101
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Laws KR, Darlington N, Kondel TK, McKenna PJ, Jauhar S. Cognitive Behavioural Therapy for schizophrenia - outcomes for functioning, distress and quality of life: a meta-analysis. BMC Psychol 2018; 6:32. [PMID: 30016999 PMCID: PMC6050679 DOI: 10.1186/s40359-018-0243-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/19/2018] [Indexed: 12/14/2022] Open
Abstract
Background The effect of cognitive behavioural therapy for psychosis (CBTp) on the core symptoms of schizophrenia has proven contentious, with current meta-analyses finding at most only small effects. However, it has been suggested that the effects of CBTp in areas other than psychotic symptoms are at least as important and potentially benefit from the intervention. Method We meta-analysed RCTs investigating the effectiveness of CBTp for functioning, distress and quality of life in individuals diagnosed with schizophrenia and related disorders. Data from 36 randomised controlled trials (RCTs) met our inclusion criteria- 27 assessing functioning (1579 participants); 8 for distress (465 participants); and 10 for quality of life (592 participants). Results The pooled effect size for functioning was small but significant for the end-of-trial (0.25: 95% CI: 0.14 to 0.33); however, this became non-significant at follow-up (0.10 [95%CI -0.07 to 0.26]). Although a small benefit of CBT was evident for reducing distress (0.37: 95%CI 0.05 to 0.69), this became nonsignificant when adjusted for possible publication bias (0.18: 95%CI -0.12 to 0.48). Finally, CBTp showed no benefit for improving quality of life (0.04: 95% CI: -0.12 to 0.19). Conclusions CBTp has a small therapeutic effect on functioning at end-of-trial, although this benefit is not evident at follow-up. Although CBTp produced a small benefit on distress, this was subject to possible publication bias and became nonsignificant when adjusted. We found no evidence that CBTp increases quality of life post-intervention. Electronic supplementary material The online version of this article (10.1186/s40359-018-0243-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK.
| | - Nicole Darlington
- School of Life and Medical Sciences, University of Hertfordshire, College Lane Campus, Hatfield, AL10 9AB, UK
| | | | - Peter J McKenna
- FIDMAG Germanes Hospitalàries Research Foundation, Barcelona and CIBERSAM, Barcelona, Spain
| | - Sameer Jauhar
- Centre of Affective Disorders, Institute of Psychiatry, London, UK
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102
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Lamster F, Kiener J, Wagner K, Rief W, Görge SC, Iwaniuk S, Leube D, Falkenberg I, Kluge I, Kircher T, Mehl S. Ist Wahn indirekt veränderbar? Ein stimmungsverbesserndes Konzept der kognitive Verhaltenstherapie für die stationäre Standardversorgung von Patienten mit schizophrenen Störungen. VERHALTENSTHERAPIE 2018. [DOI: 10.1159/000486966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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103
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Opoka SM, Ludwig L, Lincoln TM. A Systematic Review of Trials Targeting Depression and Anxiety in Patients With Delusions. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract. Negative affect and impaired emotion regulation skills are prevalent in patients with delusions and contribute to delusion formation and maintenance. This review evaluates existing research on interventions targeting negative affect and emotional processes as a causal mechanism on the pathway to delusions. A MEDLINE and PsycINFO search identified 7,909 articles. Five studies with randomized-controlled designs and three with uncontrolled designs met the inclusion criteria. Interventions comprised cognitive-behavioral and compassion-focused techniques. Overall, the review studies found positive intervention effects on negative affect and delusions. Where significant, controlled effect sizes ranged from small to large for negative affect and from moderate to large for delusions. Thus, existing research indicates that negative affect in patients with delusions can be modified by psychological therapy and points toward a carryover effect from the reduction of negative affect to a reduction of delusions. More large-scale randomized-controlled studies are needed to be able to draw valid conclusions on which types of interventions are most beneficial.
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Affiliation(s)
- Sandra M. Opoka
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
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104
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Group-Based Worry Intervention for Persecutory Delusions: an Initial Feasibility Study. Behav Cogn Psychother 2018; 46:619-625. [PMID: 29923478 DOI: 10.1017/s1352465818000383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND A one-to-one cognitive behavioural therapy intervention targeting worry significantly reduces both worry and persecutory delusions (Freeman et al., 2015). AIM To adapt this intervention for group delivery and conduct a feasibility trial within routine clinical practice. METHOD Thirteen participants were randomized to a weekly 8-session worry intervention group (n = 7) or wait-list control (n = 6). RESULTS All but one participant completed measures at all time points. Participants attended an average of six therapy sessions. CONCLUSIONS Recruitment, retention and therapy uptake were feasible. Observed treatment effects were in the expected direction, but may be diluted compared with one-to-one interventions.
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105
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Jaya ES, Ascone L, Lincoln TM. A longitudinal mediation analysis of the effect of negative-self-schemas on positive symptoms via negative affect. Psychol Med 2018; 48:1299-1307. [PMID: 28956520 DOI: 10.1017/s003329171700277x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive models postulate that negative-self-schemas (NSS) cause and maintain positive symptoms and that negative affect mediates this link. However, only few studies have tested the temporal mediation claim systematically using an appropriate design. METHODS A longitudinal cohort design in an online community sample (N = 962) from Germany, Indonesia, and the USA was used. NSS, negative affect and positive symptoms were measured at four time-points (T0-T3) over a 1-year period. Cross-lagged panel and longitudinal mediation analyses with structural equation modeling were used to test the temporal mediation. RESULTS Independent cross-lagged panel models showed a significant unidirectional longitudinal path from NSS to positive symptoms (T2-T3, β = 0.18, p < 0.01) and bidirectional longitudinal associations from NSS to negative affect (T0-T1, γ = 0.14, p < 0.01) and vice versa (T0-T1, γ = 0.19, p < 0.01). There was also a significant indirect pathway from NSS at baseline via negative affect at T1 and T2 to positive symptoms at T3 (unstandardized indirect effect coefficient = 0.020, p < 0.05, BCa CI 0.004-0.035), indicating mediation. CONCLUSIONS Our findings support the postulated affective pathway from NSS to positive symptoms via negative affect. Specifically, our data indicate that NSS and negative affect influence each other and build up over the course of several months before leading on to positive symptoms. We conclude that interrupting this process by targeting NSS and negative affect early in the process could be a promising strategy to prevent the exacerbation of positive symptoms.
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Affiliation(s)
- E S Jaya
- Faculty of Psychology,Universitas Indonesia,Depok,Indonesia
| | - L Ascone
- Clinical Psychology and Psychotherapy,Institute of Psychology,University of Hamburg,Hamburg,Germany
| | - T M Lincoln
- Clinical Psychology and Psychotherapy,Institute of Psychology,University of Hamburg,Hamburg,Germany
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106
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Improving implementation of evidence based practice for people with psychosis through training the wider workforce: Results of the GOALS feasibility randomised controlled trial. J Behav Ther Exp Psychiatry 2018; 59:121-128. [PMID: 29351861 DOI: 10.1016/j.jbtep.2017.12.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 12/18/2017] [Accepted: 12/18/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES There is a pressing need to improve access to evidence-based practice for people with psychosis. The primary aim of this study was to assess clinical feasibility of a manualised, evidence-based CBT intervention (GOALS) targeting a personalised recovery goal, delivered by the frontline workforce, following brief training. Secondly, we aimed to conduct preliminary statistical analyses of key outcomes and costs. METHODS The GOALS study is a feasibility randomised controlled trial (ISRCTN 73188383). 75 participants with current psychosis were recruited and randomly allocated to receive either treatment as usual alone or with GOALS therapy. RESULTS Brief training enabled frontline staff to deliver the therapy according to protocol and 74% of therapy participants partially or fully achieved their goals. There were significant improvements with a moderate effect size of 0.56 on goal attainment. However, preliminary statistical analyses found no significant differences between groups on our primary outcome of activity levels or other secondary outcomes Health economic analysis found that point estimates of costs, controlling for baseline costs, implied savings (even including intervention costs), but the difference was not statistically significant. LIMITATIONS The study was designed as a feasibility RCT, and therefore the results of secondary estimates of efficacy effects should be treated with caution. CONCLUSIONS This approach holds promise in supporting people with psychosis to reach personal recovery goals, cost effectively.
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107
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Hazell CM, Greenwood K, Fielding-Smith S, Rammou A, Bogen-Johnston L, Berry C, Jones AM, Hayward M. Understanding the Barriers to Accessing Symptom-Specific Cognitive Behavior Therapy (CBT) for Distressing Voices: Reflecting on and Extending the Lessons Learnt From the CBT for Psychosis Literature. Front Psychol 2018; 9:727. [PMID: 29867685 PMCID: PMC5963086 DOI: 10.3389/fpsyg.2018.00727] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/25/2018] [Indexed: 12/01/2022] Open
Abstract
The experience of hearing voices (‘auditory hallucinations’) can cause significant distress and disruption to quality of life for people with a psychosis diagnosis. Psychological therapy in the form of cognitive behavior therapy (CBT) for psychosis is recommended for the treatment of positive symptoms, including distressing voices, but is rarely available to patients in the United Kingdom. CBT for psychosis has recently evolved with the development of symptom-specific therapies that focus upon only one symptom of psychosis at a time. Preliminary findings from randomized controlled trials suggest that these symptom-specific therapies can be more effective for distressing voices than the use of broad CBT protocols, and have the potential to target voices trans-diagnostically. Whilst this literature is evolving, consideration must be given to the potential for a symptom-specific approach to overcome some of the barriers to delivery of evidence-based psychological therapies within clinical services. These barriers are discussed in relation to the United Kingdom mental health services, and we offer suggestions for future research to enhance our understanding of these barriers.
