Top 10 Psychological Treatments for Psychotic Disorders

A summary of the most used and effective psychological treatments for psychotic disorders.

Psychotic disorders usually have psychopharmacology as their first choice treatment, with antipsychotics being the most commonly used in these cases for the positive symptoms or psychotic symptoms of these disorders; however, psychotropic drugs have not shown much efficacy for the negative ones, so they need to be complemented with psychological treatment.

Psychological treatments for psychotic disorders have demonstrated their efficacy in treating the negative symptoms of psychosis, with different treatments working on social skills training, family therapies, psychoeducational interventions or cognitive rehabilitation, among others.

In this article we will briefly look at some of them psychological treatments for psychotic disorders that are most commonly used in the field of clinical psychology. most commonly used in the field of clinical psychology.

Psychoeducational Interventions for Psychotic Disorders

Before explaining the psychological treatments for psychotic disorders, it is worth highlighting the psychoeducational interventions that are carried out in order to provide important information to the population, and especially to people suffering from some type of psychosis and their families, regarding the available treatments and also to clarify issues associated with psychosis.

These psychoeducational interventions also focus on providing people with psychotic disorders with strategies to learn to manage their disorder as much as possible, as well as other difficulties they may have as a result of their disorder, so that they can lead normal lives. lead a normal life. Psychoeducational interventions are also often used to improve adherence to some of the psychological treatments for psychotic disorders, as well as to prevent a reduced likelihood of relapse.

Psychoeducational interventions can be carried out in various formats (individual, group, family, etc.) and usually last an average of 12 sessions, although shorter interventions of 10 sessions have also been found with good results.

It should be noted that family psychoeducational interventions for psychotic disorders are essential during the early stages of a psychotic disorder, once detected and diagnosed.Once detected and diagnosed, because they are beneficial for stabilization and for restructuring the patient's environment, as well as for family members to understand in greater detail what their relative's mental disorder consists of and to provide support, so that they acquire the necessary resources and guidelines for managing the disorder and preventing relapses.

2. Social skills training for psychotic disorders

There are several psychological treatments for psychotic disorders based on the training of the patient's social skills; therefore, we will highlight below the best known ones.

2.1. Generic social skills training

This modality of social skills training is usually carried out in a group format, following a behavioral orientation based on the social learning model.The psychotherapist ensures that patients are involved in the training of interpersonal skills during the group sessions.

Among the skills trained are: verbal and non-verbal communication, learning appropriate responses within a social context, assertiveness training, etc.

2.2. Cognitive-behavioral social skills training

This treatment is known worldwide by its English name "Cognitive Behavioral and Social Skills Training" (CBSST) and is used to train people with cognitive behavioral and social skills. its interventions use social skills training techniques similar to those used in classical generic models; however, this treatment stands out for its implementation of cognitive-behavioral techniques (e.g. cognitive restructuring, behavioral experiments, Socratic dialogue, etc.).However, this treatment stands out for the implementation of cognitive-behavioral techniques (e.g. cognitive restructuring, behavioral experiments, Socratic dialogue, etc.).

Social skills training based on the UCLA-FAST model.

This model of social skills training was implemented by the University of Los Angeles and is composed of training in social skills. and is composed of classic social skills training, which can be found in other models, together with psychoeducation intervention, work on relapse prevention and training in skills for good functioning in activities of daily living (p. e.g., taking medication correctly, working or even being able to live independently).

2.4. Cognitive-social skills training

This treatment has been named by its creators as "Social Cognitive Skills Training" (SCST) and was developed on the basis of working with the cognitive-social processes of patients with psychotic disorders such as the training of theory of mind skills or the perception of emotions..

It should also be noted that this skills training allows working with computer programs or videos to facilitate the training of social responses, while allowing the patient to repeat the process as many times as needed.

As we can see, there are multiple modalities of social skills training; however, there are specialized guidelines on the evidence of psychological treatments that recommend that social skills training should not be the only option, but should be complemented by other treatments for psychotic disorders, as well as by medication prescribed by a specialist for positive symptoms of schizophrenia.as well as with medication prescribed by a specialist for the positive symptoms of schizophrenia.

However, these interventions are showing promising results, so they could be a good option in terms of cost-effectiveness to treat the negative symptoms of psychotic disorders within mental health systems, such as within the public health system where, due to lack of means and sufficient personnel, such as the reduced number of psychologists present in the different hospitals, social skills training could be a good alternative to work in a group setting.

