A central feature of CBT is the need to be able to share a clear, easily grasped, rationale with the person with whom you are working, and obviously the exposition of the Interacting Cognitive Subsystems model given above does not match that description! However, it does lead to some very simple and user-friendly ideas that have been central to Helena's therapy. In summary, if the desynchrony between propositional and implicational levels, mediated by high arousal, is at the root of at least the psychotic symptom part of the problem, getting these to work together is at the heart of the solution. The ideas of shared and non-shared reality, the ability to hold two ideas at once, and the role of state of arousal in mediating access to the more "rational" explanation, as introduced above, all relate directly to this model. Fundamentally, being in the world is seen as a balancing act rather than a given. In most mental health problems the balance becomes tipped, but in psychosis it becomes dangerously destabilised. Recognising the need to keep the balance and exploring effective ways of achieving this become central to the therapy. Teasdale and others have spent some years developing the approach of mindfulness, as a way of consciously attaining this balance, for application to the treatment of depression (see Teasdale et al., 2000, for a multicentre research study applying mindfulness to the prevention of relapse in depression). Linehan (1993) makes it central to her Dialectical Behaviour Therapy approach to borderline personality disorder and adaptations of mindfulness were used in this therapy, both with the Voices group, and in individual work with Helena.
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