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Willy
Senior Contributor

Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

CBT-p offers a drug free intervention for people suffering from psychotic mental illnesses such as bipolar disorder and schizophrenia.

Two and a half years ago I made a post on this forum explaining a little about CBT-p and asking for help in finding a suitable practitioner. Rather than repeating this information, here is a link to that post.

My previous CBT-p post 

 

The situation since seems to have changed very little. Many people seem to think that CBT-p is a good idea for people suffering from psychotic mental illness but there appears to be little or no competent resources available in Australia. By comparison, CBT-p is readily available in the UK under their national health scheme.

 

A couple of years ago, JJMary responded to my original CBT-p post on this forum with the following-
Perhaps you might find it useful to do an online course on it yourself, in a way of self-help understanding? There is an inexpensive one at https://www.udemy.com/.”

 

I undertook this online course consisting of about 5 and half  hours of video lectures plus some power point slides and references. It cost me about $20 and was money well spent. The tutor, Ron Ungar, in my opinion, appears to be a knowledgeable expert in this field.
His blog https://recoveryfromschizophrenia.org/ provides insight into some different aspects and ideas about non pharmaceutical treatment of psychosis.


Even the best of courses only provide information, not treatment. Using this information to try and fix oneself could be likened to do-it-yourself brain surgery. Input from a skilled therapist would seem to be essential in any form of CBT-p service.


I have also been in contact with Eastern Melbourne, Primary Health Network (EMPHN). I was referred to these people as a source of information about CBT-p providers. EMPHN are a federal government body. I think it is important to differentiate between state and federal government organisations when looking at these sorts of things because there are substantial differences in attitudes and policies between them. I have observed this first hand in Victoria where I live. It seems to me that nearly all innovation and development in mental health treatment that has taken place in Australia in recent years has been done at the Federal government level. At the state level it would seems that there is often antagonism to anything that challenges the conservative biomedical model and the pharmacological treatment of mental illness.


Here is an extract from the most recent response from EMPHN

 

You are correct in noting that CBT based therapies and principles have been shown to be effective for a range of mental health conditions, including psychosis. Like most options available to assist with our wellbeing, it is often beneficial to implement a range of treatment strategies as there is no single intervention to fit all circumstances or experiences.
Your question around readily available clinicians with specific CBT for psychosis training is difficult to answer as there are courses and formal training available to clinicians in Australia. Perhaps it’s an area that not many clinicians seek training in or perhaps feel they can adapt their CBT principles in practice to an individual’s circumstance regardless of their diagnosis
If you are looking for support for yourself, the Australia Psychological Society website has a directory of all Psychologists registered in Australia and you are able to search by location and area of expertise, psychosis being one of the search parameters. This may provide an avenue to find clinicians who work with people experiencing psychosis to enquire what principles or therapies they utilise
Please let us know if we can be of further support or guidance.” etc


Some time ago I went through the directory of the Australia Psychological Society and various other online resources. I found a handful of people who claimed expertise in CBT-p and I have communicated with a number of them. What I discovered was that while they may well have completed some theoretical training in CBT-p they invariably have no practical experience and are therefore understandably reluctant to get involved with anybody who is prone to psychosis.


While CBT-p is based on traditional CBT, there are significant differences. Not only does it involve the knowledge and use of some interesting additional techniques but also good clinical and interpersonal skills are required in order to work safely and effectively with people prone to psychosis. These skills can be learnt. From my own experiences, the well trained volunteer Lifeline councillors have these skills but quite a few other mental health practitioners that I have come across do not.


The initial aim of CBT-p is not to replace drug therapy but rather to work along side it if and as  required. It can also offer a viable alternative to drug therapy for those who want it. In other words it provides a choice which in my experience, people in Australia with serious mental illness have seldom had. Any reduction in the existing use of anti-psychotic medication is likely to occur slowly as people who are prone to psychotic episodes become more functional. For many, that in itself would be a very worthwhile goal. CBT-p often seems to be more about managing symptoms rather that trying to prevent or suppress them. It is therefore a very different approach to the biomedical model that typically uses anti-psychotic drugs to try to suppress symptoms. For example, in recent years it has been discovered that many people who have no history of psychosis, experience phenomena such as auditory hallucinations (hearing voices) and are able to integrate these experiences into their normal everyday lives.

Hopefully over time, the use of CBT-p practices, would enable some people to become totally drug free and fully functional.

 

CBT-p is not without its problems and limitations. One of its biggest limitations is that it requires many hours of regular effort over a sustained period of time. For many people with psychotic illnesses who are stabilised on medication, just being able to get out of bed in the morning, shower and take a walk around the block can represent a significant days accomplishment.

 

A CBT-p intervention is therefore likely to be a slow and challenging process for many, particularly in the beginning but there are numerous ways in which it can probably be made easier by building incentives and motivation into a program.

 

The Covid lockdowns have shown that conventional CBT can be delivered as effectively online as with face to face counselling. There seems to me no reason why CBT-p can’t be delivered in a somewhat similar way, possibly using some sort of hybrid approach. If well thought through, this approach could substantially reduce delivery costs compared to face to face arrangements.

 

According to Federal government statistics, about 20% of Australians suffer from mental illness in any one year. This is obviously a huge problem. By contrast only about 0.5% of Australians suffer from psychotic mental illness. This much smaller number of about 125,000 people, together with the common myth that these conditions are incurable is probably the reason why psychotic illnesses have all but been ignored except for pharmaceutical treatment.

