Research in Psychology and Behavioral Sciences

Current Issue» Volume 2, Number 3 (2014)


Cognitive-Behavioural Therapy for First Episodes of Psychosis: A Case Report on the Application of a Multicomponent Treatment Protocol in Italy

1Department of Mental Health of Florence Healthcare Services, Via Fanfani, Florence, Italy

2Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, Florence, Italy;Miller Institute of Behavioural and Cognitive Psychotherapy, Corso Torino, Genoa, Italy

Research in Psychology and Behavioral Sciences. 2014, 2(3), 66-74
DOI: 10.12691/rpbs-2-3-3
Copyright © 2014 Science and Education Publishing

Cite this paper:
Sandro Domenichetti, Andrea Pozza. Cognitive-Behavioural Therapy for First Episodes of Psychosis: A Case Report on the Application of a Multicomponent Treatment Protocol in Italy. Research in Psychology and Behavioral Sciences. 2014; 2(3):66-74. doi: 10.12691/rpbs-2-3-3.

Correspondence to: Andrea  Pozza, Department of Mental Health of Florence Healthcare Services, Via Fanfani, Florence, Italy. Email:,


Objectives: Although pharmacotherapy with antipsychotic medication is an effective intervention for early psychosis (EP), drop out from treatment and relapse rates appear still relatively high. In the last decade, there is growing interest in Cognitive-Behavioural Therapy (CBT) as early intervention for EP. Some studies suggest that CBT may be an effective adjuvant to pharmacotherapy to reduce risk of development of chronic psychosis in individuals who experienced first episodes. Symptoms of depression and social anxiety are very common among patients experiencing first episode psychosis, thus impairing quality of life and functioning. This aspect may create a negative vicious cycle, that may reinforce feelings of learned helplessness and hopelessness with regard to psychosis diagnosis, thus increasing vulnerability to relapse in further episodes. However, there is little knowledge on the use of CBT to target both reoccurrence of psychotic episodes and symptoms of depression and social anxiety secondary to first psychotic episodes. The current case report presents the administration of a modular CBT semi-manualized intervention to a young patient to enhance prevention of psychosis and target symptoms of social anxiety and depression following first psychotic episodes. Methods: Treatment consisted in 21 individual weekly sessions, delivered in an outpatient setting, involving two phases. The first one targeted prevention of psychotic episodes. Case formulation was developed according to cognitive behavioural model of psychosis. Psychoeducation on early signs and vulnerability factors of relapse in psychotic episodes was delivered in order to promote patient’s self-monitoring and insight on positive symptoms prodromes. The second treatment phase targeted symptoms of depression and social anxiety. Homework based on behavioural activation were assigned in order to address depressive symptoms, and cognitive restructuring was used to normalize dysfunctional beliefs. A social skills and assertiveness training was used to target social anxiety. CBT treatment was delivered in combination with medication. Clinical interviews were conducted at pre-, immediate post-treatment, and at 5-month-follow-up, to evaluate reoccurrence of psychotic episodes, and changes in depression, social anxiety, and functioning. Results: As observed by clinical interviews, the patient did not experience further relapse in psychotic episodes. In addition, it was observed a reduction in depressive symptoms and social anxiety through the increase of the number of daily activities, social relations, work and academic engagement. Conclusions: Important limitations of the study are discussed. Future research using large randomized controlled trials with longer follow-up assessments should evaluate the effectiveness of CBT to target depressive symptoms and social anxiety for patients with EP.