3. Family therapies for psychotic disorders

Psychological treatments for psychotic disorders include family therapies and, as mentioned above, the support of the patient's family is essential for a better prognosis, the support of the patient's family is essential for a better prognosis..

Within family therapies for psychosis, there are several alternatives, so it will normally be the patient and family members who decide which modality of family intervention they prefer. Among the options are the following:

• Single or multifamily interventions.
• Family interventions in which the family member with the psychotic disorder is present or not.
• Guided by a member of the clinical team and serving as a liaison with the team, or with the team on the sidelines.
• Focused solely on psychoeducation, including cognitive treatment or other psychotherapy modalities.

This type of psychological treatments for psychosis usually have a duration between 3 and 7 months, with a minimum of 10 sessions.with at least 10 sessions as a minimum.

It is important to emphasize that psychological interventions in family format are among the most studied interventions for the treatment of psychotic disorders and have demonstrated a high empirical validity.

4. Cognitive-behavioral therapy for psychotic disorders

Within the psychological treatments for psychotic disorders, one of the most widely used options is cognitive-behavioral therapy, given its proven efficacy for numerous mental disorders.

Cognitive behavioral therapy for psychosis focuses primarily on two aspects: helping the patient and family members to understand the disorder and the positive symptoms of psychosis and, on the other hand, working on the cognitive schema. The patient's emotional disturbance, which is very likely to interfere with the emotional disturbance that a person with a psychotic disorder usually suffers from.

5. Cognitive therapy to treat hallucinations and delusional ideas

Another of the psychological treatments for psychotic disorders is "belief modification therapy" whose fundamental objectives are two types of interventions (verbal challenge and reality testing) through cognitive restructuring.

Verbal challenge consists in helping the patient with psychosis to modify the content of his or her distorted beliefs. In order to do so, the psychologist must use a non-confrontational position, so that the patient's beliefs are gradually graded.

Reality testing is used in order to verify the patient's delusional belief through an empirical test that serves to refute or confirm that belief.

These two techniques are often used together; moreover, it has been proven that reality testing alone is not effective, while if preceded by the verbal challenge technique it is effective, the latter having been shown to be the most effective component of treatment.

6. State-of-the-art psychological treatments for psychotic disorders

Two psychological treatments for breakthrough psychotic disorders will be briefly explained below.

6.1. AVATAR therapy

This is a novel psychological therapy whose main objective is to help reduce the discomfort and the frequency with which verbal hallucinations appear. verbal hallucinations that resist antipsychotic medication in patients suffering from psychotic disorders. in patients suffering from psychotic disorders.

During the sessions of this therapy there is a three-way interaction (between the psychologist, the patient and a computer software representation of the entity that the patient believes is speaking to him/her). This software has been programmed to transform the psychologist's voice to achieve the same timbre and tone as the patient hears in his head.

Within this therapy the patient can interact with the voice he/she hears in his/her head and thus be able to cope with and thus be able to confront the negative and pejorative comments he hears in his head with the aim of modifying his relationship with them and thus pay less attention to them.

This innovative therapeutic modality has adopted the relational and dialectical approach in order to work on the relationship with the auditory hallucinations of negative content. On the other hand, this therapy does not directly seek to make the voices in the patient's head disappear, but focuses on working on the patient's relationship with the voices that appear in his or her mind in order to strengthen the patient's sense of control over the voices.

For the moment, two clinical studies have been carried out with good short-term results, although further research is still needed, as it has not been possible to find sufficient long-term evidence.

6.2. The HORYZONS project

This project was developed in order to to facilitate access to psychological treatment for psychotic disorders for young people.. This project has been created from the model known as "Moderated On-Line Social Therapy" (MOST) and is a model of psychological interventions through the Internet that takes advantage of technology to expand traditional psychosocial interventions to a larger number of people. To do this, it uses an online platform that provides access to various psychosocial interventions with the help of psychologists.

The HORYZONS project, despite being quite recent, has shown in a study that the online intervention can be of great help, due to its easy accessibility, for young people who have suffered a first psychotic episode. In addition, the study showed that there were few dropouts and a high degree of satisfaction among patients, and a controlled clinical study is already underway that will last five years in order to study its long-term efficacy.