Staying Well After Psychosis – A Cognitive Interpersonal Approach to Recovery and Relapse Prevention

Andrew Gumley is Senior Lecturer in Clinical Psychology on the University of Glasgow Doctorate in clinical Psychology training Programme, a practising clinician as Honorary Consultant Clinical Psychologist in ESTEEM, North Glasgow Early Intervention Service, a trainer in cognitive behavioural psychotherapy at the Glasgow Institute for Psychosocial Interventions (GIPSI) and external consultant to the State Hospital at Carstairs Psychosocial Interventions Programme. His research interests include the evaluation of cognitive behavioural therapies for individuals who are considered to have seer and enduring mental health problems. In recent years, he has contributed to a number of randomised controlled trials of cognitive therapy involving individuals who have had or are recovering from distressing psychotic experiences, and individuals who have been diagnosed with borderline and antisocial personality disorders. His primary clinical and research interests focus on developing a psychological understanding of individual vulnerability and transition to he recurrence of psychosis. In this context Andrew is particularly interested in how the interplay between the experiences of psychosis and cognitive and interpersonal factors may prevent detection of at-risk mental states for relapse, contribute to affect dysregulation during relapse, or result in persistent and distressing emotional states such as fear of recurrence. These clinical and research interests are directed towards the development, refinement and evaluation of psychological therapies for recovery and staying well after psychosis. Matthias Schwannauer is Lecturer and Research Supervisor in Child and Adolescent Clinical Psychology on the University of Edinburgh Clinical Psychology Training Course, Research Co-ordinator in the Young People's Unit in Edinburgh and Practising clinician as consultant clinical Psychologist in an adolescent onset psychosis service in Lothian. His current clinical and research interest include the relationship between interpersonal and cognitive factors in developmental models of server and enduring disorder groups. He is particularly interested in the developmental onset of sever mental health problems with regard to psychological factors of vulnerability and resilience to psychiatric disorders. In the past few years Matthias has investigated developmental models of interpersonal and cognitive aspects of emotion regulation in a number of populations, such as depression in a highly vulnerable group of single, young homeless adolescents with an early onset psychosis and individuals suffering from bipolar disorder. He is interested in the advancement of a developmental psychopathology model of affect regulation in a range of populations with severe and recurring psychological difficulties.

About the Authors. Preface. Foreword. Acknowledgements. PART I: THEORETICAL OVERVIEW OF STAYING WELL AFTER PSYCHOSIS. 1. Current Perspectives on Relapse, Relapse Detection and Prevention. Introduction. Psychological Therapies and Relapse Prevention. Affect, Meaning and Relapse. A Cognitive Behavioural Model of Early Signs and Relapse. Antipsychotic Medication and Relapse. Implications For Staying Well After Psychosis. 2. Attachment Theory, Self-Regulation and Psychosis. Introduction. Patterns of Attachment. Attachment Theory and Later Psychopathology. Stability of Attachment Organisation. Attachment Organisation and Psychosis. 3. Psychological Factors in Vulnerability and Transition to Relapse. Introduction. The Interpersonal Context. The Wider Social Context of Psychosis. Significant Life Events. Trauma. Interpersonal Coping. Appraisals of Psychosis and Emotional Distress. Conclusions. PART II: OVERVIEW OF STRUCTURE, STYLE AND ORGANISATION OF THERAPY. 4. Overview Of Staying Well After Psychosis. Introduction. Primary and Secondary Outcomes. Assessment. Structure of Therapy. Style of Therapy. Basic Elements of the Therapeutic Stance. General Outline of Therapy Sessions. Service Model. 5. Strategies For Engagement and Formulation. Attachment Organisation, Recovery and Distress. Validation. The Evolution of Therapeutic Discourse. Case Formulation. Case Formulation in SWAP. Conclusions. PART III: SPECIFIC COGNITIVE AND INTERPERSONAL STRATEGIES FOR RECOVERY AND RELAPSE PREVENTION AFTER PSYCHOSIS. 6. Reorganisation Of The Self In Recovery: Working With Humiliation, Entrapment and Loss. Introduction. Bowlby On Loss. Clinical Interventions and Techniques. Conclusions. 7. Working With Interpersonal Distrust: Developing a Conceptualisation of the Paranoid Mind. Introduction. Paranoia as an Interpersonal Threat Response. The Paranoid Mind is Concerned with External Personal Threat. The Paranoid Mind Makes Decisions Quickly. The Paranoid Mind is Strategically Deployed. Attachment and Paranoia. Problems With The Term Paranoia. Working With The Personal Distress of the Paranoid Mind. Awareness of Paranoid Mind. Benefits and Costs of Paranoid Mind. Development of Alternative Interpersonal Strategies. Conclusions. 8. Working With Traumatic Reactions to Psychotic Experiences. Introduction . Psychosis as a Traumatic Event. Trauma Theory. Assimilation and Accommodation. Exploring Traumatic Reactions. Explaining Traumatic Reactions. Exploring Meaning Within Traumatic Memories and Imagery. Contrasting Experiences of Psychosis and PTSD. Conclusions. 9. Interpersonal Strategies. Introduction. The Social Environment. Interpersonal Environments as a Basis for Psychological Intervention. The Role of Interpersonal Anxieties and Social Withdrawal. Areas of Interpersonal Difficulties. Working With Interpersonal Sensitivity. Conclusions. 10. Working With Underlying Schema And Core Beliefs. Introduction. Early Parental Loss and Psychopathology. Childhood Abuse and Neglect. Psychological Sequelae of Childhood Abuse and Neglect. Unresolved Attachment Status. Early Childhood Trauma and Psychosis. Trauma, Dissociation and Schizotypy. Schema and Internal Working Models. Identifying Schema. Schema and Behaviour Relationships. Core Belief Change Strategies in Cognitive Therapy. Working With Underdeveloped Strategies. Conclusions. 11. Awareness, Intrusiveness and Fear of Relapse. Introduction. Phenomenology of Relapse. Subjective Experiences and Psychosis. Appraisals and Relapse. Awareness, Intrusiveness and Fear. CBT and Relapse Prevention. Exploring Experiences of Relapse. Explaining Beliefs. Early Signs Monitoring. The Initial Interview for Targeted CBT. Testing The Formulation. Decatastrophising Relapse. Contracting Intervention. Subsequent Sessions. Identifying the Most Emotionally Salient Beliefs. Introducing Flexibility into Beliefs. Transforming Beliefs. Testing Transformed Beliefs. Conclusions. 12. Conclusions. Introduction. Overview of the Treatment Manual. Therapist Training. Therapeutic Context. Appendix I: Fear of Recurrence Scale (FoRSe) Questionnaire. Appendix II: Diagrammatical kFormulation of Early Signs. Bibliography. Index.