Cognitive Therapy For Delusion
Cognitive Therapy For Delusion
See also: Delusional disorder
A delusion , in everyday language, is a fixed belief that is either false, fanciful, or derived from deception. Psychiatry defines the term more specifically as a belief that is pathological (the result of an illness or illness process). As a pathology, it is distinct from a belief based on false or incomplete information, "incorrect" dogma, stupidity, apperception, illusion, or other effects of perception.
Delusions typically occur in the context of neurological or mental illness, although they are not tied to any particular disease and have been found to occur in the context of many pathological states (both physical and mental). However, they are of particular diagnostic importance in psychotic disorders and particularly in schizophrenia, paraphrenia, manic episodes of bipolar disorder, and psychotic depression.
Psychiatric definition
Although non-specific concepts of madness have been around for several thousand years, the psychiatrist and philosopher Karl Jaspers was the first to define the three main criteria for a belief to be considered delusional in his 1917 book General Psychopathology . These criteria are:
- certainty (held with absolute conviction)
- incorrigibility (not changeable by compelling counterargument or proof to the contrary)
- impossibility or falsity of content (implausible, bizarre or patently untrue)
These criteria still continue in modern psychiatric diagnosis. The most recent Diagnostic and Statistical Manual of Mental Disorders defines a delusion as:
There is controversy over this definition, as 'despite what almost everybody else believes' implies that a person who believes something most others do not is a candidate for delusional thought. Furthermore, it is ironic that, while the above three criteria are usually attributed to Jaspers, he himself described them as only 'vague' and merely 'external'. He also wrote that, since the genuine or 'internal' 'criteria for delusion proper lie in the primary experience of delusion and in the change of the personality , we can see that a delusion may be correct in content without ceasing to be a delusion, for instance - that there is a world-war.'.
Types
Delusions are categorized as either bizarre or non-bizarre and as either mood-congruent or mood-neutral. A bizarre delusion is a delusion that is very strange and completely implausible; an example of a bizarre delusion would be that aliens have removed the affected person's brain. A non-bizarre delusion is one whose content is definitely mistaken, but is at least possible; an example may be that the affected person mistakenly believes they are under constant police surveillance. A mood-congruent delusion is any delusion whose content is consistent with either a depressive or manic state; for example, a depressed person may believe that news anchors on the television highly disapprove of him or her, or a person in a manic state might believe that they are a powerful deity. A mood-neutral delusion does not relate to the sufferer's emotional state; for example, a belief that an extra limb is growing out of the back of one's head is neutral to either depression or mania.
In addition to these categories, delusions often manifest according to a consistent theme. Although delusions can have any theme, certain themes are more common. Some of the more common delusion themes are :
- Delusion of control : This is a false belief that another person, group of people, or external force controls one's thoughts, feelings, impulses, or behavior. A person may describe, for instance, the experience that aliens actually make him or her move in certain ways and that the person affected has no control over the bodily movements. Thought broadcasting (the false belief that the affected person's thoughts are heard aloud), thought insertion, and thought withdrawal (the belief that an outside force, person, or group of people is removing or extracting a person's thoughts) are also examples of delusions of control.
- Nihilistic delusion : A delusion whose theme centres on the nonexistence of self or parts of self, others, or the world. A person with this type of delusion may have the false belief that the world is ending.
- Delusional jealousy (or delusion of infidelity) : A person with this delusion falsely believes their spouse or lover is having an affair. This delusion stems from pathological jealousy, and the person often gathers "evidence" and confronts the spouse about the nonexistent affair.
- Delusion of guilt or sin (or delusion of self-accusation) : This is a false feeling of remorse or guilt of delusional intensity. A person may, for example, believe they have committed some horrible crime and should be punished severely. Another example is a person who is convinced they are responsible for some disaster (such as fire, flood, or earthquake) with which there can be no possible connection.
- Delusion of mind being read : The false belief that other people can know one's thoughts. This is different from thought broadcasting in that the person does not believe their thoughts are heard aloud.
- Delusion of reference : The person falsely believes that insignificant remarks, events, or objects in one's environment have personal meaning or significance. For instance, a person may believe they are receiving special messages from newspaper headlines.
- Erotomania is a delusion in which one believes that another person is in love with him or her. They believe that this other person was the first to declare his or her affection, often by special glances, signals, telepathy, or messages through the media.
- Grandiose delusion : An individual is convinced they have special powers, talents, or abilities. Sometimes, the individual may actually believe they are a famous person or character (for example, a rock star). More commonly, a person with this delusion may believe they have accomplished some great achievement for which they have not received sufficient recognition (for example, the discovery of a new scientific theory).
