Cognitive Behavioral Therapy for psychosis (CBTp)

This approach is provided within a therapy model typically offered in weekly sessions over a course of therapy. This training is ideally suited to clinicians who are offering direct therapeutic services to individuals with psychosis as their primary role within the service and who have a foundational knowledge, or higher, of general CBT.

• To ensure clinicians have grounding in CBT principles
  
• To provide basic understanding of the general principles of CBT for psychosis
  
• To develop competence in formulations suitable for different levels of intervention with clients with psychosis and to use these formulations to identify where to target interventions
  
• To develop skills in developing and implementing cognitive and behavioral interventions to target positive and negative symptoms
• To implement these skills in a culturally aware and sensitive manner in a community setting
  
• To understand the role of trauma in the formation and maintenance of psychosis and interventions to address this
  

The training consists of a 3-5 day training (dependent on clinician skill level and topics to be covered) that includes didactics, role play, experiential learning, and clinical case discussion. Training in Formulation driven CBTp is only the first step in learning the model. Essential to ensuring sustainable and competent implementation of this approach is ongoing consultation and tape review. Reviewing taped CBTp sessions using the Cognitive Therapy Scale – Revised (CTS-R; Blackburn et al., 2001) provides clinicians with the opportunity to receive feedback on the use of the CBTp intervention that reflects the real-world application of this approach specific to the clients seen by the clinician.  

• Weekly consultation groups comprising four clinicians per group meeting for 60 minutes a week for 10 months via video conferencing
  
• Clinicians submit a taped session every month for competence review until clinician meets competence standard (on average six tapes)
• Meeting with managers every other month while consultation is underway to address any concerns or obstacles to implementation

CBTp informed interventions refer to interventions that have been developed specifically for front line providers working with individuals with a psychotic disorder beyond the traditional outpatient therapy clinic. This arose from a recognition that front line providers often have the most face to face contact with clients but typically have access to the least amount of training related to psychosocial interventions. The Positive Practices for working with Psychosis (PPP) model brings together a combination of CBTp skills that front line providers can use in their work with individuals in a variety of settings.

This training is ideally suited to case managers who are supporting individuals with psychosis and want to augment their training with additional skills developed specifically for working with this population. In addition, this approach may serve as a starting point for clinicians with limited exposure to CBT who want to develop a strong foundation in this approach before progressing to training in formulation based CBTp. 

• To introduce the concept of CBTp informed skills
  
• Learn the principles of the FIRST model
  
• Demonstrate skills in engagement, curious questioning, basic formulation, and interventions for attenuated and fully psychotic symptoms
  
• Implement these principles in a culturally competent and community based model 

Training in this approach consists of a 3 day training that includes didactics, role play, experiential learning, and clinical case discussion and is followed by weekly group case consultation for 10 months and fidelity review to ensure clinicians are utilizing the FIRST skills in line with the model.