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Ron Unger

Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based method to reduce distress and disability related to psychotic experiences, and to support a possible full recovery. Psychotic experiences are conceptualized as being understandable in relationship to an individual's life story, and capable of being altered when people experiment with different ways of thinking and behaving. Learn how to collaborate with people having these experiences, “exploring the evidence" rather than imposing beliefs, and developing coping options so people are not forced to rely entirely on the often limited effectiveness of medication to address problems.

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Cognitive Behavioral Therapy (CBT) for psychosis is an evidence-based method to reduce distress and disability related to psychotic experiences, and to support a possible full recovery. Psychotic experiences are conceptualized as being understandable in relationship to an individual's life story, and capable of being altered when people experiment with different ways of thinking and behaving. Learn how to collaborate with people having these experiences, “exploring the evidence" rather than imposing beliefs, and developing coping options so people are not forced to rely entirely on the often limited effectiveness of medication to address problems.

The course starts by examining the nature of psychosis and CBT, providing a foundation for understanding how CBT can be helpful. Then the basic style of CBT for psychosis is introduced, followed by an introduction to two of the most important techniques. Finally, applications of CBT are explored for some of the main problem areas, such as hearing distressing voices, paranoia, delusional beliefs, disorganization, and negative symptoms.

Included in the course are video lectures, slides with some diagrams, video demonstrations of CBT for psychosis being practiced, and links to additional resources for further study.

CBT for psychosis uses a minimal amount of jargon, and the concepts and practices tend to be easily understandable.

The course will take 6 hours to complete.

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What's inside

Learning objectives

  • Use evidence-based cbt approaches to reduce distress and disability related to psychotic experiences.
  • Identify ways to normalize psychotic experiences by seeing them as understandable in relationship to an individual’s life story, and capable of being altered
  • Create formulations that promote hope and provide direction for treatment and recovery
  • Utilize a collaborative style to engage in guided discovery of solutions to distressing psychosis-related problems
  • Describe ways of integrating this psychological approach with existing treatment methods

Syllabus

Introduction: What is CBT for Psychosis, How is It Different?

This lecture provides an overview of CBT for Psychosis, and of this class.

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Notes on taking this course

This lecture discusses the use of CBT for Psychosis with people both on antipsychotic medications and off, discusses some ideas about the relationship between medications and long term recovery, and offers some contrasts between the perspective of CBT for Psychosis and that of a purely bio-medical model.

What is Psychosis?

This video explores the breakdown of dialogue in psychosis, and the role of CBT in restoring both good external and internal dialogue.

Essentials of the style of CBT for Psychosis

This lecture covers two very fundamental aspects of any successful therapy for psychosis; the establishment of a good collaborative relationship, and the promotion of reasonable levels of hope.

Other essentials of the CBT for Psychosis approach
Normalizing: A way to reduce fear, and increase hope and successful coping
What normalizing is, what it's good for

Depending on the language used, our clients may learn how to normalize their experiences and so feel more in control and related to other human beings, or may learn to "abnormalize" their experience in a way that increases distress and alienation. This lecture will increase your understanding of how to use language to promote normalizing.

Understanding psychotic experience as being on a continuum with other human responses is very helpful within normalizing explanations: this lecture will help you understand and use this perspective.

Doug Turkington demonstrates normalizing while working with a person struggling with voices.

This lecture uses a powerful example to illustrate the role of a normalizing explanation in helping someone shift from a vicious circle of increasing distress to a virtuous circle of increased self understanding and self care.

Developing a Formulation - Finding Hope and Direction

This lecture provides some perspective on how CBT therapists address psychosis differently than what has been traditional within the mental health system, where a hypothesized "illness" has usually been conceptualized as explaining a wide number of symptoms, and where biological problems have usually been conceptualized as primary.

A wider way of understanding "bio-psycho-social" and "stress-vulnerability" is discussed, and the use of those wider understandings within formulations.

Varieties of formulations examined in this lecture include an ABC formulation, a variation of the 4 areas "kite" diagram, a spiral formulation, and a more in depth compassion focused formulation. How to use each of these types of formulation in order to nurture hope and provide direction fro recovery efforts will be explored.

This lecture presents another two types of formulations, along with examples that show how they can be used to further treatment.

A developmental formulation traces how developmental issues and related issues contribute to psychotic experience. In this lecture, a personal story of somewhat psychotic experience and then recovery will be told, with some discussion of how things might have gone differently had certain factors been other than they were. This is followed by a more general exploration of how to help people escape both a "psychotic story" and a "psychiatric story" so as to hopefully come back to an "evolving human story."

Helping Solve Problems With Voices, Visions, Etc.

Introduces a different attitude toward "hallucinations".....

