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Targeting affect leads to reduced paranoia in people with psychosis: a single case series. Behav Cogn Psychother 2020; 49:302-313. [PMID: 33070795 DOI: 10.1017/s1352465820000788] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Current psychological interventions for psychosis focus primarily on cognitive and behavioural management of delusions and hallucinations, with modest outcomes. Emotions are not usually targeted directly, despite evidence that people with psychosis have difficulty identifying, accepting and modifying affective states. AIMS This study assessed the impact of emotion regulation skills practice on affect and paranoia in seven people who met criteria for a diagnosis of schizophrenia or schizoaffective disorder. METHOD The study utilised a single case ABA design and measured emotion regulation skills, affect and paranoia over baseline, intervention and withdrawal of intervention phases. We predicted that eight sessions of skills rehearsal would lead to improved emotion regulation, reduced negative affect, increased positive affect, and reduced paranoia. RESULTS Most participants were able to learn to regulate their emotions, and reported reduced negative affect and paranoia. There was no clear pattern of change for positive affect. CONCLUSIONS These findings suggest that emotion can be targeted in psychosis, and is associated with reduced paranoia. Emotion regulation may constitute a key treatment target in cognitive behavioural therapy for psychosis.
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Bogen-Johnston L, deVisser R, Strauss C, Hayward M. A qualitative study exploring how Practitioners within Early Intervention in Psychosis Services engage with Service Users' experiences of voice hearing? J Psychiatr Ment Health Nurs 2020; 27:607-615. [PMID: 32026565 DOI: 10.1111/jpm.12612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/31/2020] [Accepted: 02/04/2020] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The experience of hearing distressing voices is commonly reported by service users with a diagnosis of first-episode psychosis, but their access to formal conversations about voices in the form of psychological therapies can be limited. Service users within Early Intervention in Psychosis (EIP) services can benefit from informal opportunities to talk about their voice hearing experiences. However, they can be reluctant to engage with these conversations. Little is known about the experiences of EIP practitioners as they try to engage service users in conversations about their voices. WHAT DOES THE PAPER ADD TO EXISTING KNOWLEDGE?: Despite EIP Services specializing in the treatment of the symptoms of psychosis such as voice hearing, practitioners can still be reluctant to initiate and continue informal conversations about voices. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: EIP practitioners may benefit from the introduction of interview guides and brief interventions to assist them with the initiation and continuation of conversations about voices. ABSTRACT: Introduction Hearing voices is a common and distressing symptom of first-episode psychosis. Formal and informal conversations about voices are helpful, but service users within Early Intervention in Psychosis (EIP) Services can be reluctant to discuss their voice hearing experiences. There is currently no literature that explores the experiences of EIP practitioners as they try to facilitate conversations about distressing voices. Aim/Question A qualitative methodology was used to investigate how EIP practitioners work with service users who hear voices. Ten practitioners were interviewed, and interviews were analysed using template analysis. Results Two themes that offer novel insights are presented: "starting a conversation about voices" and "continuing the conversation about voices." Discussion Starting and continuing a conversation about voices was considered important but not all practitioners were confident in this respect. The initiation and continuation of these conversations may need to be systematically supported. Implications for practice To support the initiation of informal conversations, a standardized interview guide for voice hearing could be introduced and systematically utilized. The continuation of these conversations could be supported by practitioners being given the opportunity to receive training in and the opportunity to deliver brief symptom-specific therapies for distressing voices.
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Affiliation(s)
- Leanne Bogen-Johnston
- University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Hove, UK
| | | | - Clara Strauss
- University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Mark Hayward
- University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Hove, UK
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Dellazizzo L, Potvin S, Phraxayavong K, Dumais A. Exploring the Benefits of Virtual Reality-Assisted Therapy Following Cognitive-Behavioral Therapy for Auditory Hallucinations in Patients with Treatment-Resistant Schizophrenia: A Proof of Concept. J Clin Med 2020; 9:E3169. [PMID: 33007909 PMCID: PMC7601104 DOI: 10.3390/jcm9103169] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/20/2020] [Accepted: 09/27/2020] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Combining cognitive behavioral therapy (CBT) for psychosis with another psychosocial intervention comprising virtual reality (VR)-assisted therapy (VRT) may improve targeted outcomes in treatment-resistant schizophrenia patients. METHODS Ten participants having followed CBT were part of our comparative clinical trial comparing VRT to CBT and were selected at the end of the study as they desired to continue to achieve improvements with VRT (CBT + VRT). Clinical assessments were administered before/after treatments and at follow-ups. Changes in outcomes were examined using linear mixed-effects models. To gain a more in depth understanding on CBT + VRT, therapists' notes, and open interviews on a sub-group of patients were qualitatively analyzed. RESULTS Findings showed that the sequence of both interventions was appreciated by all patients. Several significant improvements were found throughout time points on auditory verbal hallucinations, beliefs about voices, depressive symptoms, symptoms of schizophrenia and quality of life. Although most of these improvements were in similar range to those observed in our comparative trial, effects of CBT + VRT on depressive symptoms and symptoms of schizophrenia were larger than those found for either intervention alone. CONCLUSION This proof of concept is the first to merge gold-standard CBT with VRT for treatment refractory voices and to suggest a certain synergistic effect.
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Affiliation(s)
- Laura Dellazizzo
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC H1N 3V2, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | - Stéphane Potvin
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC H1N 3V2, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
| | | | - Alexandre Dumais
- Research Center of the Institut Universitaire en Santé Mentale de Montréal, 7331 Hochelaga, Montreal, QC H1N 3V2, Canada
- Department of Psychiatry and Addictology, Faculty of Medicine, University of Montreal, Montreal, QC H3T 1J4, Canada
- Services et Recherches Psychiatriques AD, Montreal, QC, Canada
- Institut National de Psychiatrie légale Philippe-Pinel, Montreal, QC H1C 1H1, Canada
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Tailoring cognitive behavioural therapy to subtypes of voice-hearing using a novel tabletised manual: a feasibility study. Behav Cogn Psychother 2020; 49:287-301. [PMID: 32972483 DOI: 10.1017/s1352465820000661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive behavioural therapy for psychosis (CBTp) is a recommended treatment for psychotic experiences, but its effectiveness has been questioned. One way of addressing this may be to tailor therapy materials to the phenomenology of specific psychotic experiences. AIM In this study, we investigated the acceptability of a novel treatment manual for subtypes of 'voice-hearing' experiences (i.e. auditory verbal hallucinations). An uncontrolled, single-arm design was used to assess feasibility and acceptability of using the manual in routine care for people with frequent voice-hearing experiences. METHOD The manual was delivered on a smart tablet and incorporated recent research evidence and theory into its psychoeducation materials. In total, 24 participants completed a baseline assessment; 19 started treatment, 15 completed treatment and 12 participants completed a follow-up assessment (after 10 sessions of using the manual). RESULTS Satisfaction with therapy scores and acceptability ratings were high, while completion rates suggested that the manual may be more appropriate for help with participants from Early Intervention in Psychosis services rather than Community Mental Health Teams. CONCLUSION Within-group changes in symptom scores suggested that overall symptom severity of hallucinations - but not other psychosis features, or beliefs about voices - are likely to be the most appropriate primary outcome for further evaluation in a full randomised controlled trial.
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Turner DT, Burger S, Smit F, Valmaggia LR, van der Gaag M. What Constitutes Sufficient Evidence for Case Formulation-Driven CBT for Psychosis? Cumulative Meta-analysis of the Effect on Hallucinations and Delusions. Schizophr Bull 2020; 46:1072-1085. [PMID: 32221536 PMCID: PMC7505201 DOI: 10.1093/schbul/sbaa045] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Following 2 decades of research on cognitive behavioral therapy for psychosis (CBTp), it is relevant to consider at which point the evidence base is considered sufficient. We completed a cumulative meta-analysis to assess the sufficiency and stability of the evidence base for hallucinations and delusions. METHOD We updated the systematic search from our previous meta-analytic review from August 2013 until December 2019. We identified 20 new randomized controlled trials (RCTs) resulting in inclusion of 35 RCTs comparing CBTp with treatment-as-usual (TAU) or active controls (AC). We analyzed data from participants with psychosis (N = 2407) over 75 conventional meta-analytic comparisons. We completed cumulative meta-analyses (including fail-safe ratios) for key comparisons. Publication bias, heterogeneity, and risk of bias were examined. RESULTS Cumulative meta-analyses demonstrated sufficiency and stability of evidence for hallucinations and delusions. The fail-safe ratio demonstrated that the evidence base was sufficient in 2016 for hallucinations and 2015 for delusions. In conventional meta-analyses, CBTp was superior for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01) when compared with any control. Compared with TAU, CBTp demonstrated superiority for hallucinations (g = 0.34, P < .01) and delusions (g = 0.37, P < .01). Compared with AC, CBT was superior for hallucinations (g = 0.34, P < .01), but not for delusions although this comparison was underpowered. Sensitivity analyses for case formulation, primary outcome focus, and risk of bias demonstrated increases in effect magnitude for hallucinations. CONCLUSIONS The evidence base for the effect of CBTp on hallucinations and delusions demonstrates sufficiency and stability across comparisons, suggesting limited value of new trials evaluating generic CBTp.
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Affiliation(s)
- David T Turner
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Simone Burger
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Filip Smit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam Medical Centers, Amsterdam, the Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health, Utrecht, the Netherlands
| | - Lucia R Valmaggia
- Department of Psychology, King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
- Parnassia Psychiatric Institute, The Hague, the Netherlands
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Best MW, Law H, Pyle M, Morrison AP. Relationships between psychiatric symptoms, functioning and personal recovery in psychosis. Schizophr Res 2020; 223:112-118. [PMID: 32620428 DOI: 10.1016/j.schres.2020.06.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 06/20/2020] [Accepted: 06/20/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recovery from psychosis is increasingly being viewed as a combination of symptomatic, functional, and personal recovery. Negative and depressive symptoms have been linked to community functioning, and negative affect has been linked to personal recovery. The current study examines differential associations of symptoms with functional and personal recovery, and the interaction of cognitive and emotional components of psychotic experiences in predicting recovery. METHODS Baseline data from four studies of individuals with schizophrenia-spectrum disorders were amalgamated for the current analyses. All studies utilized the Positive and Negative Syndrome Scale, Psychotic Symptom Rating Scale, Personal and Social Performance Scale, and the Questionnaire about the Process of Recovery. RESULTS 971 individuals participated across the four studies. Affective symptoms were most strongly associated with personal recovery, accounting for 30% of the variance in personal recovery and only 2% of the variance in objective functioning. Negative and disorganized symptoms were related to both functional and personal recovery, excitement symptoms were only related to personal recovery, and broad measures of positive symptoms were not associated with either functional or personal recovery. Cognitive interpretations of psychotic experiences were more strongly related to objective functioning, and emotional components of psychotic experiences were more strongly related to personal recovery; cognitive interpretations moderated the relationship between emotional characteristics and recovery measures. CONCLUSIONS Functional and personal recovery are distinct domains of recovery with differential relationships to symptomatology. Interventions that target cognitive interpretations of psychotic experiences and negative affect may be more likely to affect multiple domains of recovery.