[1]  Hutton P, Taylor PJ. Cognitive behavioural therapy for psychosis prevention: a systematic review and meta-analysis. Psychol Med 2013; 1-20.
[2]  Schimmelmann BG, Huber CG, Lambert M, et al. Impact of duration of untreated psychosis on pre-treatment, baseline, and outcome characteristics in an epidemiological first-episode psychosis cohort. J Psychiatr Res 2008; 42: 982-990.
[3]  Marshall M, Lewis S, Lockwood A, et al. Association between duration of untreated psychosis and outcome in cohorts of first-episode patients. Arch Gen Psychiatry 2005; 62: 975-983.
[4]  Cocchi A, Mapelli V, Meneghelli A, et al. Cost-effectiveness of treating first-episode psychosis: five-year follow-up results from an Italian early intervention programme. Early Intervention in Psychiatry 2011; 5: 203-211.
[5]  Kahn RS, Fleischhacker WW, Boter H, et al. Effectiveness of antipsychotic drugs in first-episode schizophrenia and schizophreniform disorder: an open randomized clinical trial. The Lancet 2008; 371: 1085-1097.
Show More References
[6]  National Institute for Health and Clinical Excellence. The NICE guideline on core interventions in the treatment and management of schizophrenia in adults in primary and secondary care. NICE 2009.
[7]  Leucht S, Arbte S, Engel RR. How effective are second-generation anti-psychotic drugs? A meta-analysis of placebo-controlled trials. Mol Psychiatry 2009; 14: 429-447.
[8]  Spencer E, Birchwood M, McGovern D. Management of first episode psychosis. Advances in Psychiatric Treatment 2001; 7: 133-142.
[9]  Penn DL, Waldheter EJ, Perkins DO, et al. Psychosocial treatment for first episode psychosis: A research update. Am J Psychiatry 2005; 162: 2220-2232.
[10]  Addington J, Gleeson J. Implementing cognitive behavioural therapy for first episode psychosis. Br J Psychiatry 2005; 187(Suppl. 48): 72-76.
[11]  Yung AR, Phillips LJ, McGorry PD et al. Prediction of psychosis: a step towards indicated prevention of schizophrenia. Br J Psychiatry 1998; 172: 14-20.
[12]  Birchwood M, Iqbal Z, Upthegrove R, et al. Psychological pathways to depression in schizophrenia: Studies in acute psychosis, post psychotic depression and auditory hallucinations. Eur Arch Psychiatry Clin Neurosci 2005; 255: 202-212.
[13]  Iqbal Z, Birchwood M, Chadwick P, et al. Cognitive approach to depression and suicidal thinking in psychosis: 2. Testing the validity of social rank model. Br J Psychiatry 2000; 177: 522-528.
[14]  Romm KL, Melle I, Thoresen C, et al. Severe social anxiety in early psychosis is associated with poor premorbid functioning, depression, and reduced quality of life. Compr Psychiatry 2012; 53: 434-440.
[15]  Turner DT, van der Gaag M, Karyotaki E, et al. Psychological interventions for psychosis: A meta-analysis of comparative outcome studies. Am J Psychiatry 2014.
[16]  Alvarez-Jimenez, M, Parker AG, Hetrick SE, et al. Preventing the second episode: a systematic review and meta-analysis of psychosocial and pharmacological trials in first-episode psychosis. Schizophr Bull, 2011; 37: 619-630.
[17]  Fowler D, Hodgekins J, Painter M, et al. Cognitive behavior therapy for improving social recovery in psychosis: A report from the ISREP MRC Trial Platform Study (Improving Social Recovery in Early Psychosis). Psychol Med 2009; 39: 1627-1636.
[18]  Steel C. (Ed.). CBT for Schizophrenia: Evidence-based Interventions and Future Directions. Chichester: John Wiley & Sons 2013.
[19]  Lewis S, Tarrier N, Haddock G et al. Randomised controlled trial of cognitive—behavioural therapy in early schizophrenia: acute-phase outcomes. Br J Psychiatry 2002; 181: s91-s97.
[20]  Haddock G, Lewis S. Psychological interventions in early psychosis. Schizophr Bull, 2005; 31: 697-704.
[21]  Morrison AP. Cognitive behaviour therapy for first episode psychosis: Good for nothing or fit for purpose? Psychosis 2009; 1: 103-112.
[22]  Cocchi A, Meneghelli A, Preti A. Programma 2000: celebrating 10 years of activity of an Italian pilot programme on early intervention in psychosis. Aust New Z J Psychiatry 2008; 42: 1003-1012.
[23]  Oosthuizen P, Emsley R, Niehaus D, Koen L, Chiliza B. The relationships between depression and remission in first-episode psychosis. World Psychiatry 2006, 5:172-176.
[24]  Sönmez N, Hagen R, Andreassen et al. Cognitive Behavior Therapy in First-Episode Psychosis with a Focus on Depression, Anxiety, and Self-Esteem. Cognitive and Behavioral Practice in press.
[25]  Gumley AI, Park C. Relapse prevention in early psychosis. In: French P., Reed M, Smith J, Raine M, Shiers D. (Eds.), Promoting recovery in early psychosis: A practice manual. Chichester: Wiley-Blackwell 2010, p. 157-167.
[26]  Morrison AP. The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy 2001; 29: 257-276.
[27]  McCabe R, Priebe S. The therapeutic relationship in the treatment of severe mental illness: A review of methods and findings. Int J Soc Psychiatry 2004; 50: 115-128.
[28]  Neale MS, Rosenheck RA. Therapeutic alliance in VA intensive case management. Psychiatr Serv 2005; 46: 719-721.
[29]  Davis L, Lysaker P. Therapeutic alliance and improvements in work performance over time in patients with schizophrenia. J Nerv Ment Dis 2007; 195: 4.
Show Less References