This lecture explores some of the problems that can arise when efforts are focused too much on the suppression of voices and other "hallucinations," and then outlines a different approach based on a combination of limit setting with acceptance.

The continuum of thoughts, dissociative experience and voice hearing

Most people with voices do best if they learn a variety of coping strategies. Some of the basic ones are outlined in this lecture.

Some people may find that hearing voices groups go well alongside CBT, while others may find these groups may be the primary support they need in working toward recovery! Learn a bit more about that.....
Developing a compassionate voice
Strategies for paranoia and troublesome beliefs

How do CBT therapists understand paranoia, and how do they work with it? Learn strategies to talk about paranoia in a helpful way and to explore it further.

Watch an experienced CBT therapist, Dr Kingdon, explore a client's paranoia using CBT strategies.

What are delusions, from a CBT perspective? This lecture reviews some of the difficulties in defining delusions and some CBT approaches to those difficulties.

How do CBT therapists work with people who seem to be delusional? This lecture outlines four different strategies that may be used at different times.

This lecture covers some approaches to helping people who helping people who seem to be delusions without directly challenging the beliefs themselves.

In this video, a person with an entrenched belief is interviewed by a CBT therapist to discover what preceded that belief, and to obtain the story of how it developed.

When a person is ready for it, exploring the evidence both for and against the belief can be helpful. This video will give you ideas about how to do that.

Watch an experienced CBT therapist help a client develop a plan for carrying out a test that might support or fail to support a particular belief.

Delusions are often framed as just "sick" beliefs to be eliminated by treatment, but many have found they are more like dreams - not to be taken literally, but very meaningful in a metaphorical way.  Treatment is about both unhooking from unhelpful literal interpretations, while discovering deeper meanings that help people move on with their lives.

When thoughts are out of order, & affect and engagement seem missing...

This lecture addresses both possible understandings of what is going on within "thought disorder" as well as strategies for working with people who are thinking and talking in this way.

Explore some possible purposes served by "negative symptoms" and then some CBT strategies for helping people overcome them.

Wrapping things up

Learn how to help people develop an individualized relapse prevention plan, which includes ideas about how to respond to, but not over-react to, the return of various kinds of problematic experiences.

Now that you know something about CBT for psychosis, how will you fit it into what you and perhaps your agency are already doing? This lecture will give you some ideas about how to do that, as well as outline some areas for future progress.

Homework is a key part of CBT, including CBT for Psychosis. Learn how to structure it into every session.

Also, it's time to think about your own "homework" as you develop your plan to put the ideas you learned in this course to work!

While this course can get you started with CBT for Psychosis, you can anticipate requiring further training in order to be a proficient practitioner. This lecture will give you some ideas about where to look to seek such training.

Resource Document for learning more about CBT for Psychosis
To Download the PowerPoint Slides

Good to know

Know what's good
, what to watch for
, and possible dealbreakers
Offers practical techniques for therapists to integrate CBT into their practice when working with individuals experiencing psychosis, which can improve patient outcomes
Emphasizes a collaborative approach, teaching learners how to work alongside individuals with psychosis to explore solutions rather than imposing beliefs, which fosters trust and engagement
Explores the use of normalizing explanations to reduce fear and increase hope, which can empower clients to feel more in control and connected to others
Requires further training to become a proficient practitioner, which may necessitate additional time and resources beyond the scope of this course
Examines the use of formulations, including ABC, kite diagrams, spiral, and compassion-focused approaches, to nurture hope and provide direction for recovery efforts
Presents strategies for addressing paranoia and troublesome beliefs, including exploring the evidence for and against beliefs, which can help clients develop more balanced perspectives

