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Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis
Cognitive Cognitive Behavioral Behavioral Treatment Treatment of of Delusions Delusions and and Paranoia Paranoia Dennis

Cognitive Cognitive Behavioral Behavioral Treatment Treatment

of of Delusions Delusions and and Paranoia Paranoia

of of Delusions Delusions and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University
of of Delusions Delusions and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University

Dennis Dennis Combs, Combs, Ph.D. Ph.D.

University

University

of Tulsa

of

Tulsa

and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University University of Tulsa of Tulsa
and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University University of Tulsa of Tulsa
and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University University of Tulsa of Tulsa
and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University University of Tulsa of Tulsa
and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University University of Tulsa of Tulsa
and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University University of Tulsa of Tulsa
and and Paranoia Paranoia Dennis Dennis Combs, Combs, Ph.D. Ph.D. University University of Tulsa of Tulsa
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only
BriefBrief BackgroundBackground Many persons consider that the only effective Many persons consider that the only

BriefBrief BackgroundBackground

Many persons consider that the only effectiveBriefBrief BackgroundBackground Many persons consider that the only effective treatments treatments for for schizophrenia

Many persons consider that the only effective

treatments treatments for for schizophrenia schizophrenia are are antipsychotic antipsychotic

schizophrenia are are antipsychotic antipsychotic medicationsmedications Pessimism Pessimism over over

medicationsmedications Pessimism Pessimism over over traditional traditional talk talk therapy therapy Pessimism Pessimism over over traditional traditional talk talk therapy therapy

approachesapproaches toto schizophreniaschizophrenia

American American Psychiatric Psychiatric Assn. Assn. (1999) (1999) guidelines guidelinestherapy approachesapproaches toto schizophreniaschizophrenia state that psychological therapies can be useful. state that

state that psychological therapies can be useful.

state that psychological therapies can be useful.

be useful. state that psychological therapies can be useful. Most beneficial once Most beneficial once the
be useful. state that psychological therapies can be useful. Most beneficial once Most beneficial once the
Most beneficial once Most beneficial once the person becomes the person becomes stable; stable; less
Most beneficial once
Most beneficial once
the person becomes
the person becomes
stable;
stable;
less
less benefit in
benefit in the acute phase of illness
the
acute phase of illness
becomes stable; stable; less less benefit in benefit in the acute phase of illness the acute
becomes stable; stable; less less benefit in benefit in the acute phase of illness the acute
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy EmpiricallyEmpirically SupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy
Therapy Therapy
Therapy Therapy

EmpiricallyEmpirically SupportedSupported TreatmentsTreatments

Behavioral and Supportive Family TherapySupportedSupported TreatmentsTreatments Behavioral and Supportive Family Therapy SocialSocial

Behavioral and Supportive Family Therapy

SocialSocial SkillsSkills TrainingTrainingFamily Therapy Behavioral and Supportive Family Therapy CognitiveCognitive -- Behavioral Behavioral

Family Therapy SocialSocial SkillsSkills TrainingTraining CognitiveCognitive -- Behavioral Behavioral

CognitiveCognitive--Behavioral

Behavioral

SupportedSupported EmploymentEmploymentTrainingTraining CognitiveCognitive -- Behavioral Behavioral AssertiveAssertive CaseCase ManagementManagement

Behavioral SupportedSupported EmploymentEmployment AssertiveAssertive CaseCase ManagementManagement

AssertiveAssertive CaseCase ManagementManagementBehavioral SupportedSupported EmploymentEmployment BehaviorBehavior Therapy/TokenTherapy/Token EconomyEconomy

BehaviorBehavior Therapy/TokenTherapy/TokenAssertiveAssertive CaseCase ManagementManagement EconomyEconomy programsprograms Chambless & Ollendick,

EconomyEconomy

programsprograms
programsprograms
Therapy/TokenTherapy/Token EconomyEconomy programsprograms Chambless & Ollendick, 2001; Roth & Fonagy, 1996;
Therapy/TokenTherapy/Token EconomyEconomy programsprograms Chambless & Ollendick, 2001; Roth & Fonagy, 1996;
Therapy/TokenTherapy/Token EconomyEconomy programsprograms Chambless & Ollendick, 2001; Roth & Fonagy, 1996;

Chambless &

EconomyEconomy programsprograms Chambless & Ollendick, 2001; Roth & Fonagy, 1996; Nathan &
EconomyEconomy programsprograms Chambless & Ollendick, 2001; Roth & Fonagy, 1996; Nathan &

Ollendick, 2001; Roth & Fonagy,

1996; Nathan & Gorman, 1998)

EconomyEconomy programsprograms Chambless & Ollendick, 2001; Roth & Fonagy, 1996; Nathan & Gorman, 1998)
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions

Cognitive Therapy for

Cognitive Therapy for

DelusionsDelusions

Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
Cognitive Therapy for Cognitive Therapy for DelusionsDelusions
psychosis arose from psychosis arose from anxiety and anxiety and with information with information
psychosis arose from psychosis arose from anxiety and anxiety and with information with information
psychosis arose from
psychosis arose from
anxiety and
anxiety and
with information
with information
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive
anxiety and anxiety and with information with information CognitiveCognitive TherapyTherapy Cognitive Cognitive

