REBT/CBT Psychoses Manuals

REBT in the Treatment of Psychoses

• Professor, Ph.D., Daniel David

I. TOPIC

Rational emotive behavior therapy (REBT) has been used to created evidence-based cognitive-behavioral therapy (CBT) interventions (i.e., clinical protocols/manuals) for psychotic disorders.

II. THE GOAL

The aims of this brief synopsis are: (1) to introduce the readers to the REBT research (i.e., clinical studies) and practice (i.e., clinical protocols/manuals) regarding psychotic disorders; (2) to encourage the use of REBT in the theory, research, practice, and training in field; and (3) to disseminate information about the available clinical manuals and/or clinical protocol that used REBT concepts/techniques in the treatment of psychotic disorders, needed for the research, training, and practice in the field (where possible, we indicate links to the full text materials).

III. BRIEF INTRODUCTION TO THE STATE OF THE ART

1. Based on general REBT, Albert Ellis’ ABC model (Ellis & Harper, 1961) has been often proposed as the framework of the CBT interventions for psychotic disorders (see for example Kingdon & Turkington, 2006). Typically, in this approach, the clinical protocols/manuals included both Beck’s cognitive therapy models/strategies/techniques and Ellis’ REBT models/strategies/techniques. As concerning specifically the REBT models/strategies/techniques:

• The cognitive restructuring and behavioral experiments (i.e., CBT techniques) used in the CBT clinical protocols for psychoses included didactic and Socratic techniques, as described in Dryden (1995), to change dysfunctional beliefs (see for example Byrne et al., 2003; Byrne et al., 2006).

• The key dysfunctional beliefs associated with command hallucinations (i.e., voice power belief) that were targeted by CBT techniques refer to both (1) descriptions/inferences [i.e., (a) about the power of the voice; (b) about the identity of the voice; (c) about the meaning of the voice] and (2) evaluations [i.e., irrational beliefs about (a) the fact that the individual must comply with the message of the voice and (b) the meaning of the voice (i.e., when the patients evaluate himself/herself globally, as “a bad person”) (see Byrne et al., 2003; Byrne et al., 2006). Indeed, the evaluations are particularly emphasized by the REBT models/strategies/techniques. In an updated model of the CBT intervention for psychoses (see Birchwood & Meaden, 2013; Meaden et al., 2013), irrational beliefs described by REBT are seen as core beliefs that have to be targeted in a separate stage of intervention in order to get long term-results, after the initial target of “power beliefs” that are more inferential in nature.

Randomized controlled trials (see Trower et al., 2004) supported such an approach (i.e., based on Byrne et al., 2003’s CBT protocol/manual).

2. Based on specific REBT, CBT clinical protocols were designed to target directly the irrational beliefs, as described by the REBT models (see Shelley et al., 2001). Preliminary empirical studies supported such an approach (see Shelley et al., 2001).

References

• Birchwood, M., & Meaden, A. (2013). Cognitive therapy for reducing distress and harmful compliance with command hallucinations. In C. Steel (ed.), CBT for schizophrenia. Evidence-based interventions and future directions. Oxford: Wiley-Blackwell.

• Byrne, S., Trower, P., & Birchwood, M. (2003). Command Hallucinations: cognitive theory, cognitive therapy and research. Journal of Cognitive Psychotherapy, 17, 67-84.

• Byrne S, Birchwood M, Trower P, Meaden A (2006). A casebook of cognitive behaviour therapy for command hallucinations. A social rank theory approach. London & New York: Routledge.

• Dryden, W. (1995). Brief rational emotive behavior therapy. Chichester, UK: Wiley.

• Ellis A, & Harper, R.A. (1961). A guide to rational living. Chatsworth, Calif: Wilshire Book Co.

• Kingdon, D., & Turkington, D (2006). The ABCs of cognitive-behavioral therapy for schizophrenia. Psychiatric Times, 23, 49-50.

• Meaden, A., Keen, N., Aston, R., Barton, K., & Bucci, S. (2013). Cognitive Therapy for Command Hallucinations. London: Routledge

• Shelley, A.M., Battaglia, J., Lucey, J., Ellis, A., & Opler, L.A. (2001). Symptom-specific group therapy for inpatients with Schizophrenia. Einstein Quarterly Journal of Biology and Medicine, 18, 21-28.

• Trower, P., Birchwood, M., Meaden, A., Byrne, S., Nelson, A., & Ross, K. (2004). Cognitive therapy for command hallucinations: Randomised controlled trial. British Journal of Psychiatry, 184, 312-20.

III. CLINICAL RESOURCES

• Byrne, S., Trower, P., & Birchwood, M. (2003). Command Hallucinations: cognitive theory, cognitive therapy and research. Journal of Cognitive Psychotherapy,17, 67-84.

o A CBT clinical protocol for command hallucinations, integrating REBT and beckian cognitive therapy

• Byrne S, Birchwood M, Trower P, Meaden A (2006). A casebook of cognitive behaviour therapy for command hallucinations. A social rank theory approach. London & New York: Routledge.

o A detailed CBT clinical manual for command hallucinations integrating REBT and beckian cognitive therapy with social rank theory

• Kingdon, D., & Turkington, D (2006). The ABCs of cognitive-behavioral therapy for schizophrenia. Psychiatric Times, 23, (7), 49-50

o A review and a case example of using a cognitive-behavioural intervention (i.e., integrating REBT and beckian cognitive therapy) for schizophrenia. For the full text see here: http://www.psychiatrictimes.com/schizophrenia/abcs-cognitive-behavioral-therapy-schizophrenia/page/0/1)

• Meaden, A., Keen, N., Aston, R., Barton, K., & Bucci, S. (2013). Cognitive Therapy for Command Hallucinations. An advanced practical companion London: Routledge.

o This a complex CBT manual for treating command hallucinations, by integrating REBT and beckian cognitive therapy. The role of REBT model is stronger here; indeed, REBT is not only the general framework of the CBT intervention (i.e., based on the general REBT’s ABC model), but the authors see the focus on REBT’s irrational beliefs important for long term-changes and thus, an important stage in the clinical protocol.

• Quintin, E. (2012). A single-case experiment for an innovative cognitive behavioral treatment of auditory hallucinations and delusions in schizophrenia. International Journal of Psychological Studies, 4, 114-121.

o A cognitive-behavioural intervention (i.e., integrating REBT and beckian cognitive therapy) for schizophrenia. For the full text see here: http://www.ccsenet.org/journal/index.php/ijps/article/view/13104/10546

• Shelley, A.M., Battaglia, J., Lucey, J., Ellis, A., & Opler, L.A. (2001). Symptom-specific group therapy for inpatients with Schizophrenia. Einstein Quarterly Journal of Biology and Medicine, 18, 21-28.

o A specific REBT group intervention for schizophrenia inpatients

IV. ON GOING TRIALS

A new clinical trial is planned (see Birchwood et al., 2011), based on Byrne et al., 2003 and Byrne et al. 2006’s clinical protocol/manual:

• Birchwood et al. (2011). A multi-centre, randomized controlled trial of cognitive therapy to prevent harmful compliance with command hallucinations. BMC Psychiatry 2011, 11:155 doi:10.1186/1471-244X-11-155.

o For the full text see here: http://www.biomedcentral.com/1471-244X/11/155