Psychotic disorders generally have psychopharmacology as the first treatment of choice, and antipsychotics are most commonly used in these cases for the positive or psychotic symptoms of these disorders; however, psychotropic drugs were not very effective for the negatives, so they must be supplemented with psychological treatment.
Psychological treatments for psychotic disorders have been shown to be effective in treating negative symptoms of psychosis, with different treatments to work on learning social skills, family therapy, psychoeducational interventions or cognitive rehabilitation, among others.
In this article, we’ll take a brief look at some of the psychological treatments for psychotic disorders which are mainly used in the field of clinical psychology.
1. Psychoeducational interventions for psychotic disorders
Before explaining the psychological treatments of psychotic disorders, it is necessary to underline the psychoeducational interventions which are carried out in order to provide important information to the population and, in particular to people suffering from a certain type of psychosis and to their relatives, concerning the treatments available and also be able to clarify the problems associated with psychosis.
These psychoeducational interventions also aim to provide people with psychotic disorders with strategies to learn how to best manage their disorder, as well as other difficulties that may result from their disorder so that they can do so. lead a normal life. Psychoeducational interventions are also often used to improve adherence to some of the psychological treatments for psychotic disorders, as well as to prevent the risk of relapse.
Psychoeducational interventions can be performed in a variety of formats (individual, group, family, etc.) and typically take an average of 12 sessions, although shorter interventions of 10 sessions have also been found with good results.
It should be noted that Family psychoeducational interventions for psychotic disorders are crucial during the early stages of a psychotic disorder, once detected and diagnosed, as they are beneficial for the stabilization and restructuring of the patient’s environment, as well as for relatives to understand in more detail what mental disorder the family member is suffering from and can serve the support. so that they acquire the resources and orientations necessary for the management of the disorder and the prevention of relapses.
2. Social skills training for psychotic disorders
There are several psychological treatments for psychotic disorders based on training the patient’s social skills; therefore, we will highlight the most well-known below.
2.1. Generic social skills training
This type of social skills training is usually done in groups, following a behavioral orientation based on the social learning model, the psychotherapist is therefore responsible for involving the patients in the training of interpersonal skills during the group sessions.
Among the skills trained are: verbal and non-verbal communication, learning appropriate responses in a social context, assertiveness training, etc.
2.2. Cognitive-behavioral social skills training
This treatment is known worldwide for its English name “Cognitive Behavioral and Social Skills Training” (CBSST) and techniques for learning social skills similar to those used in classical generic models are used in their interventions.; however, this treatment is distinguished by the implementation of cognitive-behavioral techniques (eg, cognitive restructuring, behavioral experiences, Socratic dialogue, etc.).
2.3. Social skills training based on the UCLA-FAST model
This model of social skills training was implemented by the University of Los Angeles and consists of a classic training in social skills, which we find in other models, as well as interventions in psychoeducation, work in relapse prevention and skills training for a good development in the activities of daily living (eg, taking medication correctly, working, or even being able to live independently).
2.4. Cognitive and social skills training
This treatment was referred to by its creators as “Social Cognitive Skills Training” (SCST) and was developed based on work with the cognitive-social processes of patients with psychotic disorders such as train the skills of theory of mind or emotion perception.
It should also be noted that this qualifying training makes it possible to work with computer programs or videos to facilitate the learning of social responses, while allowing the patient to repeat the process as many times as necessary.
As you can see, there are many forms of social skills training; however, there are specialist guides to the evidence for psychological treatments that recommend that social skills training not be the only option, but that it be complemented by other treatments for psychotic disorders, as well as drugs prescribed by a specialist for the positive symptoms of schizophrenia.
However, these interventions show promising results, so they could be a good cost-effective option to treat the negative symptoms of psychotic disorders within mental health systems, such as in the public health system where, due to lack of resources and support. Sufficient staff, like the small number of psychologists present in the different hospitals, social skills training could be a good alternative for working in groups.
