[acb-hsp] CBT _ Schizophrenia: Article

[J.Rayl]

Meaning versus the Stress-diathesis Model: a Review of Kingdon and Turkington's
Cognitive-behavioral
Therapy of Schizophrenia
by Sidne A. Buelow Phd
Meaning Versus the Stress-Diathesis Model: A Review of Kingdon and Turkington's Cognitive
-Behavioral
Therapy of Schizophrenia
 David G. Kingdon and Douglas Turkington. New York: The Guilford Press, 1994, 212
pp., $30.00 (hardcover).
This practical handbook by two British psychiatrists is characterized in the foreword
by Aaron Beck as providing "an alternate meaning for symptoms, lends itself to intervention...
and is easily explained and taught" (p. v). The book is divided into two main areas,
theory and application, and concludes with a brief evaluation.
The first 13 chapters present a discussion of the organic and environmental factors
involved in the development of
schizophrenia and a cognitive
 conceptualization of schizophrenic thought processes. Kingdon and Turkington explicate
the use of various
cognitive
-behavioral techniques supported by theoretical rationales and basic and clinical
research findings. The important functions of the techniques presented are: (1) to
normalize what the patient is experiencing in order to decrease fear, and (2) to
modify delusional thinking through the use of hypothesis testing. The authors make
the interesting point that the heightened suggestibility of patients experiencing
"altered states of consciousness" may affect patients detrimentally or may be employed
by the therapist to help clients entertain alternate explanations of, for example,
delusional beliefs or hallucinatory experiences.
Kingdon and Turkington take the perspective that the cognitive and behavioral disorders
of
schizophrenia are quantitatively rather than qualitatively different from normal
behavior
. They draw on basic research in such areas as sleep deprivation and sensory deprivation
to support their proposition that "normal" persons are vulnerable to schizophrenic-like
experiences such as hallucinations or paranoid ideation under certain conditions
such as extreme stress, fatigue, or psychoactive medication, and thus differ from
persons with
schizophrenia
 only in degree. Although they offer moderate support for the stress-diathesis model
of the development of
schizophrenia, the authors demonstrate a strong cognitive
 bias. Practitioners may benefit from this book while taking exception to the conceptual
limitations. Kingdon and Turkington propose that
cognitive
 behavioral techniques be used as adjuncts to pharmacotherapy and other
therapy modalities, including family and group.
The second section of the book is devoted to a discussion of specific techniques,
illustrated by case studies, with an emphasis on involving clients actively in a
dialogue about their experience and how they make sense of it. Kingdon and Turkington
suggest a nonconfrontational engagement of the client in such
cognitive
 strategies as: tracing symptom antecedents, inference chaining to weaken or dismantle
delusions, inductive questioning toward the development of more plausible explanations
of symptoms, and hypothesis testing of beliefs surrounding delusions. They suggest
that therapists selectively challenge arbitrary inferences and overgeneralizations,
both very common in this client population.
While at the time of publication Kingdon and Turkington had not conducted formal
follow-up research, they reported anecdotally that their methods resulted in a decreased
relapse rate and higher functioning for around 85 % of their patients. It is important
to note, however, that these outcomes are based on their work with a select group
of patients who had relatively adequate social and financial support, which is not
typical for patients with
schizophrenia
. Further, Kingdon and Turkington point out that clinician enthusiasm and other nonspecific
factors may account for a significant amount of the variance in patient outcome.
Without crossectional and longitudinal research support, it is not possible to say
how well their application of
cognitive
-behavioral techniques will generalize to the large heterogenous patient group with
schizophrenia
, but therapists have a long history of doing "what works" and seeking empirical
support later. The techniques are conservatively recommended by the authors to only
those already experienced in working with psychotic patients. However, the book jacket
commends the book to all health service professionals working with this population.
Therapists new to working with psychotic patients should employ these techniques
only with close supervision, due to the risks of reinforcing symptoms and of increasing
distress in a population with fragile interpersonal connections, poor reality testing,
low stress tolerance, and limited impulse control.
Kingdon and Turkington mention only briefly the affective distress of patients with
schizophrenia and refer the reader to other texts addressing specifically the cognitive
-behavioral
treatment
 of anxiety and depression. This text is presented as a compendium of techniques,
illustrated with briefcase studies, and supported with some discussion of theory
and research. The case studies are encouraging but lack sufficient detail or transcript
material, to facilitate the application of the suggested techniques to a distractible,
thought-disordered population. Negative symptoms, including avolition, alogia, and
affective flattening, which are often the most functionally disabling and the least
amenable to improvement with neuroleptics, are discussed only briefly.
In conclusion, the reader seeking a current comprehensive bibliography and analysis
of current research will be disappointed. The references include few recent citations
from the
Schizophrenia
 Bulletin, a primary source of current international research findings. Other American
references are also somewhat dated and the British references are primarily clinical
in nature. Primary sources in the area of neurobiology, therefore, are minimal. (For
a more current discussion of the stressdiathesis model and neurobiology, see Buelow
& Herbert, 1995; Seeman, 1993.) The argument by the authors that
schizophrenia
 is more quantitatively rather than qualitatively different from "normalcy" seems
designed more to decrease the fears of health-care workers and patients alike and
promote a pragmatic approach to psychotherapy than to persuade the readership on
technical grounds. The clinician searching for ideas about how one might use
cognitive
-behavioral techniques for clients with psychotic symptoms, however, and who is not
seeking a balanced explanation of the etiology of
schizophrenia
, will find this book, particularly the briefcase studies, interesting and enjoyable
reading.
-1-
Questia, a part of Gale, Cengage Learning. www.questia.com
Publication Information:
Article Title: Meaning versus the Stress-diathesis Model: a Review of Kingdon and
Turkington's Cognitive-behavioral Therapy of Schizophrenia. Contributors: Sidne A.
Buelow Phd. - author. Journal Title: Journal of Cognitive Psychotherapy. Volume:
10. Issue: 3. Publication Year: 1996. Page Number: 229+. © 1996 Springer Publishing
Company. Provided by ProQuest LLC. All Rights Reserved.
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Jessie Rayl
EM: thedogmom63 at frontier.com
PH:304.671.9780
www.facebook.com/eaglewings10

"But they that wait upon the LORD shall renew their strength; they shall
mount up with wings as eagles. They shall run, and not be weary"--Isaiah 40.31
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