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Affiliation(s)
- Cassie M Hazell
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom.,School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Sarah Fielding-Smith
- Department of Neuroscience, Brighton and Sussex Medical School, University of Sussex, Brighton, United Kingdom
| | - Aikaterini Rammou
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Leanne Bogen-Johnston
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Clio Berry
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Anna-Marie Jones
- Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, United Kingdom.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
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108
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Abstract
Background: Almost all patients admitted at acute crisis to a psychiatric ward experience clinically significant symptoms of insomnia. Ward environments pose challenges to both sleep and the delivery of therapy. Despite this, there is no description of how to adapt cognitive behavioural therapy (CBT) for insomnia to overcome these challenges. Aims: (i) To describe the key insomnia presentations observed in the Oxford Ward Sleep Solution (OWLS) trial and (ii) outline key adaptations aimed to increase accessibility and hence effectiveness of CBT for insomnia for a ward setting. Methods: Trial therapists collaboratively agreed the key insomnia presentations and therapy adaptations based on their individual reflective logs used during the trial. Results: Three key insomnia presentations are outlined. These are used to illustrate the application of 10 CBT for insomnia therapy adaptations. These include use of sleep monitoring watches to engage patients in treatment, stabilizing circadian rhythms, reducing the impact of night-time observations and managing discharge as a sleep challenge. Conclusions: Whilst inpatient wards bring challenges for sleep and therapy delivery, creative adaptations can increase the accessibility of evidence based CBT for insomnia techniques. This therapy has proven popular with patients.
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109
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Landau S, Emsley R, Dunn G. Beyond total treatment effects in randomised controlled trials: Baseline measurement of intermediate outcomes needed to reduce confounding in mediation investigations. Clin Trials 2018; 15:247-256. [PMID: 29552919 PMCID: PMC5992850 DOI: 10.1177/1740774518760300] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background: Random allocation avoids confounding bias when estimating the average
treatment effect. For continuous outcomes measured at post-treatment as well
as prior to randomisation (baseline), analyses based on (A) post-treatment
outcome alone, (B) change scores over the treatment phase or (C)
conditioning on baseline values (analysis of covariance) provide unbiased
estimators of the average treatment effect. The decision to include baseline
values of the clinical outcome in the analysis is based on precision
arguments, with analysis of covariance known to be most precise.
Investigators increasingly carry out explanatory analyses to decompose total
treatment effects into components that are mediated by an intermediate
continuous outcome and a non-mediated part. Traditional mediation analysis
might be performed based on (A) post-treatment values of the intermediate
and clinical outcomes alone, (B) respective change scores or (C)
conditioning on baseline measures of both intermediate and clinical
outcomes. Methods: Using causal diagrams and Monte Carlo simulation, we investigated the
performance of the three competing mediation approaches. We considered a
data generating model that included three possible confounding processes
involving baseline variables: The first two processes modelled baseline
measures of the clinical variable or the intermediate variable as common
causes of post-treatment measures of these two variables. The third process
allowed the two baseline variables themselves to be correlated due to past
common causes. We compared the analysis models implied by the competing
mediation approaches with this data generating model to hypothesise likely
biases in estimators, and tested these in a simulation study. We applied the
methods to a randomised trial of pragmatic rehabilitation in patients with
chronic fatigue syndrome, which examined the role of limiting activities as
a mediator. Results: Estimates of causal mediation effects derived by approach (A) will be biased
if one of the three processes involving baseline measures of intermediate or
clinical outcomes is operating. Necessary assumptions for the change score
approach (B) to provide unbiased estimates under either process include the
independence of baseline measures and change scores of the intermediate
variable. Finally, estimates provided by the analysis of covariance approach
(C) were found to be unbiased under all the three processes considered here.
When applied to the example, there was evidence of mediation under all
methods but the estimate of the indirect effect depended on the approach
used with the proportion mediated varying from 57% to 86%. Conclusion: Trialists planning mediation analyses should measure baseline values of
putative mediators as well as of continuous clinical outcomes. An analysis
of covariance approach is recommended to avoid potential biases due to
confounding processes involving baseline measures of intermediate or
clinical outcomes, and not simply for increased precision.
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Affiliation(s)
- Sabine Landau
- 1 King's College London, Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Richard Emsley
- 2 Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Graham Dunn
- 2 Centre for Biostatistics, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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110
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Calati R, Courtet P, Lopez-Castroman J. Refining Suicide Prevention: a Narrative Review on Advances in Psychotherapeutic Tools. Curr Psychiatry Rep 2018. [PMID: 29520726 DOI: 10.1007/s11920-018-0876-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Since psychotherapies for suicide prevention are receiving increasing attention, our purpose was to evaluate the related literature [meta-analyses and reviews on their effect on suicidal outcomes (A), perspective reviews concerning specific socio-demographic and clinical features (B), original studies with particular interest (C)] published over the last 3 years. RECENT FINDINGS (A) Across different diagnoses, particularly, efficacious psychotherapies were cognitive behavioral therapy-based ones and interventions directly addressing suicidal thoughts and behaviors during the treatment. When the focus was restricted to specific diagnoses, results were different: for example, in borderline patients, dialectical behavior therapy and psychodynamic psychotherapies were the only efficacious interventions. (B) Family therapies for adolescents and treatments for elderly depressed patients with disability/cognitive impairment should be further developed. (C) General long-term effects seem to be present, but specific interventions and treatment duration should be considered. Results indicated the presence of a number of promising interventions.
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Affiliation(s)
- Raffaella Calati
- INSERM U1061, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France. .,FondaMental Foundation, Créteil, France. .,Department of Emergency Psychiatry & Post-Acute Care, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France.
| | - Philippe Courtet
- INSERM U1061, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,FondaMental Foundation, Créteil, France.,Department of Emergency Psychiatry & Post-Acute Care, Lapeyronie Hospital, Montpellier University Hospital, Montpellier, France
| | - Jorge Lopez-Castroman
- INSERM U1061, University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,FondaMental Foundation, Créteil, France.,Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France
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111
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Holmes EA, Ghaderi A, Harmer CJ, Ramchandani PG, Cuijpers P, Morrison AP, Roiser JP, Bockting CLH, O'Connor RC, Shafran R, Moulds ML, Craske MG. The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science. Lancet Psychiatry 2018; 5:237-286. [PMID: 29482764 DOI: 10.1016/s2215-0366(17)30513-8] [Citation(s) in RCA: 315] [Impact Index Per Article: 52.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Emily A Holmes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Catherine J Harmer
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Trust Foundation, Warneford Hospital, Oxford, UK
| | | | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Heath Trust, Manchester, UK; School of Psychological Sciences, University of Manchester, Manchester, UK
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Claudi L H Bockting
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Rory C O'Connor
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Roz Shafran
- University College London Great Ormond Street Institute of Child Health, London, UK
| | - Michelle L Moulds
- School of Psychology, The University of New South Wales, UNSW, Sydney, NSW, Australia
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
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112
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Ricarte JJ, Del Rey F, Ros L, Latorre JM, Berna F. Abstract and experiential thinking differentially account for anomalous perception of reality in people with or without schizophrenia. Schizophr Res 2018; 193:43-50. [PMID: 28395940 DOI: 10.1016/j.schres.2017.04.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/22/2017] [Accepted: 04/01/2017] [Indexed: 11/30/2022]
Abstract
repetitive thinking is often increased in various psychopathological conditions. However, evidence for its possible contribution to psychotic symptoms relies only on correlational analysis and has not been experimentally tested within the psychotic continuum. This research aims to examine whether repetitive thinking about a negative past experience using concrete versus abstract processing might modify the reporting of anomalous sensory experiences. 89 patients with schizophrenia and 89 matched controls were asked to reflect on their most negative Self-Defining Memory during a thirty-minute period. By means of a written script, half of the participants were instructed to remember thoughts, feelings and sensations associated with the event in an abstract mode, while the other half followed an equivalent script but with concrete questions. After induced concrete-experiential thinking, both controls and patients significantly reduced self-reported anomalous reality perception. However, participants in the induced abstract-analytical thinking condition increased anomalous experience, especially sensory experience from an unexplained source. Multigroup path analyses showed that involvement in abstract-analytical thinking during the task significantly mediated the relationship between pre-test and post-test anomalous perception scores, but only in the patient group. These results suggest that abstract thinking contributes to distorted sensory experiences. In contrast, training in a concrete processing mode of past experiences may be a useful tool to reduce subjective anomalous perceptions.