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Affiliation(s)
- Michael W Best
- Department of Psychology, University of Toronto Scarborough, Toronto, Ontario, Canada.
| | - Heather Law
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Anthony P Morrison
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
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Rus-Calafell M, Ward T, Zhang XC, Edwards CJ, Garety P, Craig T. The Role of Sense of Voice Presence and Anxiety Reduction in AVATAR Therapy. J Clin Med 2020; 9:jcm9092748. [PMID: 32854387 PMCID: PMC7564300 DOI: 10.3390/jcm9092748] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/18/2020] [Accepted: 08/19/2020] [Indexed: 01/15/2023] Open
Abstract
AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time "face-to-face" dialogue. The present study explores, for the first time, the contribution of sense of voice presence, together with session-by-session reduction of anxiety and paranoid attributions about the avatar, to changes in primary outcomes following AVATAR therapy. Data from 39 participants, who completed AVATAR therapy and attended a 12-week follow-up assessment, were analysed. Mid- to high-levels of sense of voice presence were reported across the therapy sessions, along with significant reductions of anxiety levels and paranoid attributions about the avatar. The interaction of sense of voice presence and reduction of anxiety was associated with two of the significant therapy outcomes: PSYRATS total and frequency of voices. The findings suggest that improvements in voice severity and frequency at post AVATAR therapy may be influenced by the combination of feeling less anxious in the context of a realistic simulation of the voice, while voice-related distress may involve additional cognitive and relational processes.
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Affiliation(s)
- Mar Rus-Calafell
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany;
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- Correspondence:
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, 44787 Bochum, Germany;
| | - Clementine J. Edwards
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK; (T.W.); (C.J.E.); (P.G.)
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
| | - Tom Craig
- Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London SE5 8AB, UK;
- South London & Maudsley NHS Foundation Trust, London SE5 8AZ, UK
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Lam CL, Mouchlianitis E, Lee TM, Yiend J. Anxiety mediates the relationship between interpretation bias and paranoia in patients with persistent persecutory beliefs. ANXIETY STRESS AND COPING 2020; 34:96-106. [DOI: 10.1080/10615806.2020.1802435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Charlene L.M. Lam
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong, Hong Kong
| | - Elias Mouchlianitis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Tatia M.C. Lee
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, Hong Kong
- Laboratory of Neuropsychology, The University of Hong Kong, Hong Kong, Hong Kong
- Center for Brain Science and Brain-Inspired Intelligence, Guangdong-Hong Kong-Macao Greater Bay Area, Guangzhou, People’s Republic of China
| | - Jenny Yiend
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Wood L, Williams C, Billings J, Johnson S. A systematic review and meta-analysis of cognitive behavioural informed psychological interventions for psychiatric inpatients with psychosis. Schizophr Res 2020; 222:133-144. [PMID: 32586627 DOI: 10.1016/j.schres.2020.03.041] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 01/09/2023]
Abstract
Psychological interventions such as Cognitive Behavioural Therapy for psychosis (CBTp) are recommended by the National Institute of Health and Care Excellence (NICE) for delivery in the acute phase of people's mental health difficulties. However, the effectiveness of cognitive behavioural informed psychological therapies for psychiatric inpatients is unknown. The aim of this review is to examine the type, quality and efficacy of cognitive behavioural informed psychological interventions for psychiatric inpatients experiencing psychosis. A systematic review and meta-analysis was conducted of randomised controlled trials examining the efficacy of cognitive behavioural informed psychological interventions offered to acute psychiatric inpatients with psychosis on primary (positive symptoms) and secondary outcomes of interest. A total of 23 studies were identified reporting on 18 trials of interventions such as CBTp, Acceptance and Commitment Therapy (ACT) and Metacognitive Therapy (MCT). Cognitive behavioural informed psychological interventions were found not be effective in reducing positive symptoms (primary outcome) at post-therapy and at follow-up but when a one study removed analysis was conducted a positive effect was found at both time points. In regard to secondary outcomes, cognitive behavioural informed psychological interventions demonstrated a significant favourable effect on negative symptoms (post-therapy), total symptoms (post-therapy and follow-up), functioning (post-therapy and follow-up) and readmission (follow-up). These psychological interventions may have potential to be effective for those admitted to psychiatric inpatient care and in acute crisis. However, findings are equivocal with evidence that these interventions have effect on some symptom measures but not others. Further examination of inpatient adapted cognitive behavioural informed psychological interventions is required.
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Affiliation(s)
- Lisa Wood
- North East London NHS Foundation Trust, Acute and Rehabilitation Directorate, Goodmayes Hospital, Barley Lane, Ilford, Essex IG3 8XJ, United Kingdom of Great Britain and Northern Ireland; University College London, Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland.
| | - Claire Williams
- North East London NHS Foundation Trust, Acute and Rehabilitation Directorate, Goodmayes Hospital, Barley Lane, Ilford, Essex IG3 8XJ, United Kingdom of Great Britain and Northern Ireland
| | - Jo Billings
- University College London, Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
| | - Sonia Johnson
- University College London, Division of Psychiatry, Maple House, 149 Tottenham Court Road, London W1T 7BN, United Kingdom of Great Britain and Northern Ireland
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Evaluation on Efficacy of Psychological and Behavioral Intercession and Its Implications on People with Schizophrenia: A Novel Approach. Community Ment Health J 2020; 56:1103-1109. [PMID: 32086674 DOI: 10.1007/s10597-020-00589-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/15/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To examine and evaluate the efficacy of the spectrum of psychological and behavioral intercession as a novel treatment regime to address the necessity of Schizophrenia affected patients. METHOD A sum of 148 individuals with the first episode of Schizophrenia enrolled in the trial. Patients admitted in our medium-sized hospital with symptoms of schizophrenia were scrutinized carefully and selected for the intercession trial. Total selected individuals were bifurcated into two groups based on guidelines prescribed in the intervention model. Control group or standard care group (SCG) was treated with usual medications and nursing measures of psychiatry practices. Experimental Group (EG) was conferred with enriched psychological strategy and behavioral modules to tackle and satisfy their specific needs. Various methods such as positive and negative syndrome scale (PANSS), several disability screening schedule (SDGSS), satisfaction with life scale (SWLS), global assessment scale (GAS) and finally rate of recurrence of disease were evaluated and analyzed. RESULTS Efficacy of psychological and behavioral intercession on psychotic domine is proved to be effective, and a novel strategy and it is significantly reducing positive and negative psychological symptoms in the experimental group was observed attributing to the intercession. Moreover, a drastic attenuation in the rate of recurrence of disease was supporting a long term efficiency of intercession. CONCLUSION Conducting intervention on psychological and behavioral approach has explored novel treatment outcomes, targeted schizophrenia patients effectively.
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Ellett L, Tarant E, Kouimtsidis C, Kingston J, Vivarelli L, Mendis J, Chadwick P. Group mindfulness-based therapy for persecutory delusions: A pilot randomised controlled trial. Schizophr Res 2020; 222:534-536. [PMID: 32402604 DOI: 10.1016/j.schres.2020.04.023] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 01/30/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Lyn Ellett
- Department of Psychology, Royal Holloway, University of London, United Kingdom of Great Britain and Northern Ireland
| | - Eryna Tarant
- Surrey and Borders Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Christos Kouimtsidis
- Surrey and Borders Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Jessica Kingston
- Department of Psychology, Royal Holloway, University of London, United Kingdom of Great Britain and Northern Ireland
| | - Laura Vivarelli
- Surrey and Borders Partnership NHS Foundation Trust, United Kingdom of Great Britain and Northern Ireland
| | - Jeewaka Mendis
- University of Surrey, United Kingdom of Great Britain and Northern Ireland
| | - Paul Chadwick
- Department of Psychology, University of Bath, United Kingdom of Great Britain and Northern Ireland.
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Müller H, Kommescher M, Güttgemanns J, Wessels H, Walger P, Lehmkuhl G, Kuhr K, Hamacher S, Lehmacher W, Müller K, Herrlich J, Wiedemann G, Stösser D, Klingberg S, Bechdolf A. Cognitive behavioral therapy in adolescents with early-onset psychosis: a randomized controlled pilot study. Eur Child Adolesc Psychiatry 2020; 29:1011-1022. [PMID: 31599351 DOI: 10.1007/s00787-019-01415-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 09/29/2019] [Indexed: 11/26/2022]
Abstract
Cognitive behavioral therapy for psychosis (CBT) is an effective treatment in adult patients with schizophrenia. However, no randomized controlled and blinded trial in adolescents with early-onset psychosis (EOP) has been conducted. Therefore, the present pilot study explores the acceptance, tolerability, feasibility, and safety of a modified CBT in adolescents with EOP. Twenty-five adolescents with EOP were randomized to either 9 months (20 sessions) of CBT + treatment as usual (TAU) or TAU alone. The primary endpoint was the PANSS-positive subscale (P1-7). Secondary endpoints included psychopathology, global functioning, and quality of life (QoL). Acceptance, tolerability, feasibility, and safety were assessed. Blinded assessments took place by the end of the treatment (9 months) and at 24-month follow-up. Despite improvements in both groups and lack of statistical significance between CBT + TAU and TAU regarding the primary endpoint, we observed between-group effect sizes of at least d = 0.39 in favor of CBT + TAU at post-treatment for delusions, negative symptoms, functioning and QoL after the intervention and effect sizes of at least d = 0.35 after 24 months. CBT in EOP was highly acceptable (73.5% agreed to randomization), well-tolerated (83.1% attendance rate, no drop-outs), and safe (one serious adverse event (SAE) in CBT + TAU in comparison with six SAEs in TAU). These findings suggest that CBT adapted to the needs of adolescents with EOP is a promising approach regarding negative symptoms, functioning, and QoL. CBT is a safe and tolerable treatment. However, due to the small sample size and the pilot character of the study, these conclusions are limited, and should be tested in a larger, adequately powered randomized controlled trial.
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Affiliation(s)
- Hendrik Müller
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Mareike Kommescher
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Jörn Güttgemanns
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Helen Wessels
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Petra Walger
- Department of Childhood and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Gerd Lehmkuhl
- Department of Childhood and Adolescent Psychiatry and Psychotherapy, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany
| | - Kathrin Kuhr
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Cologne, Germany
| | - Stefanie Hamacher
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Cologne, Germany
| | - Walter Lehmacher
- Faculty of Medicine, Institute of Medical Statistics and Computational Biology, University Hospital Cologne, Cologne, Germany
| | - Kerstin Müller
- Kinder- und Jugendwohnheim Leppermühle, Leppermühle 1, 35418, Buseck, Germany
| | - Jutta Herrlich
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Goethe University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany
| | - Georg Wiedemann
- Department of Psychiatry and Psychotherapy, Klinikum Fulda, Pacelliallee 4, 36043, Fulda, Germany
| | - Dieter Stösser
- Department of Childhood and Adolescent Psychiatry and Psychotherapy, University of Tübingen, Geissweg 3, 72076, Tübingen, Germany
| | - Stefan Klingberg
- Department of Psychiatry and Psychotherapy, University of Tübingen, Geissweg 3, 72076, Tübingen, Germany
| | - Andreas Bechdolf
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Hospital Cologne, Cologne, Germany.
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum am Urban, Dieffenbachstraße 1, 10967, Berlin, Germany.
- Vivantes Klinikum im Friedrichshain, Berlin, Germany.
