How to deal with delusions? Under cbt.

Counseling sessions and CBT therapy would be better for you concern.

you can contact me through online appointment for further assistance

"In CBTp, the therapeutic process is conceptualized through a series of essential steps that can help reduce the patient‘s symptoms and disability by changing beliefs about these symptoms. In CBTp, the development of a strong therapeutic alliance is essential to the success of the treatment. The therapist takes an approach of ―collaborative empiricism,‖ working together with the patient as equals to better understand their experiences, thoughts, feelings and goals. The therapist utilizes empathy and normalizing to engage the patient, and works to understand the problem as the patient sees it. Rather than using an authoritative, directive, or exert style, the therapist uses what is called ―Columbo Style‖ (after the famous television detective) to gently help the patient describe their experiences, how they arrived at their conclusions, and how they developed their specific beliefs. Engagement continues throughout the therapeutic relationship, but can be thought of as the first step in the therapeutic process. The therapeutic process of CBTp is outlined below: Engagement: Empathy, normalizing, resolving ambivalence, & Columbo style Assessment: Understanding the first episode in detail, ABC assessment model, & narrative approach Formulation: Information on current beliefs and how the patient were arrived at these beliefs is assembled into a formulation. The goal of formulation is to develop a shared psychological understanding of the patient‘s problem(s)/symptom(s) Goals: Goals are based on the patient‘s problem list and formulation Interventions: Set appropriate interventions and evaluate effectiveness (e.g. reality testing/behavioral experiments; focusing on reasoning style, schema, and automatic thoughts) Relapse Work: Relapse cognitions, assessment, personal pattern of relapse, and relapse prevention interventions Within each session, maintaining the CBTp structure is crucial, as it maximizes predictability (thereby decreasing anxiety), increases patient investment and involvement in the treatment, helps exercise memory and meta-cognitive skills, and serves as a role model on how to behave/function. Below is an outline of CBTp session structure. In the first few minutes of the session, the patient and the therapist:  Complete mood check.  Quantify symptom severity.  Set up session agenda.  Set up order of topics to be discussed. During the session, the therapist:  Reviews homework assignment (if applicable).  Assesses progress during session and transitions.  Relates topics discussed to previous sessions.  Relates topics discussed to agenda of entire treatment. Then, in the final minutes of the session, the following points are addressed:  Review topics that were discussed in the session.  Make plans for next session.  Assess patient‘s view of the session (what was helpful what was not helpful?)  Complete mood check.  Review homework assignment (if applicable). " B1. Understanding Delusions Karl Jaspers, one of the key figures in psychosis research, theorized that a delusion is a combination of sensory experience and implicit meaning and is incomprehensible due to its origin in direct experience of new meaning. This also led to a belief that delusions are impossible to work with because we cannot understand them (Jaspers, 1963). Delusions can be perceptual or reasoning deficits and biases that cause an individual to misunderstand what is happening in the world (Bental, 1994; Frith, 1992; Blackwood et al., 2001). They can also be motivated beliefs that serve some intra-psychic function: paranoid delusion may be a product of complex processes of defense against negative schemata and in order to protect self-esteem (Chadwick et al., 1996; Taylor & Kinderman, 2002) (Faught & Parkinson, 1979). Another way to perceive delusions is complex behaviors contributing to formation and maintenance of beliefs: isolation, avoidance, not sharing feelings and experiences (Freeman et al., 2005; 2001). More recent understanding of delusions has been more positive: Maher asserted that impossible explanations are rather common in general, and delusions are attempts to make sense of abnormal experiences (Maher, 1974) (Maher, 1988). In essence, Maher claimed that a delusional person‘s ability to apply logic to their experience is perfectly functional – their experiences cannot be explained otherwise. Indeed, magical explanations for external phenomena are also quite common, as evidenced by one survey that indicated over 25% of respondents believed in ghosts, over 50% believed in foretelling of the future, over 50% believed in telepathy, over 60% believed in God, and over 85% believed in angels (Gallup & Jones, 1989) Thus, illogical explanations themselves are not indicative of delusions, but certain cognitive mechanisms underlying such beliefs can indicate delusions. Finally, the most recent breakthrough in the study of delusions came with the application of cognition to the understanding of the role of attentional, attributional, and reasoning biases (Richard P. Bentall, 1992; Freeman & Garety, 2003)(Garety, 