The following definitions will provide clarity around certain psychological terms in the book that may be novel to readers. Please see our book list for a complete list of references related to the terms and definitions.
Compassion Focused Therapy (CFT): is grounded in the three emotion regulation systems: drive, safety, and threat. CFT aims to enhance the compassion-based soothing system and diminish the threat-based system as a means of enhancing the ability to stimulate and move in a positive direction towards valued goals. Compassionate mind training is often used as a technique in CFT for integrating emotion-focused therapy and cognitive-behavioural therapy practices (see Gilbert 1992; Gilbert, 2009).
- Compassionate Mind Training: is a technique used within CFT that increases an individuals’ awareness of negative interactions with the self. Individuals are educated on how let go of self-criticism and instead adopt traits that are beneficial to the self including care for well-being, sensitivity, sympathy, distress tolerance, empathy, and nonjudgment (see Gilbert, 2009).
Acceptance & Commitment Therapy (ACT) for Psychosis: focuses on alleviating the cognitive inflexibility and experiential avoidance that comes with cognitive fusion by developing psychological flexibility. Six core constructs are used to achieve this: acceptance (as opposed to experiential avoidance); defusion (as opposed to cognitive fusion); mindfulness; self-as-context or self-as-observer (as opposed to attachment to the conceptualized self); values (as opposed to pursuing avoidant values); and committed action (as opposed to inaction, avoidance, and impulsivity) (see Hayes et al., 1999). ACT has been shown to help with reducing the believability of psychotic symptoms, enhancing mindfulness, attenuating depressive symptoms, and lowering the rate of repeat visits to health care services (see Hayes et al., 1999, Bach & Hayes, 2002; Bach, Hayes, & Gallop, 2012; Gaudiano & Herbert, 2006; Gaudiano, Herbert, & Hayes, 2010; White et al., 2011).
- Acceptance: Acceptance is a term associated with ACT and is an alternative to experiential avoidance. Acceptance involves the active and aware embrace of events, feelings, or thoughts without intentional attempts to change their frequency or form. For example, individuals with anxiety are taught to feel anxiety and engross themselves in any consequent emotions.
- Cognitive Fusion: is a term associated with ACT and occurs when attention is placed on the contents of one’s mind (i.e. thoughts) rather than what is sensually experienced through the five natural senses. Decisions and consequent actions are based on one’s internal experience (thoughts, memories) instead of what is realistically happening in the world (see Harris, 2009).
- Cognitive Defusion: is a term associate with ACT and is a technique that attempts to alter the undesirable aspects of a thought by creating contexts in which the unhelpful qualities of the thought are diminished. Cognitive defusion stresses the importance of observing thoughts for what they truly are and the technique may allow an individual to recognize that a thought: (1) may or may not be true; (2) is not a command that must be obeyed; (3) is not a threat; (4) is not something happening in the physical world (see Harris, 2009).
- Experiential Avoidance: is a term associated with ACT and occurs when an individual does not complete desired tasks because inner focus is placed on trying to avoid them and the painful thoughts and feelings associated with trying to complete them (i.e. being forced to speak in public, etc). Individuals with experiential avoidance often feel like their lives are narrowing and are not flourishing to their true potential because of the associated negative thoughts.
Mindfulness for Psychosis: is a psychotherapeutic approach that involves nonjudgmentally accepting one’s internal and external experiences with a focus on the present moment. Mindfulness enables exposure as opposed to the avoidance often associated with distressing delusions and hallucinations. It emphasizes the notion that thoughts are alternative reflections of reality that are not always accurate and that negative thought patterns can be attenuated by adopting a detached stance toward one’s thoughts (see Kabat-Zinn, 2003; Harris, 2009; Teasdale, Segal, & Williams, 1995; Teasdale et al., 2000).
- Metacognition: is a term used widely within Mindfulness and is the act of “thinking about thinking”, including knowledge about when and how to use certain therapeutic strategies for learning, problem solving, and/or self-care.
Cognitive Behavioral Therapy for Psychosis (CBTp): is a psychotherapeutic approach that focuses on alleviating the distressing emotions, maladaptive behaviors and dysfunctional cognitive processes that are often associated with psychosis by integrating goal-oriented cognitive strategies and experiential, emotional, and behavioural techniques such as cognitive restructuring and normalizing. Clients are educated on how to switch their automatic thoughts or cognitive distortions with alternative explanations that ultimately challenge the validity of their perceptions and enhance their problem solving skills. CBTp emphasizes fostering a strong, supportive, collaborative therapeutic alliance in order to develop skills or strategies to address stress, barriers, and distress related to psychosis such as hallucinated voices or unusual beliefs (see Beck, Rush, Shaw, & Emery, 1979; Hofmann & Asmundson, 2008).
- Core beliefs: is a term used in CBT to describe dysfunctional belief systems and attitudes that generate automatic thoughts.
- Experiential strategies: Strategies used in CBT that aim to expose individuals to new circumstances in order to allow them to gather new information and insight into the validity of their perceptions.
Behavioural Activation (BA) for Psychosis: is an approach that emphasizes the importance of increasing exposure to positive reinforcement stimuli for reactivating behaviours, such as social interaction, that have become largely dormant over the course of the psychosis. It is thought that as individuals become more engaged in reinforcement activities, they will increase their likelihood of engaging more in beneficial, healthy behaviours and will ultimately shift their behaviours and/or moods in a more positive direction at the expense of the detrimental, distressing or depressed behaviours. BA focuses on psychoeducation, identification of goals and values, mood monitoring, and graduated exposure to previously avoided activities (see Lejuez et al., 2001).
Alogia: Literally translated “poverty of speech”, is a general lack of additional, unprompted content seen in normal speech. It is a negative symptom commonly seen in individuals with psychosis and can complicate therapy because of the considerable difficulty holding fluent conversation.
Cognitive flexibility: is the ability to simultaneously consider multiple aspects of a thought at once and also change how it is thought about. It involves shifting or switching one’s thinking and attention between different tasks in response to a change in instruction and has been shown to help clients to disengage from the struggle they may be experiencing because of their psychotic symptoms.
Comorbidity: is the presence of two or more conditions at the same time in the same individual. For example, having a diagnosis of schizophrenia with co-morbid PTSD or GAD.
Egocentric bias: Individuals with psychosis often exhibit an increased tendency to have particular types of cognitive biases or distortions and one of these could include egocentric bias, which is the tendency to think only from one’s own point of view and solely on oneself (see Beck et al., 2009).
Externalizing bias: a tendency to blame others for circumstances in order to avoid negative self-attributions and defend a vulnerable self-concept.
Granulation of emotions: associated with emotion regulation, where an individual may have greater difficulty distinguishing between or labeling different emotions. For example, saying “I feel bad”, without identifying or labeling the specific emotion.
Intentionalizing bias: a tendency to believe that other people’s behaviors are based on negative or harmful intentions targeted at the individual.
Primary delusions: are delusions that arise suddenly and idiopathically (with no apparent known cause).
Rumination: is the tendency to compulsively focus attention on one’s symptoms of distress and their possible causes and consequences rather than focusing on effective solutions. Rumination tends to cause individuals to recall more negative memories that have happened to them in the past, interpret them more negatively in their current lives, and consequently become more hopeless about the future. Rumination is similar to worry but differs such that rumination focuses on bad feelings and experiences from the past and worry is associated with concerns about potential future negative experiences and threats (see Nolen-Hoeksema,1998). Focus should be placed on adopting active, goal-driven coping strategies.
Secondary delusions: are delusions where onset is understandable given the individual’s background history or current situation.