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Activities

Be better prepared before your course. Deepen your understanding during and after it. Supplement your coursework and achieve mastery of the topics covered in CBT for Psychosis with these activities:
Review the Basics of Cognitive Behavioral Therapy
Strengthen your understanding of core CBT principles to better grasp the nuances of its application to psychosis.
Show steps
  • Read introductory materials on CBT.
  • Watch videos explaining CBT techniques.
  • Summarize the key principles of CBT.
Watch Video Demonstrations of CBT Techniques
Observe experienced therapists applying CBT techniques in real-world scenarios to enhance your understanding and skills.
Show steps
  • Search for videos demonstrating CBT for psychosis.
  • Focus on videos showing specific techniques.
  • Take notes on the therapist's approach and techniques.
Review: "Cognitive Behavior Therapy for Psychosis: Theory and Practice"
Gain a deeper understanding of the theoretical underpinnings and practical applications of CBT for psychosis.
Show steps
  • Read the book's introduction and overview chapters.
  • Focus on chapters relevant to specific symptoms.
  • Take notes on key concepts and techniques.
Four other activities
Expand to see all activities and additional details
Show all seven activities
Practice Role-Playing CBT Techniques
Solidify your understanding of CBT techniques by practicing them in a safe and supportive environment.
Show steps
  • Find a partner interested in CBT for psychosis.
  • Choose a specific technique to practice.
  • Role-play a therapy session, alternating roles.
  • Provide constructive feedback to each other.
Review: "Overcoming Distressing Voices: A Self-Help Guide Using Cognitive Behavioral Techniques"
Learn practical strategies for helping individuals manage distressing voices using CBT techniques.
Show steps
  • Read the chapters on understanding voices.
  • Practice the exercises for managing voices.
  • Reflect on the book's insights and strategies.
Create a Case Study Presentation
Apply your knowledge by developing a detailed case study demonstrating the application of CBT principles to a specific individual with psychosis.
Show steps
  • Choose a hypothetical or anonymized case.
  • Develop a formulation based on CBT principles.
  • Outline the treatment plan and interventions.
  • Create a presentation summarizing the case.
Develop a CBT for Psychosis Resource Guide
Create a comprehensive resource guide for individuals with psychosis and their families, incorporating CBT principles and techniques.
Show steps
  • Research available resources on CBT for psychosis.
  • Organize the resources into categories.
  • Write brief descriptions of each resource.
  • Design the guide for easy readability and accessibility.

