Abstract |
Psychotherapy process research is a new area in the scientific field and focuses mainly on the insession phenomena in individuals with neurotic symptoms. In contrast, similar psychotherapy processes in individuals with schizophrenic symptoms remain unexplored and the corresponding mechanisms of the insession phenomena are still unknown. The aim of the present dissertation was to study the psychotherapeutic processes in psychoses and, specifically, to investigate delusion formation in individuals suffering from paranoid type schizophrenia or schizoaffective disorder. All patients were treated by the same therapist with weekly 50 minutes individual sessions. The Integrative Model was employed. According to this model, anxiety has a central etiological role in the formation of delusions. The researchers tested five hypotheses, which are related to the individuals extremely high levels of anxiety to account for the formation of delusions. According to them the delusion serves as: 1) a misinterpretation of somatic and psychological disturbances caused by high levels of anxiety, 2) a misinterpretation of the external environment caused by high levels of anxiety, 3) an evolutionary helpful reaction, 4) a «defense» against high levels of anxiety, and 5) a consequence of self-fulfilling prophecies in individuals with very negative experiences in their real life. The study population consisted of 117 individuals suffering from delusions, who received the DSM-IV diagnoses of schizophrenia paranoid type or schizoaffective disorder. The individuals were weekly evaluated, with systematic evaluations of the patients psychopathology and the patients and the therapists satisfaction of the session and their therapeutic relationship. Moreover, the insession events for the formation of delusions were studied, through the transcripts of 6 sessions of an individual, three with a good outcome and three with a poor outcome. Five raters located and evaluated the insession events. The hypotheses tested were the following: 1) The post-session ratings of anxiety and psychotic symptoms are significantly lower than the pre-session ratings. 2) The level of post-session psychotic symptoms is correlated to the reduction in the individuals anxiety levels. 3) The change in anxiety levels and psychotic symptoms is significantly related to the session quality and the individuals post-session mood. These factors were evaluated by the Greek version of the Session Evaluation Questionnaire (SEQ). 4) The mood change (anxiety reduction) is related to the patients and the therapists positive evaluations of the psychotherapeutic session, and, as a result, their satisfaction of the session quality. 5) The therapeutic relationship is affected by anxiety and psychotic symptoms. Symptom reduction contributes to the strengthening of a more positive therapeutic relationship. 6) The change in psychotic symptoms correlate to certain psychotherapeutic processes focusing on the investigation of the etiology of psychotic symptoms and, especially, delusions. 7) That more insession events focusing on the investigation of delusion formation will be counted in psychotherapeutic sessions with good outcome than in the sessions with poor outcome. 8) These insession events support the central role of anxiety as an etiological mechanism in the formation of delusions. Overall, the findings of the present dissertation support the basic hypothesis that levels of anxiety have a strategic etiological role in the formation and development of delusions in paranoid type schizophrenia and schizoaffective disorder. Our findings and further research of the aforementioned relationship may contribute to the prevention and therapeutic intervention in individuals suffering from delusions.
|