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Safety behaviours in psychotic in- patients
Peter Holmes · 07/26/01 at 11:14 ET
It is generally agreed that safety behaviours prevent patients disconfirming their unwanted belief or behaviour.Such behaviours often involve a ritual either verbal or behavioural.Therefore such safety behaviours should be discouraged.
I do not feel that this maxim of CBT(for neuroses) can be applied to work with psychotic patients.
COPING STRATEGY ENHANCEMENTS employing what might be termed safety behaviours,such as listening to music or challenging troublesome voices,give the psychotic patient some return of control over their symptoms.When such homework is reviewed
at the beginning of new sessions the patient can see the reality of his/her strategies de-powering their symptoms.So teaching the patient "to be their own therapist " in the true cbt sense.
Much current research into the use of cbt with psychosis seems to focus on a patient group receiving treatment for "first episode psychosis".Often in an out-patient setting or within the patient's home.The discouragement of safety behaviours in this group may apply,as their beliefs about their symptoms have not yet have had time to become schema -rooted.I would suggest that this does not apply to chaotic, severely disturbed in-patients,whose beliefs about their delusions or voices may be well entrenched due to the passage of time.Having settled into a deep schema network.
Any thoughts or ideas on what I've said(or not said)!
would be appreciated.
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