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Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe S, French P, Hutton P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TR, Davies L, Shields G, Buck D, Tully S, Kingdon D. Cognitive-behavioural therapy for clozapine-resistant schizophrenia: the FOCUS RCT. Health Technol Assess 2020; 23:1-144. [PMID: 30806619 DOI: 10.3310/hta23070] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). There is little evidence regarding the clinical effectiveness of pharmacological or psychological interventions for this population. OBJECTIVES To evaluate the clinical effectiveness and cost-effectiveness of cognitive-behavioural therapy (CBT) for people with CRS and to identify factors predicting outcome. DESIGN The Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial was a parallel-group, randomised, outcome-blinded evaluation trial. Randomisation was undertaken using permuted blocks of random size via a web-based platform. Data were analysed on an intention-to-treat (ITT) basis, using random-effects regression adjusted for site, age, sex and baseline symptoms. Cost-effectiveness analyses were carried out to determine whether or not CBT was associated with a greater number of quality-adjusted life-years (QALYs) and higher costs than treatment as usual (TAU). SETTING Secondary care mental health services in five cities in the UK. PARTICIPANTS People with CRS aged ≥ 16 years, with an International Classification of Diseases, Tenth Revision (ICD-10) schizophrenia spectrum diagnoses and who are experiencing psychotic symptoms. INTERVENTIONS Individual CBT included up to 30 hours of therapy delivered over 9 months. The comparator was TAU, which included care co-ordination from secondary care mental health services. MAIN OUTCOME MEASURES The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months and the primary secondary outcome was PANSS total score at the end of treatment (9 months post randomisation). The health benefit measure for the economic evaluation was the QALY, estimated from the EuroQol-5 Dimensions, five-level version (EQ-5D-5L), health status measure. Service use was measured to estimate costs. RESULTS Participants were allocated to CBT (n = 242) or TAU (n = 245). There was no significant difference between groups on the prespecified primary outcome [PANSS total score at 21 months was 0.89 points lower in the CBT arm than in the TAU arm, 95% confidence interval (CI) -3.32 to 1.55 points; p = 0.475], although PANSS total score at the end of treatment (9 months) was significantly lower in the CBT arm (-2.40 points, 95% CI -4.79 to -0.02 points; p = 0.049). CBT was associated with a net cost of £5378 (95% CI -£13,010 to £23,766) and a net QALY gain of 0.052 (95% CI 0.003 to 0.103 QALYs) compared with TAU. The cost-effectiveness acceptability analysis indicated a low likelihood that CBT was cost-effective, in the primary and sensitivity analyses (probability < 50%). In the CBT arm, 107 participants reported at least one adverse event (AE), whereas 104 participants in the TAU arm reported at least one AE (odds ratio 1.09, 95% CI 0.81 to 1.46; p = 0.58). CONCLUSIONS Cognitive-behavioural therapy for CRS was not superior to TAU on the primary outcome of total PANSS symptoms at 21 months, but was superior on total PANSS symptoms at 9 months (end of treatment). CBT was not found to be cost-effective in comparison with TAU. There was no suggestion that the addition of CBT to TAU caused adverse effects. Future work could investigate whether or not specific therapeutic techniques of CBT have value for some CRS individuals, how to identify those who may benefit and how to ensure that effects on symptoms can be sustained. TRIAL REGISTRATION Current Controlled Trials ISRCTN99672552. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 7. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Ageing and Vitality, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Clinical Trials Unit, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Paul Hutton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Helen Griffiths
- Department of Clinical Psychology, Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | - Linda Davies
- Division of Population Health, University of Manchester, Manchester, UK
| | - Gemma Shields
- Division of Population Health, University of Manchester, Manchester, UK
| | - Deborah Buck
- Division of Population Health, University of Manchester, Manchester, UK
| | - Sarah Tully
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK.,Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - David Kingdon
- Department of Psychiatry, University of Southampton, Academic Centre, Southampton, UK
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64
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Hayward M, Schlier B, Strauss C, Rammou A, Lincoln T. Construction and validation of the Approve questionnaires - Measures of relating to voices and other people. Schizophr Res 2020; 220:254-260. [PMID: 32199714 DOI: 10.1016/j.schres.2020.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND The effectiveness of psychological treatments for auditory hallucinations ('voices') needs to be enhanced. Some forms of novel treatment are working within relational frameworks to support patients to relate assertively to distressing voices. Yet, no measure of assertive relating to voices is available to assess the extent to which this skill is developed during therapy. This study aimed to assess the factor structure and validity of two new questionnaires: a measure of relating to voices and a measure of social relating. METHODS The relating measures were developed in consultation with members of the international research community and validated in a large sample (N = 402) of voice hearing patients within the UK. The measures were subjected to factor analysis and compared to measures of voice hearing, mental health and well-being to evaluate construct, convergent, discriminant, and criterion validity. RESULTS Factor analysis confirmed a three-dimensional set of items that measure assertive and non-assertive (passive and aggressive) relating. This resulted in the validation of the 'Approve' questionnaires - two 15-item measures of relating to voices and other people. CONCLUSION The Approve questionnaires can be used to assess a patient's suitability for relationally-based psychological therapies for distressing voices and the extent to which assertive relating skills are developed during the therapy.
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Affiliation(s)
- Mark Hayward
- Research & Development Department, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove BN7 3HZ, UK.
| | - Björn Schlier
- Universität Hamburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton BN1 9RH, UK
| | | | - Tania Lincoln
- Universität Hamburg, Institute of Psychology, Department of Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
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65
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Moritz S, Klein JP, Lysaker PH, Mehl S. Metacognitive and cognitive-behavioral interventions for psychosis: new developments
. DIALOGUES IN CLINICAL NEUROSCIENCE 2020; 21:309-317. [PMID: 31749655 PMCID: PMC6829173 DOI: 10.31887/dcns.2019.21.3/smoritz] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This review describes four cognitive approaches for the treatment of
schizophrenia: cognitive-behavioral therapy for psychosis (CBTp), metacognitive therapy,
metacognitive training, and metacognitive reflection insight therapy (MERIT). A central
reference point of our review is a seminal paper by James Flavell, who introduced the
term metacognition (“cognition about cognition”). In a way, every psychotherapeutic
approach adopts a metacognitive perspective when therapists reflect with clients about
their thoughts. Yet, the four approaches map onto different components of metacognition.
CBTp conveys some “metacognitive knowledge” (eg, thoughts are not facts) but is mainly
concerned with individual beliefs. Metacognitive therapy focuses on unhelpful
metacognitive beliefs about thinking styles (eg, thought suppression). Metacognitive
training brings distorted cognitive biases to the awareness of patients; a central goal
is the reduction of overconfidence. MERIT focuses on larger senses of identity and
highlights metacognitive knowledge about oneself and other persons. For CBTp and
metacognitive training, meta-analytic evidence supports their efficacy; single studies
speak for the effectiveness of MERIT and metacognitive therapy.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Philipp Klein
- Department of Psychiatry and Psychotherapy, Lübeck University, Lübeck, Germany
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center, Indiana University School of Medicine, Indianapolis, IN, US
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany;
Department of Health and Social Work, Frankfurt University of Applied Science Frankfurt, Germany
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66
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Sitko K, Bewick BM, Owens D, Masterson C. Meta-analysis and Meta-regression of Cognitive Behavioral Therapy for Psychosis (CBTp) Across Time: The Effectiveness of CBTp has Improved for Delusions. ACTA ACUST UNITED AC 2020. [DOI: 10.1093/schizbullopen/sgaa023] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Abstract
Published research shows small-to-medium effects of Cognitive Behavioral Therapy for Psychosis (CBTp) on reducing psychotic symptoms. Given the on-going development of CBTp interventions, the aim of this systematic review is to examine whether the effectiveness of CBTp has changed across time. MEDLINE, EMBASE, PsycINFO, and CENTRAL were searched for randomized controlled trials examining CBTp interventions targeting positive and/or negative symptoms vs treatment as usual. Four meta-analyses were carried out to examine the effectiveness of CBTp for: positive symptoms; delusions; hallucinations; and negative symptoms. Four meta-regressions examined whether the effectiveness of CBTp changed across time for these groups of symptoms. A total of 28 studies (n = 2698) yielded a pooled g of −0.24 (95% confidence interval [CI] −0.32, −0.16, P < .001) favoring CBTp for positive symptoms, with nonsignificant heterogeneity (Q = 26.87, P = .47; I2 =0%); 13 studies (n = 890) yielded a pooled g of −0.36 (95% CI −0.59, −0.13, P = .002) for delusions, with substantial heterogeneity (Q = 31.99, P = .001; I2 =62%); 16 studies (n = 849) yielded a pooled g of −0.26 (95% CI −0.42, −0.11, P < .001) for hallucinations, with nonsignificant heterogeneity (Q = 18.10, P = .26; I2 =17%); 19 studies (n = 1761) yielded a pooled g of −0.22 (95% CI −0.33, −0.12, P < .001) for negative symptoms, with nonsignificant heterogeneity (Q = 20.32, P = .32, I2 =11%). Meta-regressions indicated a significant effect of year on the effectiveness of CBTp only for delusions (F[1, 11] = 5.99, P = .032; R2 = 0.594); methodological quality did not effect this finding. Findings indicate small-to-medium effects of CBTp for psychotic symptoms, with increasing effectiveness across time for delusions.
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Affiliation(s)
- Katarzyna Sitko
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| | - Bridgette M Bewick
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| | - David Owens
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
| | - Ciara Masterson
- Faculty of Medicine and Health, School of Medicine, University of Leeds, Leeds, UK
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67
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Increasing access to CBT for psychosis patients: a feasibility, randomised controlled trial evaluating brief, targeted CBT for distressing voices delivered by assistant psychologists (GiVE2). Trials 2020; 21:302. [PMID: 32238176 PMCID: PMC7110645 DOI: 10.1186/s13063-020-4181-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Accepted: 02/18/2020] [Indexed: 11/12/2022] Open
Abstract
Background The National Institute for Health and Care Excellence (NICE) recommends that Cognitive Behaviour Therapy for psychosis (CBTp) is offered to all patients with a psychosis diagnosis. However, only a minority of psychosis patients in England and Wales are offered CBTp. This is attributable, in part, to the resource-intensive nature of CBTp. One response to this problem has been the development of CBTp in brief formats that are targeted at a single symptom and the mechanisms that maintain distress. We have developed a brief form of CBTp for distressing voices and reported preliminary evidence for its effectiveness when delivered by highly trained therapists (clinical psychologists). This study will investigate the delivery of this intervention by a cost-effective workforce of assistant psychologists following a brief training and evaluate the acceptability and feasibility of conducting a future, definitive, randomised controlled trial (RCT). Methods This is a feasibility study for a pragmatic, three-arm, parallel-group, superiority 1:1:1 RCT comparing a Guided self-help CBT intervention for voices and treatment as usual (GiVE) to Supportive Counselling and treatment as usual (SC) to treatment as usual alone (TAU), recruiting across two sites, with blinded post-treatment and follow-up assessments. A process evaluation will quantitatively and qualitatively explore stakeholder experience. Discussion Expected outcomes will include an assessment of the feasibility of conducting a definitive RCT, and data to inform the calculation of its sample size. If evidence from a subsequent, fully powered RCT suggests that GiVE is clinically and cost-effective when delivered by briefly trained assistant psychologists, CBTp offered in these less resource-intensive forms has the potential to generate benefits for individual patients (reduced distress, enhanced recovery and enhanced quality of life), service-level patient benefit (increased access to evidence-based psychological therapies) and economic benefits to the NHS (in terms of the reduced use of mental health inpatient services). Trial registration Current Controlled Trials, ISRCTN registration number: 16166070. Registered on 5 February 2019.
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68
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Maijer K, Staring T, Bartels-Velthuis AA, Palmen SJ, Sommer IE. Stronger than your voices: A cognitive behavioral therapy for youth suffering from auditory verbal hallucinations. Clin Child Psychol Psychiatry 2020; 25:386-400. [PMID: 31749371 DOI: 10.1177/1359104519888011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Auditory verbal hallucinations (AVHs) are a common feature in youth and mostly transient. Nevertheless, while present, AVH can cause considerable distress. Children and adolescents seeking help for distressing AVH represent a heterogeneous group in terms of underlying factors, yet they consistently suffer from their AVH. Until now, a youth-specific psychotherapeutic intervention for AVH was lacking. Experts in the field of treating AVH in both adults and youngsters collaborated with service users to develop the cognitive behavioral therapy (CBT) "Stronger Than Your Voices" (STYV). We investigated feasibility and clinical outcomes of the STYV therapy. METHODS Patients were derived from children and adolescents seeking help for AVH at the UMC Utrecht outpatient clinic with an indication for STYV therapy. Therapists preferably originated from referring health care facilities and were required to have sufficient general knowledge and experience with CBT. They received a short individual training to apply STYV. After, patients and their therapists could participate this naturalistic pilot study, assessing feasibility, tolerability, and clinical change when applying the STYV therapy. RESULTS Six participants (10-16 years old), all suffering from comorbid psychopathology, provided pre and post measures, all completing STYV therapy without experiencing an aggravation of symptoms. AVH total impact decreased 40% with Cohen's d within-group effect size (1.28) also suggesting clinically meaningful change. Therapists were positive about STYV therapy and manual. CONCLUSION The STYV therapy is feasible for youth with distressing AVH. First results indicate that STYV may be clinically effective. A trial to further test effectiveness in a larger sample is needed.
