All Title Author
Keywords Abstract


The Effect of an Educating versus Normalizing Approach on Treatment Motivation in Patients Presenting with Delusions: An Experimental Investigation with Analogue Patients

DOI: 10.1155/2013/261587

Full-Text   Cite this paper   Add to My Lib

Abstract:

Until recently a widespread recommendation for clinicians was not to respond to the content of patients' delusions but to stress at an early time point that the patient has a mental illness (educating approach). An opposed recommendation is to validate the patients’ symptoms and normalize them (normalizing approach). This study used an experimental design to compare the impact of these two approaches on treatment motivation (TM). A cover story about a person who develops persecutory delusions was used to guide a sample of 81 healthy participants who served as analogue patients into imagining experiencing delusions. This was followed by a random assignment to either an educating or a normalizing consultation with a fictive clinician. Consultations only differed in content. Finally, we assessed the participants' motivation to accept medication (Medication TM), psychological treatment (Psychological TM), and treatment offered by this particular clinician independent of the kind of treatment (Clinician-related TM). Participants in the normalizing condition showed higher Clinician-related and Psychological TM than those in the educating condition. Medication TM was unaffected by condition. Following our results using a normalizing approach seems to be advisable in a first-contact situation with patients with delusions and favourable to a simple educating approach. 1. Introduction Communication with the patient is a central feature of mental health treatment. In treating delusions, the question of what constitutes a “good communication style” is controversial. There seems to be a considerable gap between patients’ and clinicians’ perspectives of good communication in the consultation. Many patients actively attempt to talk about their delusional beliefs [1] and expect the clinician to listen and respond to their problems [2]. This expectation stands in contrast to clinical practice. Through analysing conversations in routine psychiatrist-patient consultations, McCabe et al. [1] found that psychiatrists avoid responding to the patients’ concerns and rather evade their questions. Van Meer [3] confirmed that many psychiatrists were traditionally trained not to respond to delusional beliefs. Although today the idea of discussing the content of patients’ beliefs is somewhat more widespread, many clinicians still fear that responding to delusional beliefs in an empathic manner or discussing them will make them worse [4]. Consequently, clinicians try to communicate that the delusional belief is a symptom of a mental disorder. This so-called “doctor-knows-best”

