Additional Information
Book Details
Abstract
This practical guide focuses on the reduced expression and activity often described as constituting negative symptoms of psychosis and schizophrenia. Using engaging activities and case studies to aid learning, it offers alternative explanations for these symptoms and outlines strategies for addressing them in practice
Hilary Mairs is Reader and Director of Postgraduate Education in the School of Nursing, Midwifery and Social Work at the University of Manchester, UK.
This practical guide focuses on the reduced expression and activity often described as constituting negative symptoms of psychosis and schizophrenia. Using engaging activities and case studies to aid learning, it offers alternative explanations for these symptoms and outlines strategies for addressing them in practice
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Cover | Cover | ||
| Brief contents | vi | ||
| Contents | vii | ||
| List of figures and tables | xi | ||
| Acknowledgements | xiii | ||
| Preface | xiv | ||
| Part I Background | 1 | ||
| Chapter 1 Explanations for reduced levels of expression and activity in psychosis | 3 | ||
| Biological explanations | 4 | ||
| A word about terminology | 5 | ||
| Reduced levels of expression | 6 | ||
| Reduced activity levels | 7 | ||
| Positive and negative symptoms in everyday life | 7 | ||
| Biological markers of negative symptoms | 8 | ||
| Other explanations | 11 | ||
| Under-stimulating and over-stimulating environments | 11 | ||
| Stigmatising and pessimistic messages | 12 | ||
| The role of early experiences | 12 | ||
| Depression and anxiety | 14 | ||
| Problems internalising the points of view of other people | 15 | ||
| An understandable response to developing psychosis | 15 | ||
| The impact of psychosis on self-efficacy beliefs | 17 | ||
| Primary and secondary negative symptoms | 17 | ||
| A formulation-based approach | 18 | ||
| Summary | 19 | ||
| Coming up in the next chapter | 19 | ||
| Part II Engagement | 21 | ||
| Chapter 2 Engaging people with reduced levels of expression and activity in positive therapeutic alliances | 23 | ||
| Three unhelpful assumptions | 24 | ||
| A low expressed emotion approach | 26 | ||
| Sharing accurate and normalising information | 27 | ||
| Agreeing shared goals | 29 | ||
| Setting short-term goals | 30 | ||
| Decisional balance – exploring the costs and benefits of taking steps to become more active | 31 | ||
| Completing decisional balance exercises, diaries and records | 32 | ||
| Values-based approaches | 33 | ||
| Setting mediumto long-term goals | 34 | ||
| Reaching agreement on the best tasks to help service users reach their goals | 35 | ||
| Summary | 35 | ||
| Coming up in the next chapter | 36 | ||
| Chapter 3 Engaging people in structured interventions to increase levels of expression and activity | 37 | ||
| Routine and structure | 37 | ||
| Session structure | 39 | ||
| Pre-session review | 40 | ||
| Setting a session agenda | 40 | ||
| Homework | 41 | ||
| Regular review points | 44 | ||
| Bringing the intervention sessions to a conclusion | 45 | ||
| Challenges of working in a structured way | 45 | ||
| Summary | 46 | ||
| Coming up in the next chapter | 46 | ||
| Part III A ssessment and formulation | 47 | ||
| Chapter 4 Gathering information to develop a shared understanding (formulation) of reduced levels of expression and activity | 49 | ||
| Standardised measures of negative symptoms | 50 | ||
| Standardised measures of functioning | 51 | ||
| The Reduced Expression and Activity in Psychosis (REAP) semi-structured interview | 52 | ||
| Capturing current activity levels | 54 | ||
| Using activity diaries | 54 | ||
| The Time Budget Measure | 58 | ||
| Reviewing current activity levels | 58 | ||
| Timelines | 60 | ||
| Formulations suggesting biological explanations | 62 | ||
| Formulations suggesting psychological explanations | 63 | ||
| Formulations suggesting social and environmental explanations | 65 | ||
| Summary | 65 | ||
| Coming up in the next chapter | 66 | ||
| Chapter 5 Behavioural approaches to help people increase their activity levels | 67 | ||
| Positive and negative reinforcement | 68 | ||
| Behavioural activation for psychosis | 68 | ||
| Evidence base for behavioural activation | 69 | ||
| Behavioural activation for reduced activity in psychosis | 69 | ||
| Presenting a rationale for behavioural activation | 70 | ||
| Maintaining motivation | 76 | ||
| Reviewing behavioural approach | 78 | ||
| Involving friends, family and companions in the behavioural activation approach | 79 | ||
| Challenges in facilitating a behavioural activation approach | 80 | ||
| Summary | 80 | ||
| Coming up in the next chapter | 81 | ||
| Chapter 6 Cognitive strategies to help people address defeatist predictions | 82 | ||
| Cognitive restructuring: Background and theory | 83 | ||
| Cognitive restructuring to address reduced levels of expression and activity | 84 | ||
| Evidence base for cognitive restructuring | 85 | ||
| Presenting a rationale for cognitive restructuring | 86 | ||
| Capturing negative predictions | 87 | ||
| Discussing negative predictions in relation to a recent event | 87 | ||
| Eliciting negative predictions from a thought diary | 89 | ||
| Reviewing negative prediction diaries | 90 | ||
| Examining negative predictions and generating more realistic expectations | 92 | ||
| Behavioural experiments | 95 | ||
| Staying well and maintaining gains | 95 | ||
| Summary | 96 | ||
| Coming up in the next chapter | 96 | ||
| Chapter 7 Other approaches for helping people with reduced levels of expression and activity | 97 | ||
| Social skills training | 97 | ||
| Art therapies | 99 | ||
| Cognitive remediation and integrated neurocognitive therapy | 100 | ||
| Schemes to secure employment | 101 | ||
| Guided peer support groups | 102 | ||
| Loving kindness meditation | 102 | ||
| Anticipatory pleasure skills training | 103 | ||
| Multiple family groups | 104 | ||
| Summary | 105 | ||
| Coming up in the next chapter | 105 | ||
| Chapter 8 Supporting families in coping with reduced levels of express ion and activity in psychosis | 106 | ||
| Family intervention: Background and theory | 106 | ||
| Generating alternative explanations | 109 | ||
| Style of information sharing | 112 | ||
| Discussing the medical terminology | 113 | ||
| Discussing service user frustration | 113 | ||
| Positive reframing | 116 | ||
| Discussing the restorative function of reduced expression/activity | 116 | ||
| Discussing medication | 117 | ||
| Enhancing family members’ coping strategies | 117 | ||
| Problem-solving approaches | 118 | ||
| Making positive requests | 119 | ||
| Managing stress and expectations in the longer term | 120 | ||
| Sharing experiences with others in similar situations | 120 | ||
| Summary | 121 | ||
| Coming up in the next chapter | 121 | ||
| Chapter 9 Helping mental health teams understand reduced levels of expression and activity | 122 | ||
| Team training | 122 | ||
| Training methods | 124 | ||
| Theories of adult learning | 124 | ||
| Training personnel | 126 | ||
| Training structure | 126 | ||
| Team formulation | 127 | ||
| Team formulation sessions: Practical considerations | 130 | ||
| Team formulation sessions: Structure | 131 | ||
| Summary | 132 | ||
| References | 133 | ||
| Index | 146 |