- Persecutory delusion : These are the most common type of delusions and involve the theme of being followed, harassed, cheated, poisoned or drugged, conspired against, spied on, attacked, or obstructed in the pursuit of goals. Sometimes the delusion is isolated and fragmented (such as the false belief that co-workers are harassing), but sometimes are well-organized belief systems involving a complex set of delusions ("systematized delusions"). People with a set of persecutory delusions may believe, for example, they are being followed by government organizations because the "persecuted" person has been falsely identified as a spy. These systems of beliefs can be so broad and complex that they can explain everything that happens to the person.
- Religious delusion : Any delusion with a religious or spiritual content. These may be combined with other delusions, such as grandiose delusions (the belief that the affected person was chosen by God, for example), delusions of control, or delusions of guilt. Beliefs that would be considered normal for an individual's religious or cultural background are also often called delusions by some. However, religious beliefs are generally not addressed as "problems" or even "delusions" by physicians, perhaps except in cases of hyperreligiosity.
- Somatic delusion : A delusion whose content pertains to bodily functioning, bodily sensations, or physical appearance. Usually the false belief is that the body is somehow diseased, abnormal, or changed—for example, infested with parasites.
Diagnostic issues
The modern definition and Jaspers' original criteria have been criticised, as counter-examples can be shown for every defining feature.
Studies on psychiatric patients have shown that delusions can be seen to vary in intensity and conviction over time which suggests that certainty and incorrigibility are not necessary components of a delusional belief.
Delusions do not necessarily have to be false or 'incorrect inferences about external reality'. Some religious or spiritual beliefs by their nature may not be falsifiable, and hence cannot be described as false or incorrect, no matter whether the person holding these beliefs was diagnosed as delusional or not.
In other situations the delusion may turn out to be true belief. For example, delusional jealousy, where a person believes that their partner is being unfaithful (and may even follow them into the bathroom believing them to be seeing their lover even during the briefest of partings) may result in the faithful partner being driven to infidelity by the constant and unreasonable strain put on them by their delusional spouse. In this case the delusion does not cease to be a delusion because the content later turns out to be true.
In other cases, the delusion may be assumed to be false by a doctor or psychiatrist assessing the belief, because it seems to be unlikely, bizarre or held with excessive conviction. Psychiatrists rarely have the time or resources to check the validity of a person’s claims leading to some true beliefs to be erroneously classified as delusional. This is known as the Martha Mitchell effect, after the wife of the attorney general who alleged that illegal
Effectiveness of cognitive therapy for delusions in ...
The British Journal of Psychiatry 175: 331-335 (1999) © 1999 The Royal College of Psychiatrists Effectiveness of cognitive therapy for delusions in routine clinical practice
Amazon.com: Cognitive Therapy for Delusions, Voices and ...
Amazon.com: Cognitive Therapy for Delusions, Voices and Paranoia (Wiley Series in Clinical Psychology) (9780471938880): Paul Chadwick, Max J. Birchwood, Peter Trower: Books
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Dr. Aaron Beck recently responded to an interviewer’s questions about addressing delusions among Schizophrenic patients. One of the central tenets of Cognitive Therapy is that ...
IoP: event: Cognitive-behaviour Therapy for Delusions
From Institute of Psychiatry: event: Cognitive-behaviour Therapy for Delusions
Cognitive Therapy for Delusions, Voices and Paranoia ...
Cognitive Therapy for Delusions, Voices and Paranoia Wiley Series in Clinical Psychology: Amazon.co.uk: Paul Chadwick, Max J. Birchwood, Peter Trower: Books
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Cognitive-behavioural Therapy with Delusions and Hallucinations: A Practice Manual 2e Mental Health Nursing & the Community: Amazon.co.uk: Hazel Nelson: Books
Amazon.com: Cognitive Therapy for Delusions, Voices and ...
Amazon.com: Cognitive Therapy for Delusions, Voices and Paranoia (Wiley Series in Clinical Psychology) (9780471961734): Paul Chadwick, Max J. Birchwood, Peter Trower: Books
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Cognitive Therapy for Hallucinations and Delusions ... "Cognitive Therapy for Hallucinations and Delusions" Professor Douglas Turkington ...
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Internationally respected authors, actively working in this area, establish theoretical reasons for extending cognitive therapy to these symptoms.
Wiley::Cognitive Therapy for Delusions, Voices and ...
A Cognitive View of Delusions and Voices. The Practice of Therapy and the Problem of Engagement. Delusions: Assessment and Formulation. Challenging Delusions.
