Health & Clinical

  • Created by: Anjuma
  • Created on: 10-05-15 10:22


Aim: Measure the psychological and physiological stress response in two catogories of employees.

  • 24 Swedish Swamil workers (14 High risk workers, finishers & 10 Cleaners, control group)
  • Quasi experiment, Independant measures design
  • 14 HRW had to finish off wood at last stage of processing timber, machine paced worked, isolated, repetative, high skilled, productivity determined wage rate for entire factory.
  • Stress related hormones (adrenaline) in urine were measure on non/working days
  • Self reports on mood/alertness/caffine, Body temp recorded, self raiting scales on words such as 'sleepiness' 'wellbeing'

Results: HRW secreted more stress hormones on work days then rest, higher to control group.     Also showed higher levels of stress related illness (headaches, absentiesm) Self report shows HRW felt more rushed and irritated than control group and rated a lower well being.

Conclusions:  Combination of work stressors, in particular repetiveness lead to chronic physiological arousal, leading to stress related ilness and absentiesm.

To reduce this in workforce employers need to allow employees to experience some sense of control over the pace of their work. 

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Kanner et al (Daily Hassels & Uplifts)

Aim: Compare the Hassels and Uplift scale and the Berkman Life Events Scale as predictors psychological symptoms of stress.

  • 100 Middle aged, California, predominantly White, adequate income, protestant
  • Longitudinal study, self report, psychometric tests, repeated design.
  • Test sent one month before study began, participants had to complete, The Hassels raiting everymonth for 9 months, Life Events raiting after 10 months, Hopkins Symptoms Checklist, Bradburn Moral Scale every 9 months


  • The Hassels Scale better predictor of psychological & physiological symptoms then Life Events.
  • Hassels were consistant month to month
  • Life Events for men positively correlated with Hassels and Negatively with uplifts
  • For women more Life Events reported = More Hassels and Uplifts reported.
  • Hassels correlated with psychological symptoms of HSCL. More hassels = More Symptoms reported.

Conclusions: Assesment of Daily hassels & Uplifts maybe better approach to predicting stress then life events approach.

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Geer and Maisel

Aim: See if percieved control or actualy control can reduce stress reactions to adverse stimuli

  • 60 psychology undergrads from New York uni, Lab experiment, Independant measures
  • Stress measured using galvani skin response and heart rate electrodes
  • 3 Conditions; 1 - given control over how long they looked at the images, 2 - were warned photos would be 60 seconds apart, they would view for 35s & a 10s warning tone would precede each photo, 3 - were told they would see photos and hear tones from time to time but were not given timing or any control.
  • each participant were seated in sound proof room, wired up GSR & ECG, Callibrated for 5mins whilist participant relaxed & baseline was taken, Intructions read via intercom. Only group one could terminate the photo, each flashed for 35s, with 10 second tone preceding it. GSR taken on the onset of the tone/

Results: ECG recordings appeared inaccurate therefore discarded. Group 2 showed most stress, Group 1 showed the least stress

Conslusions: That having control over your environment can reduce stress response.

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Stress is caused by faulty processing of information.

Aim:  Compare Standard behavioural measures with Cognitive ones

  • 21 students responded to advert, Fiel experiment
  • Tested with anxiety questionaire before and after the treatment
  • 8 therapy sessions, control group were told they were on waiting list
  • SIT: 8 therapy sessions giving insight in to their thoughts & feelings, they were given positive statements to say & relaxation techniques to use in stressful situations
  • Standard behaviour measures: 8 therapy sessions with only progressive relaxation training whilst imaging stressfull situations


Both therapy sessions showed improvement, SIT showed the most improvement, more reported improvement of anxiety.

Conclusions:  Stress inoculation therapy is an effective way of redcuing stress anxiety in students who are prone to anxiety in test situations, more effective than behavioural techniques.

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Biofeedback: become awae of physiological responses and learning to control it and apply in other everyday situations.

