CPG for Psychosocial Interventions in Severe Mental ... - GuÃaSalud

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• Behavioural change has been mediated by cognitive activities. In other words, the systematic alteration and identification of disadaptive cognitive aspects will produce the desired behavioural changes. • The acceptance of reciprocal determinism between thought, environment and behaviour. • The therapy is designed to help people identify, test reality and correct dysfunctional conceptions or beliefs. Patients are helped to recognise the connections between cognitions, affection and behaviour, together with their consequences, to make them aware of the role of images and negative thoughts on maintaining the problem. • The techniques applied in this approach include cognitive restructuring, problemsolving, self-instructional training, etc. In general, environmental manipulations are used in cognitive-behavioural modification, as in other approaches, but here these manipulations represent information feedback tests or experiments that provide an opportunity for people to question, reassess and acquire self-control over disadaptive behaviour, feelings and cognitions, at the same time as they practice trained skills. • The therapeutic relationship is collaborative and the active role of the client is emphasised 26 . Social Skills Training Social skills are understood as the specific response capacities required for effective social performance 27 . Social skills, therefore, are a series of behaviours carried out by an individual in an interpersonal context that express feelings, attitudes, desires, opinions or rights of that individual in a way that adapts to the situation, respecting that behaviour in others, and which generally solve the problems of the situation at the same time as they reduce the probability of future problems to a minimum 28 . Social skills training consists in behavioural learning techniques that permit people with schizophrenia and other incapacitating mental disorders to acquire an interpersonal handling of the illnesses and independent living skills to improve their functioning in the community 29 . The module postulates that social competence is based on a set of three skills: social perceptions or reception skills, social cognition or processing skills and behavioural response or expression skills 30 . Following these premises, social skills training has been included in CBT because it is in this paradigm where work is mainly done on social skills of people with schizophrenia. To be able to acquire this series of attitudes and behaviours, there are social skills training programmes that integrate structured psychosocial interventions, either in groups or individually, or both, created to improve social behaviour and reduce the stress and difficulty in handling social situations. The components of the social skills training procedure are derived from the basic principles of learning that include operational conditioning, experimental analysis of behaviour, the theory of social learning, social psychology and social cognition 29 . There are four key components: • Meticulous behavioural assessment of a list of interpersonal social skills. • Emphasis on both verbal and non-verbal communication. • Training focused on the individual’s perception and on the processing of relevant social situations, as well as the individual’s ability to offer adequate social reinforcements. • Work done at home, as well as the interventions that are carried out in the clinic 8 . 36 CLINICAL PRACTICE GUIDELINES IN THE SPANISH NHS
From another point of view, social skills training can be based on three models: the basic model based on corrective learning, social problem-solving and cognitive rehabilitation 27 . There are very few definitions in literature of any of these three approaches, with respect to their effects on the generalisation of behaviours and the improvement in social functioning 31 . The grounds for using social skills training in schizophrenia are based on multiple empiric and conceptual sources. Social skills and social competence can be considered as protective factors within the stress-vulnerability diathesis model for schizophrenia. Reinforcing the skills and social competence of people with schizophrenia -together with other evidence-based interventions- reduces and compensates the harmful effects of the cognitive deficit, neurobiological vulnerability, stressful events and social maladjustment 29 . Question to be answered • Is cognitive behavioural therapy-based psychological intervention effective in the treatment of people with SMI? The studies found analyse the effectiveness of CBT either aimed at people with SMI and a diagnosis of schizophrenia and related disorders or at people with SMI and a diagnosis of bipolar disorders. No studies have been found that discriminate psychosocial interventions for severe compulsive obsessive disorder or Severe Mental Illnesses as only population. Cognitive-behavioural therapy (CBT) for people with SMI and a diagnosis of schizophrenia and related disorders Jones et al 32 perform a SR comprised of 19 RCTs; quasi-randomised studies were excluded. No trial was able to use a double-blind experiment, due to the difficulties inherent to the concealment process in psychosocial interventions. Out of all the RCTs, 7 studies tried to reduce any resulting bias by using assessors who were unaware of the designation. The duration of the trials varied between 8 weeks 33 and 5 years 34 , but the average duration was approximately 20 months. The 19 trials focused their study on people with psychosis, such as schizophrenia, delirium disorder or schizoaffective disorder, and they all used operative criteria for the diagnoses (DSM III-R, DSM-IV or ICD-10). It was reported that many people suffered other comorbid mental disorders such as depression or anxiety disorder. In only one trial, the duration of the illness was less than 5 years 35 . Some authors intentionally selected people with medication-resistant symptoms 36,37 . The ages of the participants varied between 18 and 65 years old. The following interventions are assessed in this review: • Cognitive-behavioural therapy: this has been used to make reference to different interventions, so the reviewers prepared the following specific criteria to be able to define a cognitive-behavioural intervention as such: – The intervention must represent the establishment of relationships between thoughts, feelings and actions of the person with respect to the symptom in question. – It must also represent the correction of false perceptions, irrational beliefs and reasoning biases of the person in connection with the symptom in question. – It must involve at least one of the following conditions: Control by the person of his or her thoughts, feelings and behaviours related to the symptom in question, and the proposal of alternatives to cope with it. CLINICAL PRACTICE GUIDELINES FOR PSICHOSOCIAL INTERVENTIONS IN SEVERE MENTAL ILLNESS 37
Page 1: Clinical Practice Guidelines for Ps
Page 4 and 5: This CPG is an aid for decision mak
Page 7 and 8: Table of Contents Presentation 7 Au
Page 9 and 10: Presentation Healthcare practice is
Page 11 and 12: Authorship and collaborators CPG de
Page 13: José Manuel Lalana Cuenca. Special
Page 16 and 17: c) SERVICE LEVEL INTERVENTIONS •
Page 18 and 19: A B A A B B B C Psychosocial inter
Page 20 and 21: B B B C A C C 5.3. SERVICE LEV
Page 22 and 23: 20 CLINICAL PRACTICE GUIDELINES IN
Page 24 and 25: independence, quality of life, pers
Page 26 and 27: This guideline is aimed at mental h
Page 28 and 29: Figure 1. Search Strategy Search fo
Page 30 and 31: The highest evidence level found wa
Page 33 and 34: 4. Characteristics of the CPG 4.1.