CognitiveCognitive TherapyTherapy

Cognitive Cognitive therapy therapy for forwith information CognitiveCognitive TherapyTherapy treatment treatment methods methods for for

treatment treatment methods methods for for

therapy for for treatment treatment methods methods for for depressiondepression CT CT is is based based

depressiondepression CT CT is is based based on on the the idea idea that that psychotic CT CT is is based based on on the the idea idea that that psychotic psychotic

symptoms symptoms are are associated associated

processingprocessing biasesbiases

–– Attention, appraisal, attributional, belief

Attention, appraisal, attributional, belief

formation formation and maintenance and maintenance
formation
formation
and maintenance
and
maintenance
attributional, belief Attention, appraisal, attributional, belief formation formation and maintenance and maintenance
attributional, belief Attention, appraisal, attributional, belief formation formation and maintenance and maintenance
attributional, belief Attention, appraisal, attributional, belief formation formation and maintenance and maintenance
attributional, belief Attention, appraisal, attributional, belief formation formation and maintenance and maintenance
attributional, belief Attention, appraisal, attributional, belief formation formation and maintenance and maintenance
attributional, belief Attention, appraisal, attributional, belief formation formation and maintenance and maintenance
CognitiveCognitive Therapy,Therapy, cont.cont. CT CT is is most most effective effective in in the treatment
CognitiveCognitive Therapy,Therapy, cont.cont. CT CT is is most most effective effective in in the treatment
CognitiveCognitive Therapy,Therapy, cont.cont. CT CT is is most most effective effective in in the treatment
CognitiveCognitive Therapy,Therapy, cont.cont. CT CT is is most most effective effective in in the treatment
CognitiveCognitive Therapy,Therapy, cont.cont. CT CT is is most most effective effective in in the treatment
CognitiveCognitive Therapy,Therapy, cont.cont. CT CT is is most most effective effective in in the treatment
CognitiveCognitive Therapy,Therapy, cont.cont. CT CT is is most most effective effective in in the treatment
CognitiveCognitive Therapy,Therapy, cont.cont.
CT CT is is most most effective effective in in
the treatment of
the treatment of
persistent, residual psychotic symptoms
persistent, residual psychotic symptoms
–– 2525--60% 60% of of individuals individuals
with with psychosis psychosis have have
symptoms symptoms following following medication medication treatment treatment
Each episode of psychosis
Each episode of psychosis
leads to more
leads to more
functional and social impairment
functional and social
impairment
CoCo--morbid mood symptoms are also quite
morbid mood symptoms are also quite
common in
common
in
psychosis
psychosis
(40%)
(40%)
symptoms are also quite morbid mood symptoms are also quite common in common in psychosis psychosis
symptoms are also quite morbid mood symptoms are also quite common in common in psychosis psychosis
symptoms are also quite morbid mood symptoms are also quite common in common in psychosis psychosis
symptoms are also quite morbid mood symptoms are also quite common in common in psychosis psychosis
symptoms are also quite morbid mood symptoms are also quite common in common in psychosis psychosis
symptoms are also quite morbid mood symptoms are also quite common in common in psychosis psychosis
CognitiveCognitive Therapy,Therapy, cont.cont. WellWell--established treatment in established treatment in England--
CognitiveCognitive Therapy,Therapy, cont.cont. WellWell--established treatment in established treatment in England--
CognitiveCognitive Therapy,Therapy, cont.cont. WellWell--established treatment in established treatment in England--
CognitiveCognitive Therapy,Therapy, cont.cont. WellWell--established treatment in established treatment in England--
CognitiveCognitive Therapy,Therapy, cont.cont. WellWell--established treatment in established treatment in England--
CognitiveCognitive Therapy,Therapy, cont.cont. WellWell--established treatment in established treatment in England--
CognitiveCognitive Therapy,Therapy, cont.cont. WellWell--established treatment in established treatment in England--
CognitiveCognitive Therapy,Therapy, cont.cont.
WellWell--established treatment in
established treatment in
England-- offeredoffered
England
toto allall personspersons
CanCan treattreat specificspecific symptomssymptoms
–– DelusionsDelusions
–– HallucinationsHallucinations
–– NegativeNegative SymptomsSymptoms
Part of a comprehensive treatment package
Part of a comprehensive treatment package
Combined with other
Combined with other
treatments such as social
treatments such as social
skills training,
skills training,
coping
coping
skills
skills
treatments such as social treatments such as social skills training, skills training, coping coping skills skills
treatments such as social treatments such as social skills training, skills training, coping coping skills skills
treatments such as social treatments such as social skills training, skills training, coping coping skills skills
treatments such as social treatments such as social skills training, skills training, coping coping skills skills
treatments such as social treatments such as social skills training, skills training, coping coping skills skills
treatments such as social treatments such as social skills training, skills training, coping coping skills skills
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when CognitiveCognitive TherapyTherapy
over over time time (naturally) (naturally) that that present when present when
over over
time time (naturally) (naturally)
that
that
present when
present when

CognitiveCognitive TherapyTherapy forfor DelusionsDelusions

Delusions can be modified and are not asCognitiveCognitive TherapyTherapy forfor DelusionsDelusions Delusions can be modified and are not as rigidly held as

Delusions can be modified and are not as

rigidly held as previously believed

rigidly held as previously believed

as previously believed rigidly held as previously believed Conviction Conviction levels levels vary vary and and

Conviction Conviction levels levels vary varyas previously believed rigidly held as previously believed and and in in response response to to

and and in in response response to to cognitive cognitive therapy therapy

Watts et al. (1973) arguedresponse response to to cognitive cognitive therapy therapy Watts et al. (1973) argued psychological reactance is

Watts et al. (1973) argued

Watts et al. (1973) argued Watts et al. (1973) argued psychological reactance is psychological reactance is

psychological reactance is

psychological reactance is

direct confrontation is used

direct confrontation is

used

–– Avoid Avoid a direct challenge to beliefs a direct challenge to beliefs
–– Avoid
Avoid
a direct challenge to beliefs
a
direct challenge to beliefs
used direct confrontation is used –– Avoid Avoid a direct challenge to beliefs a direct challenge
used direct confrontation is used –– Avoid Avoid a direct challenge to beliefs a direct challenge
used direct confrontation is used –– Avoid Avoid a direct challenge to beliefs a direct challenge
used direct confrontation is used –– Avoid Avoid a direct challenge to beliefs a direct challenge
used direct confrontation is used –– Avoid Avoid a direct challenge to beliefs a direct challenge
used direct confrontation is used –– Avoid Avoid a direct challenge to beliefs a direct challenge
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)
itself itself it it
itself itself
it it
itself itself it it CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued 1)1)