1989). The cognitive processes (or cognitive biases) that may be related to the formation and maintenance of delusional beliefs include: a tendency to jump to conclusions; emotional reasoning; decreased belief flexibility; negative beliefs about self; theory of mind deficits; tendency to make external personal attributions for negative events; selective attention to threat.B2. Working with Delusions When working with patients displaying delusions, the therapist may need to concentrate on working with cognitive biases prior to working with delusional content. In the context of the therapeutic relationship, the following techniques may be employed: B2.a. Delusion–specific assessment of beliefs: In assessing beliefs, a comprehensive understanding of the patient’s belief structure must be obtained, including: ● Content ● Conviction ● Preoccupation ● Distress (emotional impact) ● Behavioral impact (safety behaviors) ● Current triggers ● Initial formation ● Positive and Negative Consequences ● Current coping strategies B2.b. Formulation: After the belief is assessed, a formulation must be made collaboratively with the patient. Reasons for adapting the belief must be weighed against the reasons for maintaining the belief, which will help build a foundation from which to challenge the belief.B2.c. Re-evaluating beliefs: Here it is vital to help the individual review the evidence they have presented. Start with evidence for the delusions on a day-to-day basis. It can be helpful to offer alternative explanations for the patient‘s beliefs, and to gently point out inconsistencies and fallacies in the patient‘s belief structure. The alternative explanation can either be pointed out by the therapist or elicited from the patient. Through this collaborative process, the therapistencourages the patient to weigh out delusional beliefs and alternative interpretations in the light of available evidence. Remember that delusion is a reaction to puzzling or threatening experiences, and thus it follows that the patient would attempt to find meaning when frightened, anxious, or confused. Offering alternative explanations may reduce these feelings. B2.d. Reality testing: Encourage the patient to engage in specific behaviors for the purpose of testing the validity of her/his belief. Make predictions about external events so that outcome of these events could serve as tests of those predictions. The therapist will develop an experiment collaboratively with the patient. The following questions should be considered when devising the experiment. ● What is the thought that you need to test out? ● What would be a good way of finding out what you need to know? ● What exactly information is needed? ● How may this be measurable?After the experiment: ● How does the outcome relate to the original thought? ● How much do you believe that thought now? ● To what extent were your original predictions confirmed or disconfirmed? ● On the basis of the experiment, what is the most realistic and helpful view of the situation? The ―3 C‘s‖ is one way to teach patients to begin practicing reality testing on their own. An outline of the process is below. Catch It:  What is the automatic thought?  What was going through your mind?  Is this thought helping me reach my goal? Check It:  How did it make you feel/do?  What is the evidence for/against it?  What would you say to a friend with that thought?  Is this a mistake in thinking (e.g., ―jumping to conclusions‖; ―all or none‖)? Change It:  What is an alternative? Another possibility?  Could you think anything else about it?  Does the new thought help you reach your goal? B2.e. Verbal Challenges of Delusions: In CBTp, clinicians verbally challenge patients‘ delusions in a gentle and unintimidating manner. The therapist can gently point out inconsistencies in the patient‘s belief system and then elicit alternative interpretations of the evidence. If necessary, the therapist can also gently offer alternative explanations. The therapistthen encourages the patient to weigh out the delusional beliefs and the alternative beliefs in light of the existing evidence. B2.f. Normalizing Cognitive Processes: To help patients make sense of and deal with delusions, the therapist needs to convey that a delusion is a reaction to a puzzling or threatening experience, such as hearing a voice or panic. The therapist portrays the delusion as a reasonable attempt to find meaning when the patient was frightened or anxious, and highlights that in the moment it functioned to reduce the sense of confusion and feelings of fear" (Source R Paper)

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This diagnosis is made when a client's shows both features of psychotic and features of obsessive features. But my question to u will be how do u know your diagnosis and what led u to know about schizoeffctive disoder.  Bcz most people with psychological illness read much about these, and which led them to more Anxiety. First advice will be stop reading about it and if you are having delusion than medication is best treatment for sometime and than therapy will be used to control obsessive nature. But with your cases i still believe diagnosis is important.

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