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Affiliation(s)
- Kim Maijer
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, The Netherlands.,De Bascule, The Netherlands
| | - Tonnie Staring
- Department for Transition Psychiatry and First Episode Psychosis, Altrecht Psychiatric Institute, The Netherlands
| | - Agna A Bartels-Velthuis
- Rob Giel Research Center, University Center for Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands
| | - Saskia Jmc Palmen
- Brain Center Rudolf Magnus, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - Iris Ec Sommer
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands.,Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Norway
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69
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Ma CF, Chan SKW, Chien WT, Bressington D, Mui EYW, Lee EHM, Chen EYH. Cognitive behavioural family intervention for people diagnosed with severe mental illness and their families: A systematic review and meta-analysis of randomized controlled trials. J Psychiatr Ment Health Nurs 2020; 27:128-139. [PMID: 31549461 DOI: 10.1111/jpm.12567] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 01/12/2023]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: Cognitive behavioural therapy for psychosis (CBTp) and family intervention (FI) for psychosis are effective evidence-based interventions, but they are practically difficult to be implemented in many clinical settings. The CBTp and FI approaches have been integrated to form cognitive behavioural family intervention (CBFI). This brief intervention may be more feasible to implement in clinical practice. A few individual studies reported the effectiveness of CBFI, but no systematic review and meta-analysis have been conducted. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE: CBFI was effective for reducing overall positive and negative symptoms immediately following the intervention. Compared to CBTp, the intervention seems to be more effective to reduce delusions. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The results of this review suggest that the brief CBFI is an effective family-inclusive intervention that could be integrated into clinical practice. Mental health nurses with adequate training and support may implement and develop CBFI to improve the recovery of people diagnosed with SMI and support their families. Abstract Introduction Cognitive behavioural family intervention (CBFI) may be an effective brief psychosocial intervention for people diagnosed with severe mental illness (SMI) and their families. No systematic review has summarized the effectiveness of CBFI. Aim This review aimed to systematically examine the trial evidence of the effectiveness of CBFI versus treatment as usual (TAU) on improving the outcomes of people diagnosed with SMI and their families. Method Eligible randomized controlled trials were identified from nine databases. Three investigators independently took part in selection of articles, data extraction and risk assessment. Pooled treatment effects were computed using random-effects models. Results Four studies consisting of 524 participants were included. The risk of bias was low-unclear in most areas. The pooled CBFI effect on four service user outcomes including overall positive symptoms, delusions, overall negative symptoms and general psychopathology was significantly improved at post-treatment, compared with TAU, whereas effects on hallucinations and insight were equivocal. Discussion The findings reveal that CBFI is superior to TAU in treating positive and negative symptoms immediately following the intervention. Implications for Practice Mental health nurses may practise CBFI to enrich the psychiatric nursing service and promote nurse-led intervention. However, there is currently no substantial evidence that the intervention is effective over the longer term.
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Affiliation(s)
- Chak Fai Ma
- Kwai Chung Hospital, Kowloon, Hong Kong.,Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Sherry Kit Wa Chan
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Daniel Bressington
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | | | - Edwin Ho Ming Lee
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong
| | - Eric Yu Hai Chen
- Department of Psychiatry, Li Ka Shing Faculty of Medicine, Queen Mary Hospital/The University of Hong Kong, Pok Fu Lam, Hong Kong.,The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Pok Fu Lam, Hong Kong
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70
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Bell IH, Rossell SL, Farhall J, Hayward M, Lim MH, Fielding-Smith SF, Thomas N. Pilot randomised controlled trial of a brief coping-focused intervention for hearing voices blended with smartphone-based ecological momentary assessment and intervention (SAVVy): Feasibility, acceptability and preliminary clinical outcomes. Schizophr Res 2020; 216:479-487. [PMID: 31812327 DOI: 10.1016/j.schres.2019.10.026] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/25/2019] [Accepted: 10/10/2019] [Indexed: 11/15/2022]
Abstract
BACKGROUND Voice-hearing experiences can be distressing and impairing, and existing psychological treatments show modest effectiveness. Ecological momentary assessment and intervention (EMA/I) are two promising approaches which may be used as digital tools to support and enhance existing psychological therapies. The aim of this study was to investigate the potential clinical utility of smartphone-based EMA/I in a blended, coping focused therapy for voice-hearing experiences. METHOD This pilot RCT focused on feasibility, acceptability and preliminary estimations of efficacy. Thirty-four participants with persisting and distressing voices were randomised to receive the four-session intervention along-side treatment-as-usual (TAU) or TAU-only. RESULTS Findings supported the feasibility and acceptability of the approach, with good engagement and satisfaction rates, and clinical outcomes showed the intervention holds promise for improving coping, overall severity of voices and to some degree their negative impact. CONCLUSION This is the first examination of the use of EMA/I in a blended therapy for psychotic experiences, with findings suggesting these technologies show promise as clinical tools.
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Affiliation(s)
- Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Australia.
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Australia; Department of Psychiatry, St. Vincent's Hospital, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia; NorthWestern Mental Health, Melbourne Health, Australia
| | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - Sarah F Fielding-Smith
- Sussex Partnership NHS Foundation Trust, UK; School of Psychology, University of Sussex, UK
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Australia.
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71
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Steel C, Schnackenberg J, Travers Z, Longden E, Greenfield E, Meredith L, Perry H, Corstens D. Voice hearers’ experiences of the Making Sense of Voices approach in an NHS setting. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2020. [DOI: 10.1080/17522439.2019.1707859] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Craig Steel
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Joachim Schnackenberg
- Stiftung Diakoniewerk Kropp & St Ansgar gGmbH Kropp, Kropp, Germany
- EFC Institut, Hohn, Germany
| | - Zoe Travers
- Psychological Services, Berkshire Healthcare Foundation Trust, Bracknell, UK
| | - Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Emily Greenfield
- Psychological Services, Berkshire Healthcare Foundation Trust, Bracknell, UK
| | - Lynette Meredith
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Hayley Perry
- Thames Valley Clinical Trials Unit, University of Reading, Reading, UK
| | - Dirk Corstens
- MET ggz Roermond and Maastricht University, Netherlands
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72
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Turner DT, Reijnders M, van der Gaag M, Karyotaki E, Valmaggia LR, Moritz S, Lecomte T, Turkington D, Penadés R, Elkis H, Cather C, Shawyer F, O'Connor K, Li ZJ, de Paiva Barretto EM, Cuijpers P. Efficacy and Moderators of Cognitive Behavioural Therapy for Psychosis Versus Other Psychological Interventions: An Individual-Participant Data Meta-Analysis. Front Psychiatry 2020; 11:402. [PMID: 32431633 PMCID: PMC7214739 DOI: 10.3389/fpsyt.2020.00402] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 04/21/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Study-level meta-analyses have demonstrated the efficacy of cognitive-behavioural therapy for psychosis (CBTp). Limitations of conventional meta-analysis may be addressed using individual-participant-data (IPD). We aimed to determine a) whether results from IPD were consistent with study-level meta-analyses and b) whether demographic and clinical characteristics moderate treatment outcome. METHODS We systematically searched PubMed, Embase, PsychInfo and CENTRAL. Authors of RCTs comparing CBTp with other psychological interventions were contacted to obtain original databases. Hierarchical mixed effects models were used to examine efficacy for psychotic symptoms. Patient characteristics were investigated as moderators of symptoms at post-treatment. Sensitivity analyses were conducted for risk of bias, treatment format and study characteristics. RESULTS We included 14 of 23 eligible RCTs in IPD meta-analyses including 898 patients. Ten RCTs minimised risk of bias. There was no significant difference in efficacy between RCTs providing IPD and those not (p >0.05). CBTp was superior vs. other interventions for total psychotic symptoms and PANSS general symptoms. No demographic or clinical characteristics were robustly demonstrated as moderators of positive, negative, general or total psychotic symptoms at post-treatment. Sensitivity analyses demonstrated that number of sessions moderated the impact of treatment assignment (CBTp or other therapies) on total psychotic symptoms (p = 0.02). CONCLUSIONS IPD suggest that patient characteristics, including severity of psychotic symptoms, do not significantly influence treatment outcome in psychological interventions for psychosis while investing in sufficient dosage of CBTp is important. IPD provide roughly equivalent efficacy estimates to study-level data although significant benefit was not replicated for positive symptoms. We encourage authors to ensure IPD is accessible for future research.
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Affiliation(s)
- David T Turner
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mirjam Reijnders
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands.,Parnassia Psychiatric Institute, The Hague, Netherlands
| | - Eirini Karyotaki
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,South London and Maudsley NHS Trust, London, United Kingdom
| | - Steffen Moritz
- Klinik für Psychiatrie und Psychotherapie, Arbeitsgruppe Klinische Neuropsychologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Tania Lecomte
- Département de Psychologie, Université de Montréal, Montréal, QC, Canada
| | - Douglas Turkington
- Wolfson Unit, Centre for Aging and Vitality, Newcastle-upon-Tyne, United Kingdom
| | - Rafael Penadés
- Hospital Clínic Barcelona, University of Barcelona, IDIBAPS-CIBERSAM, Barcelona, Spain
| | - Helio Elkis
- Department and Institute of Psychiatry, University de São Paulo Medical School, São Paulo, Brazil
| | - Corinne Cather
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Frances Shawyer
- Southern Synergy, Department of Psychiatry, Faculty of Medicine, Nursing and Health Sciences, School of Clinical Sciences at Monash Health, Monash University, Melbourne, VIC, Australia
| | - Kieron O'Connor
- Department Psychiatrie, Université de Montréal, Montréal, QC, Canada
| | - Zhan-Jiang Li
- Department of Clinical Psychology, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit, Amsterdam, Netherlands
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73
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Knott V, Wright N, Shah D, Baddeley A, Bowers H, de la Salle S, Labelle A. Change in the Neural Response to Auditory Deviance Following Cognitive Therapy for Hallucinations in Patients With Schizophrenia. Front Psychiatry 2020; 11:555. [PMID: 32595542 PMCID: PMC7304235 DOI: 10.3389/fpsyt.2020.00555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 06/01/2020] [Indexed: 12/28/2022] Open
Abstract
Adjunctive psychotherapeutic approaches recommended for patients with schizophrenia (SZ) who are fully or partially resistant to pharmacotherapy have rarely utilized biomarkers to enhance the understanding of treatment-effective mechanisms. As SZ patients with persistent auditory verbal hallucinations (AVH) frequently evidence reduced neural responsiveness to external auditory stimulation, which may impact cognitive and functional outcomes, this study examined the effects of cognitive behavioral therapy for voices (CBTv) on clinical and AVH symptoms and the sensory processing of auditory deviants as measured with the electroencephalographically derived mismatch negativity (MMN) response. Twenty-four patients with SZ and AVH were randomly assigned to group CBTv treatment or a treatment as usual (TAU) condition. Patients in the group CBTv condition received treatment for 5 months while the matched control patients received TAU for the same period, followed by 5 months of group CBTv. Assessments were conducted at baseline and at the end of treatment. Although not showing consistent changes in the frequency of AVHs, CBTv (vs. TAU) improved patients' appraisal (p = 0.001) of and behavioral/emotional responses to AVHs, and increased both MMN generation (p = 0.001) and auditory cortex current density (p = 0.002) in response to tone pitch deviants. Improvements in AVH symptoms were correlated with change in pitch deviant MMN and current density in left primary auditory cortex. These findings of improved auditory information processing and symptom-response attributable to CBTv suggest potential clinical and functional benefits of psychotherapeutical approaches for patients with persistent AVHs.