Aim: If biofeedback techniques work & help reduce tension headaches or if it's due to placed effect

  • 18 (predominantly F) replied to advert in USA, screened through telephone and have psychiatric and medical test to ensure no other causes for headaches were present
  • 3 Groups: (A) Biofeedback training with relaxation using EMG, (B) Biofeedback training with false feedback (C) Control group
  • Lab, Muscle tension measured by EMG, Psychometric test for depression, questionaire on headaches
  • All kept diary for 2 weeks, raiting headaches Mild - Severe, (A) & (B) were told to practise relaxation after training 15-20 mins a dat

Results: After 3 months (A)'s mucsle tensions was lowest, reported headaches lower than baseline, follow up, 3 low headaches, 1 reduction

Biofeedback is an effective way to reduce stress levels by reducing tensions, therefore an effective method of stress management

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Waxler - Morrison et al

Surrounding yourself with support can have positive effect on yout mental well being

Aim: How womens relationships influence her response to breast caner & survival

  • 133 women, Vancouver, mailed
  • self administered questionaire on (demographics, educational level, who they are responsible for, perception of support from others, contact with friends)
  • Psychometric testn
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Geer and Maisel

Physiological measures of stress can overcome subjectivity of self report, by relying on the scietific measure of hormones, chemicals, heart rate & blood pressure.

Validity? physiological changes such as caffine, drugs, alcohol can mimic stress reactions.

Same study as before, GSR electrodes placed between the palm and forearm of non preferred arm of the paticipants, ECG attached in standard positions.

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Holmes and Rahe

Aim: Creating a method that estimates the extent to which life events are stressors

  • 394 participants (range of educational abilities, races and religions
  • A questionaire to ascertain how much each life event was considered a stressor
  • 43 life events put together based on examination of 5000 medical reports of American patients
  • Ratings should be based on personal experience
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Johanson et al

Combined approach of physiological and self report provides both scientific and qualitative data.

Same study as before

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Mental disorder (personal harm, suffering, abnormality, performance limitations), more than once of these elements has to occur at the same time over a prolonged period of time.

Aim: Compare the two ways of categorising dysfunctional behaviour

DSM- IV - 1000 mental health professionals collaborated to produce this to improve reliability of mental health diagnosis. a diagnostic tool to help identify particular disorders & regularly updated. Consists of Axis (5),

  • Axis (I) Clinical disorders, except mental retardation & personality disorders,
  • Axis (II) Personality disorders and mental retardation
  • Clinical disorders consist of 16 main catogories: Schizo, Mood disorder, Anxiety Disorder

ICD- 10 - Published by World Health Organisation, Consists of 10 main groups (E.g F2 Schizophrenia, F3 Mood (Affective) DIsorders, F6 Disorders of personality. ICD was used in 40 countries to if it improve psychiatric diagnosis across cultures, however only a snapshot so must continue to be revised.

Major difference between the two being the multi axial tool, DSM is more holitic taking in to consideration general medical conditions, social, environmental problems.

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Rosenhan & Seligman

Aim: How can we define abnormality or normality

Way 1: Statistical Infrequency, Human behaviour is abnormal if it falls outside the range typical for people, (70 - 130 IQ points, less or more is infrequent therefore considered abnormal) 

Way 2: Deviation from Social Norms, Behaviour that deviates from the norm of a culture is considered abnormal. However depression is common but still disfunctional illness

Way 3: Failure to Function Adequately, Not functioning in a way that enables them to live independantly, E.g Dysfunctional behaviour, distressed behavioue, irrational behaviour.

Way 4: Deviation from Ideal Mental Health, Absence of normality indicates normality, however normaility is difficult to define, Johada's 6 elements of optimal living: Positive view of self, personal growth &developement, autonomy, accurate view of reality, positive relationships, master of your own environment.

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Ford & Widiger

Healthcare professions used different adjectives to describe males and females who were considered to be more submissive and concerned with appearance so therefore not fitting with this description makes female abnormal.