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Affiliation(s)
- J J Ricarte
- Department of Psychology, Faculty of Medicine, University of Castilla La Mancha, Spain
| | - F Del Rey
- Department of Psychology, Faculty of Medicine, University of Castilla La Mancha, Spain
| | - L Ros
- Department of Psychology, Faculty of Medicine, University of Castilla La Mancha, Spain.
| | - J M Latorre
- Department of Psychology, Faculty of Medicine, University of Castilla La Mancha, Spain
| | - F Berna
- Unité INSERM 1114, Physiopathologie et Psychopathologie Cognitive de la Schizophrénie, Hôpitaux Universitaires de Strasbourg, Strasbourg Cedex, France; Université de Strasbourg, 4 rue Kirchleger, Strasbourg, France; FMTS: Fédération de Médecine Translationnelle de Strasbourg, France
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113
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Nittel CM, Lincoln TM, Lamster F, Leube D, Rief W, Kircher T, Mehl S. Expressive suppression is associated with state paranoia in psychosis: An experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:291-312. [PMID: 29460461 DOI: 10.1111/bjc.12174] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/09/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Although emotional instability and problems in emotion regulation (ER) are known to be linked to the formation and maintenance of psychosis and paranoia, it remains unclear whether the use of specific ER strategies is associated with it. The first aim of the study was to explore the association between emotional instability and paranoia. The second and third aims were to investigate whether the use of maladaptive ER strategies leads to paranoia in patients with psychosis in daily life and whether the use of more adaptive ER strategies reduces paranoia. DESIGN A prospective momentary assessment study over the course of 6 days was performed. METHOD Participants with psychosis (n = 32) reported repeatedly over six consecutive days on the presence and instability of positive and negative emotions, their use of adaptive (reappraisal, acceptance, distraction, social sharing, reflection) and maladaptive ER strategies (rumination, expressive suppression) and momentary paranoia in their daily life. RESULTS Hierarchical linear regression analysis revealed that patients with psychosis who presented pronounced instability of negative emotions showed more severe levels of state paranoia. In addition, patients with psychosis who used expressive suppression when confronted with negative emotions at one point in time presented more pronounced levels of state paranoia at the following point in time. CONCLUSION The results presented here suggest that both emotional instability and the use of expressive suppression might cause state paranoia and thus add to our understanding of causal mechanisms related to paranoia such as instability of negative emotions and the use of less adaptive ER strategies. PRACTITIONER POINTS Maladaptive emotion regulation strategies and more pronounced instability of negative emotions are relevant to paranoia in patients with psychosis and should be a special focus of CBTp interventions. Future interventions designed for patients suffering from paranoia should promote coping with unstable negative emotions and replacing or reducing maladaptive emotion regulation strategies with adaptive ones.
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Affiliation(s)
- Clara Marie Nittel
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tania Marie Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany
| | - Fabian Lamster
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany.,Center for Acute Psychiatric Disorders, University Hospital of Psychiatry Zurich, Switzerland
| | - Dirk Leube
- AWO Center of Mental Health, Halle, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Health and Social Work, University of Applied Science, Frankfurt am Main, Germany
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114
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Abstract
Purpose of the Review This review identifies the early developmental processes that contribute to schizotypy and suspiciousness in adolescence and adulthood. It includes the most recent literature on these phenomena in childhood. Recent Findings The early developmental processes that affect schizotypy and paranoia in later life are complex. In contrast to existing studies of psychiatric patients and clinical/nonclinical adult populations, the study of schizotypy and suspiciousness in young children and adolescents is possible due to new child-appropriate dimensional assessments. New assessments and the advancement of technology (e.g., virtual reality in mental health) as well as statistical modeling (e.g., mediation and latent-class analyses) in large data have helped identified the developmental aspects (e.g., psychosocial, neurocognitive and brain factors, nutrition, and childhood correlates) that predict schizotypy and suspiciousness in later life. Summary Prospective longitudinal designs in community youths can enhance our understanding of the etiology of schizophrenia-spectrum disorders and, in the future, the development of preventive interventions by extending adult theories and interventions to younger populations.
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Affiliation(s)
- Keri K Wong
- 1Department of Psychology, University of Cambridge, Cambridge, UK.,Cambridge, Cambridgeshire UK
| | - Adrian Raine
- 3Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, Philadelphia, PA USA
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115
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116
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Development of novel behavioral interventions in an experimental therapeutics world: Challenges, and directions for the future. Schizophr Res 2018. [PMID: 28629888 PMCID: PMC5732899 DOI: 10.1016/j.schres.2017.06.010] [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] [Indexed: 11/23/2022]
Abstract
Recently, the focus of funding mechanisms associated with clinical trials has changed to be consistent with an experimental therapeutics approach. While this approach holds considerable promise, the paradigm shift has presented challenges for behavioral trials in complex psychiatric illness such as schizophrenia, as molecular targets - the classic focus in experimental therapeutics paradigms - may not represent logical targets for many psychosocial interventions designed to treat multifaceted, multiply determined symptoms. Clear guidelines for alternate models have not been offered, leaving large numbers of clinical trials researchers unclear about how to frame their work. We address some of the challenges for behavioral interventions research, and offer guidance for the development of novel approaches to the application of a target engagement framework to behavioral clinical trials.
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Andersson E, Holmes EA, Kavanagh D. Innovations in digital interventions for psychological trauma: harnessing advances in cognitive science. Mhealth 2018; 4:47. [PMID: 30505845 PMCID: PMC6232069 DOI: 10.21037/mhealth.2018.09.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 09/27/2018] [Indexed: 11/06/2022] Open
Abstract
A range of digital psychological interventions have demonstrated a positive impact on trauma-related problems in controlled trials, but there is room for further improvements in their form, reach and impact. Most to date have been adaptions of established face-to-face treatments. In this paper, we highlight a complementary emerging route to their development, which draws on advances in cognitive science theory and research and applies them to clinical contexts. Three examples are given regarding laboratory research with potential applications to digital interventions for trauma-related mental health problems: a digital game to reduce intrusive memories of trauma, novel cognitive techniques for worry, and digitally supported mental imagery to enhance motivation for functional behavior change. Much of this research is still at an early stage, meriting a balance of optimism and caution. However, even if only a few digital applications of cognitive science constitute substantial improvements to complement current treatments, their potential for large-scale use at low unit cost may provide significant benefits across populations.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska institute, Stockholm, Sweden
| | - Emily A. Holmes
- Department of Clinical Neuroscience, Division of Psychology, Karolinska institute, Stockholm, Sweden
| | - David Kavanagh
- Centre for Children’s Health Research, Institute of Health and Biomedical Innovation, and School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
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118
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Sellers R, Wells A, Parker S, Morrison AP. Do people with psychosis engage in unhelpful metacognitive coping strategies? A test of the validity of the Cognitive Attentional Syndrome (CAS) in a clinical sample. Psychiatry Res 2018; 259:243-250. [PMID: 29091823 DOI: 10.1016/j.psychres.2017.10.032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 10/14/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
The Self-Regulatory Executive Function (S-REF) model assumes that unhelpful metacognitive coping strategies characterised by worry, rumination, threat monitoring and attempts to control thoughts, have a central role in psychological disorders and prolonged negative affect. Collectively, these strategies constitute the Cognitive Attentional Syndrome (CAS). This research aims to test whether a questionnaire designed to capture these responses (the CAS-1: Wells, 2009, p. 268) is a valid assessment tool in clinical psychosis, and to test whether activation of the CAS is associated with positive and negative outcomes. A sample of 60 people with psychosis completed a semi-structured interview about psychotic symptoms, the CAS-1 self-report measure and validated self-report measures of metacognitive beliefs, negative affect, quality of life and recovery. The CAS-1 demonstrated good internal consistency, concurrent validity and predictive validity. Hierarchical multiple regression analyses revealed that negative metacognitive beliefs predict negative affect, perceptions of recovery and quality of life in people with psychosis over and above psychotic symptoms. CAS-1 scores did not contribute additional variance in the final regression models. Implications for theory and clinical practice are discussed.
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Affiliation(s)
- Rachel Sellers
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom.
| | - Adrian Wells
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Sophie Parker
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
| | - Anthony P Morrison
- School of Health Sciences, the Faculty of Biology, Medicine and Health, the University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
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119
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Opoka SM, Lincoln TM. The Effect of Cognitive Behavioral Interventions on Depression and Anxiety Symptoms in Patients with Schizophrenia Spectrum Disorders: A Systematic Review. Psychiatr Clin North Am 2017; 40:641-659. [PMID: 29080591 DOI: 10.1016/j.psc.2017.08.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Depression and anxiety are prominent comorbid disorders in psychosis and relevant to psychotic symptom formation and maintenance. This poses the question of whether psychological interventions are effective in improving symptoms of depression and anxiety in patients with psychosis. A systematic review of the literature identified 14 studies evaluating a broad range of interventions targeting depression, anxiety, and posttraumatic stress disorder in patients with psychosis. The reviewed studies support the effectiveness of cognitive-behavioral interventions in improving the target symptoms. Further research is needed to examine whether the effects carry over to psychotic symptoms in the long term.
