Recovery-Oriented Cognitive Therapy: Evidence to Practice

 Recovery-Oriented Cognitive Therapy:

Based on the cognitive model, CT-R is an empirically supported procedure for successfully operationalizing and realizing recovery for individuals with serious mental illness. The approach involves meeting people where they are, accessing their adaptive mode, developing aspirations and steps toward successfully achieving them, strengthening positive beliefs, weakening negative beliefs, and developing resiliency in regards to stress and challenges. CT-R can be delivered as individual therapy, group therapy, as part of a team-based approach, and can form the basis of a therapeutic milieu. CT-R has been successfully applied to individuals across the full range of severity, from early in their course to those who have been chronically institutionalized for decades.

Randomized Trial to Evaluate the Efficacy of Cognitive Therapy for Low-Functioning Patients With Schizophrenia: Clinical trial demonstrating the effectiveness of recovery-oriented cognitive therapy to improve everyday functioning, negative symptoms, and positive symptoms for individuals with severe and persistent schizophrenia.

Six-month Follow-Up of Recovery-Oriented Cognitive Therapy for Low-Functioning Schizophrenia: Follow-up paper shows gains in functioning, negative symptoms, and positive symptoms were maintained six months after treatment was completed; also, individuals with a longer course of illness showed improvement by the follow-up.

Rapid improvement in beliefs, mood, and performance following an experimental success experience in an analogue test of recovery-oriented cognitive therapy: an Analogue study of recovery-oriented cognitive therapy showing that rapid improvement in putative mechanisms of the therapy – reduced dysfunctional beliefs and improved positive beliefs about self and mood – is associated with improvement in performance.

Successfully Breaking a 20-Year Cycle of Hospitalizations With Recovery-Oriented Cognitive Therapy for Schizophrenia: A case study of the successful application of recovery-oriented cognitive therapy (CT-R) to empower an individual with chronic course illness get back to a life of their choosing

Advances in Cognitive Therapy for Schizophrenia: Empowerment and Recovery in the Absence of Insight: a case study in which CT-R is used to produced pulpal success in life without the development of insights into illness.

Recovery-Oriented Cognitive Therapy Shows Lasting Benefits for People with Schizophrenia: American Psychiatric Association (APA) news post describing recovery-oriented cognitive therapy producing sustained improvement among individuals with schizophrenia, even among those with the most chronic illness.

Recovery-Oriented Talk Therapy May Help Curb Schizophrenia: Philly.com feature article about recovery-oriented cognitive therapy and its benefits

Theory and Review Paper:

In and out of schizophrenia: Activation and deactivation of the negative and positive schemas: article about how treatment target for those diagnosed with schizophrenia may be influenced by how they view their experiences and confidence.

What accounts for poor functioning in people with schizophrenia: a re-evaluation of the contributions of neurocognitive v. attitudinal and motivational factors: A look at the literature on the influence of non-neurocognitive factors (decrease in motivation, effort, dysfunctional attitudes, etc.) on performance test in order to clarify their contributions. To access supplemental material that did not make it into the published paper, click here.

Basic Science:

With the cognitive model as the theoretical guide, these studies aim to uncover psychological mechanisms that impair psychosocial functioning for individuals with schizophrenia as well as mechanisms of change to promote successful recovery and resiliency. Mechanisms become targets of treatment.

From neurocognition to community participation in serious mental illness: the intermediary role of dysfunctional attitudes and motivation: Longitudinal study identifies two independent pathways linking defeatist and asocial beliefs to community involvement.

Defeatist Beliefs as a Mediator of Cognitive Impairment, Negative Symptoms, and Functioning in Schizophrenia: Original paper demonstrating Defeatist beliefs as a mechanism connecting poor performance on neurocognitive tests, negative symptoms, and poor functioning in schizophrenia.

Dysfunctional Attitudes and Expectancies in Deficit Syndrome Schizophrenia: Article is demonstrating that individuals diagnosed with schizophrenia who have the most severe and persistent negative symptoms endorse defeatist and asocial beliefs to a greater extent than individuals with less severe negative symptoms.

Asocial beliefs as predictors of asocial behavior in schizophrenia: Manuscript showing that asocial beliefs are associated with poor social functioning.

Evaluation sensitivity as a moderator of communication disorder in schizophrenia: This paper describes how sensitivity to evaluation moderated the relationship between cognitive impairment and communication disorder in schizophrenia.

