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In a patient who the quality of their cognitions are closer to delusional (v. overvalued or distorted), how does one conceptualize the value of exposure-based interventions?
Patients that come to mind are those that have obsessions without insight and patients whose “trauma” may actually be a delusion (or delusional perception of a real event). I’ve found that “brining up exposure” will invalidate the patient and in the former case, increase suspiciousness—paranoia or even elicit dissociation.
I remember reading someplace that a treatment for one with grandiose delusions is to accept the cognitions UNTIL that person has another area to leverage their self-esteem (also, the risk of suicide if confronted).
Is there evidence that PE works in psychosis + PTSD? What about PTSD based on a delusion or OCD without insight? I’m mentioning OCD here because the OCD without insight always confused me as it compares to delusional disorder; I suppose the recurrence and intrusiveness of the cognitions is more consistent with OCD?
I’d appreciate your help! With some patients, the therapy seemingly “goes better” when the focus is here—now and almost always blows up the alliance when the focus turns back to exposure. I want to be vigilant in doing the hard and difficult work by not colluding with avoidance, but I don’t want to hurt my patient either.
I believe this is a debate in the dissociative disorders regarding exposure (phased based treatment v. PE).
Patients that come to mind are those that have obsessions without insight and patients whose “trauma” may actually be a delusion (or delusional perception of a real event). I’ve found that “brining up exposure” will invalidate the patient and in the former case, increase suspiciousness—paranoia or even elicit dissociation.
I remember reading someplace that a treatment for one with grandiose delusions is to accept the cognitions UNTIL that person has another area to leverage their self-esteem (also, the risk of suicide if confronted).
Is there evidence that PE works in psychosis + PTSD? What about PTSD based on a delusion or OCD without insight? I’m mentioning OCD here because the OCD without insight always confused me as it compares to delusional disorder; I suppose the recurrence and intrusiveness of the cognitions is more consistent with OCD?
I’d appreciate your help! With some patients, the therapy seemingly “goes better” when the focus is here—now and almost always blows up the alliance when the focus turns back to exposure. I want to be vigilant in doing the hard and difficult work by not colluding with avoidance, but I don’t want to hurt my patient either.
I believe this is a debate in the dissociative disorders regarding exposure (phased based treatment v. PE).