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Affiliation(s)
- Sandra M Opoka
- Clinical Psychology and Psychotherapy, Institut of Psychology, Universität Hamburg, Von-Melle-Park-5, Hamburg 20146, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institut of Psychology, Universität Hamburg, Von-Melle-Park-5, Hamburg 20146, Germany
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120
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Garety PA, Ward T, Freeman D, Fowler D, Emsley R, Dunn G, Kuipers E, Bebbington P, Waller H, Greenwood K, Rus-Calafell M, McGourty A, Hardy A. SlowMo, a digital therapy targeting reasoning in paranoia, versus treatment as usual in the treatment of people who fear harm from others: study protocol for a randomised controlled trial. Trials 2017; 18:510. [PMID: 29096681 PMCID: PMC5667466 DOI: 10.1186/s13063-017-2242-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023] Open
Abstract
Background Paranoia is one of the most common symptoms of schizophrenia-spectrum disorders, and is associated with significant distress and disruption to the person’s life. Developing more effective and accessible psychological interventions for paranoia is a clinical priority. Our research team has approached this challenge in two main ways: firstly, by adopting an interventionist causal approach to increase effectiveness and secondly, by incorporating user-centred inclusive design methods to enhance accessibility and usability. Our resultant new digital intervention, SlowMo, intensively targets a reasoning style associated with paranoia, fast thinking, characterised by jumping to conclusions and belief inflexibility. It consists of an easy-to-use, enjoyable and memorable digital interface. An interactive web-based app facilitates delivery of face-to-face meetings which is then synchronised with an innovative mobile app for use in daily life. Methods/Design We aim to test the clinical efficacy of SlowMo over 24 weeks to determine the mechanisms through which it reduces paranoia, and to identify participant characteristics that moderate its effectiveness. In a parallel-group randomised controlled trial, with 1:1 allocation, 360 participants with distressing persecutory beliefs will be independently randomised to receive either the SlowMo intervention added to treatment as usual (TAU) or TAU, using randomly varying permuted blocks, stratified by paranoia severity and site. Research workers will be blind to therapy allocation. The primary outcome is paranoia severity over 24 weeks; our hypothesised mechanism of change is reasoning; moderators include negative symptoms and working memory; and secondary outcomes include wellbeing, quality of life, and service use. The accessibility, usability and acceptability of the digital platform will be assessed. Discussion SlowMo has been developed as the first blended digital therapy to target fears of harm from others through an inclusive design approach. In addition to testing its efficacy, this trial will add to our understanding of psychological mechanisms in paranoia. The study will examine the usability and adherence of a novel digital therapy, including an app for self-management, in a large sample of people affected by severe mental health difficulties. Trial registration ISRCTN registry, ID: ISRCTN32448671. Registered prospectively on 30 January 2017. Date assigned 2 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2242-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philippa A Garety
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Thomas Ward
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Helen Waller
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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121
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Psychotic-like experiences and happiness in the English general population. J Affect Disord 2017; 222:211-217. [PMID: 28711798 DOI: 10.1016/j.jad.2017.07.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/29/2017] [Accepted: 07/06/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Psychotic-like experiences (PLEs) have been associated with a variety of adverse outcomes but how they affect happiness in individuals with PLE is unknown. Thus, the aim of the study was to assess the association between PLEs and happiness, and the factors that may influence this association. METHODS Nationally representative data from the 2007 Adult Psychiatric Morbidity Survey including adults aged ≥ 16 years was analyzed. The Psychosis Screening Questionnaire was used to assess past 12-month PLE. Individuals who endorsed at least one of the following were considered to have any PLE: thought control, paranoia, strange experiences, auditory hallucinations. Happiness (3-point scale) was assessed with a validated question with higher scores indicating lower levels of happiness. The association between PLE and happiness was assessed by multivariable ordinal logistic regression. Mediation analysis was also performed. RESULTS Among the 7363 individuals included in the analysis, the prevalence of any PLE increased with decreasing levels of happiness [very happy (2.3%), fairly happy (5.4%), not too happy (14.9%)]. This was also shown in the multivariable analysis adjusted for sociodemographic factors and stressful life events (from very happy to not too happy: OR = 2.41; 95%CI = 1.86-3.12). Mediation analysis showed that anxiety disorders explained the largest proportion of the association (38.8%) followed by depressive episode (28.5%), insomnia (21.9%), disability (16.5%), pain (12.5%), social support (10.0%), and physical health conditions (6.0%). LIMITATIONS The cross-sectional design limits causal inference. CONCLUSION Interventions to identify and address conditions that may have a negative impact on happiness in individuals with PLE may be important to improve their well-being.
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Bird JC, Waite F, Rowsell E, Fergusson EC, Freeman D. Cognitive, affective, and social factors maintaining paranoia in adolescents with mental health problems: A longitudinal study. Psychiatry Res 2017; 257:34-39. [PMID: 28715666 DOI: 10.1016/j.psychres.2017.07.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 07/04/2017] [Accepted: 07/11/2017] [Indexed: 11/24/2022]
Abstract
Paranoia may be a significant concern during adolescence, but there has been little research on excessive mistrust in young people. In this longitudinal study we set out to test the predictive ability of a number of cognitive, affective, and social factors in the early development of paranoia in a clinical adolescent population. Thirty four help-seeking adolescents, aged 11-16 years, reporting paranoid thoughts and attending mental health services were recruited. Self-report and interview assessments of paranoia were conducted at baseline. Measures relating to a cognitive model of persecutory delusions were completed. Paranoia was reassessed after three months with thirty three participants. Significant predictors of paranoia persistence were anxiety, depression, worry, negative self-beliefs, perceptual anomalies, insomnia, affective reactivity, bullying, and cyber victimization. No effect was found for reasoning bias or negative perceptions of academic ability, social competence, and physical appearance. In conclusion, many of the maintenance factors implicated in adult paranoia are likely to prove important in the early development of paranoia in young people. Further experimental and treatment studies are now needed to examine the causal role of these factors in the occurrence of paranoia in adolescents.
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Affiliation(s)
- Jessica C Bird
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Eleanor Rowsell
- Buckinghamshire CAMHS, Oxford Health NHS Foundation Trust, The Sue Nicholls Centre, Bierton Road, Aylesbury, Buckinghamshire HP20 1EG, United Kingdom
| | - Emma C Fergusson
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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124
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Moffa G, Catone G, Kuipers J, Kuipers E, Freeman D, Marwaha S, Lennox BR, Broome MR, Bebbington P. Using Directed Acyclic Graphs in Epidemiological Research in Psychosis: An Analysis of the Role of Bullying in Psychosis. Schizophr Bull 2017; 43:1273-1279. [PMID: 28521005 PMCID: PMC5737513 DOI: 10.1093/schbul/sbx013] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Modern psychiatric epidemiology researches complex interactions between multiple variables in large datasets. This creates difficulties for causal inference. We argue for the use of probabilistic models represented by directed acyclic graphs (DAGs). These capture the dependence structure of multiple variables and, used appropriately, allow more robust conclusions about the direction of causation. We analyzed British national survey data to assess putative mediators of the association between bullying victimization and persecutory ideation. We compared results using DAGs and the Karlson-Holm-Breen (KHB) logistic regression commands in STATA. We analyzed data from the 2007 English National Survey of Psychiatric Morbidity, using the equivalent 2000 survey in an instant replication. Additional details of methods and results are provided in the supplementary material. DAG analysis revealed a richer structure of relationships than could be inferred using the KHB logistic regression commands. Thus, bullying had direct effects on worry, persecutory ideation, mood instability, and drug use. Depression, sleep and anxiety lay downstream, and therefore did not mediate the link between bullying and persecutory ideation. Mediation by worry and mood instability could not be definitively ascertained. Bullying led to hallucinations indirectly, via persecutory ideation and depression. DAG analysis of the 2000 dataset suggested the technique generates stable results. While causality cannot be fully determined from cross-sectional data, DAGs indicate the relationships providing the best fit. They thereby advance investigation of the complex interactions seen in psychiatry, including the mechanisms underpinning psychiatric symptoms. It may consequently be used to optimize the choice of intervention targets.