Aim: Find out if clinicals were stereotypic genders when diagnosing disorders

  • 354 clinical psychologist randomly selected from national register
  • Independant design, each given female, male, unspecified case study
  • each recieved 1/9 cases, including ASPD, histrionic personality disorder (HPD) or both
  • each asked to diagnose illness in each case study on a 7 point scale and extent to which patient appeared to have each of nine disorders:

(1) Dysthemic (2) Adjustment (3) Alcohol abuse (4) Cycothymic disorder (5) Narcissistic

Results: Sex unspecified case histories were diagnosed mostly with borderline personality disorder, ASPD was correctly diagnosed more in males then females, Females ASPD were misdiagnosed with HPD more than males. HPD correctly diagnosed more in females.

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Watson and Raynor

Aim: See if it is possible to induce a fear of previously unfeared object through classical conditioning.

  • Case study, Unemotional Little Albert 8 months old, lived in hospital with mother, nurse
  • Baseline reactions to stimuli were noted he showed no fear,
  • Session (1) presented with a rat, when he reached out steal bar behind him was hit (repeated) 1st time he jumped and felll forward, 2nd time he began to whimper, fear response conditioned
  • Session (2) Following week rat presented alone, 2 with loud noice, alone again. Albert began crying imedietely crawling away from the rat
  • Session (3) 5 days later given, given toy blocks (neutral stimulus) presentations of rat, rabbit, dog, santa claus mask, which produced negative responses of crying, transference of fear had been made to other similar objects. He played happily with toy blocks

Conclusions: It is possible to condition fear through classical conditioning, transference had been made to similar objects, less like original stimuli produced less negative response, Time had not removed the fear response. He was taken out of hospital so they were not able to find ways of removing phobia in the laboratory.

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Beck et al

Aim: Understand cognitive distortions in patients with depression

  • 50 patients diagnosed with depression compared to 31 non depressed (matched pairs)
  • Clinical interviews of patients undergoing therapy for depression
  • Some patients kept diaries of their thoughs & brought these to therapy sessions
  • Verbalisation of non depressed patients were compared to the depressed


  • Themes appearing in depressed patients(low self-steem, self blame, desire to escape, paranoia)
  • Depressed patients had sterotypical responses to situations & regarded themself as inferior 
  • Some felt themselves unlovable and alone
  • self blame shown even when blame couldn't be apportioned to the person

These distortions tended to be automatic, involuntary, plausible and persistent.

Conclusion: In depression patients have cognitive distortions that deviate from realistic and logical thinking,

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Gottesman & Shields

Aim: Review research into genetic transmission of schizophrenia

  • 3 Adoptions studies, 5 twin studies (monozygotic and dizygotic)
  • Incidence of schizophrenia in adopted children & monozygotic twins was exprapolated from reseach


  • Adoption studies found increased incidence of schizophrenia in children with schizophrenic biological parents.
  • Biological siblings of children with schizophrenia showed higher percentage of schizophrenia
  • All twin studies found high concordance rate for schizophrenia in monozygotic twins than DZ
  • In gottesman and shields of study rate was 58% for MZ and 12 for DZ

Conclusions: There is obviously a heavy genetic input into the onset of schizophrenia, however due the concordance rate being below 100% shows there must be some interaction with the environement

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Behaviour is learnt, little to do with individual but instead the situation they are in.                    Aim: Treat a girl with specific noise phobias using systematic disensitisation

  • 9 year old lucy feared loud noises (ballons, fireworks, parry popers) Lower then average IQ, not depressed, anxious or fearful.
  • Lucy was brought to therapy session, told what would happen parents gave consent
  • (1st session) Lucy constructed hierachy of feared noises, she was taught breathing &imagery to relax (home in bed with toys) she had a hypothertical fear thermometre as she was given the stimulus. She had paired her fear with relaxation, deep breathing and imagining her at home
  • she then asociated the noise wtih feeling calm after four sessions, she did not need to imagine

Results: After session one she was reluctant to let balloons burst, event at far end of corridor, when therapist done it any way she cried and was encouraged to breath deeply and relax. After fourth session she was ablle to signal a ballon to burts 10 metres away with mild anxiety. Next 3 sessions she was able to pull a party popper, by final sessions fear thermometre scores had decreased.