Cognitive Insight Predicts Favorable Outcome in Cognitive Behavioral Therapy for Psychosis: In the CBT of psychosis in South London improvement in cognitive insight improvement in treatment insight is mediator

Exploring the Temporal Relationship Between Cognitive Insight and Neurocognition in Schizophrenia: A Prospective Analysis: An investigation of prospective links between impairment of cognitive function and cognitive insight, using data from two longitudinal studies of adults diagnosed with schizophrenia. In both studies, cognitive insight predicted changes in neurocognitive performance, suggesting that reductions in cognitive insight temporally preceded by neurocognitive changes. It is essential to note neither study showed the reverse relationship.

Dissemination and Implementation:

CT-R has been implemented at all levels of care for individuals with serious mental illness.

Books

Schizophrenia: Cognitive Theory, Research, and Therapy (2009) Guilford Press.: New York, NY.

Recovery-oriented cognitive therapy for schizophrenia (in press). Guilford Press.: New York, NY.

Articles

Effects of a Recovery-Oriented Cognitive Therapy Training Program on Inpatient Staff Attitudes and Incidents of Seclusion and Restraint: Manuscript describing a successful milieu-wide, multidisciplinary, recovery-oriented cognitive therapy training program on an urban acute inpatient unit treating individuals with serious mental illness.

Training Peer Specialists in Cognitive Therapy Strategies for Recovery: Article explains an innovative recovery-oriented cognitive therapy training program collaboratively developed with peer specialists to promote their effectiveness.

CBT Addresses Most-Debilitating Symptoms in Chronic Schizophrenia: Psychiatric News article details how recovery-oriented cognitive therapy helps mental health providers operationalize recovery work, engaging all individuals with serious mental illness, however challenging, to successfully collaborate and make progress on their self-defined aspirations.

Outreach and Engagement for Early Psychosis: NAMI blog written by Drs. Ellen Inverso and Paul Grant in which they describe Recovery-Oriented Cognitive Therapy framework.

Workshops/Webinars

Recovery-Oriented Cognitive Therapy: Watch Drs. Paul M. Grant and Ellen Inverso present at NAMI NJ 2017 Conference

Recovery-Oriented Cognitive Therapy: Resiliency, Recovery & Flourishing: Watch Drs. Paul M. Grant and Ellen Inverso discuss an approach they have helped to pioneer via 2017 ISPS Webinar.

Mechanism of Training

  • Webinar: 1-3hrs a basic introduction to the principles of CT-R
  • Workshops: 2-30hrs in-depth, in-person or over the web, introducing recovery program and delivers the basics through experiential learning and expert demonstration of skills
  • Consultations: a 1-2 hrs focusing on tailoring strategy, building skills, and promoting recovery with challenging individuals alongside an expert
    • Challenging Case: Expert consultation helps trainees promote progress for low-functioning individuals. Demonstrates benefits of the program and invigorates staff via results.
    • Key personnel: Trainees develop competency in therapeutic strategies to promote recovery. Therapists, psychiatrist, nurses, social workers, drug/alcohol specialists, case managers, and peer specialists can be trained to become agents for change
    • Milieu-wide: This is a full team-wide, unit-wide approach to training that involves tailored workshops and consultation to transform the therapeutic milieu to a recovery orientation.
    • Therapist: trainees learn to formulate individual cases to promote progress toward recovery and resiliency to respect to challenges (negative, positive symptoms, aggression, etc.). The process includes competency determined by means of a standardized method.
  • Innovative Program Evaluation: Operationalized recovery principles are measured throughout to inform treatment and track progress.
  • Train-the-Trainer: Beck staff train trainees to direct implementation of sustainability efforts to continue the work.

 

Training Settings to Date
  • State Hospital (Civil & Forensic)
  • Jail Diversion Team
  • Extended Acute Care (EAC)
  • Assertive Community Treatment Teams (ACT)
  • Long-Term Structured Residences (LTSR)
  • Residential Treatment Facility for Adults (RTFA)
  • Supported Housing
  • Individual Therapy
  • 1st Episode Teams
  • Ultra High Risk
  • Day Treatment Programs

 

Training Locations to Date
  • Philadelphia
  • Pennsylvania
  • Georgia
  • Massachusetts
  • Virginia
  • Utah
  • Delaware
  • New Jersey

 

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