Page 35 and 36: The main focus of rehabilitation is
Page 37: 5. Psychosocial type rehabilitation
Page 41 and 42: defined as “standard care” or
Page 43 and 44: General global state In the short r
Page 45 and 46: Specific symptoms: when CBT was com
Page 47 and 48: In the systematic review by Kurtz a
Page 49 and 50: Summary of evidence 1- 1- 1- 1- 1-
Page 51 and 52: People with SMI and a diagnosis of
Page 53 and 54: 5.1.3. Interpersonal therapy The li
Page 55 and 56: weekly or fortnightly sessions. The
Page 57 and 58: 5.1.5. Family interventions There a
Page 59 and 60: In the RCT carried out by Hogarty e
Page 61 and 62: A family intervention of more than
Page 63 and 64: After two years’ treatment, and b
Page 65 and 66: Family intervention vs. other psych
Page 67 and 68: 1- 1- 1- 1- 1- 1- 1- 1- 1+ No diffe
Page 69 and 70: Question to be answered • Are pys
Page 71 and 72: Summary of evidence Pyschoeducation
Page 73 and 74: with schizophrenia and that the tre
Page 75 and 76: With reference to the type of train
Page 77 and 78: would normally receive and which in
Page 79 and 80: Hypnosis vs. relaxation No improvem
Page 81 and 82: Supervised fl ats are a community h
Page 83 and 84: 3 Programmes directed to leisure an
Page 85 and 86: SMI (schizophrenia, affective schiz
Page 87 and 88: When PVT is compared with standard
Page 89 and 90:
Patients included in the individual
Page 91 and 92:
1+ 1+ 1++ 1+ 1+ 1+ 1+ The people in
Page 93 and 94:
Music therapy Music therapy + stand
Page 95 and 96:
A series of Case Management systems
Page 97 and 98:
• The satisfaction data originati
Page 99 and 100:
Loss of contact With respect to the
Page 101 and 102:
There is not sufficient evidence, e
Page 103 and 104:
1+ 1+ 1+ 1+ Respect to ICM teams or
Page 105 and 106:
Finally, in the RCT by Cheng et al
Page 107 and 108:
5.4.2. “Homeless” with SMI The
Page 109 and 110:
Patients who access housing with no
Page 111:
ceptive disorders. This series of c
Page 115 and 116:
7. Recommendations for Future Resea
Page 117:
Appendices
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Appendix 2. Information obtained fr
Page 122 and 123:
Appendix 4. Information for people
Page 124 and 125:
4. Regulatory and legal framework 1
Page 126 and 127:
Several protocols have been publish
Page 128 and 129:
The coordination of these resources
Page 130 and 131:
Social protection systems Pursuant
Page 132 and 133:
Specifi c regulation • (SPANISH)
Page 134 and 135:
Service Management: The first anti-
Page 136 and 137:
on Mental Health and the future Eur
Page 138 and 139:
Spanish Society of Legal Psychiatry
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Appendix 5. Abbreviations ACT Asser
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Appendix 6. Glossary Therapy adhere
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Appendix 7. Declaration of interest
Page 146 and 147:
15 Rossler W. Psychiatric rehabilit
Page 148 and 149:
53 Graeber DA, Moyers TB, Griffi th
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86 Schooler NR, Keith SJ, Severe JB
Page 152 and 153:
117 Sohlberg MM, Mateer CA. Effecti
Page 154 and 155:
154 López M, García-Cubillana P,
Page 156 and 157:
190 Bond GR, Drake RE. Predictors o
Page 158 and 159:
225 Hurley AD. Individual psychothe
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