rof. David G.

Kingdon
Ponencia: "Tratamientos cognitivo-conductuales de los delirios" Da: Sbado, 8 de Junio del 2013 Hora: 12:00 - 12:45

BIOGRAFA
David Kingdon is Professor of Mental Health Care Delivery at the University of Southampton, UK, and honorary consultant adult psychiatrist for Southern Health NHS Trust. He has previously worked as Medical Director for Nottingham Health Care Trust and Senior Medical Officer (Severe Mental Illness) in the UK Department of Health. He chaired the Expert Working Group leading to the Council of Europe s Recommendation 2004(10) on Psychiatry and Human Rights (1996-2003). His research interests are in cognitive therapy of severe mental health conditions and mental health service development on which he has published many papers, chapters and books. He is currently working on a number of studies funded by MRC, NIHR & NIMH into cognitive therapy in the US, China, & UK and into the development of mental health care pathways. He has given invited lectures and workshops in the US, Canada, Brazil, Mexico, Europe, China, Japan and Korea.

RESUMEN
Cognitive therapy is now well established in international guidelines for the treatment of psychosis. Clinical guidelines published by PORT, APA and NICE all encourage its use in patients with persistent symptoms including delusional beliefs. There are a range of cognitive theories regarding the origins of delusions; these essentially describe misunderstanding of abnormal alomalous ('strange or puzzling') perceptions. There has been debate around whether reasoning is affected directly or whether the perceptions themselves are abnormal. There is now some evidence that arbitrary inferences are made but these can frequently be understood in the context of the individual's life experiences. For example, if trauma has been experienced in childhood, a guarded, even paranoid, approach to the external world is completely understandable even if it is an over-generalisation. There is also evidence that people with psychosis are more likely to 'jump to conclusions' - making decisions on the basis of less information than control groups. On the other hand, the use of hallucinogenic drugs can lead to abnormal perceptions which can then be misinterpreted and become incorporated into the person's 'real world'.

Treatment involves developing an effective therapeutic relationship, developing a collaborative formulation based on the predisposing and perpetuating circumstances prior to development of the delusion and then linking beliefs, emotions and behavior together. Understanding the person's narrative and then using structured reasoning can help in developing rapport and shifting peripheral delusions. Core beliefs inevitably take longer to move but frequently the behavour contingent upon them begins to shift and techniques using inference chaining can be helpful. A metacognitive approach focusing on the worry about the beliefs is also showing promising results.

REFERENCIAS

[BOOK] Wright J, Turkington D, Kingdon D, Basco M (2009). Cognitive therapy for severe mental illness. APPI: Washington 2009.

[book] Kingdon D, Turkington D. (2005). Cognitive behaviour therapy for schizophrenia. Guilford: NY 2005.

[PDF] Freeman D, Dunn G, Startup H and Kingdon D (2012). The effects of reducing worry in patients with persecutory delusions: study protocol for a randomized controlled trial . Trials, 13, (1), 223.

Hepworth CR, Ashcroft K, Kingdon D. (2011). Auditory Hallucinations: A Comparison of Beliefs about Voices in Individuals with Schizophrenia and Borderline Personality Disorder . Clin Psychol Psychother. 2011 Oct 4.

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Clin Psychol Psychother. 2013 May;20(3):239-45. doi: 10.1002/cpp.791. Epub 2011 Oct 4.

Auditory Hallucinations: A Comparison of Beliefs about Voices in Individuals with Schizophrenia and Borderline Personality Disorder.
Hepworth CR, Ashcroft K, Kingdon D. Source
National Specialist CAMHS Dialectical Behaviour Therapy Service, Maudsley Hospital, London, UK.

Abstract
OBJECTIVE: Individuals with borderline personality disorder (BPD) may experience distressing auditory hallucinations, phenomenologically similar to those seen in psychosis. However, access to effective intervention is limited. The cognitive model of auditory hallucinations highlights the role of appraisals in maintaining distress. Cognitive behavioural therapy (CBT) that targets such beliefs has shown efficacy in psychosis. This study examined appraisals about voices in individuals with psychosis and those with BPD to establish whether CBT for voices might have clinical utility for those with BPD. METHODS: Participants included 45 patients with distressing auditory hallucinations, recruited from the National Health Service. All participants received a structured clinical diagnostic interview and the Beliefs about Voices Questionnaire. Ten participants met criteria for BPD (22%), 23 met criteria for a diagnosis of schizophrenia (51%) and 12 met criteria for both disorders (27%). RESULTS: Multivariate analyses confirmed that there were no group differences in beliefs about the malevolence or omnipotence of voices, or in behavioural resistance or engagement. Those with BPD and those with both diagnoses reported significantly greater emotional resistance than those

with schizophrenia. Those with schizophrenia reported significantly greater emotional engagement with their voices. CONCLUSION: Auditory hallucinations in psychosis and BPD do not differ in their phenomenology or cognitive responses (beliefs about the power and malevolence of their dominant voice). The main differential appears to be the affective response. CBT that focuses on appraisals and the relationship with voices may be helpful for distressing auditory hallucinations in individuals with BPD as well as psychosis. Copyright 2011 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: It may be important to assess the presence of and experience of voices in those with a diagnosis of BPIt may be helpful to consider both beliefs about voices and the individual's affective responses to voices.CBT designed to target voices in psychosis (focusing on both the appraisal and the relationship with voices) may be helpful for those with BPD. Copyright 2011 John Wiley & Sons, Ltd.