Career center

Learners who complete CBT for Psychosis will develop knowledge and skills that may be useful to these careers:
Mental Health Counselor
Mental health counselors provide guidance to individuals and groups who are dealing with issues that affect their mental health and well-being. This course helps mental health counselors better understand and treat individuals experiencing psychosis. By learning evidence-based CBT approaches, counselors can more effectively reduce distress and disability related to psychotic experiences. The course's focus on normalizing psychotic experiences and developing collaborative solutions aligns directly with the goals of mental health counseling, allowing counselors to provide more compassionate and effective care. The course helps build a strong foundation for supporting clients on their journey to recovery.
Clinical Psychologist
Clinical psychologists assess, diagnose, and treat mental, emotional, and behavioral disorders. This course helps clinical psychologists expand their toolkit with Cognitive Behavioral Therapy (CBT) techniques tailored for psychosis. The ability to create formulations that promote hope and utilize a collaborative style learned here helps psychologists engage in guided discovery of solutions to distressing psychosis-related problems. The course's detailed exploration of CBT applications for specific problem areas, such as hearing distressing voices and paranoia, provides valuable strategies for clinical practice. A clinical psychologist working with psychosis may find the strategies presented in the course to be extremely helpful in their practice, whether in research or private consultations.
Psychotherapist
Psychotherapists treat mental and emotional disorders through the use of psychological techniques. This course may help psychotherapists integrate evidence-based CBT approaches into their practice, specifically for clients experiencing psychosis. The course's learning objectives, such as creating formulations that promote hope and engaging in guided discovery of solutions, align directly with the goals of psychotherapy. The various techniques presented in the course can also improve outcomes in a clinical setting. This is a very useful course for any psychotherapist looking to expand their practice and the services they offer.
Psychiatric Nurse
Psychiatric nurses specialize in the care of individuals with mental health conditions. This course may help psychiatric nurses integrate psychological approaches with existing treatment methods. Psychiatric nurses can apply the learning objectives from this course, such as normalizing psychotic experiences and using collaborative problem-solving, to improve patient outcomes. The course emphasizes understanding psychotic experiences within an individual's life story, which helps psychiatric nurses provide more personalized and holistic care. Learning to use language to promote normalizing is helpful for those in this role.
Social Worker
Social workers often work with vulnerable populations, including individuals experiencing mental health challenges. This course may allow social workers to broaden their understanding of psychosis and the application of CBT techniques. By learning to identify ways to normalize psychotic experiences and create formulations that promote hope, social workers can better advocate for and support their clients. The course's emphasis on collaborative problem-solving aligns with the social work values of empowerment and client-centered care. It also helps them explore ways of integrating psychological approaches with existing treatment methods.
Researcher
Researchers design and conduct studies to investigate various aspects of mental health, including the effectiveness of different treatment approaches for psychosis. This course may help researchers gain a deeper understanding of CBT principles and techniques, informing the design and implementation of research projects. By learning about the lived experiences of individuals with psychosis and the factors that contribute to recovery, researchers can develop more relevant and impactful research questions. This course may also illuminate ways to integrate psychological approaches into existing research methodologies. An advanced degree, such as a PhD, is typically required.
Rehabilitation Counselor
Rehabilitation counselors work with individuals who have disabilities, including mental health conditions, to help them achieve their personal and vocational goals. This course may help rehabilitation counselors enhance their understanding of psychosis and its impact on an individual's ability to function. By learning CBT techniques aimed at reducing distress and promoting recovery, rehabilitation counselors can better support their clients in achieving meaningful outcomes. This course may help rehabilitation counselors integrate psychological approaches with existing treatment methods.
Occupational Therapist
Occupational therapists help individuals develop and maintain the skills needed for daily living and working. This course may provide occupational therapists with insights into the cognitive and emotional challenges faced by individuals with psychosis. The focus on reducing distress and disability related to psychotic experiences can inform occupational therapy interventions aimed at improving functional outcomes. The material in the course around developing a collaborative style to engage in guided discovery of solutions to distressing psychosis-related problems can be applied to many therapeutic interventions.
Case Manager
Case managers coordinate services and support for individuals with complex needs, including those with mental health conditions. This course may provide case managers with a better understanding of the challenges faced by individuals with psychosis and the potential benefits of CBT. The knowledge gained from this course can inform case management strategies aimed at improving access to appropriate services and promoting recovery. The course's discussion of collaborative problem-solving helps case managers work more effectively with clients and treatment teams. They will also have a better understanding of how to integrate psychological approaches with existing treatment methods.
Crisis Counselor
Crisis counselors provide immediate support to individuals experiencing acute mental health crises. This course may give crisis counselors valuable tools for de-escalating situations involving individuals with psychosis. The emphasis on understanding psychotic experiences within an individual's life story can help crisis counselors respond with greater empathy and effectiveness. By learning techniques for collaborative problem-solving, crisis counselors can help individuals develop coping strategies and access appropriate resources. Crisis counselors will also better understand how to integrate psychological approaches with existing treatment methods.
Addiction Counselor
Addiction counselors guide individuals through substance abuse recovery. This course may help addiction counselors understand the co-occurrence of psychosis and addiction. The techniques taught could be transformative in such cases. Knowing how to reduce distress and disability related to psychotic experiences helps create more effective treatment plans. They will also better understand the need to normalize psychotic experiences and promote treatment adherence. This course may help them integrate psychological approaches with existing treatment methods.
Marriage and Family Therapist
Marriage and family therapists provide therapy to couples and families dealing with a range of issues. This course may allow marriage and family therapists understand how psychosis can impact family dynamics and relationships. By learning CBT techniques for reducing distress and promoting recovery, therapists can help families develop healthier coping mechanisms and communication patterns. The course's focus on collaborative problem-solving aligns with the principles of family therapy, promoting shared understanding and mutual support. Marriage and family therapists may also be better positioned to integrate psychological approaches with existing treatment methods.
Pastoral Counselor
Pastoral counselors provide counseling services within a religious or spiritual context. This course may provide pastoral counselors with insights into the intersection of faith, spirituality, and mental health, particularly in relation to psychosis. By learning to normalize psychotic experiences and promote hope, pastoral counselors can offer compassionate support to individuals struggling with these challenges. The course's emphasis on collaborative problem-solving aligns with the values of many faith traditions, encouraging individuals to find meaning and purpose in their lives. Pastoral counselors may also find value in how to integrate psychological approaches with existing treatment methods.
Guidance Counselor
Guidance counselors typically work in schools or educational settings, helping students with academic, personal, and social development. This course may give guidance counselors a better understanding of the mental health challenges that some students may face, including those related to psychosis. By learning to identify ways to normalize difficult experiences and promote hope, guidance counselors can create a more supportive and inclusive school environment. The course's emphasis on collaborative communication skills and guided discovery can enable guidance counselors to better encourage students to seek support who may need it. Counselors may also find this course useful for understanding how to integrate psychological approaches with existing student services.
Community Health Worker
Community health workers serve as liaisons between communities and healthcare providers, often working with underserved populations. This course may empower community health workers with knowledge about psychosis and evidence-based approaches like CBT. By learning to create formulations that promote hope and utilize a collaborative style, community health workers can play a key role in connecting individuals with mental health services and promoting wellness within their communities. This course may also provide the basic knowledge to integrate psychological approaches with existing community support programs.

Reading list

We've selected two books that we think will supplement your learning. Use these to develop background knowledge, enrich your coursework, and gain a deeper understanding of the topics covered in CBT for Psychosis.
Foundational text in CBT for psychosis. It provides a comprehensive overview of the theory and practice of CBT for individuals experiencing psychosis. It is commonly used as a textbook in academic settings and by clinicians seeking to deepen their understanding of this specialized area. This book adds depth to the course by providing detailed case studies and practical guidance.
Provides practical, step-by-step guidance on using CBT techniques to manage distressing voices. It is written in an accessible style and is suitable for both clinicians and individuals experiencing voices. This book expands on the course material by providing specific strategies for addressing auditory hallucinations and promoting self-management.

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