3. Family therapies for psychotic disorders
Psychological treatments for psychotic disorders include family therapy and, as already mentioned, support from the patient’s family is essential for a better prognosis.
Within family therapy for psychosis, there are several alternatives, so it is usually the patient and their loved ones who decide which type of family intervention they prefer. Some of the options that should be highlighted include the following:
- Single-family or multi-family interventions.
- Family interventions in which the family member with the psychotic disorder is present or not.
- Whether they are guided by a member of the clinical team and serve as a liaison with the team, or with the team on the fringes.
- Focused only on psychoeducation, including cognitive processing or other forms of psychotherapy.
This type of psychological treatment for psychosis they usually last between 3 and 7 months, with at least 10 sessions.
It is important to note that psychological interventions in the family format are the most studied interventions for the treatment of psychotic disorders and have shown high empirical validity.
4. Cognitive-behavioral therapy for psychotic disorders
Among the psychological treatments for psychotic disorders, one of the most widely used options is cognitive behavioral therapy, given its proven effectiveness for many mental disorders.
Cognitive behavioral therapy for psychosis mainly focuses on two aspects: help the patient and his relatives to understand the disorder and the positive symptoms of psychosis and, on the other hand, to work on cognitive patterns the patient who is very likely to interfere with the emotional disorder that a person with a psychotic disorder usually suffers from.
5. Cognitive therapy to treat hallucinations and delusions
Another psychological treatment for psychotic disorders is “belief modification therapy” which the fundamental objectives are two types of interventions (verbal challenge and reality test) through cognitive restructuring.
The verbal challenge is to help the patient with psychosis to modify the content of his distorted beliefs. This is why the psychologist must adopt a non-confrontational position, so that the patient’s beliefs are gradually graduated.
Proof of reality it is used to verify the delusional belief of the patient through an empirical test which serves to refute by confirming this belief.
These two techniques are often used together; moreover, it has been proven that the reality test alone is not effective, whereas if it is preceded by the verbal challenge technique, it is effective, having proved that the latter is the most effective component of the treatment. .
6. Psychological treatments of the latest generation of psychotic disorders
Two innovative psychological treatments for psychotic disorders will be briefly described below.
6.1. AVATAR therapy
This is a new psychological therapy whose main objective is to help reduce discomfort and the frequency with which they appear. verbal hallucinations that are resistant to antipsychotic drugs in patients with psychotic disorders.
During sessions of this therapy, a three-way interaction takes place (between the psychologist, the patient, and a computer software representation of the entity the patient thinks he is talking about). This software has been programmed to transform the psychologist’s voice and achieve the same timbre and tone once the patient hears in the head.
Within this therapy he seeks to allow the patient to interact with the voice he hears in his head and thus be able to face the negative and pejorative comments that he hears in mind in order to modify his relationship with them and thus pay them less attention.
This innovative therapeutic modality has adopted a relational and dialectical approach in order to work on the relationship with negative auditory hallucinations. On the other hand, this therapy does not directly seek to make the voices disappear in the head, but focuses on working on the patient’s relationship with the voices that appear in his mind in order to strengthen the feeling of control over the voices by part of the patient.
So far, two clinical trials have been conducted with good short-term results, although more research remains to be done, as long-term evidence has not been sufficient.
6.2. The HORYZONS project
This project was developed in order to facilitate access to psychological treatments for psychotic disorders for young people. This project was created from the model known as ‘Moderate Online Social Therapy’ (MOST) and is a model of psychological interventions via the Internet that uses technology to extend traditional psychosocial interventions to more people. people. To do this, it uses an online platform that provides access to various psychosocial interventions with the help of psychologists.
The HORYZONS project, although quite recent, has shown through a study very promising results, because the online intervention can be very useful, by its easy access, for young people who have suffered a first psychotic episode. Additionally, the study found that there were few dropouts and a high degree of patient satisfaction and a controlled clinical study is underway that will take five years to investigate its long-term effectiveness.