(June 4, 2019) After decades of use in populations diagnosed with depression, anxiety, or post-traumatic stress disorder, cognitive behavioral therapy (CBT) is starting to become part of the mainstream treatment landscape for individuals with serious mental illness.
CBT is a common form of psychotherapy that helps individuals identify and address negative thought patterns. Practitioners may ask clients to pay attention to how they respond to various situations and keep a journal to track their thoughts. Clients will then develop strategies to recognize when their thoughts are inaccurate, or otherwise leading to unhealthy outcomes. By examining the feelings and beliefs that color symptoms of mental illness or adverse life events, CBT aims to steer a person’s thinking toward a more realistic and positive approach to everyday challenges. CBT is inherently participatory on the part of the person receiving treatment, and involves a significant amount of communication and relationship-building between the client and therapist.
Although CBT has been practiced since the 1960s, its use in treating individuals with psychotic disorders remains relatively uncommon. Even after being designated as an evidence-based practice over the past ten years, CBT for psychosis faces a dearth of trained practitioners that limits accessibility. But with a new appreciation for the social and emotional effects of psychotic disorders that are not typically addressed by medication alone, proponents are finding innovative ways to bring the therapy to more patients.
On May 14, the University of Washington School of Medicine held the first-ever CBT for psychosis training for families and friends of individuals with serious mental illness. The Psychosis REACH (Recovery by Enabling Adult Carers at Home) program is designed to empower those closest to someone with a psychotic disorder through evidence-based techniques, when knowing how to help may feel impossible. The curriculum focuses on normalizing symptoms, appropriate care and communication, and strategies for preventing relapse, and will be offered on an annual basis free-of-charge to participants. A program like REACH not only benefits those caring for a loved one with serious mental illness, but extends components of CBT to a population unlikely to receive them from a formally-trained provider.
The CBT initiative from the University of Washington also includes a CBT smartphone app intervention, called FOCUS, deployed to 20 health centers across the state. The FOCUS app mimics aspects of CBT by actively involving users—and their personal, real-time experiences of mental illness—in treatment. Through prompted self-assessments and reminders, the app helps users cope with symptoms such as mood changes or hallucinations, maintain good sleep hygiene, and adhere to treatment plans. On a broader scale, FOCUS also addresses access issues by bringing principles of CBT to users without the costs associated with seeing a trained provider in-person. The app was shown to have similarly positive effects on recovery, while showing greater ease of beginning and maintaining treatment, compared to a typical group-based intervention.
And fully solidifying a place for CBT tech among the top minds of psychiatry, the FOCUS app served as the basis for a discussion on mobile mental health, or mHealth, at the 2019 American Psychiatric Association Annual Meeting.
CBT and its associated interventions have had a storied past for individuals with psychotic disorders, seeing periods of support, trepidation, and access limitations. However, at a time when innovation and technology are putting more power in the hands of patients and their families than ever before, CBT for psychosis may have finally found its footing.
Jessica Walthall
Research and Advocacy Associate
Treatment Advocacy Center
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