CognitiveCognitive TherapyTherapy forfor Delusions,Delusions, continuedcontinued

1)1) ChallengingChallenging thethe evidenceevidenceforfor Delusions,Delusions, continuedcontinued 2) Challenging the delusion 2) Challenging the delusion 3)

2) Challenging the delusion1)1) ChallengingChallenging thethe evidenceevidence 2) Challenging the delusion 3) 3) Empirical Empirical or or

2) Challenging the delusion

2) Challenging the delusion 2) Challenging the delusion 3) 3) Empirical Empirical or or behavioral behavioral

3) 3) Empirical Empirical or or behavioral behavioral testing testing2) Challenging the delusion 2) Challenging the delusion –– Behavioral testing is less effective when Behavioral

–– Behavioral testing is less effective when

Behavioral testing is less effective when

delivered alone, but more effective when

delivered alone, but more effective when

followsfollows verbalverbal challengechallenge

–– Verbal challenge weakens the belief for the

Verbal challenge weakens the belief for the

behavioral behavioral intervention intervention to to
behavioral
behavioral
intervention
intervention
to
to
challenge weakens the belief for the behavioral behavioral intervention intervention to to be effective be effective

be effective

be effective

challenge weakens the belief for the behavioral behavioral intervention intervention to to be effective be effective
challenge weakens the belief for the behavioral behavioral intervention intervention to to be effective be effective
challenge weakens the belief for the behavioral behavioral intervention intervention to to be effective be effective
challenge weakens the belief for the behavioral behavioral intervention intervention to to be effective be effective
challenge weakens the belief for the behavioral behavioral intervention intervention to to be effective be effective
challenge weakens the belief for the behavioral behavioral intervention intervention to to be effective be effective
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few
or life life least least important important to to
or
life
life
least least important important to to
or life life least least important important to to ChallengingChallenging thethe EvidenceEvidence The first few

ChallengingChallenging thethe EvidenceEvidence

The first few sessions are devoted toto to ChallengingChallenging thethe EvidenceEvidence The first few sessions are devoted to understanding how the

The first few sessions are devoted to

understanding how the delusion was formed or

understanding how the delusion was formed

was formed or understanding how the delusion was formed important events in the client’s important events

important events in the client’s

important events in the client’s

Rank Rank order order the the evidence evidence from from mostmost importantimportant mostmost importantimportant

Challenge Challenge the the least least important important evidence evidence first firstthe evidence evidence from from mostmost importantimportant Therapist provides an alternative explanation Therapist

Therapist provides an alternative explanationTherapist provides an alternative explanation

Therapist provides an alternative explanation

explanation Therapist provides an alternative explanation Client Client explanation explanation is weaker is weaker
explanation Therapist provides an alternative explanation Client Client explanation explanation is weaker is weaker
Client Client explanation explanation is weaker is weaker method method
Client Client explanation explanation
is weaker
is
weaker method
method
Therapist provides an alternative explanation Client Client explanation explanation is weaker is weaker method method
Therapist provides an alternative explanation Client Client explanation explanation is weaker is weaker method method
are trying to kill me.” are trying to kill me.” late late at at night
are trying to kill me.” are trying to kill me.” late late at at night
are trying to kill me.”
are trying to kill me.”
late late at at night night
they
they
were pointing
were pointing
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:
at at night night they they were pointing were pointing SampleSample HierarchyHierarchy Delusion: Delusion:

SampleSample HierarchyHierarchy

Delusion: Delusion: “Neighbors “Neighborswere pointing were pointing SampleSample HierarchyHierarchy 1) 1) Neighbors Neighbors were were up up 2) 2)

1) 1) Neighbors Neighbors were were up upDelusion: Delusion: “Neighbors “Neighbors 2) 2) Put Put curtains curtains up up in in their their

“Neighbors 1) 1) Neighbors Neighbors were were up up 2) 2) Put Put curtains curtains up

2) 2) Put Put curtains curtains up up in in their their house house“Neighbors 1) 1) Neighbors Neighbors were were up up 3) 3) Husband Husband went went inside

3) 3) Husband Husband went went inside inside when when I I got got home homePut curtains curtains up up in in their their house house 4) 4) Looked Looked outside

4) 4) Looked Looked outside outside and and atat mymy househouse atat mymy househouse

Looked Looked outside outside and and atat mymy househouse 5) Came over 5) Came over to
Looked Looked outside outside and and atat mymy househouse 5) Came over 5) Came over to
Looked Looked outside outside and and atat mymy househouse 5) Came over 5) Came over to
5) Came over 5) Came over to to talk talk and and then I got
5) Came over
5) Came over
to
to
talk
talk
and
and
then I got sick
then I got sick
the
the
next
next
day
day
5) Came over 5) Came over to to talk talk and and then I got sick
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation ––
of treatment of treatment
of treatment
of treatment

SupplementarySupplementary InterventionsInterventions

SupplementarySupplementary InterventionsInterventions 1)1) AccommodationAccommodation –– Have the client seek

1)1) AccommodationAccommodation

–– Have the client seek out or look for things in

Have the client seek out or look for things in

for things in Have the client seek out or look for things in the the environment

the the environment environment that that are are contrary contrary to to their their beliefbelief –– HomeworkHomework exerciseexercise