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Affiliation(s)
- Verner Knott
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada.,Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Nicola Wright
- Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Dhrasti Shah
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Ashley Baddeley
- Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Hayley Bowers
- Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
| | - Sara de la Salle
- School of Psychology, University of Ottawa, Ottawa, ON, Canada.,Clinical Neuroelectrophysiology and Cognitive Research Laboratory, University of Ottawa Institute of Mental Health Research, Ottawa, ON, Canada
| | - Alain Labelle
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.,Schizophrenia Program, The Royal Ottawa Mental Health Centre, Ottawa, ON, Canada
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74
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Lüdtke T, Platow-Kohlschein H, Rüegg N, Berger T, Moritz S, Westermann S. Mindfulness Mediates the Effect of a Psychological Online Intervention for Psychosis on Self-Reported Hallucinations: A Secondary Analysis of Voice Hearers From the EviBaS Trial. Front Psychiatry 2020; 11:228. [PMID: 32308631 PMCID: PMC7145894 DOI: 10.3389/fpsyt.2020.00228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychological online interventions (POIs) could represent a promising approach to narrow the treatment gap in psychosis but it remains unclear whether improving mindfulness functions as a mechanism of change in POIs. For the present study, we examined if mindfulness mediates the effect of a comprehensive POI on distressing (auditory) hallucinations. METHODS We conducted a secondary analysis on voice hearers (n = 55) from a randomized controlled trial evaluating a POI for psychosis (EviBaS; trial registration NCT02974400, clinicaltrials.gov). The POI includes a module on mindfulness and we only considered POI participants in our analyses who completed the mindfulness module (n = 16). RESULTS Participants who completed the mindfulness module reported higher mindfulness (p = 0.015) and lower hallucinations (p = 0.001) at post assessment, compared to controls, but there was no effect on distress by voices (p = 0.598). Mindfulness mediated the POI's effect on hallucinations (b = -1.618, LLCI = -3.747, ULCI = -0.054) but not on distress by voices (b = -0.057, LLCI = -0.640, ULCI = 0.915). LIMITATIONS AND DISCUSSION Completion of the mindfulness module was not randomized. Hence, we cannot draw causal inferences. Even if we assumed causality, it remains unclear which contents of the POI could have resulted in increased mindfulness and reduced hallucinations, as participants completed other modules as well. In addition, confounding variables could explain the mediation and the sample size was small. Nonetheless, the overall pattern of results indicates that the POI is likely to improve mindfulness, and that increased mindfulness could partially explain the POI's efficacy.
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Affiliation(s)
- Thies Lüdtke
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Platow-Kohlschein
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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75
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Schlier B, Ludwig L, Wiesjahn M, Jung E, Lincoln TM. Fostering coping as a mechanism of symptom change in cognitive behavioural therapy for psychosis. Schizophr Res 2020; 215:416-423. [PMID: 31481336 DOI: 10.1016/j.schres.2019.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 04/01/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Cognitive behavioural therapy for psychosis (CBTp) has been repeatedly shown to ameliorate psychotic symptoms. However, so far we have little understanding of the mechanisms of change in CBTp. In this study, we tested whether improved cognitive and behavioural efforts to manage taxing external or internal demands (=coping) constitute a mechanism of change in CBTp. METHODS Using data from a published trial for a secondary analysis, we tested whether the continuous symptomatic improvement of patients (n = 57) who received up to 45 sessions of CBTp and completed weekly self-assessments of symptoms (suspiciousness, individualised positive and negative symptoms, and individualised symptoms of depression) was mediated by preceding improvement in self-assessed coping using multilevel analysis. A reverse model in which symptom improvement predicted improved coping was also tested. RESULTS Continuous improvement in suspiciousness, negative symptoms, and depression over the course of CBTp was preceded by improvement in coping. Improvement in suspiciousness or positive symptoms did not predict subsequent improvement in coping, whereas improvement in negative symptoms and depression predicted subsequent improvement in coping. CONCLUSION Coping constitutes a mechanism of change, albeit to a different extent for different symptom clusters. Further research needs to explore how best to utilise this mechanism and optimise its integration with other active ingredients of CBTp to maximise therapeutic gain.
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Affiliation(s)
- Björn Schlier
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Lea Ludwig
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Martin Wiesjahn
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Esther Jung
- Philipps-University Marburg, Department of Psychology, Clinical Psychology and Psychotherapy, Gutenbergstraße 18, 35032 Marburg, Germany
| | - Tania M Lincoln
- Universität Hamburg, Institute of Psychology, Clinical Psychology and Psychotherapy, Von-Melle-Park 5, 20146 Hamburg, Germany
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76
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de Bont P, de Jongh A, van den Berg D. Psychosis: An Emerging Field for EMDR Research and Therapy. JOURNAL OF EMDR PRACTICE AND RESEARCH 2019. [DOI: 10.1891/1933-3196.13.4.313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
It has only been in this last decade that trauma-focused treatments (TFT) have been studied in patients with psychotic disorders. Before, the paradigm stated that TFT was contraindicated in these patients because clinicians and researchers assumed the risk of exacerbation of symptoms was too high. The purpose of this article is to examine the effectiveness of eye movement desensitization and reprocessing (EMDR) therapy in the treatment of psychosis. To this end, we will present a brief narrative review of the current state of research in this particular field. The results suggest that, contrary to the “no-TFT-in-psychosis” paradigm, TFTs such as EMDR therapy can successfully be used to reduce trauma-related symptoms in patients with psychosis. Moreover, there are now provisional indications that psychotic symptoms such as delusions and hallucinations can be targeted directly and indirectly using EMDR therapy.
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77
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Thomas S, Höfler M, Schäfer I, Trautmann S. Childhood maltreatment and treatment outcome in psychotic disorders: a systematic review and meta-analysis. Acta Psychiatr Scand 2019; 140:295-312. [PMID: 31357235 DOI: 10.1111/acps.13077] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Childhood maltreatment (CM) plays an important role in the aetiology and course of psychotic disorders and is associated with characteristics that could be relevant for treatment. We aimed to conduct a systematic review and meta-analysis on the association between CM and treatment outcome in psychotic disorders. METHODS Treatment outcome was defined as change in psychotic symptoms or in social or occupational functioning between first and last reported measurement in the course of a pharmacological and/or psychological treatment. RESULTS Twelve treatment results from seven studies (636 patients, average treatment duration: 59.2 weeks) were included. CM was related to poorer treatment outcomes in psychotic disorders (OR = 1.51, 95% CI = [1.08, 2.10]). There is evidence that this association might increase with illness duration and increasing age and might be stronger in schizophrenia samples. CONCLUSIONS Childhood maltreatment is highly understudied with regard to treatment outcome in psychotic disorders. The need for more studies is emphasized by the fact that this meta-analysis reveals evidence for a poorer treatment response in patients with CM. If this association is confirmed, the identification of patients with CM and the consideration of associated clinical and biological conditions could contribute to improve treatment outcome in psychotic disorders.
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Affiliation(s)
- S Thomas
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - M Höfler
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - I Schäfer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Center for Interdisciplinary Addiction Research, University of Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - S Trautmann
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.,Department of Psychology, Medical School Hamburg, Hamburg, Germany
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78
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Uncharted Waters: Treating Trauma Symptoms in the Context of Early Psychosis. J Clin Med 2019; 8:jcm8091456. [PMID: 31547447 PMCID: PMC6780072 DOI: 10.3390/jcm8091456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 09/05/2019] [Accepted: 09/08/2019] [Indexed: 12/27/2022] Open
Abstract
Psychosis is conceptualized in a neurodevelopmental vulnerability-stress framework, and childhood trauma is one environmental factor that can lead to psychotic symptoms and the development of psychotic disorders. Higher rates of trauma are associated with higher psychosis risk and greater symptom frequency and severity, resulting in increased hospitalization rates and demand on outpatient primary care and mental health services. Despite an estimated 70% of individuals in the early stages of psychosis reporting a history of experiencing traumatic events, trauma effects (post-traumatic anxiety or depressive symptoms) are often overlooked in psychosis treatment and current interventions typically do not target commonly comorbid post-traumatic stress symptoms. We presented a protocol for Trauma-Integrated Cognitive Behavioral Therapy for Psychosis (TI-CBTp), an approach to treating post-traumatic stress symptoms in the context of early psychosis care. We provided a brief summary of TI-CBTp as implemented in the context of Coordinated Specialty Care and presented preliminary data supporting the use of TI-CBTp in early psychosis care. The preliminary results suggest that individuals with comorbid psychosis and post-traumatic stress symptoms can be appropriately and safely treated using TI-CBTp within Coordinated Specialty Care.
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79
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Mehl S, Werner D, Lincoln TM. Corrigendum: Does Cognitive Behavior Therapy for psychosis (CBTp) show a sustainable effect on delusions? A meta-analysis. Front Psychol 2019; 10:1868. [PMID: 31555162 PMCID: PMC6724716 DOI: 10.3389/fpsyg.2019.01868] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 07/29/2019] [Indexed: 11/29/2022] Open
Abstract
[This corrects the article DOI: 10.3389/fpsyg.2015.01450.].
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Affiliation(s)
- Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Marburg, Germany
- Department of Health and Social Work, Frankfurt University of Applied Science, Frankfurt, Germany
| | - Dirk Werner
- Department of Psychological Methods and Statistics, University of Hamburg, Hamburg, Germany
| | - Tania M. Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
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80
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Kopelovich SL, Strachan E, Sivec H, Kreider V. Stepped Care as an Implementation and Service Delivery Model for Cognitive Behavioral Therapy for Psychosis. Community Ment Health J 2019; 55:755-767. [PMID: 30623294 DOI: 10.1007/s10597-018-00365-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 12/29/2018] [Indexed: 10/27/2022]
Abstract
Cognitive behavioral therapy for schizophrenia spectrum disorders is an evidence-based treatment that is recommended by United States schizophrenia treatment guidelines. Based on recent estimates, only 0.3% of individuals with a primary psychotic disorder are able to access this treatment in the United States. Stepped care interventions have shown promise as an applied treatment delivery model in other settings and for other psychotherapeutic interventions. The current paper describes how the stepped care model can be applied to CBT for psychosis in the US to increase access to the intervention in community mental health settings by leveraging the multidisciplinary team.