 

The cost of psychotic illness however, which is mostly born by the Federal government is anything but trivial. My back-of-envelope calculation puts this cost at around $10 billion per year.

 

By comparison, the cost of setting up and operating a national online CBT-p program would be trivial. Even it it reduces current support costs by only a small amount, it is hard to see how it wouldn’t be a profitable proposition for government. In an ideal world, reducing human suffering should be free of monetary considerations but if it can be achieved at the same time as significant savings in mental health care costs, this would appear to be a windfall.

 

A project like this needs the sponsorship of an organisation like SANE to get behind it and solicit support from the Federal government. The next step after that would be to engage the support and expertise of the psychology departments of one or more Universities. Some Australian Universities have already demonstrated their skills in this area with successful online CBT projects like e-couch , Moodgym, ThisWayUp etc.

 

I would be more than willing to participate as a shared experience user in the development of such a program. I expect that there would also be a ready supply of other volunteers from the 125,000 Australians suffering from psychotic mental illness.

 

A CBT-p service would be a significant step upwards in online mental health service delivery in Australia. It is obviously quite achievable. With a little bit of thoughtful innovation an organisation like SANE Australia could well become a world leader in CBT-p best practices.

 

There is much more I could say on this subject but this post is already getting quite lengthy so I will leave it here and see what interest and feedback follows.

 

Regards

Willy

8 REPLIES 8

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

I have been told about this but have been unable to successfully put it into practice. I agree that to be able to have a way to freely have access to this would help many. Some of us need detailed help.

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

Hi Lucycannon

I don't think you could put this into practice by yourself. As far as I can see you  need a competent guide that you can first build a trusting relationship with. That guide would then hopefully be able to help us navigate through what for most of us would be very unfamiliar territory. 

Regards

Willy

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

Hello @Willy  and @Lucycannon 

I really like your research and determination to repost about the issue Willy. 

 

I believe it is absolutely worthwhile.  I have watched a couple of videos on the subject.  It is so much better to engage with people experiencing times of psychosis, than dump them in the too hard basket and simply medicate ... which happens more often than most like to admit.  

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited. A Silly Idea

I am rather prone to silly ideas that people usually call delusions or hallucinations. Occasionally out of the morass of all the mental chaos and confusion comes something worthwhile or useful

 

The original idea that the "Voices" started talking to me about was  peer-to-peer do- it-yourself CDT-p, without a trained professional councillor. Rather than just dismiss them I started googling around to see if anybody had actually ever attempted to do anything like this. After awhile I came upon a PDF document called Dealing With Psychosis
It says:
Learning new skills is not easy. It is important to have somebody who can support you in the process

Your support person could be a:

  • Health Professional
  • Family Member
  • Close Friend·

Pick someone you feel comfortable with and can trust. You may choose to have a few
different people support you. Some of the skills in this toolkit will be easier to learn
and practice if you have more than one Support Person.

 

If you don’t have a Support Person, you can still use this toolkit and learn new skills.
Some people who have used the toolkit alone said that they found it useful but felt it
would be even better having a Support Person available.

 

A later section of this guide is specifically for the Support Person. Feel free to look
through the For the Support Person section on page 85 if you are curious.

 

The full 115 page guide can be downloaded here if anybody is interested

 

Download Dealing With Psychosis workbook  

 

Does anyone have anymore silly ideas, thoughts, feedback?

Regards

Willy

 

 

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

You know, I was a "guinea-pig" for online CBT years ago. It helped me a lot back then and there's been a lot of time to refine the model. I dunno, maybe it could be a school thing. Could make for a more nutric world.

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

I am aware that there have been a few CBTp trials run by various universities. They typically run for a few months and are a "once off".  Unfortunately I only ever seem to hear about them once they are underway or completed so I have never been able to get into one of these trials.

My investigations via Google show that there is quite a bit of ongoing government sponsored, university run programs like this in the USA, UK and various parts of Europe. The reports are extremely encouraging but nothing like this appears to be happening in Australia at this stage. Why is this so and more importantly, what can be done about it?

I have also been hoping to stumble across an online CBTp program in another English speaking country that I could access. Everything I have come across so far seems to be limited to people in the country or region that sponsors them which is not unreasonable.  

 

I will keep looking and reporting back here what I find. 

 

Any thoughts, ideas or feedback are encouraged. You never know who might be looking at this forum.

 

Regards

Willy

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

Hi Willy,

 

Thanks for your post. It really struck a chord with me, as someone who suffers from schizophrenia.

 

When I followed your link to the recovery from schizophrenia website https://recoveryfromschizophrenia.org/ I found a blog article about an amazing treatment programme for treating persecutory delusions - The Feeling Safe Program.

 

Although my illness is not generally typified by persecutory delusions I have a friend who is very treatment-resistant and consistently posts paranoid persecutory delusions often on social media.

 

I join you in wishing that these kinds of treatments were available in Australia. I would love to see my friend get some relief!

 

As for me, I think I am going to take Ron's course when I get a chance. It looks interesting.

 

Thanks again,

Sol

Re: Cognitive Behavioural Therapy for Psychosis (CBT-p) revisited.

I found Ron Ungar's course quite good. It would take a lot of reading of text books to get that access to that much information, experience and wisdom.

Regards

Willy

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