Company. 4Cognitive-Behavioral Therapy (CBT)Approaches in SchizophreniaCorinne Cather, [email protected] Program of the Massachusetts General Hospital/Harvard Medical SchoolThoughtsBehaviorPhysicalEmotion Nobody like me The world is dangerous People want to hurt me Isolation Avoidance Hypervigilance Fatigue Panic PainWhat is CBT?Who Has Gotten CBT? On antipsychotic medication  Treatment refractory Inpatients and outpatients First-episode and chronic Residents of the UK Historical Factors Discouraging CBT for Schizophrenia Schizophrenia too severe  Biological model of disorder Schizophrenics not seen as active in own treatment Modifying delusions as potentially harmful Limited generalizability of early token economy-based interventions5Factors Encouraging CBTfor Schizophrenia 30 – 50% experience residual symptoms  Patients develop their own coping strategies Suboptimal medication adherence in55% outpatients  Promising results of large controlled trialsWhy isn’t CBT a part of your practice with schizophrenia?a) CBT is practiced in our settingb) CBT is not reimbursable c) CBT is too difficult for most patientsd) CBT is too difficult for most therapistsPrinciples of CBT Delusions represent an attempt to make sense of negative affect Symptoms are maintained by appraisal and behavior Distortions are