–– Gradual Gradual increase increase in in perception perception of of these these

events events over over the the course course

Gradual increase increase in in perception perception of of these these events events over over the
Gradual increase increase in in perception perception of of these these events events over over the
Gradual increase increase in in perception perception of of these these events events over over the
Gradual increase increase in in perception perception of of these these events events over over the
Gradual increase increase in in perception perception of of these these events events over over the
Gradual increase increase in in perception perception of of these these events events over over the
ChallengingChallenging thethe DelusionDelusion ItselfItself 1) Focus on the inconsistency and irrationality of 1) Focus
ChallengingChallenging thethe DelusionDelusion ItselfItself 1) Focus on the inconsistency and irrationality of 1) Focus
ChallengingChallenging thethe DelusionDelusion ItselfItself 1) Focus on the inconsistency and irrationality of 1) Focus
ChallengingChallenging thethe DelusionDelusion ItselfItself 1) Focus on the inconsistency and irrationality of 1) Focus
ChallengingChallenging thethe DelusionDelusion ItselfItself 1) Focus on the inconsistency and irrationality of 1) Focus
ChallengingChallenging thethe DelusionDelusion ItselfItself 1) Focus on the inconsistency and irrationality of 1) Focus
ChallengingChallenging thethe DelusionDelusion ItselfItself 1) Focus on the inconsistency and irrationality of 1) Focus
ChallengingChallenging thethe DelusionDelusion ItselfItself
1) Focus on the inconsistency and irrationality of
1) Focus on the inconsistency and irrationality of
thethe beliefbelief
–– “Would “Would it it make make sense sense for for
things to be this way?”
things to be this way?”
–– Point Point out out inconsistencies inconsistencies
or or problems problems in in reasoning reasoning
–– Bizarre Bizarre delusions delusions are are especially especially vulnerable vulnerable
2) Belief is an attempt to explain unusual,
2) Belief is an attempt to explain unusual,
puzzling,puzzling, oror ambiguousambiguous eventsevents
–– NormalizesNormalizes thethe beliefbelief
–– AnxietyAnxiety isis aa commoncommon prepre--cursorcursor
3) Discuss
3) Discuss
emotional
emotional
and
and
behavioral costs of
behavioral costs of
the
the
delusions
delusions
vs.
vs.
alternative
alternative
belief
belief
costs of behavioral costs of the the delusions delusions vs. vs. alternative alternative belief belief
costs of behavioral costs of the the delusions delusions vs. vs. alternative alternative belief belief
costs of behavioral costs of the the delusions delusions vs. vs. alternative alternative belief belief
costs of behavioral costs of the the delusions delusions vs. vs. alternative alternative belief belief
costs of behavioral costs of the the delusions delusions vs. vs. alternative alternative belief belief
costs of behavioral costs of the the delusions delusions vs. vs. alternative alternative belief belief
BehavioralBehavioral ExperimentsExperiments Behavioral Behavioral experiments experiments are ways to test out are
BehavioralBehavioral ExperimentsExperiments
Behavioral Behavioral experiments experiments
are ways to test out
are ways to test out
the
the
clientsclients beliefbelief
Direct Direct disconfirmation, disconfirmation, powerful powerful
Must Must be be collaborative collaborative in in
nature nature
to to be be effective effective
Must Must be be specific specific (delusion (delusion vs. vs.
prediction)prediction)
alternative
alternative
Not to “prove” the belief,
Not to “prove” the belief,
but to
but to test it out
test it out
the belief, but to but to test it out test it out to Predictions Predictions are
to
to
the belief, but to but to test it out test it out to Predictions Predictions are
the belief, but to but to test it out test it out to Predictions Predictions are
the belief, but to but to test it out test it out to Predictions Predictions are
the belief, but to but to test it out test it out to Predictions Predictions are
the belief, but to but to test it out test it out to Predictions Predictions are
the belief, but to but to test it out test it out to Predictions Predictions are
the belief, but to but to test it out test it out to Predictions Predictions are
Predictions Predictions are are done done in in
Predictions Predictions
are are done done
in in

by the client

by the client

to Predictions Predictions are are done done in in by the client by the client advance
to Predictions Predictions are are done done in in by the client by the client advance
to Predictions Predictions are are done done in in by the client by the client advance

advance and agreed to

advance and agreed

to Predictions Predictions are are done done in in by the client by the client advance
to Predictions Predictions are are done done in in by the client by the client advance
to Predictions Predictions are are done done in in by the client by the client advance
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes
star on website to check or or delusions delusions of of
star
on website to check
or or delusions delusions of of
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she
star on website to check or or delusions delusions of of SampleSample ExperimentsExperiments Client believes she

SampleSample ExperimentsExperiments

Client believes she can tell the futuredelusions of of SampleSample ExperimentsExperiments Client believes she can tell the future –– Test: Test:

Client believes she can tell the future

–– Test: Test: Pause Pause a a videotape videotape and and ask ask client client what what will will

occuroccur

and and ask ask client client what what will will occuroccur Client believes he is an

Client believes he is an professional footballand and ask ask client client what what will will occuroccur Client believes he is an

Client believes he is an professional football star

–– Test: Access list of players

Test: Access list of players on website to check

of players Test: Access list of players on website to check Works Works well well for

Works Works well well for for grandiose grandioseof players Test: Access list of players on website to check reference, but persecutory delusions require

reference, but persecutory delusions require

reference, but persecutory delusions require

more care and planning.

more care and planning.

persecutory delusions require reference, but persecutory delusions require more care and planning. more care and planning.
persecutory delusions require reference, but persecutory delusions require more care and planning. more care and planning.
persecutory delusions require reference, but persecutory delusions require more care and planning. more care and planning.
persecutory delusions require reference, but persecutory delusions require more care and planning. more care and planning.
persecutory delusions require reference, but persecutory delusions require more care and planning. more care and planning.
persecutory delusions require reference, but persecutory delusions require more care and planning. more care and planning.
persecutory delusions require reference, but persecutory delusions require more care and planning. more care and planning.
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia

Cognitive Therapy for

Cognitive Therapy for

ParanoiaParanoia

Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
Cognitive Therapy for Cognitive Therapy for ParanoiaParanoia
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods
methods methods
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon
methods methods OverviewOverview DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon

OverviewOverview

DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon paranoia?paranoia?
DefinitionsDefinitions andand developmentdevelopment WhyWhy focusfocus onon paranoia?paranoia? WhyWhy focusfocus onon paranoia?paranoia?