Connection of Subjective Entropy Maximum Principle to the Main Laws of Psych

1Mechanics Department, Mechanical-Energetical Faculty, Aero-Space Institute, National Aviation University, Kyiv, Ukraine

Research in Psychology and Behavioral Sciences. 2014, 2(3), 59-65
DOI: 10.12691/rpbs-2-3-2
Copyright © 2014 Science and Education Publishing

Cite this paper:
Kasianov Vladimir Aleksandrovich, Goncharenko Andriy Viktorovich. Connection of Subjective Entropy Maximum Principle to the Main Laws of Psych. Research in Psychology and Behavioral Sciences. 2014; 2(3):59-65. doi: 10.12691/rpbs-2-3-2.

Correspondence to: Goncharenko  Andriy Viktorovich, Mechanics Department, Mechanical-Energetical Faculty, Aero-Space Institute, National Aviation University, Kyiv, Ukraine. Email:


Herein it has been made an attempt to find some mathematical models of the main laws of psychology on the basis of the variational principle of the subjective entropy maximum. On the basis of the subjective entropy of an individual preferences extremization principle, using the necessary conditions for extremums of a functional to exist, we get the widely known main fundamental laws of psychophysics: the Bouguer-Weber, Weber-Fechner, Stevens, Zabrodin laws. It has been considered a few special cases of the models for the aggregating functions for sensations and perceptions, as well as cognitive functions for preferences and desires. Also it was obtained expressions for canonical distributions in the case of two-dimensional distribution of sensations and perceptions. The proposed approach, postulating the extremality of human’s psych functioning, has the theoretically substantiated value for researches with the use of the principle for the general empirical laws in applied psychology.



