The phenomenology of emotion experience in first-episode psychosis.

BACKGROUND: Although it has been suggested that disturbances in emotion experience and regulation play a central role in the aetiology and psychopathology of schizophrenia spectrum disorders, the phenomenology of emotion experience in schizophrenia remains under-researched. SAMPLING AND METHODS: In-depth interviews were conducted twice with each of the 20 participants (firstly at admission and secondly 6 months later). Data collection and analysis were guided by the principles of phenomenological study of lived experience. RESULTS: The emotion experiences described by our participants vary greatly in both quality and intensity, but appear to have a common phenomenology. Anxiety is reported as the basic emotion which buffers, transforms and sometimes supplants all others. Emotions in general are experienced as foreign, unstable and perturbing, thereby contributing greatly to feelings of ambivalence, perplexity and an unstable sense of self in general. CONCLUSIONS: The findings of this study have important therapeutic and theoretical implications because they suggest that emotion experiences in schizophrenia spectrum disorders may underlie a wide range of psychopathological phenomena in both the cognitive and social functioning domains. Due to the relatively small sample size and its selection from psychotherapeutic units, the results may not be generalizable to all schizophrenia patients.

Cognitive-behavioral therapy for schizophrenia: a critical evaluation of its theoretical framework from a clinical-phenomenological perspective.

BACKGROUND: Cognitive-behavioral therapy (CBT) has played an increasingly important role in psychotherapy for schizophrenia since the 1990s, but it has also encountered many theoretical and practical limitations. For example, methodologically rigorous meta-analyses have recently found only modest overall effect sizes of CBT treatment, and therefore questions have emerged about forwhat and for whom it actually works. METHOD: The focus of the present paper is to elucidate the theoretical assumptions underlying CBT for schizophrenia and to examine their consistency with abnormalities of experience and self-awareness frequently reported by schizophrenia patients and systematically studied in phenomenological psychopathology from the beginning of the 20th century. RESULTS: We argue that a strong theoretical emphasis on cognitive appraisals with only subsidiary attention devoted to affective and behavioral processes - as is characteristic of many forms of CBT - cannot satisfactorily account for the complex subjective experiences of schizophrenia patients. We further argue that certain theoretical strategies widely employed in CBT to explore and explain mental disorders, which involve atomization and, at times, a reification of mental phenomena, can be problematic and may result in a loss of explanatory potential. Finally, we provide a detailed account of how negative symptoms and delusions are conceptualized in CBT and consider the question of how these concepts fit the actual phenomenology of schizophrenia. CONCLUSION: We suggest that further advancement of CBT theory and practice can benefit from a dialogue with phenomenological psychiatry in the search for effective psychotherapeutic strategies for schizophrenia patients.

Psychopathology of schizophrenia in Ljubljana (Slovenia) from 1881 to 2000: changes in the content of delusions in schizophrenia patients related to various sociopolitical, technical and scientific changes.

BACKGROUND: Clinical observations and research have found the content of delusions in schizophrenia to be sensitive to sociopolitical and cultural factors. AIMS: The aim of this retrospective case-note study was to determine changes in the frequencies of various contents of delusions in schizophrenia patients over time. METHODS: A total of 120 records of first-time admission schizophrenia patient at Ljubljana's psychiatric hospital in the period from 1881 to 2000 were randomly selected. Information was taken from each record to fill out a form specially created for this study. The frequencies of delusions with regard to their content in various time spans were compared. RESULTS: A marked increase in two delusional themes--persecution and self-reference--was found after the change of political regime (1941-2000) in Slovenia. After the spread of radio in the 1920s and television in the 1950s in Slovenia, there was an obvious increase in delusions of outside influence and control as well as delusions with technical themes. A striking increase in the percentage of Schneiderian first-rank symptoms was found after the spread of Schneider's ideas in the 1950s. CONCLUSIONS: Sociopolitical changes and scientific and technical developments have a marked influence on the delusional content in schizophrenia.