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Affiliation(s)
- Giusi Moffa
- Division of Psychiatry, University College London, London, UK,Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gennaro Catone
- Department of Mental and Physical Health and Preventive Medicine, University of Naples SUN, Naples, Italy,Faculty of Educational Science, Suor Orsola Benicasa University, Naples, Italy
| | | | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK,Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, Beckenham, UK
| | - Daniel Freeman
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Steven Marwaha
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, UK
| | - Belinda R Lennox
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Matthew R Broome
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK,Warneford Hospital, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK,To whom correspondence should be addressed; Division of Psychiatry, University College London, 67-73 Riding House St, London W1T 7NF, UK; tel: +44-(0)20-7679-9465, e-mail:
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125
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Freeman D, Sheaves B, Goodwin GM, Yu LM, Nickless A, Harrison PJ, Emsley R, Luik AI, Foster RG, Wadekar V, Hinds C, Gumley A, Jones R, Lightman S, Jones S, Bentall R, Kinderman P, Rowse G, Brugha T, Blagrove M, Gregory AM, Fleming L, Walklet E, Glazebrook C, Davies EB, Hollis C, Haddock G, John B, Coulson M, Fowler D, Pugh K, Cape J, Moseley P, Brown G, Hughes C, Obonsawin M, Coker S, Watkins E, Schwannauer M, MacMahon K, Siriwardena AN, Espie CA. The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis. Lancet Psychiatry 2017; 4:749-758. [PMID: 28888927 PMCID: PMC5614772 DOI: 10.1016/s2215-0366(17)30328-0] [Citation(s) in RCA: 383] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 07/16/2017] [Accepted: 07/19/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. METHODS We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. FINDINGS Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohen's d=1·11; p<0·0001), paranoia (-2·22, -2·98 to -1·45, Cohen's d=0·19; p<0·0001), and hallucinations (-1·58, -1·98 to -1·18, Cohen's d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. INTERPRETATION To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. FUNDING Wellcome Trust.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Guy M Goodwin
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Ly-Mee Yu
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Alecia Nickless
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK; Oxford Health National Health Service (NHS) Foundation Trust, Oxford, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
| | - Annemarie I Luik
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK; Big Health Ltd, London, UK
| | - Russell G Foster
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK
| | - Vanashree Wadekar
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Christopher Hinds
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Ray Jones
- School of Nursing and Midwifery, Faculty of Health and Human Sciences, Plymouth University, Plymouth, UK
| | - Stafford Lightman
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK
| | - Steve Jones
- Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Richard Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Peter Kinderman
- Psychological Sciences, Institute of Psychology Health and Society, University of Liverpool, Liverpool, UK
| | - Georgina Rowse
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
| | - Traolach Brugha
- Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, Centre for Medicine, University of Leicester, Leicester, UK
| | - Mark Blagrove
- Department of Psychology, University of Swansea, Swansea, UK
| | - Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Leanne Fleming
- Department of Psychology, University of Strathclyde, Glasgow, UK
| | - Elaine Walklet
- Department of Psychology, Institute of Health and Society, University of Worcester, Worcester, UK
| | - Cris Glazebrook
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - E Bethan Davies
- National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Chris Hollis
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; National Institute for Healthcare Research MindTech Healthcare Technology Co-operative, Institute of Mental Health, University of Nottingham, Nottingham, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Bev John
- School of Psychology and Therapeutic Studies, University of South Wales, Treforest, UK
| | - Mark Coulson
- Department of Psychology, School of Science and Technology, University of Middlesex, London, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, UK
| | | | - John Cape
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Moseley
- School of Psychology, University of Central Lancashire, Preston, UK
| | - Gary Brown
- Psychology Department, Royal Holloway, Egham, UK
| | - Claire Hughes
- University of Cambridge Centre for Family Research, Cambridge, UK
| | - Marc Obonsawin
- School of Psychological Sciences and Health, University of Strathclyde, Glasgow UK
| | - Sian Coker
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Edward Watkins
- SMART Lab, College of Life and Environmental Sciences, Sir Henry Wellcome Building for Mood Disorders Research, University of Exeter, Exeter, UK
| | - Matthias Schwannauer
- School of Health in Social Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | - Kenneth MacMahon
- School of Health in Social Sciences, University of Edinburgh, Medical School, Edinburgh, UK
| | | | - Colin A Espie
- Sleep and Circadian Neuroscience Institute, Nuffield Department of Clinical Neurosciences, University of Oxford, Sir William Dunn School of Pathology, Oxford, UK; Big Health Ltd, London, UK
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126
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Moritz S, Göritz AS, McLean B, Westermann S, Brodbeck J. Do depressive symptoms predict paranoia or vice versa? J Behav Ther Exp Psychiatry 2017; 56:113-121. [PMID: 27817827 DOI: 10.1016/j.jbtep.2016.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 09/30/2016] [Accepted: 10/15/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Affective versus nonaffective psychoses are today no longer regarded as mutually exclusive disorders. Theorists have recently highlighted the role of affective symptoms in the formation of paranoid beliefs, particularly negative beliefs about the self, interpersonal sensitivity, sleep disturbances, and worrying, which exist along a continuum in the general population. For the present study, we tested the bidirectional causal relationships between paranoia and affect. METHOD A large population sample (N = 2,357) was examined at three time-points (baseline, six months, two years) as to the severity of subclinical paranoid beliefs (Paranoia Checklist, PCL) and depressive symptoms (Patient Health Questionnaire-9, PHQ-9). Worrying and avoidance were measured with items from the Maladaptive and Adaptive Coping Style Questionnaire (MAX). RESULTS Depression and paranoid symptoms were strongly cross-sectionally related (r = 0.69) and showed high stability (r > 0.72). Depressive symptoms at T2 predicted paranoid symptoms at T3 (beta = 0.16; no significant relationship from T1 to T2), whereas paranoid symptoms predicted depressive symptoms from T1 to T2 (beta = 0.09; no significant relationship from T2 to T3). LIMITATIONS Results should be replicated in a sample of paranoid patients, as risk factors for subclinical versus manifest paranoia may differ. Some constructs were measured with single items derived from a new scale. CONCLUSIONS The predictive association of depression to subsequent paranoia was small and confined to the long interval from T2 to T3. Treatments should target both paranoia and depression - irrespective of their causal relationship - particularly as patients with psychosis consider treatment of their emotional problems a priority.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany
| | - Benjamin McLean
- School of Psychology, Flinders University, South Australia, Australia
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Jeannette Brodbeck
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
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127
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The relationship between cognitive biases and psychological dimensions of delusions: The importance of jumping to conclusions. J Behav Ther Exp Psychiatry 2017; 56:51-56. [PMID: 27527489 DOI: 10.1016/j.jbtep.2016.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive biases play a role in the development and maintenance of delusions. However, delusions are multidimensional (i.e., emotional and cognitive facets) and often co-occur with auditory hallucinations. Therefore, further refinement of the precise relationship between cognitive biases, delusions, and hallucinatory experiences is warranted. METHODS A total sample of 167 patients with schizophrenia spectrum disorders was split into two groups consisting of patients with active delusions (n = 127) and active hallucinations (n = 92). All patients were assessed for delusions and hallucinations using the semi-structured psychotic symptom rating scales (PSYRATS), which assesses the emotional (i.e., distress) and cognitive (i.e., conviction, preoccupation) dimensions of these symptoms. Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQp) self-report questionnaire (assessing jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking biases). Multiple stepwise regressions were performed to investigate the relationship between delusions and cognitive biases, while controlling for auditory hallucinations (and vice-versa). RESULTS The only cognitive bias to significantly predict delusions after controlling for the severity of auditory hallucinations was the jumping to conclusions (JTC) bias (predicted both emotional and cognitive dimensions). Only the emotional dimension of auditory hallucinations was predicted by the intentionalising and dichotomous thinking biases, after delusional severity was controlled for. LIMITATIONS The cross-sectional design precludes causal inferences. Only positive psychotic symptoms were assessed and no wider psychopathology assessment was utilised (e.g., negative symptoms, anxiety, depression). CONCLUSIONS The jumping to conclusions bias is associated with both delusional conviction and emotional distress.
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128
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Howells FM, Kingdon DG, Baldwin DS. Current and potential pharmacological and psychosocial interventions for anxiety symptoms and disorders in patients with schizophrenia: structured review. Hum Psychopharmacol 2017; 32. [PMID: 28812313 DOI: 10.1002/hup.2628] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/30/2017] [Accepted: 07/11/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Between 30% and 62% of patients with schizophrenia present with co-morbid anxiety disorders that are associated with increased overall burden. Our aim was to summarize current and potential interventions for anxiety in schizophrenia. DESIGN Structured review, summarizing pharmacological and psychosocial interventions used to reduce anxiety in schizophrenia and psychosis. RESULTS Antipsychotics have been shown to reduce anxiety, increase anxiety, or have no effect. These may be augmented with another antipsychotic, anxiolytic, or antidepressant. Novel agents, such as L-theanine, pregabalin, and cycloserine, show promise in attenuating anxiety in schizophrenia. Psychosocial therapies have been developed to reduce the distress of schizophrenia. Cognitive behavioural therapy (CBT) has shown that benefit and refinements in the therapy have been successful, for example, for managing worry in schizophrenia. CBT usually involves more than 16 sessions, as short courses of CBT do not attenuate the presentation of anxiety in schizophrenia. To address time and cost, the development of manualized CBT to address anxiety in schizophrenia is being developed. CONCLUSIONS The presence of coexisting anxiety symptoms and co-morbid anxiety disorders should be ascertained when assessing patients with schizophrenia or other psychoses as a range of pharmacological and psychosocial treatments are available.
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Affiliation(s)
- Fleur M Howells
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - David G Kingdon
- Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
| | - David S Baldwin
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry Faculty of Medicine, University of Southampton, Southampton, UK
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129
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Moritz S, Pfuhl G, Lüdtke T, Menon M, Balzan RP, Andreou C. A two-stage cognitive theory of the positive symptoms of psychosis. Highlighting the role of lowered decision thresholds. J Behav Ther Exp Psychiatry 2017; 56:12-20. [PMID: 27501907 DOI: 10.1016/j.jbtep.2016.07.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/02/2016] [Accepted: 07/05/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES We outline a two-stage heuristic account for the pathogenesis of the positive symptoms of psychosis. METHODS A narrative review on the empirical evidence of the liberal acceptance (LA) account of positive symptoms is presented. HYPOTHESIS At the heart of our theory is the idea that psychosis is characterized by a lowered decision threshold, which results in the premature acceptance of hypotheses that a nonpsychotic individual would reject. Once the hypothesis is judged as valid, counterevidence is not sought anymore due to a bias against disconfirmatory evidence as well as confirmation biases, consolidating the false hypothesis. As a result of LA, confidence in errors is enhanced relative to controls. Subjective probabilities are initially low for hypotheses in individuals with delusions, and delusional ideas at stage 1 (belief formation) are often fragile. In the course of the second stage (belief maintenance), fleeting delusional ideas evolve into fixed false beliefs, particularly if the delusional idea is congruent with the emotional state and provides "meaning". LA may also contribute to hallucinations through a misattribution of (partially) normal sensory phenomena. Interventions such as metacognitive training that aim to "plant the seeds of doubt" decrease positive symptoms by encouraging individuals to seek more information and to attenuate confidence. The effect of antipsychotic medication is explained by its doubt-inducing properties. LIMITATIONS The model needs to be confirmed by longitudinal designs that allow an examination of causal relationships. Evidence is currently weak for hallucinations. CONCLUSIONS The theory may account for positive symptoms in a subgroup of patients. Future directions are outlined.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Gerit Pfuhl
- Department of Psychology, UiT The Arctic University of Norway, N-9037, Tromsø, Norway
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada; Vancouver Coastal Health, Vancouver, BC, Canada
| | - Ryan P Balzan
- School of Psychology, Flinders University Adelaide, SA, Australia
| | - Christina Andreou
- Center for Gender Research and Early Detection, University of Basel, University Psychiatric Clinics, Basel, Switzerland
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130
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Andreou C, Wittekind CE, Fieker M, Heitz U, Veckenstedt R, Bohn F, Moritz S. Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study. J Behav Ther Exp Psychiatry 2017; 56:144-151. [PMID: 27919404 DOI: 10.1016/j.jbtep.2016.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/19/2016] [Accepted: 11/24/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases. METHODS 92 patients with current or past delusions were randomized to receive 12 twice-weekly sessions of either MCT+ or a control intervention within a randomized controlled rater-blind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted. RESULTS At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability thresholds to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up. LIMITATIONS Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group. CONCLUSIONS The result pattern suggests that MCT+ led to earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects.
