ABSTRACT
This report consists of the personal reflections of seven frontline clinicians who participated in a formal training program for the psychotherapy of psychosis implemented in a large public clinic setting. The training was part of a quality improvement initiative, consisting of 12 hours of didactic presentation followed by 30 hours of weekly peer-group supervision. The clinicians comment on ways of working with patients prior to the training, and how their views and techniques changed as a result of the training. The reflections of frontline staff provide proof of the concept that psychotherapy for psychosis techniques can be added to existing clinical skills, and that it is possible to implement a program in psychotherapy for psychosis in a busy public clinic.
Subject(s)
Community Mental Health Services , Community Psychiatry , Hospitals, Municipal , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Public Health Practice , Adolescent , Adult , Child , Child Abuse, Sexual/diagnosis , Child Abuse, Sexual/psychology , Child Abuse, Sexual/therapy , Child, Preschool , Cognitive Behavioral Therapy/education , Cognitive Behavioral Therapy/methods , Community Psychiatry/education , Cross-Cultural Comparison , Curriculum , Hospitalization , Humans , Life Change Events , Male , Milieu Therapy/education , Milieu Therapy/methods , Physician-Patient Relations , Psychiatric Department, Hospital , Psychotic Disorders/diagnosis , Schizophrenia/diagnosis , Schizophrenia/therapy , Schizophrenic Psychology , Treatment Outcome , United Kingdom , United StatesABSTRACT
The concept of cognitive insight was introduced in 2004 to describe the capacity of patients with psychosis to distance themselves from their psychotic experiences, reflect on them, and respond to corrective feedback. The Beck Cognitive Insight Scale (BCIS) was developed to evaluate these aspects of cognitive flexibility and to complement scales that describe the lack of awareness of mental illness and its characteristics. The BCIS has generated a moderate research literature, which is the subject of the current review. Several independent groups have demonstrated that the BCIS is reliable, demonstrates convergent and construct validity, and distinguishes patients with psychosis from healthy controls and patients without psychosis. While the majority of the studies have focused on the relationship of the BCIS to delusions, several have examined its relationship to negative symptoms, depression, anxiety, and functional outcome. Cognitive insight has predicted positive gains in psychotherapy of psychosis, and improvement in cognitive insight has been correlated with improvement in delusional beliefs. Finally, preliminary findings relate neurocognition, metacognition, and social cognition, as well as reduced hippocampal volume to cognitive insight. A heuristic framework is presented to guide future research.