Conclusions: Noise phobia in children are amendable to systematic desensitisation, important factors seem to be control.

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Biological treatments are often the first treatment offered because diagnosis is made by medical practioner.

Aim: See if drug Phenelzine can help treat patients with social phobias

  • 80 patients meeting DSM criteria for socal phobia, medically fit, assesed to see that no other disorders were present and signed consent form.
  • 3 conditions, 8 weeks, assesed for anxiety and phobia (1) Phenelzine (2) atenolol (3) placebo
  • Patients were assesed at the begining then given drug/placebo with gradual dosage increase
  • Each patient was reasessed on the Hamiltion raiting sclare and Liebowits social phobia sclae
  • Double blind situation using independant evaluators to carry out clinical assesments.

Results: After 8 weeks Phenelzine groups showed better scores on the test for anxiety compared to control group, no significant difference between Atenolol and placebo groups

Conclusions: Phenelzine but not Atenolol is effective in treating social phobia after 8 weeks of treatment.

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Ost & Westling

Aim: Compare CBT with applied relaxation as therapies for panic disorder

  • 38 patients (more female, married, single, divorce, occupations) Longitudinal
  • Dsm diagnosed with panic disorder with/without agoraphobia
  • recruited refereal or newspaper, 2 conditions (cognitive/drug therapy)
  • baseline assesments of panick attack taken using variety of questionaires
  • patients had diary to record details of every attack
  • 12 weeks treatment last 50/60mins a week with homework, applied relaxation used to identify what cause panic attacks, training started with tension relief of muscles, after 8 sessions patients were able to practise techniques in stressfull situations, CBT was used to identify misinterpretation of physical symptom & generate alternative cognitive response, this was then tested in panic situations induced but were not allowed to avoid them. then reassed on questionairs, after 1 year follow up questionaire

Results: Applied relaxation showed 65% panic free patients, this increased after one year, CBT showed a higher (74%) panic free patients, 89% after a year, differences were not significant.

Both CBT and Applied relxation worked at reducing panic attacks but it's difficult to rule out some cognitive changes in the appliead relaxation group even though this is not focused in research

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Anxiety (Panic disorder, Phobia, PTS)

DSM-IV Classification for specific phobia

  • Marked & persistent fear that is excessive or unreasonable
  • Exposure to phobic stimulus provokes immediate anxiety response
  • The person recongnises the fear as excessive 
  • The phobic situation is avoided 
  • The phobic disrrupts the person's normal life & has lasted more than 8 months in U18's

ICD-10 Classificatio for specific phobia

  • Psychological autonomic sypmtoms must be primary manifestations of anxiety and not secondary of other symptoms such as delusions
  • Anxiety must restricted to the presence of aparticular phobic object/situation
  • Phobic situation is avoided whereever possible

Phobiacs have definite persistent fear of particular object/situation. Stimulus such as snake, mans bear will provoke imediete response, may be similiar to a panic attack, physical symptoms may be experience such as shortness of breath, intense fear, loose control, if fear disrupts everyday life the disorder may be diagnosed. Maybe triggered by non existant threats.

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Affective disorders

DSM-IV Classification of single episode depression: (Five or more symptoms)

  • Insomnia most nights
  • Fidgeting or letheargy, tierdness, feeling worthlessness or guilt, less ability to concentrate
  • Recurrent thoughts of death

ICD-10 Classification depressions:

  • Depressed mood, reduced energy, marked tiredness only after slight effort 
  • Reduced concentration/attention, reduced self-esteem & self confidence
  • Ideas of guilt and unworthiness, bleak & persimistic views of the future
  • Ideas or acts of self harm/sucide, distrubed sleep, reduced apetite.

Extreme mood changes, often damaging to the suferer, Depressions = feeling down, Mania = feeling elated, the alternation = Bipolar soemtime with periods of normality in between. Dysthymia  = persistant depression can cause poor appetite/over eating, insomnia, low self esteem. Although everyone has mood changes as a natural response to life events, the characteristic of affective disorders are disabling moods preventing an individual living a normal life at work, socially.