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Affiliation(s)
- Sarah L Kopelovich
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA.
| | - Eric Strachan
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 325 9th Avenue, Box 359911, 98104, Seattle, WA, USA
| | - Harry Sivec
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
| | - Valerie Kreider
- Best Practices in Schizophrenia Treatment (BeST) Center, Northeast Ohio Medical University, Rootstown, OH, USA
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81
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Affiliation(s)
- S Jauhar
- Department of Psychological Medicine,Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - K R Laws
- School of Life and Medical Sciences, University of Hertfordshire,Hatfield,UK
| | - P J McKenna
- FIDMAG Research Foundation, Barcelona and CIBERSAM,Spain
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82
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Soneson E, Russo D, Knight C, Lafortune L, Heslin M, Stochl J, Georgiadis A, Galante J, Duschinsky R, Grey N, Gonzalez-Blanco L, Couche J, Griffiths M, Murray H, Reeve N, Hodgekins J, French P, Fowler D, Byford S, Dixon-Woods M, Jones PB, Perez J. Psychological interventions for people with psychotic experiences: protocol for a systematic review and meta-analysis. Syst Rev 2019; 8:124. [PMID: 31122287 PMCID: PMC6533690 DOI: 10.1186/s13643-019-1041-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/10/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Many people who have common mental disorders, such as depression and anxiety, also have some psychotic experiences. These experiences are associated with higher clinical complexity, poor treatment response, and negative clinical outcomes. Psychological interventions have the potential to improve outcomes for people with psychotic experiences. The aims of this systematic review are to (1) synthesise the evidence on the effectiveness and cost-effectiveness of psychological interventions to reduce psychotic experiences and their associated distress and (2) identify key components of effective interventions. METHODS Our search strategy will combine terms for (1) psychological interventions, (2) psychotic experiences, and (3) symptoms associated with psychotic experiences. We will search the following online databases: MEDLINE, Embase, PsycINFO, all Cochrane databases, British Nursing Index (BNI), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Health Management Information Consortium (HMIC), Education Resources Information Center (ERIC), and EconLit. Our primary outcome is the proportion of people who recovered or remitted from psychotic experiences after the intervention. Our secondary outcomes are changes in positive psychotic symptoms, negative psychotic symptoms, depression, anxiety, functioning (including social, occupational, and academic), quality of life, and cost-effectiveness. Two independent reviewers will judge each study against pre-specified inclusion and exclusion criteria and will extract study characteristics, outcome data, and intervention components. Risk of bias and methodological quality will be assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies and the Drummond Checklist. Results will be synthesised using random-effects meta-analysis and narrative synthesis. DISCUSSION The identification of effective psychological interventions and of specific components associated with intervention effectiveness will augment existing evidence that can inform the development of a new, tailored intervention to improve outcomes related to psychotic symptoms, anxiety and depression, distress, functioning, and quality of life. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033869.
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Affiliation(s)
- Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Debra Russo
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK.
| | - Clare Knight
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Louise Lafortune
- Department of Public Health and Primary Care, Cambridge Institute of Public Health, University of Cambridge, Cambridge, CB2 0SR, UK
| | - Margaret Heslin
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Jan Stochl
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Alex Georgiadis
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Robbie Duschinsky
- The Primary Care Unit, Cambridge Institute of Public Health, University of Cambridge School of Clinical Medicine, Box 113, Cambridge Biomedical Campus, Cambridge, CB2 0SR, UK
| | | | - Leticia Gonzalez-Blanco
- Department of Psychiatry, University of Oviedo - CIBERSAM - Servicio de Salud del Principado de Asturias, Oviedo, Spain
| | - Juliet Couche
- Health in Mind, Sussex Partnership NHS Foundation Trust, Woodside, The Drive, Hellingly, East Sussex, BN27 4ER, UK
| | | | - Hannah Murray
- Oxford Centre for Anxiety Disorders and Trauma, Paradise Square, Oxford, OX1 1TW, UK
| | - Nesta Reeve
- Norfolk and Suffolk NHS Foundation Trust, Hellesdon Hospital, Drayton High Road, Norwich, NR6 5BE, UK
| | - Joanne Hodgekins
- Department of Clinical Psychology, Elizabeth Fry Building, Norwich Medical School, University of East Anglia, Norwich, NR4 7TJ, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M25 3BL, UK
| | - David Fowler
- School of Psychology, Pevensey Building, University of Sussex, Brighton, BN1 9QH, UK
| | - Sarah Byford
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK
| | - Mary Dixon-Woods
- THIS Institute (The Healthcare Improvement Studies Institute), University of Cambridge, Cambridge, CB2 0AH, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
| | - Jesus Perez
- Department of Psychiatry, University of Cambridge, Cambridge, CB2 0SZ, UK
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83
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84
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An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.31407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are numerous psychological approaches to psychosis that differ in focus, specificity and formats. These include psychodynamic, humanistic, cognitive-behavioural and
third-wave-approaches, psychoeducation, various types of training-based approaches and family interventions.
We briefly describe the main aims and focus of each of these approaches, followed by a review of their evidence-base in regard to improvement in symptoms, relapse and
functioning. We conducted a systematic search for meta-analyses dating to 2017 for each of the approaches reviewed. Where numerous meta-analyses for an approach were available,
we selected the most recent, comprehensive and methodologically sound ones.
We found convincing short- and long-term evidence for cognitive behavioural approaches if the main aim is to reduce symptom distress. Evidence is also strong for psychoeducative
family interventions that include skills training if the main aim is to reduce relapse and rehospitalisation. Acceptance and commitment therapy, mindfulness-based approaches,
meta-cognitive and social skills training, as well as systemic family interventions, were also found to be efficacious, depending on the outcome of interest, but meta-analyses
for these approaches were based on a comparatively lower number of outcome studies and a narrower selection of outcome measures. We found no convincing evidence for
psychodynamic approaches, humanistic approaches or patient-directed psychoeducation (without including the family).
An array of evidence-based psychological therapies is available for psychotic disorders from which clinicians and patients can choose, guided by the strength of the evidence and
depending on the outcome area focused on. Increased effort is needed in terms of dissemination and implementation of these therapies into clinical practice.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
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85
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Sheaves B, Peters E, Stahl D, Johns L. Changes in care costs associated with cognitive behavioural therapy for psychosis delivered in routine clinical practice. J Ment Health 2019; 29:605-610. [PMID: 30902027 DOI: 10.1080/09638237.2019.1581327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Schizophrenia spectrum disorders are long-term disabling conditions placing high economic demands on health services.Aim: To investigate whether cognitive behavioural therapy for psychosis (CBTp), delivered in a specialist psychological therapies service, was associated with a reduction in intensive care costs.Methods: Days using inpatient care and out of hours crisis support were recorded (N = 69). Costs associated with high intensity care use in the 12 months pre-referral were compared to during, and 12 months following cessation of therapy.Results: Despite the majority of participants incurring £0 at all time periods, costs of intensive mental health care more than halved with CBTp delivery, with a significant decrease during therapy, and at trend level after therapy (p = 0.07). Post hoc analysis revealed that offsetting the cost of therapy for those who utilised intensive care services at any time point (N = 18) resulted in therapy being cost neutral during therapy and cost effective (at trend level) 12 months following cessation of therapy.Conclusion: CBTp may reduce costs associated with intensive psychiatric care, even in a population where the minority use these services. Investment in therapy may lead to both clinical and financial benefits.
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Affiliation(s)
- Bryony Sheaves
- Department of Psychology, Psychology & Neuroscience (IoPPN), King's College London, Institute of Psychiatry, London, UK.,Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,PICuP Clinic, South London and Maudsley NHS Foundation Trust (SLaM), P079, Clinical Treatment Centre, Maudsley Hospital, London, UK
| | - Emmanuelle Peters
- Department of Psychology, Psychology & Neuroscience (IoPPN), King's College London, Institute of Psychiatry, London, UK.,Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Daniel Stahl
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK
| | - Louise Johns
- Department of Psychology, Psychology & Neuroscience (IoPPN), King's College London, Institute of Psychiatry, London, UK.,Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.,PICuP Clinic, South London and Maudsley NHS Foundation Trust (SLaM), P079, Clinical Treatment Centre, Maudsley Hospital, London, UK
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86
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Switzer F, Harper SF. A narrative review of the barriers to the implementation of cognitive behavioural therapy for psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2019. [DOI: 10.1080/17522439.2019.1578400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Fiona Switzer
- Psychological Therapies, Herdmanflat Hospital, NHS Lothian, Haddington, UK
| | - Sean F. Harper
- Department of Clinical Psychology, NHS Lothian, Edinburgh, UK
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87
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Thomas N, Bless JJ, Alderson-Day B, Bell IH, Cella M, Craig T, Delespaul P, Hugdahl K, Laloyaux J, Larøi F, Lincoln TM, Schlier B, Urwyler P, van den Berg D, Jardri R. Potential Applications of Digital Technology in Assessment, Treatment, and Self-help for Hallucinations. Schizophr Bull 2019; 45:S32-S42. [PMID: 30715539 PMCID: PMC6357981 DOI: 10.1093/schbul/sby103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The field of digital mental health is rapidly expanding with digital tools being used in assessment, intervention, and supporting self-help. The application of digital mental health to hallucinations is, however, at a very early stage. This report from a working group of the International Consortium on Hallucinations Research considers particular synergies between the phenomenon of hallucinations and digital tools that are being developed. Highlighted uses include monitoring and managing intermittently occurring hallucinations in daily life; therapeutic applications of audio and video media including virtual and augmented reality; targeting verbal aspects of hallucinations; and using avatars to represent hallucinatory voices. Although there is a well-established Internet-based peer support network, digital resources for hallucinations have yet to be implemented in routine practice. Implementation may benefit from identifying how to market resources to the broad range of populations who experience hallucinations and identifying sustainable funding models. It is envisaged that digital tools will contribute to improved self-management and service provision for people experiencing hallucinations.
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Affiliation(s)
- Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Josef J Bless
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | | | - Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychosis Early Intervention, South London and Maudsley NHS Trust, London, UK
| | - Tom Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Trust, Heerlen, The Netherlands
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
- Institute of Neuroscience, Newcastle University, Newcastle-Upon-Tyne, UK
| | - David van den Berg
- Research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Renaud Jardri
- PsyCHIC Team, SCALab CNRS UMR-9193, Lille University, Lille, France
- CURE Platform, CHU Lille, Fontan Hospital, Lille, France
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88
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Freeman D, Lister R, Waite F, Yu LM, Slater M, Dunn G, Clark D. Automated psychological therapy using virtual reality (VR) for patients with persecutory delusions: study protocol for a single-blind parallel-group randomised controlled trial (THRIVE). Trials 2019; 20:87. [PMID: 30696471 PMCID: PMC6350360 DOI: 10.1186/s13063-019-3198-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 01/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background Persecutory delusions are a major psychiatric problem and are associated with a wide range of adverse outcomes. Our theoretical model views these delusions as unfounded threat beliefs which persist due to defence behaviours (e.g. avoidance) that prevent disconfirmatory evidence being processed. The treatment implications are that patients need to (1) go into feared situations and (2) not use defence behaviours. This enables relearning of safety and hence paranoia diminution. However, this is very difficult for patients due to their severe anxiety. A solution is to use virtual reality (VR) social situations, which are graded in difficulty and which patients find much easier to enter. We have now automated the provision of cognitive therapy within VR using an avatar coach, so that a therapist is not required and the treatment is scalable. In the THRIVE trial, the automated VR cognitive treatment will be tested against a VR control condition. It will contribute to our wider programme of work developing VR for patients with psychosis. Methods Patients with persistent persecutory delusions in the context of non-affective psychosis will be randomised (1:1) to the automated VR cognitive treatment or VR mental relaxation (control condition). Each VR treatment will comprise approximately four sessions of 30 min. Standard care will remain as usual in both groups. Assessments will be carried out at 0, 2, 4 (post treatment), 8, 16, and 24 weeks by a researcher blind to treatment allocation. The primary outcome is degree of conviction in the persecutory delusion (primary endpoint 4 weeks). Effect sizes will be re-established by an interim analysis of 30 patients. If the interim effect size suggests that the treatment is worth pursuing (d > 0.1), then the trial will go on to test 90 patients in total. Secondary outcomes include real world distress, activity levels, suicidal ideation, and quality of life. Mediation will also be tested. All main analyses will follow the intention-to-treat principle. The trial is funded by the Medical Research Council Developmental Pathway Funding Scheme. Discussion The trial will provide the first test of automated cognitive therapy within VR for patients with psychosis. The treatment is potentially highly scalable for treatment services. Trial registration ISRCTN, ISRCTN12497310. Registered on 14 August 2018. Electronic supplementary material The online version of this article (10.1186/s13063-019-3198-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK. .,Oxford Health NHS Foundation Trust, Oxford, UK. .,NIHR Oxford Health Biomedical Research Centre, Oxford, UK.