WhyWhy focusfocus onon paranoia?paranoia? Cognitive Cognitive biases biases found found in in paranoia

Cognitive Cognitive biases biases found found in in paranoia paranoiaWhyWhy focusfocus onon paranoia?paranoia? BehavioralBehavioral characteristicscharacteristics

BehavioralBehavioral characteristicscharacteristicsCognitive Cognitive biases biases found found in in paranoia paranoia Treatment Treatment issues issues and and

Treatment Treatment issues issues and andCognitive Cognitive biases biases found found in in paranoia paranoia BehavioralBehavioral characteristicscharacteristics

in in paranoia paranoia BehavioralBehavioral characteristicscharacteristics Treatment Treatment issues issues and and
in in paranoia paranoia BehavioralBehavioral characteristicscharacteristics Treatment Treatment issues issues and and
in in paranoia paranoia BehavioralBehavioral characteristicscharacteristics Treatment Treatment issues issues and and
in in paranoia paranoia BehavioralBehavioral characteristicscharacteristics Treatment Treatment issues issues and and
in in paranoia paranoia BehavioralBehavioral characteristicscharacteristics Treatment Treatment issues issues and and
form of self-- form of self beliefs beliefs of of harm harm and and specific
form of self-- form of self beliefs beliefs of of harm harm and and specific
form of self--
form of self
beliefs beliefs
of of harm harm and and
specific (Garety &
specific (Garety &
anticipated
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be
specific (Garety & specific (Garety & anticipated DefinitionsDefinitions Paranoia Paranoia can can be be

DefinitionsDefinitions

Paranoia Paranoia can can be be defined defined as as a aspecific (Garety & anticipated DefinitionsDefinitions referential referential thinking thinking characterized

referential referential thinking thinking characterized characterized by by suspicion, suspicion, ill ill

will,will, wariness,wariness, andand resentmentresentment

will,will, wariness,wariness, andand resentmentresentment “Self“Self asas aa targettarget ofof others”others”

“Self“Self asas aa targettarget ofof others”others”will,will, wariness,wariness, andand resentmentresentment At At delusional delusional levels, levels, the the

At At delusional delusional levels, levels, the the“Self“Self asas aa targettarget ofof others”others” malevolent intentions become malevolent intentions become

malevolent intentions become

malevolent intentions become

Freeman,Freeman, 2000)2000)

HarmHarm isis onon-- going and/or anticipated --going and/or anticipated

going and/or

ParanoidParanoid ideationideation cancan bebeHarmHarm isis onon -- going and/or anticipated going and/or foundfound inin normalnormal persons persons and and

foundfound inin normalnormal

ideationideation cancan bebe foundfound inin normalnormal persons persons and and persons persons with with psychosis
persons persons and and persons persons with with psychosis psychosis Continuum Continuum
persons persons and and persons persons with with
psychosis psychosis
Continuum
Continuum

approach

approach

of paranoia

of paranoia

and and persons persons with with psychosis psychosis Continuum Continuum approach approach of paranoia of paranoia
and and persons persons with with psychosis psychosis Continuum Continuum approach approach of paranoia of paranoia
and and persons persons with with psychosis psychosis Continuum Continuum approach approach of paranoia of paranoia
and and persons persons with with psychosis psychosis Continuum Continuum approach approach of paranoia of paranoia
and and persons persons with with psychosis psychosis Continuum Continuum approach approach of paranoia of paranoia
and and persons persons with with psychosis psychosis Continuum Continuum approach approach of paranoia of paranoia
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas
several areas
several areas
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual
several areas several areas DevelopmentDevelopment Paranoia Paranoia can can arise arise from from ContextualContextual

DevelopmentDevelopment

Paranoia Paranoia can can arise arise from fromseveral areas several areas DevelopmentDevelopment ContextualContextual factorsfactors –– Incarceration,

ContextualContextual factorsfactorsParanoia Paranoia can can arise arise from from –– Incarceration, Incarceration, public public

arise arise from from ContextualContextual factorsfactors –– Incarceration, Incarceration, public public

–– Incarceration, Incarceration, public public settings, settings, racism, racism, one one way way mirrors mirrors

Modeling Modeling and and learning learning influences influences (Haynes, (Haynes,settings, racism, racism, one one way way mirrors mirrors 1986)1986) Stress model of psychosis

1986)1986)

learning influences influences (Haynes, (Haynes, 1986)1986) Stress model of psychosis VulnerabilityVulnerability --

Stress model of psychosis

VulnerabilityVulnerability-- Stress model of psychosis --Stress model of psychosis

–– Anxiety producing events, especially ambiguous

Anxiety producing events, especially ambiguous

ambiguous Anxiety producing events, especially ambiguous eventsevents –– Perception Perception of threat of
eventsevents –– Perception Perception of threat of threat or or unusual experiences unusual experiences
eventsevents –– Perception Perception of threat of threat or or unusual experiences unusual experiences
eventsevents
––
Perception
Perception
of threat
of threat
or or
unusual experiences
unusual experiences
eventsevents –– Perception Perception of threat of threat or or unusual experiences unusual experiences
eventsevents –– Perception Perception of threat of threat or or unusual experiences unusual experiences
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems
problems
problems
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,
problems problems WhyWhy FocusFocus onon Paranoia?Paranoia? NegativeNegative emotionsemotions –– Anxiety, Anxiety,

WhyWhy FocusFocus onon Paranoia?Paranoia?