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Psychotic disorder

Psychosis is general term for disorders that involve a loss of contact with reality, covers many disorders: delusions, hallucinations therefore leading to widthrawl to from outside world as the person becomes more confused and disorientated. Symptoms can be postive: (present in schizo, absent in normal people) or negative (Absent in schizo, present in normal people) 

DSM-Iv diagnosis:

  • (1) Characteristics symptoms (2/more): Delusions, halluciantions, disorganised speech/behaviour, Negative sypmtoms (2) Social/ occupational dysfunction (3) Duration: 6 months continous signs of distrubance (4) No other explanations can be found (i.e Meds)


  • Thought Eco, Dellusion of control, Hallucinatory voices, Persistent dellusions, Irrelevant speech, catatonic behaviour, negative symptoms such as marked apathy.

Affects males and females equally. 5 Different types: Paranoid, Disorganised, Catatonic, Undifferenciated, Residual.

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Characteristics of Schizophrenia

(+)(type1) - Genetically inherited a/s with dopamine disfunction, repsonds well to medication. Hallucination: Hears, smells, feels, sees something not present, Most common = hearing voices individuals may try find explanation for them such as hidden microphones, loudspeakers. Sufferes answer & conversate to the voice feeling obliged to do as they say even if it is harm.             Dellusions: Kind of unusual belief in the sense individual strongly believe in it without any evidence (I am the Queen/Elvis) & may often come out of the bloom. Paranoid delusions feelings of persecuted/harrased (my partner is being unfaithful) (MI5 are spying on me) Delusion of reference day to day events are about them e.g radio, tv programes. Thought Disorder: Muddled thinking, harder to concentrate (Tv, job,studies) disconnected thoughts drifting from one idea to another, amking it difficult for people to follow and understand their conversation, feelings of being controlled.

(-)(type2) Nerudevelopment disorder arising from prenate/perinatal (no medication response) Theese refer to a reduction of normal behaviour resulting in widthdrawl & isolation, Apathy (cba to comunicate with others, General lack of emotion, Inappropriate effect (laughing at bad news) According to DSM-IV 3 diagnostic criteria must be met

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Aim: Identify social skills that psyhotic patients may lack

  • Review methods used to asses social skills we should have & identify problems psychotic patients may have in behaving apropriately in social situations
  • Review article identified key features we should have, Methods include role playing or social skills, behaviour assesment of observable behaviour and biologica data. Skills are monitred in novel situations to see durability

Findings: Individual schizophreninc patients lack appropriate social learning from past experiences, Institutionalisatio can lead to loss of social skills, Excessive anxiety impedes social performance, cognitive deficits may also lead to faulty perceptions of other peoples action or the situation leading to inappropriate social behaviours

Conclusions: schizophrenic patients lack social skills needed to function normall, may be due to factors such as institutionalisation, cognitive deficits. But lack of social skills lead to lack of positive reinforcers for sociall acceptable behaviour so abnormal behviour is maintained.

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Gottesman and Shields

Aim: Review research on genetics & schizophrenia

  • 3 adoption studies & 5 twins studies (MZ & DZ), Total 711 participant
  • Incident of schizophrenia in adopted children &MZ twins was compared to biological parents & siblings & adoptive parents & siblings.
  • Concordance rate (how often both twins were diagnosed with schizo) was compared between DZ and MZ twins. An increased incidence of schizo in bio relatives & higheer concordace rates between MX rwins would indicate a genetic bases for schizophrenia

Findings: All 3 adoption studies found increased incidence of schizo in adopted children with schizo bio parent, Normal children fostered to schizo parents & adoptive parents of schizo children showed little evidence. All twin studies found high concordance rate for schizo in MZ twins than DZ.

Conclusions: Obviously a significant gentic input onto the onsent of schizophrenia, but concordance rate being less then 100% indicates there must be some interaction with the environment, also there is confusion as to whether one or more genes are responsible for predisposing a person to schizophrenia.

