Staying Well After Psychosis: A Cognitive Interperson Approach to Recovery and Relapse Prevention

308 Pages·2006·2.08 MB·English

by  Andrew Gumley

STAYING WELL
AFTER PSYCHOSIS
A Cognitive Interpersonal Approach to
Recovery and Relapse Prevention
Andrew Gumley
University of Glasgow
and
Matthias Schwannauer
University of Edinburgh

STAYING WELL AFTER PSYCHOSIS

STAYING WELL
AFTER PSYCHOSIS
A Cognitive Interpersonal Approach to
Recovery and Relapse Prevention
Andrew Gumley
University of Glasgow
and
Matthias Schwannauer
University of Edinburgh
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Library of Congress Cataloging-in-Publication Data
Gumley, Andrew.
Staying well after psychosis : a cognitive interpersonal approach to recovery and relapse prevention /
Andrew Gumley, Matthias Schwannauer.
p. cm.
Includes bibliographical references and index.
ISBN-13: 978-0-470-02184-2 (hbk) – 978-0-470-02185-9 (pbk)
ISBN-10: 0-470-02184-5 (hbk) – 0-470-02185-3 (pbk)
1. Schizophrenia – Treatment. 2. Schizophrenia – Relapse. 3. Psychotherapy. 4. Cognitive therapy.
I. Schwannauer, Matthias. II. Title.
[DNLM: 1. Psychotic Disorders – therapy. 2. Psychotic Disorders – prevention & control.
3. Recurrence – prevention & control. 4. Cognitive Therapy – methods. WM 600 G974s 2006]
RC514.G786 2006
362.2¢6–dc22
2005024833
British Library Cataloguing in Publication Data
Acatalogue record for this book is available from the British Library
ISBN-13 978-0-470-02184-2 (hbk) 978-0-470-02185-9 (pbk)
ISBN-10 0-470-02184-5 (hbk) 0-470-02185-3 (pbk)
Typeset in 10/12pt Palatino by SNPBest-set Typesetter Ltd., Hong Kong
Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall
This book is printed on acid-free paper responsibly manufactured from sustainable forestry
in which at least two trees are planted for each one used for paper production.
CONTENTS
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Foreword by Max Birchwood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii
PART I THEORETICALOVERVIEW . . . . . . . . . . . . . . . . . . . . . . 1
1 Current Perspectives on Relapse, Relapse Detection and
Prevention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Psychological Therapies and Relapse Prevention . . . . . . . . . . . 4
Affect, Meaning and Relapse . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
ACognitive Behavioural Model of Early Signs and Relapse . . 23
Antipsychotic Medication and Relapse . . . . . . . . . . . . . . . . . . . 27
Implications for Staying Well after Psychosis . . . . . . . . . . . . . . 32
2 Attachment Theory, Self-regulation and Psychosis . . . . . . . . . 34
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Patterns of Attachment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
Attachment Theory and Later Psychopathology . . . . . . . . . . . . 38
Stability of Attachment Organisation . . . . . . . . . . . . . . . . . . . . . 42
Attachment Organisation and Psychosis . . . . . . . . . . . . . . . . . . 43
3 Psychological Factors in Vulnerability and Transition to
Relapse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
The Interpersonal Context . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
The Wider Social Context of Psychosis . . . . . . . . . . . . . . . . . . . 54
Significant Life Events . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Interpersonal Coping . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
vi CONTENTS
Appraisals of Psychosis and Emotional Distress . . . . . . . . . . . . 62
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
PART II OVERVIEW OF STRUCTURE, STYLE AND
ORGANISATION OF THERAPY . . . . . . . . . . . . . . . . . . . . . . . . . . 65
4 Overview of Principles and Procedures . . . . . . . . . . . . . . . . . . 67
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Primary and Secondary Outcomes . . . . . . . . . . . . . . . . . . . . . . . 67
Assessment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Structure of Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Style of Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75
Basic Elements of the Therapeutic Stance . . . . . . . . . . . . . . . . . 79
General Outline of Therapy Sessions . . . . . . . . . . . . . . . . . . . . . 79
Service Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