NegativeNegative emotionsemotionsproblems problems WhyWhy FocusFocus onon Paranoia?Paranoia? –– Anxiety, Anxiety, anger, anger, and and depression

–– Anxiety, Anxiety, anger, anger, and and depression depression

Anxiety, anger, anger, and and depression depression PersonallyPersonally distressingdistressing LowLow

PersonallyPersonally distressingdistressing LowLow selfself -- esteemesteem
PersonallyPersonally distressingdistressing LowLow selfself -- esteemesteem LowLow selfself--esteemesteem

Social avoidance/Occupationaldistressingdistressing LowLow selfself -- esteemesteem Social avoidance/Occupational PoorPoor intimateintimate

Social avoidance/Occupational

PoorPoor intimateintimate relationshipsrelationshipsSocial avoidance/Occupational Social avoidance/Occupational Cognitive rigidity/poor tolerance for ambiguity Cognitive

Cognitive rigidity/poor tolerance for ambiguityPoorPoor intimateintimate relationshipsrelationships Cognitive rigidity/poor tolerance for ambiguity Poor rapport

Cognitive rigidity/poor tolerance for ambiguity

Poor rapport and Poor rapport and
Poor rapport and
Poor rapport and

treatment compliance

treatment compliance

rigidity/poor tolerance for ambiguity Poor rapport and Poor rapport and treatment compliance treatment compliance
rigidity/poor tolerance for ambiguity Poor rapport and Poor rapport and treatment compliance treatment compliance
rigidity/poor tolerance for ambiguity Poor rapport and Poor rapport and treatment compliance treatment compliance
rigidity/poor tolerance for ambiguity Poor rapport and Poor rapport and treatment compliance treatment compliance
rigidity/poor tolerance for ambiguity Poor rapport and Poor rapport and treatment compliance treatment compliance
rigidity/poor tolerance for ambiguity Poor rapport and Poor rapport and treatment compliance treatment compliance
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and Paranoia is a
these these persons persons stems from an an cognitive and cognitive and
these these
persons persons
stems from
an an
cognitive and
cognitive and
persons stems from an an cognitive and cognitive and Paranoia is a significant concern for Paranoia

Paranoia is a significant concern forpersons stems from an an cognitive and cognitive and Paranoia is a significant concern for treatmenttreatment

Paranoia is a significant concern for

treatmenttreatment staffstaff andand othersothers

for treatmenttreatment staffstaff andand othersothers Negative Negative reactions reactions to to The treatment of

Negative Negative reactions reactions to tofor treatmenttreatment staffstaff andand othersothers The treatment of paranoia stems from The treatment of

The treatment of paranoia stems fromothersothers Negative Negative reactions reactions to to The treatment of paranoia understanding understanding of of

The treatment of paranoia

understanding understanding of of the the

behavioral biases associated with the

behavioral biases associated with the

conditioncondition

understanding of of the the behavioral biases associated with the behavioral biases associated with the conditioncondition
understanding of of the the behavioral biases associated with the behavioral biases associated with the conditioncondition
understanding of of the the behavioral biases associated with the behavioral biases associated with the conditioncondition
understanding of of the the behavioral biases associated with the behavioral biases associated with the conditioncondition
understanding of of the the behavioral biases associated with the behavioral biases associated with the conditioncondition
understanding of of the the behavioral biases associated with the behavioral biases associated with the conditioncondition
understanding of of the the behavioral biases associated with the behavioral biases associated with the conditioncondition
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia
words than neutral or events events style style the situation for
words than neutral or
events events
style style
the situation for
neutral or events events style style the situation for CognitiveCognitive BiasesBiases inin ParanoiaParanoia

CognitiveCognitive BiasesBiases inin ParanoiaParanoia

SelectiveSelective attentionattention forfor threatthreatfor CognitiveCognitive BiasesBiases inin ParanoiaParanoia –– Take longer to read threat ening Take longer to read

–– Take longer to read threatening

Take longer to read threatening words than neutral or

depresseddepressed wordswords

ening words than neutral or depresseddepressed wordswords Memory bias for negative Memory bias for negative

Memory bias for negativeening words than neutral or depresseddepressed wordswords Memory bias for negative Externalizing Externalizing

Memory bias for negative

Externalizing Externalizing attributional attributionalwordswords Memory bias for negative Memory bias for negative –– Tend to blame others rather than

–– Tend to blame others rather than the situation for

Tend to blame others rather than

negativenegative eventsevents –– Very Very common common for for ambiguous ambiguous situations situations

TheoryTheory ofof mindmind deficitsdeficitscommon for for ambiguous ambiguous situations situations –– Problems Problems inferring inferring the intentions

–– Problems

Problems

inferring

inferring

the intentions

the intentions

and motivations of

and motivations

of

othersothers to to conclusions bias conclusions bias
othersothers
to
to
conclusions bias
conclusions bias

Jumpingof othersothers to to conclusions bias conclusions bias Jumping – – Using less evidence to make

Jumping

conclusions bias conclusions bias Jumping Jumping – – Using less evidence to make Using less evidence
conclusions bias conclusions bias Jumping Jumping – – Using less evidence to make Using less evidence
conclusions bias conclusions bias Jumping Jumping – – Using less evidence to make Using less evidence