| | - Rachel Lister
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Ly-Mee Yu
- Primary Care Clinical Trials Unit, Nuffield Department of Primary care Health Sciences, University of Oxford, Oxford, UK
| | - Mel Slater
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Graham Dunn
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, Manchester, UK
| | - David Clark
- NIHR Oxford Health Biomedical Research Centre, Oxford, UK.,Department of Experimental Psychology, University of Oxford, Oxford, UK
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89
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Steel C, Schnackenberg J, Perry H, Longden E, Greenfield E, Corstens D. Making Sense of Voices: a case series. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2019. [DOI: 10.1080/17522439.2018.1559874] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Craig Steel
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Joachim Schnackenberg
- Stiftung Diakoniewerk Kropp & St Ansgar gGmbH Kropp, Kropp, Germany
- EFC Institut, Hohn, Germany
| | - Hayley Perry
- Thames Valley Clinical Trial Unit, University of Reading, Reading, UK
| | - Eleanor Longden
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Dirk Corstens
- MET ggz Roermond and Maastricht University, Netherlands
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90
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Cavelti M, Thompson K, Hulbert C, Betts J, Jackson H, Francey S, Chanen A. Preliminary Evidence for the Cognitive Model of Auditory Verbal Hallucinations in Youth With Borderline Personality Disorder. Front Psychiatry 2019; 10:292. [PMID: 31156473 PMCID: PMC6531498 DOI: 10.3389/fpsyt.2019.00292] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 04/15/2019] [Indexed: 12/17/2022] Open
Abstract
Objectives: This is the first study to explore cognitive, emotional, and behavioral responses to voices in youth with borderline personality disorder (BPD) compared with those with schizophrenia spectrum disorder (SZ), and to examine if negative appraisals of voices predict depression and anxiety across the groups. Methods: The sample comprised 43 outpatients, aged 15-25 years, who reported auditory verbal hallucinations (AVH) and were diagnosed with either Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) BPD or SZ. Data were collected using the Psychotic Symptom Rating Scales, the revised Beliefs About Voices Questionnaire, the Voice Rank Scale, and the Depression Anxiety Stress Scale. Results: Youth with BPD did not differ from youth with SZ in beliefs about the benevolence or malevolence of voices. Youth with BPD appraised their voices as more omnipotent and of higher social rank in relation to themselves, compared with youth with SZ. In both diagnostic groups, beliefs about malevolence and omnipotence of voices were correlated with more resistance toward voices, and beliefs about benevolence with more engagement with voices. In addition, perceiving the voices as being of higher social rank than oneself and negative voice content were both independent predictors of depression, irrespective of diagnostic group. In contrast, negative appraisals of voices did not predict anxiety after adjusting for negative voice content. Conclusions: This study replicated the link between negative appraisals of voices and depression that has been found in adults with SZ in a mixed diagnostic youth sample. It, thus, provides preliminary evidence that the cognitive model of AVH can be applied to understanding and treating voices in youth with BPD.
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Affiliation(s)
- Marialuisa Cavelti
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia.,University Hospital for Child and Adolescent Psychiatry and Psychotherapy, The University of Bern, Bern, Switzerland
| | - Katherine Thompson
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Carol Hulbert
- Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, VIC, Australia
| | - Jennifer Betts
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Henry Jackson
- University Hospital for Child and Adolescent Psychiatry and Psychotherapy, The University of Bern, Bern, Switzerland
| | - Shona Francey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Andrew Chanen
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, VIC, Australia.,Orygen Youth Health, Melbourne, VIC, Australia
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91
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Balzan RP, Mattiske JK, Delfabbro P, Liu D, Galletly C. Individualized Metacognitive Training (MCT+) Reduces Delusional Symptoms in Psychosis: A Randomized Clinical Trial. Schizophr Bull 2019; 45:27-36. [PMID: 30376124 PMCID: PMC6293215 DOI: 10.1093/schbul/sby152] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Individualized metacognitive training (MCT+) is a novel psychotherapy that has been designed to specifically target delusional beliefs in people with psychosis. It works by developing an awareness of the implausible content of delusional beliefs, while also targeting the cognitive biases that contribute to their formation and maintenance. It was expected that MCT+ would lead to significantly greater reductions in delusional severity compared to a cognitive remediation (CR) active control condition. A total of 54 patients with a schizophrenia spectrum disorder and active delusions were randomized into four 2-hourly sessions of MCT+ (n = 27) or CR (n = 27). All participants completed posttreatment assessment, and only 2 participants did not complete 6-month follow-up assessment, resulting in MCT+ (n = 26) and CR (n = 26) for final analysis. The primary outcome measures of delusional and positive symptom severity were assessed rater-blind; secondary outcome assessment was non-blinded and included clinical and cognitive insight, the jumping to conclusions (JTC) bias, and cognitive functioning. Participants in the MCT+ condition showed significant reductions in delusional and overall positive symptom severity (large effect) and improved clinical insight (moderate effect) relative to CR controls. In contrast, CR controls showed moderate improvement in problem-solving ability relative to MCT+, but no other cognitive domain. Importantly, these findings were maintained at 6-month follow-up. The study adds further efficacy to the MCT program, and suggests that even brief psychotherapy can help to ameliorate the symptoms of psychosis.
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Affiliation(s)
- Ryan P Balzan
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia,To whom correspondence should be addressed; College of Education, Psychology, and Social Work, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia; tel: +61-8-8201-3082, fax: +61-8-8201-3877, e-mail:
| | - Julie K Mattiske
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia
| | - Paul Delfabbro
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Dennis Liu
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia,Northern Adelaide Local Health Network, Adelaide, Australia
| | - Cherrie Galletly
- Discipline of Psychiatry, University of Adelaide, Adelaide, Australia,Northern Adelaide Local Health Network, Adelaide, Australia,Ramsay Health Care (SA) Mental Health Services, Adelaide, Australia
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92
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Lincoln TM, Peters E. A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations. Schizophr Res 2019; 203:66-79. [PMID: 29352708 DOI: 10.1016/j.schres.2017.12.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 12/29/2022]
Abstract
Studies on cognitive behavioural therapy for psychosis (CBTp) have developed from evaluating generic approaches to focusing on specific symptoms. The evidence for targeted studies on delusions and hallucinations was reviewed. We included randomized controlled trials (RCTs) examining the effect of individualized CBT-based interventions focusing either on delusions or on hallucinations. Twelve suitable RCTs were identified. Four RCTs focused on delusions, of which three took a focused approach targeting mechanisms assumed causal to persecutory delusions. Eight RCTs focused on hallucinations, a common component of these studies being a focus on the perceived power imbalance between the voice(s) and the voice-hearer, to reduce distress and dysfunction. Only three RCTS were powered adequately; the remainder were pilot trials. All trials reported effect sizes against treatment-as-usual above d=0.4 on at least one primary outcome at post-therapy, with several effects in the large range. Effects on the primary outcome were maintained for five of the seven studies that had significant outcomes and reported a follow-up comparison, but most of the follow-up periods were brief. Although targeted studies are still in their infancy, the results are promising with a tendency towards higher effects compared to the small-to-moderate range found for generic CBTp. In clinical practice, CBTp will need to continue including a range of approaches that can be adapted to patients in a flexible manner according to the primary goals and prevalent combination of symptoms. However, symptom-focused and causal-interventionist approaches are informative research strategies to evaluate the efficacy of separate components or mechanisms of generic CBTp.
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Affiliation(s)
- Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany.
| | - Emmanuelle Peters
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, Psychological Interventions Clinic for outpatients with Psychosis (PICuP), London, UK
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93
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Matthijssen SJMA, Heitland I, Verhoeven LCM, van den Hout MA. Reducing the Emotionality of Auditory Hallucination Memories in Patients Suffering From Auditory Hallucinations. Front Psychiatry 2019; 10:637. [PMID: 31620028 PMCID: PMC6759685 DOI: 10.3389/fpsyt.2019.00637] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/06/2019] [Indexed: 11/30/2022] Open
Abstract
Eye movement desensitization and reprocessing (EMDR) therapy targets emotionally disturbing visual memories of traumatic life events, and may be deployed as an efficacious treatment for posttraumatic stress disorder. A key element of EMDR therapy is recalling an emotionally disturbing visual memory while simultaneously performing a dual task. Previous studies have shown that auditory emotional memories may also become less emotional as a consequence of dual tasking. This is potentially beneficial for psychotic patients suffering from disturbing emotional auditory memories of auditory hallucinations. The present study examined whether and to what extent emotionality of auditory hallucination memories could be reduced by dual tasking. The study also assessed whether a modality matching dual task (recall + auditory taxation) could be more effective than a cross modal dual task (recall + visual taxation). Thirty-six patients suffering from auditory hallucinations were asked to recall an emotionally disturbing auditory memory related to an auditory hallucination, to rate emotionality of the memory, and to recall it under three conditions: two active conditions, i.e., visual taxation (making eye-movements) or auditory taxation (counting aloud), and one control condition (staring at a non-moving dot) counterbalanced in order. Patients re-rated emotionality of the memory after each condition. Results show the memory emotionality of auditory hallucinations was reduced and the active conditions showed stronger effects than the control condition. No modality-specific effect was found: the active conditions had an equal effect.
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Affiliation(s)
| | - Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Liselotte C M Verhoeven
- Personality Disorders, GGZ Centraal, Amersfoort, Netherlands.,Hospital psychiatry, mood disorders and anxiety, Meander Medical Centre, Amersfoort, Netherlands
| | - Marcel A van den Hout
- Altrecht Academic Anxiety Centre, Altrecht GGZ, Utrecht, Netherlands.,Clinical Psychology, Utrecht University, Utrecht, Netherlands
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94
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Using Explicit Case Formulation to Improve Cognitive Processing Therapy for PTSD. Behav Ther 2019; 50:155-164. [PMID: 30661556 DOI: 10.1016/j.beth.2018.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/11/2018] [Accepted: 04/11/2018] [Indexed: 11/20/2022]
Abstract
We investigated the utility of explicit case formulation (CF) within Cognitive Processing Therapy (CPT) for individuals with posttraumatic stress disorder (PTSD). An uncontrolled pre-posttreatment design was used. Participants attended 12-16 weekly sessions of CPT with explicit CF, where CF guided treatment length and treatment components. Treatment was completed by 19 of the 23 participants who started therapy. Results revealed significant reductions in PTSD and depression severity as well as unhelpful PTSD-related beliefs from pre- to posttreatment (ds between 1.10 - 1.92) and treatment gains were maintained at 3-month follow-up. Of the participants available at posttreatment for assessment, 69% (n = 11/16) met good end-state functioning for PTSD and 62% (n = 8/13) did so at follow-up. Finally, 72% (n = 13/18) of those interviewed at posttreatment no longer met criteria for PTSD and this was found for 93% of those assessed at follow-up (n = 14/15). Treatment, and CF in particular, was found to be acceptable by participants. Explicit case formulation did not interfere with positive outcomes of Cognitive Processing Therapy for PTSD. Further clinical implications and future directions for research are discussed.
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95
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Morrison AP. Should people with psychosis be supported in choosing cognitive therapy as an alternative to antipsychotic medication: A commentary on current evidence. Schizophr Res 2019; 203:94-98. [PMID: 29606545 DOI: 10.1016/j.schres.2018.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Revised: 03/07/2018] [Accepted: 03/08/2018] [Indexed: 01/19/2023]
Abstract
Evidence from randomised controlled trials suggest that both antipsychotic medication and cognitive behaviour therapy (CBT) can be helpful to people with a diagnosis of a schizophrenia spectrum disorder. On this basis, many clinical guidelines recommend that people with psychosis should be offered both antipsychotic medication and CBT and that they should be collaboratively involved in the decisions about which treatment options they choose. The reality of service provision is often very different, with data regarding the availability of such treatment options and the extent of user involvement in decision making suggesting that medication is much more widely available and that service users are often not involved in these decisions, despite retaining decision making capacity. Many patients choose not to take antipsychotic medication, often due to inefficacy or side effects, but there is little evidence regarding whether CBT can be effective as an alternative to antipsychotic medication. However, several recent trials suggest that CBT without medication may be a safe and acceptable option for people with psychosis. The implications for clinical practice and future research are considered and it is recommended that informed choices that include the option to try CBT without antipsychotic medication are supported.