5 Strategies for Engagement and Formulation . . . . . . . . . . . . . . 86
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Attachment Organisation, Recovery and Distress . . . . . . . . . . . 86
Validation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
The Evolution of Therapeutic Discourse . . . . . . . . . . . . . . . . . . 95
Case Formulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97
Case Formulation in SWAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102
PART III SPECIFIC COGNITIVE AND INTERPERSONAL
STRATEGIES FOR RECOVERY AND RELAPSE PREVENTION
AFTER PSYCHOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103
6 Reorganisation of the Self in Recovery: Working with
Humiliation, Entrapment and Loss . . . . . . . . . . . . . . . . . . . . 105
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Life Events and their Dimensions . . . . . . . . . . . . . . . . . . . . . . . 106
Bowlby on Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Clinical Interventions and Techniques . . . . . . . . . . . . . . . . . . . . 111
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122
7 Working with Interpersonal Distrust: Developing a
Conceptualisation of the Paranoid Mind . . . . . . . . . . . . . . . 124
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124
Paranoia as an Interpersonal Threat Response . . . . . . . . . . . . . 124
The Paranoid Mind is Strategically Deployed . . . . . . . . . . . . . . 126
CONTENTS vii
Attachment and Paranoia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126
Problems with the Term ‘Paranoia’ . . . . . . . . . . . . . . . . . . . . . . 128
Working with the Personal Distress of the Paranoid Mind . . . . 129
Awareness of the Paranoid Mind . . . . . . . . . . . . . . . . . . . . . . . . 132
Development of an Accepting Rationale for Paranoia as a
Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Benefits and Costs of the Paranoid Mind . . . . . . . . . . . . . . . . . 135
Development of Alternative Interpersonal Strategies . . . . . . . . 137
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
8 Working with Traumatic Reactions to Psychotic
Experiences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Psychosis as a Traumatic Event . . . . . . . . . . . . . . . . . . . . . . . . . 141
Trauma Theory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Assimilation and Accommodation . . . . . . . . . . . . . . . . . . . . . . . 147
Exploring Traumatic Reactions . . . . . . . . . . . . . . . . . . . . . . . . . 150
Explaining Traumatic Reactions . . . . . . . . . . . . . . . . . . . . . . . . . 152
Exploring Meaning within Traumatic Memories and Imagery . 154
Contrasting Experiences of Psychosis and PTSD . . . . . . . . . . . 158
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160
9 Interpersonal Strategies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
The Social Environment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Interpersonal Environments as a Basis for Psychological
Intervention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
The Role of Interpersonal Anxieties and Social Withdrawal . . . 167
Areas of Interpersonal Difficulties . . . . . . . . . . . . . . . . . . . . . . . 173
Working with Interpersonal Sensitivity . . . . . . . . . . . . . . . . . . . 177
Conclusions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181
10 Working with Underlying Schemata and Core Beliefs . . . . . . 182
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182
Early Parental Loss and Psychopathology . . . . . . . . . . . . . . . . . 182
Childhood Abuse and Neglect . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Psychological Sequelae of Childhood Abuse and Neglect . . . . 183
Unresolved Attachment Status . . . . . . . . . . . . . . . . . . . . . . . . . . 185
Early Childhood Trauma and Psychosis . . . . . . . . . . . . . . . . . . 186
Trauma, Dissociation and Schizotypy . . . . . . . . . . . . . . . . . . . . 187
Schemata and Internal Working Models . . . . . . . . . . . . . . . . . . 189
Identifying Schemata . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 192
Schemata and Behaviour Relationships . . . . . . . . . . . . . . . . . . . 193
Core Belief Change Strategies in Cognitive Therapy . . . . . . . . . 195