Using less evidence to make

Using less evidence to

datadata

make decisions; gather decisions; gather
make
decisions; gather
decisions; gather
– – Using less evidence to make Using less evidence to datadata make decisions; gather decisions;

less less

– – Using less evidence to make Using less evidence to datadata make decisions; gather decisions;
AssociatedAssociated BehaviorsBehaviors Safety behaviors to prevent negative Safety behaviors to prevent negative
AssociatedAssociated BehaviorsBehaviors Safety behaviors to prevent negative Safety behaviors to prevent negative
AssociatedAssociated BehaviorsBehaviors Safety behaviors to prevent negative Safety behaviors to prevent negative
AssociatedAssociated BehaviorsBehaviors Safety behaviors to prevent negative Safety behaviors to prevent negative
AssociatedAssociated BehaviorsBehaviors Safety behaviors to prevent negative Safety behaviors to prevent negative
AssociatedAssociated BehaviorsBehaviors Safety behaviors to prevent negative Safety behaviors to prevent negative
AssociatedAssociated BehaviorsBehaviors Safety behaviors to prevent negative Safety behaviors to prevent negative
AssociatedAssociated BehaviorsBehaviors
Safety behaviors to prevent negative
Safety behaviors to prevent negative
outcomesoutcomes
–– Avoidance Avoidance and and Escape Escape from from
harmharm themthem
others others who who may may
–– Prevents disconfirmation of
Prevents disconfirmation of
beliefs and
beliefs and
person interprets these as “near misses”
person interprets these as “near misses”
Increased social distance from others
Increased social distance from others
Poor social skills and expression of hostile
Poor social skills and expression of hostile
statementsstatements
others Poor social skills and expression of hostile Poor social skills and expression of hostile statementsstatements
others Poor social skills and expression of hostile Poor social skills and expression of hostile statementsstatements
others Poor social skills and expression of hostile Poor social skills and expression of hostile statementsstatements
others Poor social skills and expression of hostile Poor social skills and expression of hostile statementsstatements
others Poor social skills and expression of hostile Poor social skills and expression of hostile statementsstatements
others Poor social skills and expression of hostile Poor social skills and expression of hostile statementsstatements
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model
Consequence model
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --
Consequence model TreatmentTreatment IssuesIssues RapportRapport buildingbuilding isis keykey AntecedentAntecedent --

TreatmentTreatment IssuesIssues

RapportRapport buildingbuilding isis keykeyConsequence model TreatmentTreatment IssuesIssues AntecedentAntecedent -- BeliefBelief -- Consequence model forfor

AntecedentAntecedent -- BeliefBelief -- Consequence model -- BeliefBelief-- Consequence model

AntecedentAntecedent -- BeliefBelief -- Consequence model forfor understandingunderstanding eventsevents Motivation

forfor understandingunderstanding eventsevents

Motivation and engagement to find outmodel forfor understandingunderstanding eventsevents Motivation and engagement to find out more about beliefs and

Motivation and engagement to find out

more about beliefs and events in life

more about beliefs and events in life

and events in life more about beliefs and events in life Reduce personal distress and negative

Reduce personal distress and negativeand events in life more about beliefs and events in life Reduce personal distress and negative

Reduce personal distress and negative

distress and negative Reduce personal distress and negative moodsmoods Improve Improve trust and trust and
moodsmoods Improve Improve trust and trust and relationships relationships

moodsmoods

moodsmoods Improve Improve trust and trust and relationships relationships

Improvemoodsmoods Improve trust and trust and relationships relationships

Improve

moodsmoods Improve Improve trust and trust and relationships relationships
moodsmoods Improve Improve trust and trust and relationships relationships
moodsmoods Improve Improve trust and trust and relationships relationships

trust and

trust and

relationships

relationships

moodsmoods Improve Improve trust and trust and relationships relationships
personal distress and negative moodsmoods Improve Improve trust and trust and relationships relationships
personal distress and negative moodsmoods Improve Improve trust and trust and relationships relationships
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations CognitiveCognitive
to fully attend to and move move to to real real life life interpretations
to fully attend to and
move move to to real real
life life
interpretations
and move move to to real real life life interpretations CognitiveCognitive TechniquesTechniques Attention and social

CognitiveCognitive TechniquesTechniques

interpretations CognitiveCognitive TechniquesTechniques Attention and social perception biases Attention and social

Attention and social perception biases

Attention and social perception biases

–– Encourage the person to fully attend to and

Encourage the person

the person to fully attend to and Encourage the person describedescribe eacheach situationsituation ––

describedescribe eacheach situationsituation

–– Practice Practice in in session session and and then then eventsevents

–– Separate out facts vs.

Separate out facts vs. interpretations

(paranoid(paranoid beliefs)beliefs)

vs. interpretations (paranoid(paranoid beliefs)beliefs) –– Emotional expression training Emotional expression
vs. interpretations (paranoid(paranoid beliefs)beliefs) –– Emotional expression training Emotional expression
–– Emotional expression training Emotional expression training
–– Emotional expression training
Emotional expression
training
interpretations (paranoid(paranoid beliefs)beliefs) –– Emotional expression training Emotional expression training
interpretations (paranoid(paranoid beliefs)beliefs) –– Emotional expression training Emotional expression training
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for When an problematic
or or paranoid paranoid beliefs beliefs with with methods methods for for
or
or
paranoid paranoid beliefs beliefs with with
methods methods
for
for
beliefs beliefs with with methods methods for for When an problematic event is reported When an

When an problematic event is reportedbeliefs beliefs with with methods methods for for When an problematic event is reported expressedexpressed

When an problematic event is reported

expressedexpressed inin therapytherapy

event is reported expressedexpressed inin therapytherapy Verbal Verbal disputation disputation of of standard