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Affiliation(s)
- Anthony P Morrison
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom; Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom.
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96
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Gianfrancesco O, Bubb VJ, Quinn JP. Treating the "E" in "G × E": Trauma-Informed Approaches and Psychological Therapy Interventions in Psychosis. Front Psychiatry 2019; 10:9. [PMID: 30761022 PMCID: PMC6363686 DOI: 10.3389/fpsyt.2019.00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/08/2019] [Indexed: 12/31/2022] Open
Abstract
Despite advances in genetic research, causal variants affecting risk for schizophrenia remain poorly characterized, and the top 108 loci identified through genome-wide association studies (GWAS) explain only 3.4% of variance in risk profiles. Such work is defining the highly complex nature of this condition, with omnigenic models of schizophrenia suggesting that gene regulatory networks are sufficiently interconnected such that altered expression of any "peripheral" gene in a relevant cell type has the capacity to indirectly modulate the expression of "core" schizophrenia-associated genes. This wealth of associated genes with small effect sizes makes identifying new druggable targets difficult, and current pharmacological treatments for schizophrenia can involve serious side effects. However, the fact that the majority of schizophrenia genome-wide associated variants fall within non-coding DNA is suggestive of their potential to modulate gene regulation. This would be consistent with risks that can be mediated in a "gene × environment" (G × E) manner. Stress and trauma can alter the regulation of key brain-related pathways over the lifetime of an individual, including modulation of brain development, and neurochemistry in the adult. Recent studies demonstrate a significant overlap between psychotic symptoms and trauma, ranging from prior trauma contributing to psychosis, as well as trauma in response to the experience of psychosis itself or in response to treatment. Given the known effects of trauma on both CNS gene expression and severity of psychosis symptoms, it may be that pharmacological treatment alone risks leaving individuals with a highly stressful and unresolved environmental component that continues to act in a "G × E" manner, with the likelihood that this would negatively impact recovery and relapse risk. This review aims to cover the recent advances elucidating the complex genetic architecture of schizophrenia, as well as the long-term effects of early life trauma on brain function and future mental health risk. Further, the evidence demonstrating the role of ongoing responses to trauma or heightened stress sensitivity, and their impact on the course of illness and recovery, is presented. Finally, the need for trauma-informed approaches and psychological therapy-based interventions is discussed, and a brief overview of the evidence to determine their utility is presented.
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Affiliation(s)
- Olympia Gianfrancesco
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Vivien J Bubb
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - John P Quinn
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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97
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Hardy A, Wojdecka A, West J, Matthews E, Golby C, Ward T, Lopez ND, Freeman D, Waller H, Kuipers E, Bebbington P, Fowler D, Emsley R, Dunn G, Garety P. How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo. JMIR Ment Health 2018; 5:e11222. [PMID: 30518514 PMCID: PMC6300708 DOI: 10.2196/11222] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. OBJECTIVE This study aimed to optimize the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface. METHODS We conducted inclusive, user-centered design research characterized by purposive sampling of extreme users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's double diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping, and a mood board; define, consisting of workshops to synthesize findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded. RESULTS Consistent with our previous work, the Thinking Well case series showed medium to large effects on paranoia and well-being and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia, and provide tailored interpersonal support from therapists and peers, although they reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalization and normalization, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with 2 key concepts of thoughts visualized as bubbles and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A Web app supports the delivery of 8 face-to-face sessions, which are synchronized to a native mobile app. CONCLUSIONS SlowMo makes use of personalization, ambient information, and visual metaphors to tailor the appeal, engagement, and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multicentered randomized controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface to optimize its impact in daily life.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Wojdecka
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Jonathan West
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Ed Matthews
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | | | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Natalie D Lopez
- Department of Psychology, Royal Holloway, Egham, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Helen Waller
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Graham Dunn
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
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98
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Larøi F, Thomas N, Aleman A, Fernyhough C, Wilkinson S, Deamer F, McCarthy-Jones S. The ice in voices: Understanding negative content in auditory-verbal hallucinations. Clin Psychol Rev 2018; 67:1-10. [PMID: 30553563 DOI: 10.1016/j.cpr.2018.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/23/2018] [Accepted: 11/10/2018] [Indexed: 12/25/2022]
Abstract
Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by mechanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emotional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further development of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area.
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Affiliation(s)
- Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Jones Lies vei 91, Bergen 5009, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium; NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway.
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sam Wilkinson
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
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99
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Koops S, Blom JD, Bouachmir O, Slot MI, Neggers B, Sommer IE. Treating auditory hallucinations with transcranial direct current stimulation in a double-blind, randomized trial. Schizophr Res 2018; 201:329-336. [PMID: 29934249 DOI: 10.1016/j.schres.2018.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/05/2018] [Accepted: 06/08/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Transcranial direct current stimulation (tDCS) could be a treatment option for medication-resistant auditory hallucinations (AH), but so far results have been inconclusive, and large sample trials have been missing. This study used tDCS as a treatment method for these hallucinations in a double-blind, placebo-controlled study with a relatively large sample size. METHODS Fifty-four patients of several diagnostic categories with medication-resistant AH were randomized and treated during 10 sessions of 20 min each, with either 2 mA tDCS or placebo, administered on five consecutive days (i.e., two sessions per day). Anodal stimulation was targeted at the left dorsolateral prefrontal cortex, cathodal stimulation at the left temporoparietal junction. AH severity was assessed using the Auditory Hallucination Rating Scale (AHRS). Other outcome measures were assessed with the Positive and Negative Syndrome Scale (PANSS), the Stroop, and the Trail Making Test. RESULTS AH frequency and severity decreased significantly over time, as did the scores on the total and general subscales of the PANSS. However, there was no significant interaction effect with the treatment group on any of the main outcome measures. CONCLUSIONS We found no evidence that tDCS is more effective for medication-resistant AH than placebo, even though AH frequency and severity decreased in both groups. An alternative strategy may be to offer tDCS at an earlier stage of illness. In the light of recent investigations into the neurophysiological mechanisms behind tDCS, we may also have to consider the possibility that tDCS is not able to induce any long-lasting brain changes.
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Affiliation(s)
- Sanne Koops
- Psychiatry Department, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Jan Dirk Blom
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH The Hague, the Netherlands; Faculty of Social and Behavioural Sciences, Leiden University, P.O. Box 9555, 2300 RB Leiden, the Netherlands; University of Groningen, University Medical Center Groningen, Department of Psychiatry, P.O. Box 30.001, 9700 RB Groningen, the Netherlands.
| | - Ouarda Bouachmir
- Parnassia Psychiatric Institute, Kiwistraat 43, 2552 DH The Hague, the Netherlands.
| | - Margot I Slot
- Psychiatry Department, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Bas Neggers
- Psychiatry Department, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.
| | - Iris E Sommer
- Faculty of Medical Sciences, University of Groningen, University Medical Center Groningen, Deusinglaan 2, 9713 AW Groningen, the Netherlands; Faculty of Biological and Medical Psychology, University of Bergen, Jonas Liesvei 91, 5009 Bergen, Norway.
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100
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Morrison AP, Pyle M, Gumley A, Schwannauer M, Turkington D, MacLennan G, Norrie J, Hudson J, Bowe SE, French P, Byrne R, Syrett S, Dudley R, McLeod HJ, Griffiths H, Barnes TRE, Davies L, Kingdon D. Cognitive behavioural therapy in clozapine-resistant schizophrenia (FOCUS): an assessor-blinded, randomised controlled trial. Lancet Psychiatry 2018; 5:633-643. [PMID: 30001930 PMCID: PMC6063993 DOI: 10.1016/s2215-0366(18)30184-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/30/2018] [Accepted: 05/08/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Although clozapine is the treatment of choice for treatment-refractory schizophrenia, 30-40% of patients have an insufficient response, and others are unable to tolerate it. Evidence for any augmentation strategies is scarce. We aimed to determine whether cognitive behavioural therapy (CBT) is an effective treatment for clozapine-resistant schizophrenia. METHODS We did a pragmatic, parallel group, assessor-blinded, randomised controlled trial in community-based and inpatient mental health services in five sites in the UK. Patients with schizophrenia who were unable to tolerate clozapine, or whose symptoms did not respond to the drug, were randomly assigned 1:1 by use of randomised-permuted blocks of size four or six, stratified by centre, to either CBT plus treatment as usual or treatment as usual alone. Research assistants were masked to allocation to protect against rater bias and allegiance bias. The primary outcome was the Positive and Negative Syndrome Scale (PANSS) total score at 21 months, which provides a continuous measure of symptoms of schizophrenia; PANSS total was also assessed at the end of treatment (9 months). The primary analysis was by randomised treatment based on intention to treat, for all patients for whom data were available. This study was prospectively registered, number ISRCTN99672552. The trial is closed to accrual. FINDINGS From Jan 1, 2013, to May 31, 2015, we randomly assigned 487 participants to either CBT and treatment as usual (n=242) or treatment as usual alone (n=245). Analysis included 209 in the CBT group and 216 in the treatment as usual group. No difference occurred in the primary outcome (PANSS total at 21 months, mean difference -0·89, 95% CI -3·32 to 1·55; p=0·48), although the CBT group improved at the end of treatment (PANSS total at 9 months, mean difference -2·40, -4·79 to -0·02; p=0·049). During the trial, 107 (44%) of 242 participants in the CBT arm and 104 (42%) of 245 in the treatment as usual arm had at least one adverse event (odds ratio 1·09, 95% CI 0·81 to 1·46; p=0·58). Only two (1%) of 242 participants in the CBT arm and one (<1%) of 245 in the treatment as usual arm had a trial-related serious adverse event. INTERPRETATION At 21-month follow-up, CBT did not have a lasting effect on total symptoms of schizophrenia compared with treatment as usual; however, CBT produced statistically, though not clinically, significant improvements on total symptoms by the end of treatment. There was no indication that the addition of CBT to treatment as usual caused adverse effects. The results of this trial do not support a recommendation to routinely offer CBT to all people who meet criteria for clozapine-resistant schizophrenia; however, a pragmatic individual trial might be indicated for some. FUNDING National Institute for Health Research Technology Assessment programme.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, Zochonis Building, University of Manchester, Manchester, UK.
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, Zochonis Building, University of Manchester, Manchester, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Matthias Schwannauer
- Department of Clinical Psychology, School of Health in Social Science, Old Medical School, The University of Edinburgh, Edinburgh, UK
| | - Douglas Turkington
- Academic Psychiatry, Northumberland, Tyne and Wear NHS Foundation Trust, Centre for Aging and Vitality, Newcastle General Hospital, Newcastle upon Tyne, UK
| | - Graeme MacLennan
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Edinburgh Clinical Trials Unit, Usher Institute of Population Health Sciences & Informatics, Nine Edinburgh BioQuarter, The University of Edinburgh, Edinburgh, UK
| | - Jemma Hudson
- Centre for Healthcare Randomised Trials, Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Samantha E Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK
| | - Paul French
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK; Zochonis Building, University of Manchester, Manchester, UK; Division of Psychology and Mental Health, Zochonis Building, University of Manchester, Manchester, UK
| | - Suzy Syrett
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK; Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, Tranwell Unit, Queen Elizabeth Hospital, Gateshead, UK
| | - Hamish J McLeod
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Helen Griffiths
- Department of Clinical Psychology, School of Health in Social Science, Old Medical School, The University of Edinburgh, Edinburgh, UK
| | | | - Linda Davies
- Division of Population Health, Zochonis Building, University of Manchester, Manchester, UK
| | - David Kingdon
- University Department of Psychiatry, Academic Centre, University of Southampton, Southampton, UK
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