[1]  Chen, Jing, “An Entropy Theory of Psychology and its Implication to Behavioral Finance”. [Online]. Available at Social Science Research Network.
[2]  [Kasianov, V.A., Elements of subjective analysis: monograph, National Aviation University, Kyiv, Ukraine, 2003, 224.] [in Russian].
[3]  [Kasianov, V.A., Subjective analysis: monograph, National Aviation University, Kyiv, Ukraine, 2007, 512.] [in Russian].
[4]  Kasianov, V., Subjective entropy of preferences. Subjective analysis: monograph, Institute of aviation, Warsaw, Poland, 2013, 644.
[5]  [Kasianov, V.A., Goncharenko, A.V., Light and shadow. Proportions of shadow economy. Entropy approach: monograph, Kafedra, Kyiv, Ukraine, 2013, 86.] [in Russian].
Show More References
[6]  Goncharenko, A.V., “Some identities of subjective analysis derived on the basis of the subjective entropy extremization principle by Professor V.A. Kasianov”, Automatic Control and Information Sciences, 2014, Vol. 2, No. 1. 20-25. March 2014.
[7]  Goncharenko, A.V., “Measures for estimating transport vessels operators’ subjective preferences uncertainty”, Scientific proceedings of Kherson state maritime academy: Scientific journal, 1 (6). 59-69. Jun. 2012.
[8]  Goncharenko, A.V., “A particular case of a variational problem of control in an active aviation system”, Transactions of the institute of aviation. Selected problems of air transport. Warsaw, Poland: Institute of Aviation Scientific Publications, 2013, № 228. 3-12. 2013.
[9]  Jaynes, E.T., “Information theory and statistical mechanics”, Physical review, 106 (4). 620-630. 1957.
[10]  Jaynes, E.T., “Information theory and statistical mechanics. II”, Physical review, 108 (2). 171-190. 1957.
[11]  [Gusev, A.N., Sensation and perception. / General psychology: in 7 vol.: study-book for students of higher educational institutions / under review of B.C. Bratus. Vol. 2, Publishing Center “Akademia”, Moscow, Russia, 2007, 416.] [in Russian].
[12]  “Weber-Fechner law”, Wikipedia, the free encyclopedia. [Online]. Available: http://en.–Fechner_law. [Accessed Apr. 8, 2013].
[13]  [Rubinstein, S.L., Fundamentals of general psychology, State Study-Pedagogical Publishing House of the Ministry of Education of Russian Soviet Federative Socialist Republic, Moscow, USSR, 1946, 704.] [in Russian].
Show Less References


Food for Thought: the Efficiency of Glucose Metabolism Predicts the Self-generation of Temporally Distant Cognition

1Department of Psychology, Northumbria University, Newcastle upon Tyne, UK

2Sir Charles Gairdner Hospital, Perth, Western Australia

3Centre for Brain Ageing and Vitality, Newcastle University, UK

4Centre for Human Psychopharmacology, Swinburne University, Melbourne, Australia

5Department of Psychology, University of York, UK

Research in Psychology and Behavioral Sciences. 2014, 2(3), 54-58
DOI: 10.12691/rpbs-2-3-1
Copyright © 2014 Science and Education Publishing

Cite this paper:
Riby L.M., Orme E., Greer J., Gillan A., Griffiths R., Aspray T., Scholey A., Smallwood J.. Food for Thought: the Efficiency of Glucose Metabolism Predicts the Self-generation of Temporally Distant Cognition. Research in Psychology and Behavioral Sciences. 2014; 2(3):54-58. doi: 10.12691/rpbs-2-3-1.

Correspondence to: Riby  L.M., Department of Psychology, Northumbria University, Newcastle upon Tyne, UK. Email:


The generation of thought independent of environmental input occupies almost half of mental life and is important for skills such as creativity and planning. To understand how this ubiquitous cognitive process relates to the brain's ‘energy budget’, a cross-sectional study is carried out to examine how the capacity for mental time travel relates to the efficiency with which adults metabolize glucose, the brain’s primary source of fuel. On day 1 the ability of a group of 36 younger and 36 older individuals to metabolize glucose was assessed using the gold standard two-hour glucose tolerance test. Twenty-four hours later, the same group of participants returned to the laboratory to perform a non-demanding choice reaction time task during which experience sampling was used to assess the frequency with which they generated thoughts that were unrelated to the here and now. Analysis indicated that younger individuals who were the most efficient at metabolizing glucose exhibited mental time travel that spanned longer time periods. Given the importance of self-generated thought in daily life these results suggest that the capacity to mentally simulate events not present in the immediate environment is highly dependent on efficient glucose metabolism.