Verbal Verbal disputation disputation of ofevent is reported expressedexpressed inin therapytherapy standard standard cognitive cognitive therapy therapy

standard standard cognitive cognitive therapy therapy

Supporting vs. disconfirming evidenceof of standard standard cognitive cognitive therapy therapy Supporting vs. disconfirming evidence thethe beliefbelief

Supporting vs. disconfirming evidence

thethe beliefbelief

Supporting vs. disconfirming evidence thethe beliefbelief post rating of paranoia PrePre-- post rating of paranoia
Supporting vs. disconfirming evidence thethe beliefbelief post rating of paranoia PrePre-- post rating of paranoia

post rating of paranoia

PrePre--post rating of paranoia post rating of paranoia

beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise

following this

following this

beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise
exerciseexercise
exerciseexercise
beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise
beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise
beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise
beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise
beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise
beliefbelief post rating of paranoia PrePre-- post rating of paranoia following this following this exerciseexercise
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and theory of mind, and more demanding) is is the the automatic
theory of mind, and
theory of mind, and
more demanding)
is is the the automatic automatic
and more demanding) is is the the automatic automatic Jumping Jumping to to conclusions, conclusions,

Jumping Jumping to to conclusions, conclusions,and more demanding) is is the the automatic automatic externalizingexternalizing attributionsattributions Consider

externalizingexternalizing attributionsattributions

Consider situational interpretations asexternalizingexternalizing attributionsattributions Consider situational interpretations as alternatives

Consider situational interpretations as

interpretations as Consider situational interpretations as alternatives (cognitively more demanding) alternatives

alternatives (cognitively more demanding)

alternatives (cognitively

May May not not be be the the default default way way of of processing processing events events(cognitively more demanding) alternatives (cognitively forfor thesethese personspersons When When stressed stressed

forfor thesethese personspersons

When When stressed stressed blames blames others others attributionattribution attributionattribution

stressed blames blames others others attributionattribution Emphasize Emphasize the the link link between between
stressed blames blames others others attributionattribution Emphasize Emphasize the the link link between between
stressed blames blames others others attributionattribution Emphasize Emphasize the the link link between between
stressed blames blames others others attributionattribution Emphasize Emphasize the the link link between between
Emphasize Emphasize the the link link between between emotional/behavioral emotional/behavioral consequences
Emphasize
Emphasize
the the link link between between
emotional/behavioral
emotional/behavioral
consequences
consequences

blaming others and

blaming others and

between emotional/behavioral emotional/behavioral consequences consequences blaming others and blaming others and
between emotional/behavioral emotional/behavioral consequences consequences blaming others and blaming others and
between emotional/behavioral emotional/behavioral consequences consequences blaming others and blaming others and
between emotional/behavioral emotional/behavioral consequences consequences blaming others and blaming others and
between emotional/behavioral emotional/behavioral consequences consequences blaming others and blaming others and
between emotional/behavioral emotional/behavioral consequences consequences blaming others and blaming others and
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information Social avoidance and safety
to “check things to “check things beforehand person information person information
to “check things
to “check things
beforehand
person information
person information
things beforehand person information person information Social avoidance and safety behaviors Social avoidance and

Social avoidance and safety behaviorsthings beforehand person information person information Social avoidance and safety behaviors Encourage the person

Social avoidance and safety behaviors

Encourage the personand safety behaviors Social avoidance and safety behaviors Encourage the person out”out” Role play social skills

Encourage the person

safety behaviors Encourage the person Encourage the person out”out” Role play social skills Role play social

out”out”

Role play social skillsEncourage the person Encourage the person out”out” Role play social skills beforehand May May need need

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ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant
ContactContact Info rm ationInfo rm ation DennisDennis R.R. Combs,Combs, Ph.D.Ph.D. AssistantAssistant

ContactContact InformationInformation

DennisDennis R.R. Combs,Combs, Ph.D.Ph.D.ContactContact Info rm ationInfo rm ation AssistantAssistant ProfessorProfessor ofof Psy chol ogyPsy chol ogy

AssistantAssistant ProfessorProfessor ofof Psychol ogyPsy chol ogy chologyPsychology

ProfessorProfessor ofof Psy chol ogyPsy chol ogy Director, Director, Psychotic Psychotic Disorde rs Disorde

Director, Director, Psychotic Psychotic Disorders Disorde rs R esearch R esearch LaboratoryLaboratory rs Disorders Research Research LaboratoryLaboratory

Consultation, research, and as sessment d assessment

Consultation, research, and assessment

servicesservices UniversityUniversity ofof TulsaTulsa UniversityUniversity ofof TulsaTulsa

Email:Email: dennis dennis - - combs@utulsa.edu combs@utulsa.edu dennisdennis--combs@utulsa.educombs@utulsa.edu

Phone: Phone: (918) (918) 631 631 --27512751
Phone:
Phone: (918)
(918)
631
631
--27512751
Email:Email: dennis dennis - - combs@utulsa.edu combs@utulsa.edu Phone: Phone: (918) (918) 631 631 --27512751
Email:Email: dennis dennis - - combs@utulsa.edu combs@utulsa.edu Phone: Phone: (918) (918) 631 631 --27512751
Email:Email: dennis dennis - - combs@utulsa.edu combs@utulsa.edu Phone: Phone: (918) (918) 631 631 --27512751
Email:Email: dennis dennis - - combs@utulsa.edu combs@utulsa.edu Phone: Phone: (918) (918) 631 631 --27512751
Email:Email: dennis dennis - - combs@utulsa.edu combs@utulsa.edu Phone: Phone: (918) (918) 631 631 --27512751
Email:Email: dennis dennis - - combs@utulsa.edu combs@utulsa.edu Phone: Phone: (918) (918) 631 631 --27512751