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Prof. Richard Bentall

 

Richard Bentall  Controversias Psiquiatria Barcelona
Talk 1 Debate 1. Is psychiatry currently undergoing a crisis?
Date Thursday, April 20th, 2017
Time 18:30 - 19:00
Talk 2 New approaches in psychotherapy. Is anything more to merge?
Date Saturday, April 22nd, 2017
Time 09:45 - 10:30

 
BIOGRAPHY

Richard Bentall is Professor of Clinical Psychology at Liverpool University and has previously held chairs at Manchester University and Bangor University. He graduated with a BSc and then a PhD in experimental psychology at the University College of North Wales (now Bangor University) and then completed his clinical training at Liverpool University. He also holds an MA in philosophy applied to health care awarded by University College Swansea (now Swansea University). His research interests have mainly focused on psychosis. He has studied the cognitive and emotional mechanisms involved in psychotic symptoms such as hallucinations, paranoid delusions and manic states, using methods ranging from psychological experiments, and experience sampling to functional magnetic resonance imaging. Most recently, his research has focused on why social risk factors (for example childhood adversities such as poverty, abuse, and bullying) provoke the cognitive and emotional changes that lead to these symptoms. In collaboration with colleagues at Manchester and elsewhere he has also conducted large scale randomized controlled trials of psychological interventions for people diagnosed with schizophrenia, bipolar disorder and prodromal psychosis. He has published over 200 peer-review papers and a number of books including Madness explained: Psychosis and human nature (Penguin, 2003) and Doctoring the mind: Why psychiatric treatments fail (Penguin, 2009).

 
ABSTRACT

Few doubt that it is possible to develop novel biological interventions for psychosis and both the early and recent history of biological psychiatry testify to the energies devoted to this goal. By contrast, there have been periods of extreme pessimism about the value of psychological interventions for severe mental illness, particularly (after the publicity surrounding the celebrated case of Dr Rafael Osheroff) during the period in the which the neoKraepelinian movement was dominant in the final quarter of the last century. This pessimism caused some effective therapeutic strategies (notably the token economy) to be neglected, and impeded the search for novel psychological approaches. Although this period came to an end with experiments, beginning in the UK, on the effectiveness of cognitive-behavioural therapy for psychosis, even now some question the effectiveness of psychological therapies. Possibly, psychotherapeutic pessimism rests on the background assumptions that interventions conducted through the medium of conversation amount to nothing more specific than the application of simple human kindness, and that the ability to be kind is commonplace.

In fact, there has been a longstanding debate within psychotherapy research between two viewpoints. On the one hand, following Carl Rogers, some have argued that the therapeutic relationship is the critical ingredient in psychotherapy; this position is associated with what is known as the Dodo Bird Conjecture (after a character in Alice Through the Looking Glass) that all psychotherapies are equally effective. On the other side of the argument, some researchers, notably from the CBT tradition, insist that specific therapeutic strategies are required to achieve effectiveness.

In fact, recent research supports a compromise between these two positions, which might be called the Starling Bird Conjecture. In a reanalysis of data from the SoCRATES CBT trial for early schizophrenia, my colleagues and I found that the therapeutic alliance was a significant determinant of outcomes, with a good alliance predicting good outcomes and, a poor alliance predicting poor outcomes; importantly, we were able to use novel statistical techniques to show that the effects of the therapeutic alliance were likely causal. At the same time, other researchers within the CBT tradition have adapted specific techniques to target specific psychological process in psychosis. An example is Freeman’s brief intervention targeted at worry, which has been shown to produce a reduction in paranoid symptoms mediated by a reduction in the target mechanism.

Going forwards, the lessons from the findings about the therapeutic alliance have implications for the delivery of all psychiatric interventions. Indeed (another conjecture), it is probable that substantially better outcomes could be achieved by making it a requirement that all clinicians have adequate interpersonal and communication skills. At the same time, our increasing understanding of the mechanisms that lead to symptoms is providing new targets for novel psychotherapeutic techniques. For example, the recent recognition that early trauma plays a causal role in psychosis has led to promising studies of the effectiveness of trauma-focused treatments such as EMDR.

When judging whether to be optimistic about the future, we should be mindful that the number of psychotherapy trials thus far conducted is very small compared to the number of pharmacotherapy trials, and that the first rigorous psychotherapy trials were published only a quarter of a century ago. There is much scope for further innovation.

 
REFERENCES

[PDF] Freeman, D., et al. (2015). Effects of cognitive behaviour therapy for worry on persecutory delusions in patients with psychosis (WIT): A parallel, single-blind, randomised controlled trial with a mediation analysis. Lancet Psychiatry, 2, 305-313.

[web] Goldsmith, L. P., Lewis, S. W., Dunn, G., & Bentall, R. P. (2015). Psychological treatments for early psychosis can be beneficial or harmful, depending on the therapeutic alliance: An instrumental variable analysis. Psychological Medicine, 45, 2365-2373.

[web] Jauhar, S., et al. (2014). Cognitive-behavioural therapy for the symptoms of schizophrenia: Systematic review and meta-analysis with examination of potential bias. Br J Psychiatry. 2014 Jan;204(1):20-9. doi: 10.1192/bjp.bp.112.116285.

[web] van den Berg, DPG, et al. (2016). Prolonged exposure vs Eye Movement Desensitization and Reprocessing vs waiting list for Posttraumatic Stress Disorder in patients with a psychotic disorder: A randomized clinical trial. JAMA Psychiatry. 2015 Mar;72(3):259-67. doi: 10.1001/jamapsychiatry.2014.2637.

[web] Varese, F., et al. (2012). Childhood adversities increase the risk of psychosis: A meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661-671. doi:10.1093/schbul/sbs050

Wampold, B. E., & Imel, Z. E. (2015). The great psychotherapy debate: The evidence for what makes psychotherapy work. New York: Routledge.