Until now, I have not written much about the psychotic mode. There
A recent paper showed that a large proportion of individuals with schizophrenia had preexisting psychiatric disorders (Albert et.al, In Press). I assume that the cognitive distortions in schizophrenia are in some way related to the preexisting cognitive distortions associated with these non-psychotic disorders (depression, anxiety, OCD, personality disorders, etc.). The biases in the cognitive triad are reflected in the biases in the inferential and anticipatory processes.
The key concept that helps to explain psychosis is the word bias. Ordinarily we think of this term as a process by which external stimuli are warped to fit into an internal representation. However, individuals may already have an internal representation (belief) of say a stranger who they automatically dislike. Similarly, in psychosis, it is possible to view the impermeability of delusions as due to an extremely powerful bias, in this case, an externalizing bias. As an example of the differences in biases, say I have a pain in my chest, I may have a
We generally do not directly address the more extreme beliefs that take the form of delusions, but
- When possible, by satisfying the needs that are represented in the delusion
- Through our general CT-R using aspirations,
, group participation etc. problem solving
At times it is valuable to elicit the actual distortions in the individuals “reasoning.” This is particularly valuable when one is conducting a chain analysis to understand an individual’s inappropriate or aggressive behavior. For example, a woman wanted to punish another woman on the unit whom she believed had insulted her. A chain analysis revealed that the other woman had simply disagreed with her about the contents of a movie they had both seen. The individual had the following sequence: “Since she disagreed with me, she doesn’t respect me” > (belief: “If someone insults you, you need to punish them or else they will repeat this act.”) > urge to strike the other woman. The clinician attempted to divert the individual at this point and asked if that is the way she had brought up her two daughters. The woman replied that she would not want her daughters to act in this way and that she had tried to teach them to rise above it when they got angry. She then went over to the other woman and re-established a positive relationship. The clinician noted that the individual had greatly exaggerated the meaning of being disagreed with and when she gained the objectivity regarding her daughter’s upbringing, she was able to modify her interpretation and make peace with the other person.
Albert, U. et al. (In Press). Prevalence of non-psychotic disorders in ultra-high risk individuals and transition to psychosis: A systematic review.PsychiatryResearch. https://doi.org/10.1016/j.psychres.2018.09.028