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Affiliation(s)
- Christina Andreou
- Center for Gender Research and Early Detection, University Psychiatric Clinics Basel, Switzerland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Charlotte E Wittekind
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Martina Fieker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Ulrike Heitz
- Center for Gender Research and Early Detection, University Psychiatric Clinics Basel, Switzerland
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Francesca Bohn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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131
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Rek S, Sheaves B, Freeman D. Nightmares in the general population: identifying potential causal factors. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1123-1133. [PMID: 28712041 PMCID: PMC5581821 DOI: 10.1007/s00127-017-1408-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 06/15/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Nightmares are inherently distressing, prevent restorative sleep, and are associated with a number of psychiatric problems, but have rarely been the subject of empirical study. Negative affect, linked to stressful events, is generally considered the key trigger of nightmares; hence nightmares have most often been considered in the context of post-traumatic stress disorder (PTSD). However, many individuals with heightened negative affect do not have nightmares. The objective of this study was to identify mechanistically plausible factors, beyond negative affect, that may explain why individuals experience nightmares. METHOD 846 participants from the UK general population completed an online survey about nightmare occurrence and severity (pre-occupation, distress, and impairment), negative affect, worry, depersonalisation, hallucinatory experiences, paranoia, alcohol use, sleep duration, physical activity levels, PTSD symptoms, and stressful life events. Associations of nightmares with the putative predictive factors were tested controlling for levels of negative affect. Analyses were also repeated controlling for levels of PTSD and the recent occurrence of stressful life events. RESULTS Nightmare occurrence, adjusting for negative affect, was associated with higher levels of worry, depersonalisation, hallucinatory experiences, paranoia, and sleep duration (odds ratios 1.25-1.45). Nightmare severity, controlling for negative affect, was associated with higher levels of worry, depersonalisation, hallucinatory experiences, and paranoia (R 2s: 0.33-0.39). Alcohol use and physical activity levels were not associated with nightmares. DISCUSSION The study identifies a number of potential predictors of the occurrence and severity of nightmares. Causal roles require testing in future longitudinal, experimental, and treatment studies.
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Affiliation(s)
- Stephanie Rek
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
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132
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Sellers R, Wells A, Morrison AP. Are experiences of psychosis associated with unhelpful metacognitive coping strategies? A systematic review of the evidence. Clin Psychol Psychother 2017; 25:31-49. [DOI: 10.1002/cpp.2132] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 02/09/2017] [Accepted: 07/28/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Rachel Sellers
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
- Psychosis Research Unit; Greater Manchester West Mental Health Foundation NHS Trust; Manchester UK
| | - Adrian Wells
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
| | - Anthony P. Morrison
- Division of Psychology and Mental Health, School of Health Sciences; University of Manchester; Manchester UK
- Psychosis Research Unit; Greater Manchester West Mental Health Foundation NHS Trust; Manchester UK
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133
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Szymczynska P, Walsh S, Greenberg L, Priebe S. Attrition in trials evaluating complex interventions for schizophrenia: Systematic review and meta-analysis. J Psychiatr Res 2017; 90:67-77. [PMID: 28231496 DOI: 10.1016/j.jpsychires.2017.02.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 01/27/2017] [Accepted: 02/08/2017] [Indexed: 11/18/2022]
Abstract
Essential criteria for the methodological quality and validity of randomized controlled trials are the drop-out rates from both the experimental intervention and the study as a whole. This systematic review and meta-analysis assessed these drop-out rates in non-pharmacological schizophrenia trials. A systematic literature search was used to identify relevant trials with ≥100 sample size and to extract the drop-out data. The rates of drop-out from the experimental intervention and study were calculated with meta-analysis of proportions. Meta-regression was applied to explore the association between the study and sample characteristics and the drop-out rates. 43 RCTs were found, with drop-out from intervention ranging from 0% to 63% and study drop-out ranging from 4% to 71%. Meta-analyses of proportions showed an overall drop-out rate of 14% (95% CI: 13-15%) at the experimental intervention level and 20% (95% CI: 17-24%) at the study level. Meta-regression showed that the active intervention drop-out rates were predicted by the number of intervention sessions. In non-pharmacological schizophrenia trials, drop-out rates of less than 20% can be achieved for both the study and the experimental intervention. A high heterogeneity of drop-out rates across studies shows that even lower rates are achievable.
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Affiliation(s)
- P Szymczynska
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK.
| | - S Walsh
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK
| | - L Greenberg
- Pragmatic Clinical Trials Unit, Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
| | - S Priebe
- Unit for Social and Community Psychiatry, Newham Centre for Mental Health, Queen Mary University of London, E13 8SP, UK
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134
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Brief Coping Strategy Enhancement for Distressing Voices: an Evaluation in Routine Clinical Practice. Behav Cogn Psychother 2017; 46:226-237. [DOI: 10.1017/s1352465817000388] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Hearing voices can be a common and distressing experience. Psychological treatment in the form of cognitive behavioural therapy for psychosis (CBTp) is effective, but is rarely available to patients. The barriers to increasing access include a lack of time for clinicians to deliver therapy. Emerging evidence suggests that CBTp delivered in brief forms can be effective and offer one solution to increasing access. Aims: We adapted an existing form of CBTp, coping strategy enhancement (CSE), to focus specifically on distressing voices in a brief format. This intervention was evaluated within an uncontrolled study conducted in routine clinical practice. Method: This was a service evaluation comparing pre–post outcomes in patients who had completed CSE over four sessions within a specialist out-patient service within NHS Mental Health Services. The primary outcome was the distress scale of the Psychotic Symptoms Rating Scale – Auditory Hallucinations (PSYRATS-AH). Results: Data were available from 101 patients who had completed therapy. A reduction approaching clinical importance was found on the PSYRATS distress scale post-therapy when compared with the baseline. Conclusions: The findings from this study suggest that CSE, as a focused and brief form of CBTp, can be effective in the treatment of distressing voices within routine clinical practice. Within the context of the limitations of this study, brief CSE may best be viewed as the beginning of a therapeutic conversation and a low-intensity intervention in a stepped approach to the treatment of distressing voices.
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135
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Hayward M, Jones AM, Bogen-Johnston L, Thomas N, Strauss C. Relating Therapy for distressing auditory hallucinations: A pilot randomized controlled trial. Schizophr Res 2017; 183:137-142. [PMID: 27916286 DOI: 10.1016/j.schres.2016.11.019] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/05/2016] [Accepted: 11/13/2016] [Indexed: 11/24/2022]
Abstract
Auditory hallucinations (AH) are a common and distressing experience and patients report distress reduction to be a priority. Relating Therapy adopts a symptom-specific and mechanism focused approach to the reduction of AH distress. We conducted this single-blind, pragmatic, parallel groups, superiority pilot RCT within a single mental health centre in the UK. Patients (18+years) with persistent and distressing AH, irrespective of diagnosis were randomly allocated to receive either Relating Therapy and Treatment-as-usual (RT) or Treatment as-usual alone (TAU). Assessment of outcome was completed pre-randomisation (T0), 16weeks post-randomisation (T1) and 36weeks post-randomisation (T2). The primary outcome was the 5-item Distress scale of the Psychotic Symptoms Rating Scale - Auditory Hallucinations (PSYRATS-AHRS) at T1. We randomly assigned 29 patients to receive RT (n=14) or TAU (n=15). Twenty-five patients (86%) provided complete datasets. Compared with TAU, RT led to reductions in AH distress in the large effect size range across T1 and T2. Our findings suggest that Relating Therapy might be effective for reducing AH distress. A larger, suitably powered phase 3 study is needed to provide a precise estimate of the effects of Relating Therapy for AH distress.
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Affiliation(s)
- Mark Hayward
- School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom.
| | | | | | - Neil Thomas
- Swinburne University of Technology, Australia.
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton BN1 9RH, United Kingdom.
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136
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Abstract
Delusion is central to the conceptualization, definition, and identification of schizophrenia. However, in current classifications, the presence of delusions is neither necessary nor sufficient for the diagnosis of schizophrenia, nor is it sufficient to exclude the diagnosis of some other psychiatric conditions. Partly as a consequence of these classification rules, it is possible for delusions to exist transdiagnostically. In this article, we evaluate the extent to which this happens, and in what ways the characteristics of delusions vary according to diagnostic context. We were able to examine their presence and form in delusional disorder, affective disorder, obsessive-compulsive disorder, borderline personality disorder, and dementia, in all of which they have an appreciable presence. There is some evidence that the mechanisms of delusion formation are, at least to an extent, shared across these disorders. This transdiagnostic extension of delusions is an argument for targeting them therapeutically in their own right. However there is a dearth of research to enable the rational transdiagnostic deployment of either pharmacological or psychological treatments.