[1]  Killingsworth, M. A., & Gilbert, D. T. A Wandering Mind is an Unhappy Mind. Science, 330, 932. 2010.
[2]  Smallwood, J. Distinguishing how from why the mind wanders: a process-occurrence framework for self-generated thought. Psychological Bulletin, 139, 519-535. 2013.
[3]  Tulving, E. Episodic Memory: From Mind to Brain. Annual Review of Psychology, 51, 1-25. 2002.
[4]  Baird, B., Smallwood, J., Mrazek, M. D., Kam, J. W. Y., Franklin, M. S., & Schooler, J. W. Inspired by Distraction: Mind Wandering Facilitates Creative Incubation. Psychological Science, 23, 1117-1122. 2012.
[5]  Smallwood, J., Ruby, F. J. M., & Singer, T. Letting go of the present: Mind-wandering is associated with reduced delay discounting. Consciousness and Cognition, 22, 1-7. 2013.
Show More References
[6]  Baird, B., Smallwood, J., & Schooler, J. W. Back to the future: Autobiographical planning and the functionality of mind-wandering. Consciousness and Cognition, 20 (4), 1604-1611. 2011.
[7]  Barron, E., Riby, L. M., Greer, J., & Smallwood, J. Absorbed in Thought: The Effect of Mind Wandering on the Processing of Relevant and Irrelevant Events. Psychological Science, 22 (5), 596-601. 2011.
[8]  Smallwood, J., Schooler, J. W., Turk, D. J., Cunningham, S. J., Burns, P., & Macrae, C. N. Self-reflection and the temporal focus of the wandering mind. Consciousness and Cognition, 20 (4), 1120-1126. 2011.
[9]  Levinson, D. B., Smallwood, J., & Davidson, R. J. The Persistence of Thought Evidence for a Role of Working Memory in the Maintenance of Task-Unrelated Thinking. Psychological Science, 23 (4), 375-380. 2011.
[10]  Christoff, K., Gordon, A., Smallwood, J., Smith, R., & Schooler, J. W. Experience sampling during fMRI reveals default network and executive system contributions to mind wandering. Proceedings of the National Academy of Sciences, USA, 106, 8719-8724. 2009.
[11]  Mason, M. F., Norton, M. I., Van Horn, J. D., Wegner, D. M., Grafton, S. T., & Macrae, C. N. Wandering Minds: The Default Network and Stimulus-Independent Thought. Science, 315 (5810), 393-395. 2007.
[12]  Stawarczyk, D., Majerus, S., Maquet, P., & D'Argembeau, A. Neural Correlates of Ongoing Conscious Experience: Both Task-Unrelatedness and Stimulus-Independence Are Related to Default Network Activity. Plos ONE 6 (2), e16997. 2011.
[13]  Riby, L. M., & Riby, D. M. Glucose, ageing and cognition: the hippocampus hypothesis.In Ballesteros S (Ed). Pp 79-92. Age, Cognition and Neuroscience/Envejecimiento, Cognicio´n y Neurociencia, UNED, Varia: Madrid. 2006.
[14]  Smith, M. A., Riby, L. M., van Eekelen, J. A. M., & Foster, J. K. Glucose enhancement of human memory: A comprehensive research review of the glucose memory facilitation effect. Neuroscience and Biobehavioural Reviews, 35 (3), 770-783. 2011.
[15]  Messier, C., Awad-Shimoon, N., Gagnon, M., Desrochers, A., & Tsiakas, M. Glucose regulation is associated with cognitive performance in young nondiabetic adults. Behavioural Brain Research, 222 (1), 81-88. 2011.
[16]  Riby, L. M., McLaughlin, J.,Riby, D. M. & Graham, C. Lifestyle, glucose regulation and the cognitive effects of glucose load in middle-aged adults. British Journal of Nutrition, 100, 1128. 2008.
[17]  Smith, M. A., & Foster, J. K. Glucoregulartory and order effects on verbal episodic memory in healthy adolescents after oral glucose administration. Biological Psychology, 79, 209-215. 2008.
