Cognitive Behavioral Approaches in Schizophrenia RELEASE DATE SEPTEMBER 2005 SM MGH PA 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 Release Date September 2005 www MGHCME org 1 This page left blank intentionally Release Date September 2005 www MGHCME org 2 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 Release Date September 2005 www MGHCME org 3 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 Release Date September 2005 www MGHCME org 4 What is CBT Cognitive Behavioral Therapy CBT Approaches in Schizophrenia Thoughts Corinne Cather Ph D Nobody like me The world is dangerous People want to hurt me Emotion ccather partners org Behavior Schizophrenia Program of the Massachusetts General Hospital Harvard Medical School Isolation Avoidance Hypervigilance Physical Fatigue Panic Pain Historical Factors Discouraging CBT for Schizophrenia Who Has Gotten CBT Schizophrenia too severe Biological model of disorder Schizophrenics not seen as active in On antipsychotic medication Treatment refractory Inpatients and outpatients First episode and chronic Residents of the UK own treatment Modifying delusions as potentially harmful Limited generalizability of early token economy based interventions 5 Factors Encouraging CBT for Schizophrenia Why isn t CBT a part of your practice with schizophrenia 30 50 experience residual symptoms Patients develop their own coping a CBT is practiced in our setting strategies b CBT is not reimbursable Suboptimal medication adherence in c CBT is too difficult for most patients 55 outpatients d CBT is too difficult for most therapists Promising results of large controlled trials Principles of CBT Hallucination Delusions represent an attempt to make sense of negative affect I can t handle this Symptoms are maintained by appraisal and behavior Distortions are amenable to cognitive and behavioral approaches Avoidance 6 Distress Selective Attention Feel Threatened Safety Behaviors Guy in black jacket Information Search Unsmiling policeman Distress Cashier who gave me extra He is following me Other people want to hurt me Impatient shopkeeper Goals of CBT Cognitive Biases in Paranoia Exaggerated self serving bias bad things Decrease distress Adopt living with illness strategy