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Affiliation(s)
- Paul Bebbington
- UCL Division of Psychiatry, Faculty of Brain Sciences, Tottenham Court Road, London, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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137
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Sellers R, Gawęda Ł, Wells A, Morrison AP. The role of unhelpful metacognitive beliefs in psychosis: Relationships with positive symptoms and negative affect. Psychiatry Res 2016; 246:401-406. [PMID: 27788460 DOI: 10.1016/j.psychres.2016.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 01/13/2023]
Abstract
The Self-Regulatory Executive Function (s-REF) model assumes that a common set of unhelpful metacognitive beliefs have a central role in predisposition to psychological disorder and the maintenance of symptoms and distress. This research aims to test whether the five unhelpful metacognitive beliefs implicated in the model are associated with positive symptoms of psychosis and whether they are a better predictor of negative affect than topological characteristics of positive symptoms. A sample of people with psychosis completed a semi-structured interview about psychotic symptoms and self-report measures of metacognitive beliefs (MCQ-30), anxiety and depression. Hierarchical multiple regression analyses suggested that unhelpful metacognitive beliefs predict negative affect in people with psychosis over and above symptom frequency and other topological characteristics of symptoms captured by the Psychotic Symptoms Rating Scale (PSYRATS). The findings support the application of the metacognitive model to emotional distress in people with psychosis.
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Affiliation(s)
- Rachel Sellers
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom.
| | - Łukasz Gawęda
- II Department of Psychiatry, Medical University of Warsaw, Poland; Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
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138
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Abstract
BACKGROUND Delusional disorder (DD) is an under-researched condition and its relationship to schizophrenia (SZ) controversial. This study aimed to further characterize DD and to examine multi-domain evidence for the distinction between DD and SZ. METHOD Using univariate analyses we examined 146 subjects with DD, 114 subjects with paranoid SZ and 244 subjects with non-paranoid SZ on 52 characteristics from several domains including demographics, risk factors, premorbid features, illness characteristics, index episode features, delusional-related features, response to treatment and outcome. In a further step, we searched for independent associations of the examined characteristics with DD v. SZ. RESULTS Univariate analyses showed that DD differed from either form of SZ in 40 characteristics, the pattern of findings indicated that paranoid SZ was much more similar to non-paranoid SZ than DD. Relative to subjects with SZ, those with DD were more likely to have drug abuse before illness onset, better premorbid sexual adjustment, later age at illness onset, higher levels of affective symptoms and lack of insight, poorer response to antipsychotic medication, better functioning in the domains of personal care, paid work and social functioning; last, subjects with DD had fewer but more severe delusions and higher ratings of conviction of delusional experience than those with SZ. Predominance of jealousy and somatic delusions was confined to subjects with DD. CONCLUSIONS DD and SZ represent two distinct classes of disorders, the differential features of DD being of nosological, aetiological and therapeutic relevance.
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Affiliation(s)
- V Peralta
- Department of Psychiatry,Complejo Hospitalario de Navarra,Pamplona,Spain
| | - M J Cuesta
- Instituto de Investigación Sanitaria de Navarra (IdisNa)Pamplona,Spain
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139
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Hazell CM, Hayward M, Cavanagh K, Jones AM, Strauss C. Guided self-help cognitive behavioral intervention for VoicEs (GiVE): study protocol for a pilot randomized controlled trial. Trials 2016; 17:351. [PMID: 27456976 PMCID: PMC4960672 DOI: 10.1186/s13063-016-1494-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 07/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Cognitive behavior therapy for psychosis (CBTp) is an effective intervention for people who hear distressing voices (auditory hallucinations). However, there continues to be a problem of poor access to CBTp. Constraints on health care funding require this problem to be addressed without a substantial increase in funding. One solution is to develop guided self-help forms of CBTp to improve access, and a symptom-specific focus on, for example, distressing voices (auditory verbal hallucinations) has the potential to enhance effectiveness. We term this cognitive behavior therapy for distressing voices (CBTv). Methods/design This trial is an external pilot randomized controlled trial comparing the effects of 12-week guided self-help CBTv (with eight therapist support sessions) with a wait list control condition. Informed consent will be obtained from each participant. Half of the 30 participants will be randomized to receive guided self-help CBTv immediately; the remaining half will receive the intervention after a 12-week delay. All participants will continue with their usual treatment throughout the study. Outcomes will be assessed using questionnaires completed at baseline and 12 weeks postrandomization. Interviews will be offered to all those who receive therapy immediately to explore their experiences with the intervention. Discussion The outcomes of this trial, both quantitative and qualitative, will inform the design of a definitive randomized controlled trial of guided self-help CBTv. If this intervention is effective, it could help to increase access to CBT for those who hear distressing voices. Trial registration ISRCTN registration number ISRCTN77762753. Registered on 23 July 2015.
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Affiliation(s)
- Cassie M Hazell
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QJ, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QJ, UK.,R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QJ, UK
| | - Anna-Marie Jones
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Falmer, Brighton, BN1 9QJ, UK. .,R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, BN3 7HZ, UK.
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140
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Persecutory delusions: a cognitive perspective on understanding and treatment. Lancet Psychiatry 2016; 3:685-92. [PMID: 27371990 DOI: 10.1016/s2215-0366(16)00066-3] [Citation(s) in RCA: 166] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/24/2016] [Accepted: 02/15/2016] [Indexed: 11/20/2022]
Abstract
A spectrum of severity of paranoia (unfounded thoughts that others are deliberately intending to cause harm) exists within the general population. This is unsurprising: deciding whether to trust or mistrust is a vital aspect of human cognition, but accurate judgment of others' intentions is challenging. The severest form of paranoia is persecutory delusions, when the ideas are held with strong conviction. This paper presents a distillation of a cognitive approach that is being translated into treatment for this major psychiatric problem. Persecutory delusions are viewed as threat beliefs, developed in the context of genetic and environmental risk, and maintained by several psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and the use of safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering feared situations after reduction of the influence of the maintenance factors. An exciting area of development will be a clinical intervention science of how best to enhance learning of safety to counteract paranoia.
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141
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Waite F, Myers E, Harvey AG, Espie CA, Startup H, Sheaves B, Freeman D. Treating Sleep Problems in Patients with Schizophrenia. Behav Cogn Psychother 2016; 44:273-87. [PMID: 26751571 PMCID: PMC4855992 DOI: 10.1017/s1352465815000430] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Sleep disturbance is increasingly recognized as a major problem for patients with schizophrenia but it is rarely the direct focus of treatment. The main recommended treatment for insomnia is cognitive behavioural therapy, which we have been evaluating for patients with current delusions and hallucinations in the context of non-affective psychosis. AIMS In this article we describe the lessons we have learned about clinical presentations of sleep problems in schizophrenia and the adaptations to intervention that we recommend for patients with current delusions and hallucinations. METHOD Twelve factors that may particularly contribute to sleep problems in schizophrenia are identified. These include delusions and hallucinations interfering with sleep, attempts to use sleep as an escape from voices, circadian rhythm disruption, insufficient daytime activity, and fear of the bed, based upon past adverse experiences. Specific adaptations for psychological treatment related to each factor are described. CONCLUSIONS Our experience is that patients want help to improve their sleep; sleep problems in schizophrenia should be treated with evidence-based interventions, and that the interventions may have the added benefit of lessening the psychotic experiences. A treatment technique hierarchy is proposed for ease of translation to clinical practice.
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Affiliation(s)
| | | | | | - Colin A. Espie
- Sleep and Circadian Neuroscience Institute, University of Oxford, UK
| | - Helen Startup
- Sussex Partnership NHS Foundation Trust, and University of Oxford, UK
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142
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Targeting Recovery in Persistent Persecutory Delusions: A Proof of Principle Study of a New Translational Psychological Treatment (the Feeling Safe Programme). Behav Cogn Psychother 2016; 44:539-52. [PMID: 27044885 PMCID: PMC4988271 DOI: 10.1017/s1352465816000060] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: Many patients do not respond adequately to current pharmacological or psychological treatments for psychosis. Persistent persecutory delusions are common in clinical services, and cause considerable patient distress and impairment. Our aim has been to build a new translational personalized treatment, with the potential for wide use, that leads to high rates of recovery in persistent persecutory delusions. We have been developing, and evaluating individually, brief modular interventions, each targeting a key causal factor identified from our cognitive model. These modules are now combined in “The Feeling Safe Programme”. Aims: To test the feasibility of a new translational modular treatment for persistent persecutory delusions and provide initial efficacy data. Method: 12 patients with persistent persecutory delusions in the context of non-affective psychosis were offered the 6-month Feeling Safe Programme. After assessment, patients chose from a personalized menu of treatment options. Four weekly baseline assessments were carried out, followed by monthly assessments. Recovery in the delusion was defined as conviction falling below 50% (greater doubt than certainty). Results: 11 patients completed the intervention. One patient withdrew before the first monthly assessment due to physical health problems. An average of 20 sessions (SD = 4.4) were received. Posttreatment, 7 out of 11 (64%) patients had recovery in their persistent delusions. Satisfaction ratings were high. Conclusions: The Feeling Safe Programme is feasible to use and was associated with large clinical benefits. To our knowledge this is the first treatment report focused on delusion recovery. The treatment will be tested in a randomized controlled trial.