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Put forward a theory relation to schemas, theese are packages of information stored in our memories that influence the way we interpret later events. He believes that a central deficit in schizophrenics is the breakdown in relationship between information already stored in the memory and new sensory information. E.g if we go to a resturant we know how to beahve and what to expect based on past experience and this usually happens without concious awareness. Hemsley suggests theese processes break down in schizophrenics and these schema's are not activated as a result schizophrenics are subject to info overload & don't know which info to pay attention to and what to ignore. Hemsley furthuer suffests that internal thoughts are not recongnized as coming from their own memory and therefore may be experienecd as auditory hallucinations.

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Paul & Lentz

Aim: Compare effectiveness of soical learning, milieu therapeutic centres, hospital programmes for treating patients with psychotic disorders

  • 4 1/2 years, 3 groups chronically instutionalised psychotic patients from 4 state hospitals in Illinois, initally 84 patients that had been deemed unlikely to be released from their institution
  • Patients were assesed trhought observations, interview and rating scales prior to the project, 6 month intervals, prior to release, 6 month interval after release. 
  • Social Learning therapy based on classical & operant conditioning, basic features of token economy were used, 85.2% treatment time a week of their free time. Millieu Therapy based on theraputic community concpet, focus on group problem solving, pressure & interaction between community members (85.2%) Hospital conditioned varied due to different/same sex wards, generally had less time for meetings, focused activities, more time eating & unstructured time (4.9%)

Findings: Every asessment level SL programme was most effective measure by IAB (used 3 psychometric tests to asses social behaviour & level of functioning. MTP showed some improvement. By end of study more from SL centre were relased follwed by Millieu and under 50% from hospital all with similar functioning levels. SL 10.7% released to independant living, 7.1%MT 0% from hospital. So SL was more effective, similar staff levels for both clinics make SL more cost effective

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Kane et al

Aim: Carry out 1Yr double blind research study to see effectiveness of fluphenazine as treatment for schizophrenia

  • 28 patients(50:50) referred to NY clinic had only one schizo episode & been in remission for atleast 4 weeks during the last year, no drug abuse/other medical conditions (consented)
  • Randomly assigned (2 treatment groups, 1placebo. Patients removed if they dropped out, had toxic side effects, relapsed (Assesed whether this happend), relapse was defined as substantial clinical deterioration, 2 researchers would decide on the reason for a patient leaving. 

Findings: 7/17 taking placebo relapsed by 19 weeks, 7 dropped out by 21 weeks

Treatment groups no relapses, one dropout by week 24, 2 toxic side effects dropout week 32

Conclusions: Results suggested that patients with one episode of schizophrenia can be successfully treated using fluphenazine once they were in remision.

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Sensky et al

Aim: Compare CBT with non specific befriending interventions for patients with schizophrenia in effectively reducing positive symptoms

  • Randomised controlled design (2 groups: CBT group & Non specific befriending group)
  • 90 patients from Newcastle, Cleveland, Durham, London, no responding to medication
  • Both interventions were delivered by 2 experienced nurses who recieved regular supervison CBT: Initially engaging with patient examining antecendents of psychotic disorder, developing normal rationale &treatments of other disorder. specific techniques for (+) were used e.g critical analysis of beliefs about auditory hallucinations, then helped to change beliefs & taught coping stratergies to deal with voices Befriending: Same time allocation at same intervals as P in CBT. Therapist were empatheic & non directive, there was no attempt at therapy, session focused on hobbies sports, current affairs, assed by blind raters at baseline after treatments lasting upto 9 months, assesed using comprehensive psychiatric rating scale, scale for assessment of (-) & depression rating scale. 19 individual treatments sessions over 9M      

Findings: Both interventions resulted in significant reductions in (+) & (-) After treatment no difference between 2 groups, 9 month follow up evaluation CBT group showed greater improvement in all measures, Befriending group had lost some benifits.                                    CBT is effective in treating (-) & (+) that are resistant to standard antipsychotic drugs with its benifits staying effective over 9 months of follow up.

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