[18]  Smith, M. A., Riby, L. M., Sünram-Lea, S. I., Van Eekelen, J. A. M., & Foster, J. K. Glucose modulates event-related potential components of recollection and familiarity in healthy adolescents. Psychopharmacology, 205, 11-20. 2009.
[19]  Smith, M. A., Hii, H. L., Foster, J. K., & van Eekelen, J. A. M. Glucose enhancement of memory is modulated by trait anxiety in healthy adolescent males. Journal of Psychopharmacology, 60-70. 2011.
[20]  Riby, L. M., Marriott, A., Bullock, R., Hancock, J., Smallwood, J., & McLaughlin, J. The effects of glucose ingestion and glucose regulation on memory performance in older adults with mild cognitive impairment. European Journal of Clinical Nutrition 63, 566-571. 2009.
[21]  Awad, N., Gagnon, M., & Messier, C. The Relationship Between Impaired Glucose Tolerance, Type 2 Diabetes, and Cognitive Function. Journal of Clinical and Experimental Neuropsychology, 26 (8), 1044-1080. 2004.
[22]  Riby, L. M., Meikle, A., & Glover, C. The effects of age, glucose ingestion and gluco-regulatory control on episodic memory. Age and Ageing, 33 (5), 483-487. 2004.
[23]  Riby, L.M. The impact of age and task domain on cognitive performance: A meta-analytic review of the glucose facilitation effect. Brain Impairment (Cognitive Ageing Special Issue) 5, 145-165. 2004.
[24]  Giambra, L. M. Task-unrelated thought frequency as a function of age: A laboratory study. Psychology and Aging 4 (2), 136-143. 1989.
[25]  Giambra, L. M. The influence of aging on spontaneous shifts of attention from external stimuli to the contents of consciousness. Experimental Gerontology, 28 (4-5), 485-492. 1993.
[26]  McVay, J. C., Meier, M. E., Touron, D. R., & Kane, M. J. Aging ebbs the flow of thought: Adult age differences in mind wandering, executive control, and self-evaluation. Acta Psychologica, 142, 136-147. 2013.
[27]  Jackson, J. D., & Balota, D. A. Mind-wandering in younger and older adults: Converging evidence from the sustained attention to response task. Psychology and Aging, 27 (1), 106-119. 2012.
[28]  Wagner, U., Degirmenci, M., Drosopoulos, S., Perras, B., & Born, J. Effects of Cortisol Suppression on Sleep-Associated Consolidation of Neutral and Emotional Memory. Biological Psychiatry, 58 (11), 885-893. 2005.
[29]  Buckner, R. L., Andrews-Hanna, J. R., & Schacter, D. L. The Brain’s Default Network; Anatomy, Function, and Relevance to Disease. Annals of the New York Academy of Sciences, 1124, 1-38. 2008.
[30]  Harrison, B. J., Pujol, J., López-Solà, M., Hernández-Ribas, R., Deus, J., Ortiz, H., Soriano-Mas, C., Yücel, M., Pantelis, C., & Cardoner, N. Consistency and functional specialization in the default mode brain network. PNAS, 115 (28), 9781-9786. 2008.
[31]  Immordino-Yang, M.H., Christodoulou, J.A. & Singh, V. Rest Is Not Idleness:Implications of the Brain’s Default Mode for Human Development and Education, Perspectives on Psychological Science, 7 (4), 352-364. 2012.
[32]  Hagger, M. S., Wood, C., Stiff, C., & Chatzisarantis, N. L. Ego depletion and the strength model of self-control: a meta-analysis. Psychological Bulletin, 136 (4), 495. 2010.
[33]  Bernhardt, B. C., Smallwood, J., Tusche, A., Ruby, F., Engen, H., Steinbeis, N., & Stinger, T Medial prefrontal and anterior cingulate cortical thickness predicts shared individual differences in self-generated thought and temporal discounting. Neuroimage.
[34]  Gailliot, M. T., & Baumeister, R. F. The physiology of willpower: Linking blood glucose to self-control. Personality and Social Psychology Review, 11, 303-327. 2007.
Show Less References