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143
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Hazell CM, Hayward M, Cavanagh K, Strauss C. A systematic review and meta-analysis of low intensity CBT for psychosis. Clin Psychol Rev 2016; 45:183-92. [PMID: 27048980 DOI: 10.1016/j.cpr.2016.03.004] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Revised: 01/29/2016] [Accepted: 03/19/2016] [Indexed: 11/19/2022]
Abstract
Sixteen sessions of individual cognitive behavior therapy for people with psychosis (CBTp) is recommended. However, access to CBTp is poor, so the potential of low intensity CBTp (fewer than 16 sessions of face-to-face contact) is being explored. A systematic review and meta-analysis was conducted of 10 controlled trials evaluating low intensity CBTp. Significant between-group effects were found on the primary outcome, symptoms of psychosis, at post-intervention (d=-0.46, 95% CI: -0.06, -0.86) and follow-up (d=-0.40, 95% CI: -0.06, -0.74). Study quality did not moderate post-intervention psychosis outcomes, nor did contact time/number of sessions or therapy format (individual versus group). Between-group effects on secondary outcomes (depression, anxiety and functioning) were not significant at post-intervention, but became significant at follow-up for depression and functioning outcomes (but not for anxiety). Overall, findings suggest that low intensity CBTp shows promise with effect sizes comparable to those found in meta-analyses of CBTp more broadly. We suggest that low intensity CBTp could help widen access. Future research is called for to identify mechanisms of change and to ascertain moderators of outcome so that low intensity CBTp targets key mechanisms (so that scarce therapy time is used effectively) and so that interventions offered are matched to patient need.
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Affiliation(s)
- Cassie M Hazell
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove BN3 7HZ, UK.
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK.
| | - Clara Strauss
- School of Psychology, University of Sussex, Falmer, Brighton BN1 9QJ, UK; R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove BN3 7HZ, UK.
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144
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Startup H, Pugh K, Dunn G, Cordwell J, Mander H, Černis E, Wingham G, Shirvell K, Kingdon D, Freeman D. Worry processes in patients with persecutory delusions. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2016; 55:387-400. [DOI: 10.1111/bjc.12109] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 01/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Helen Startup
- Department of Psychiatry; University of Oxford; UK
- Sussex Partnership NHS Foundation Trust; West Sussex; UK
| | - Katherine Pugh
- Department of Psychiatry; University of Oxford; UK
- Sussex Partnership NHS Foundation Trust; West Sussex; UK
| | - Graham Dunn
- Centre for Biostatistics; Institute of Population Health; University of Manchester; UK
- MRC NW Hub for Trials Methodology Research
| | - Jacinta Cordwell
- Academic Department of Psychiatry; Faculty of Medicine; University of Southampton; Southampton; UK
| | - Helen Mander
- Academic Department of Psychiatry; Faculty of Medicine; University of Southampton; Southampton; UK
| | - Emma Černis
- Department of Psychiatry; University of Oxford; UK
| | - Gail Wingham
- Academic Department of Psychiatry; Faculty of Medicine; University of Southampton; Southampton; UK
| | - Katherine Shirvell
- Academic Department of Psychiatry; Faculty of Medicine; University of Southampton; Southampton; UK
| | - David Kingdon
- Academic Department of Psychiatry; Faculty of Medicine; University of Southampton; Southampton; UK
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145
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Freeman D, Waite F, Emsley R, Kingdon D, Davies L, Fitzpatrick R, Dunn G. The efficacy of a new translational treatment for persecutory delusions: study protocol for a randomised controlled trial (The Feeling Safe Study). Trials 2016; 17:134. [PMID: 26969128 PMCID: PMC4788840 DOI: 10.1186/s13063-016-1245-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 02/19/2016] [Indexed: 12/11/2022] Open
Abstract
Background Persecutory delusions (strong unfounded fears that others intend harm to the person) occur in more than 70 % of the patients diagnosed with schizophrenia. This major psychotic experience is a key clinical target, for which substantial improvement in treatment is needed. Our aim is to use advances in theoretical understanding to develop a much more efficacious treatment that leads to recovery in at least 50 % of people with persistent persecutory delusions. Our cognitive conceptualisation is that persecutory delusions are threat beliefs, developed in the context of genetic and environmental risk, maintained by a number of psychological processes including excessive worry, low self-confidence, intolerance of anxious affect and other internal anomalous experiences, reasoning biases, and safety-seeking strategies. The clinical implication is that safety has to be relearned, by entering the feared situations after reduction of the influence of the maintenance factors. We have been individually evaluating modules targeting causal factors. These will now be tested together as a full treatment, called The Feeling Safe Programme. The treatment is modular, personalised, and includes patient preference. We will test whether the new treatment leads to greater recovery in persistent persecutory delusions, psychological well-being, and activity levels compared to befriending (that is, controlling for therapist attention). Methods/design The Feeling Safe Study is a parallel group randomised controlled trial for 150 patients who have persecutory delusions despite previous treatment in mental health services. Patients will be randomised (1:1 ratio) to The Feeling Safe Programme or befriending (both provided in 20 sessions over 6 months). Standard care will continue as usual. Online randomisation will use a permuted blocks algorithm, with randomly varying block size, stratified by therapist. Assessments, by a rater blind to allocation, will be conducted at 0, 6 (post treatment), and 12 months. The primary outcome is the level of delusional conviction at 6 months. Secondary outcomes include levels of psychological well-being, suicidal ideation, and activity. All main analyses will be intention-to-treat. The trial is funded by the NHS National Institute for Health Research. Discussion The Feeling Safe study will provide a Phase II evaluation of a new targeted translational psychological treatment for persecutory delusions. Trial registration Current Controlled Trials ISRCTN18705064 (registered 11 November 2015).
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
| | - David Kingdon
- Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Linda Davies
- Centre for Health Economics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester Academic Health Centre, Manchester, UK
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146
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Oh HY, Singh F, Koyanagi A, Jameson N, Schiffman J, DeVylder J. Sleep disturbances are associated with psychotic experiences: Findings from the National Comorbidity Survey Replication. Schizophr Res 2016; 171:74-8. [PMID: 26805412 DOI: 10.1016/j.schres.2016.01.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 01/07/2016] [Accepted: 01/10/2016] [Indexed: 10/22/2022]
Abstract
Sleep disturbances have been linked to psychotic experiences in the general adult populations of multiple countries, but this association has yet to be confirmed in the United States using robust diagnostic measures. We analyzed a subsample (n=2304) of the National Comorbidity Survey Replication, and found that when compared with those who did not report any sleep problems, individuals with sleep disturbances lasting two weeks or longer over the past 12months were significantly more likely to report at least one psychotic experience during that same time frame. Specifically, difficulty falling asleep, waking up during the night, early morning awakenings, and feeling sleepy during the day were each associated with greater odds of reporting psychotic experiences over the past year after controlling for socio-demographic variables. However, only difficulty falling asleep and early morning awakenings were still significant after adjusting for DSM comorbid disorders. Reporting three or four types of sleep disturbances was especially predictive of psychotic experiences. Our findings underscore the importance of detecting and reducing sleep problems among individuals who report PE.
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Affiliation(s)
- Hans Y Oh
- University of California, Berkeley, School of Public Health, 50 University Hall #7360, Berkeley, CA 94720-7360, USA; Pacific Institute for Research and Evaluation, 180 Grand Avenue Suite #1200, Oakland, CA 94612, USA.
| | - Fiza Singh
- University of California, San Diego, Department of Psychiatry, 9500 Gilman Drive, La Jolla, CA 92093-0810, USA.
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Research and Development Unit, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, 08830, Spain.
| | - Nicole Jameson
- University of Maryland, Baltimore, School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA
| | - Jason Schiffman
- University of Maryland, Baltimore, School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA.
| | - Jordan DeVylder
- University of Maryland, Baltimore, School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA.
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147
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Naeem F, Khoury B, Munshi T, Ayub M, Lecomte T, Kingdon D, Farooq S. Brief Cognitive Behavioral Therapy for Psychosis (CBTp) for Schizophrenia: Literature Review and Meta-analysis. Int J Cogn Ther 2016. [DOI: 10.1521/ijct_2016_09_04] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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148
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[Guideline-conform psychiatric psychotherapeutic treatment for patients with schizophrenia : A normative evaluation of necessary personnel requirements]. DER NERVENARZT 2016; 87:286-94. [PMID: 26820457 DOI: 10.1007/s00115-015-0056-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary. OBJECTIVES The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV). METHODS The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated. RESULTS In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts). DISCUSSION These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for inpatient psychiatric healthcare in Germany.
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149
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Windgassen S, Goldsmith K, Moss-Morris R, Chalder T. Establishing how psychological therapies work: the importance of mediation analysis. J Ment Health 2016; 25:93-9. [DOI: 10.3109/09638237.2015.1124400] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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150
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Kuipers E, Onwumere J, Peters E. Psychological therapies for psychosis: a view from the hills. Lancet Psychiatry 2016; 3:9-10. [PMID: 26772054 DOI: 10.1016/s2215-0366(15)00570-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/10/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Elizabeth Kuipers
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London SE5 8AF, UK
| | - Juliana Onwumere
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London SE5 8AF, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Department of Psychology, London SE5 8AF, UK.
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