References

[1]  R. McCabe, C. Heath, T. Burns, and S. Priebe, “Engagement of patients with psychosis in the consultation: conversation analytic study,” British Medical Journal, vol. 325, no. 7373, pp. 1148–1151, 2002.
[2]  B. Schneider, H. Scissons, L. Arney et al., “Communication between people with schizophrenia and their medical professionals: a participatory research project,” Qualitative Health Research, vol. 14, no. 4, pp. 562–577, 2004.
[3]  R. van Meer, “Engaging patients with psychosis in consultations. To listen or not to listen,” British Medical Journal, vol. 326, no. 7388, pp. 549–549, 2003.
[4]  X. Amador, I Am Not Sick—I Don't Need Help, Vida Press, New York, NY, USA, 2010.
[5]  T. M. Lincoln, E. Lüllmann, and W. Rief, “Correlates and long-term consequences of poor insight in patients with schizophrenia. A systematic review,” Schizophrenia Bulletin, vol. 33, no. 6, pp. 1324–1342, 2007.
[6]  A. Zygmunt, M. Olfson, C. A. Boyer, and D. Mechanic, “Interventions to improve medication adherence in schizophrenia,” American Journal of Psychiatry, vol. 159, no. 10, pp. 1653–1664, 2002.
[7]  T. M. Lincoln, K. Wilhelm, and Y. Nestoriuc, “Effectiveness of psychoeducation for relapse, symptoms, knowledge, adherence and functioning in psychotic disorders: a meta-analysis,” Schizophrenia Research, vol. 96, no. 1–3, pp. 232–245, 2007.
[8]  D. G. Kingdon and D. Turkington, Cognitive Therapy of Schizophrenia, Guilford Press, New York, NY, USA, 2004.
[9]  D. R. Fowler, P. A. Garety, and E. Kuipers, Cognitive Behaviour Therapy for Psychosis: Theory and Practice, Wiley, Chichester, UK, 1995.
[10]  P. Chadwick, M. Birchwood, and P. Trower, Cognitive Behaviour Therapy for Delusions, Voices and Paranoia, Wiley, Chichester, UK, 1996.
[11]  D. I. Velligan, P. J. Weiden, M. Sajatovic et al., “The expert consensus guideline series: adherence problems in patients with serious and persistent mental illness,” The Journal of Clinical Psychiatry, vol. 70, supplement 4, pp. 1–48, 2009.
[12]  D. J. Martin, J. P. Garske, and M. Katherine Davis, “Relation of the therapeutic alliance with outcome and other variables: a meta-analytic review,” Journal of Consulting and Clinical Psychology, vol. 68, no. 3, pp. 438–450, 2000.
[13]  R. McCabe and S. Priebe, “The therapeutic relationship in the treatment of severe mental illness: a review of methods and findings,” International Journal of Social Psychiatry, vol. 50, no. 2, pp. 115–128, 2004.
[14]  D. Turkington and D. Kingdon, “Using a normalising rationale in the treatment of schizophrenic patients,” in Cognitive-Behavioural Interventions with Psychotic Disorders, G. Haddock and P. D. Slade, Eds., Routledge, London, UK, 1996.
[15]  L. M. van Vliet and P. M. Spreeuwenberg, “The validity of using analogue patients in practitioner-patient communication research: systematic review and meta-analysis,” Journal of General Internal Medicine, vol. 27, no. 11, pp. 1528–1543, 2012.
[16]  C. Burgers, C. J. Beukeboom, and L. Sparks, “How the doc should (not) talk: when breaking bad news with negations influences patients’immediate responses and medical adherence intentions,” Patient Education and Counseling, vol. 89, no. 2, pp. 267–273, 2012.
[17]  W. Verheul, A. Sanders, and J. Bensing, “The effects of physicians' affect-oriented communication style and raising expectations on analogue patients' anxiety, affect and expectancies,” Patient Education and Counseling, vol. 80, no. 3, pp. 300–306, 2010.
[18]  T. P. Gilmer, C. R. Dolder, J. P. Lacro et al., “Adherence to treatment with antipsychotic medication and health care costs among medicaid beneficiaries with schizophrenia,” American Journal of Psychiatry, vol. 161, no. 4, pp. 692–699, 2004.
[19]  A. Schweickhardt, R. Leta, and J. Bauer, “Inanspruchnahme von Psychotherapie in Abh?ngigkeit von der Psychotherapiemotivation w?hrend der Indikationsstellung in einer Klinikambulanz,” Psychosomatic Medicine and Psychotherapy, vol. 55, no. 8, pp. 378–385, 2005.
[20]  C. L. Mulder, G. T. Koopmans, and M. W. Hengeveld, “Lack of motivation for treatment in emergency psychiatry patients,” Social Psychiatry and Psychiatric Epidemiology, vol. 40, no. 6, pp. 484–488, 2005.
[21]  R. M. Ryan, R. W. Plant, and S. O'Malley, “Initial motivations for alcohol treatment: relations with patient characteristics, treatment involvement, and dropout,” Addictive Behaviors, vol. 20, no. 3, pp. 279–297, 1995.
[22]  E. Lüllmann, S. Berendes, W. Rief, and T. M. Lincoln, “Benefits and harms of providing biological causal models in the treatment of psychosis—an experimental study,” Journal of Behavior Therapy and Experimental Psychiatry, vol. 42, no. 4, pp. 447–453, 2011.
[23]  E. P. Holmes, P. W. Corrigan, P. Williams, J. Canar, and M. A. Kubiak, “Changing attitudes about schizophrenia,” Schizophrenia Bulletin, vol. 25, no. 3, pp. 447–456, 1999.
[24]  J. P. Lacro, L. B. Dunn, C. R. Dolder, S. G. Leckband, and D. V. Jeste, “Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: a comprehensive review of recent literature,” Journal of Clinical Psychiatry, vol. 63, no. 10, pp. 892–909, 2002.
[25]  T. Lecomte, A. Spidel, C. Leclerc, G. W. MacEwan, C. Greaves, and R. P. Bentall, “Predictors and profiles of treatment non-adherence and engagement in services problems in early psychosis,” Schizophrenia Research, vol. 102, no. 1–3, pp. 295–302, 2008.
[26]  K. Jaspers, Allgemeine Psychopathologie, Springer DE, 1973.
[27]  D. Kingdom, T. Sharma, and D. Hart, “What attitudes do psychiatrists hold towards people with mental illness?” Psychiatric Bulletin, vol. 28, no. 11, pp. 401–406, 2004.
[28]  L. C. Johns and J. Van Os, “The continuity of psychotic experiences in the general population,” Clinical Psychology Review, vol. 21, no. 8, pp. 1125–1141, 2001.
[29]  T. M. Lincoln and E. Keller, “Delusions and hallucinations in students compared to the general population,” Psychology and Psychotherapy, vol. 81, no. 3, pp. 231–235, 2008.
[30]  M. C. Angermeyer, P. Breier, S. Dietrich, D. Kenzine, and H. Matschinger, “Public attitudes toward psychiatric treatment: an international comparison,” Social Psychiatry and Psychiatric Epidemiology, vol. 40, no. 11, pp. 855–864, 2005.
[31]  M. C. Angermeyer and H. Matschinger, “Public attitude towards psychiatric treatment,” Acta Psychiatrica Scandinavica, vol. 94, no. 5, pp. 326–336, 1996.
[32]  A. Riecher-R?ssler, E. Rechsteiner, M. D'Souza, E. von Castelmur, and J. Aston, “Frühdiagnostik und Frühbehandlung schizophrener Psychosen—ein Update,” Schweizer Medizinisches Forum, vol. 6, pp. 603–609, 2006.
[33]  R. Vauth and R. D. Stieglitz, Chronisches Stimmenh?ren und persistierender Wahn, Hogrefe, G?ttingen, Germany, 2007.

Full-Text

comments powered by Disqus