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Berkhof M, van der Stouwe ECD, Geraets CNW, Pot-Kolder RMCA, van der Gaag M, Veling W. Relations between changes in safety behavior, paranoid ideations, cognitive biases, and clinical characteristics of patients with a psychotic disorder over time. Schizophr Res 2024; 272:98-103. [PMID: 39214023 DOI: 10.1016/j.schres.2024.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 08/14/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Safety behaviors, both positive (maladaptive coping behavior) and negative (avoidance behavior), are used by people with paranoid delusions to avoid perceived threats. Safety behaviors contribute to the persistence of paranoid delusions by preventing disconfirmation of threat beliefs and may influence other psychiatric symptoms. This study investigated how changes in safety behaviors are related to changes in paranoid ideation, social anxiety, depression, cognitive biases and self-esteem over time. METHODS This study included 116 patients diagnosed with a psychotic disorder (DSM-IV) and at least moderate levels of paranoid ideations (GTPS >40).The data were collected as part of a multi-center randomized controlled trial where patients were randomized to VR-CBT (n = 58) or treatment as usual (TAU; n = 58). Assessments were completed at baseline (T0), after three months (T3) and after six months (T6). For all variables, change scores between T0 and T3 and T3 and T6 were calculated and Pearson correlations between change scores were computed. RESULTS A decrease in total safety behavior was related to diminished paranoid ideation, social anxiety, and depression. No significant temporal associations were found between changes in safety behavior and changes in cognitive biases and self-esteem. Similar but less robust results were found for respectively negative safety behavior and positive safety behavior. CONCLUSION Dropping safety behavior can be specifically targeted in behavioral interventions. Whereas there appears to be a relation with reduction in anxiety, paranoia, and depressive symptoms, changes in safety behavior do not seem to align with changes in cognitive thinking processes.
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Affiliation(s)
- M Berkhof
- University Medical Center Groningen, University of Groningen, the Netherlands.
| | | | - C N W Geraets
- University Medical Center Groningen, University of Groningen, the Netherlands
| | | | - M van der Gaag
- Parnassia Psychiatry Institute, the Netherlands; Department of Clinical Psychology, VU University, the Netherlands
| | - W Veling
- University Medical Center Groningen, University of Groningen, the Netherlands
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Gilbert P. Threat, safety, safeness and social safeness 30 years on: Fundamental dimensions and distinctions for mental health and well-being. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:453-471. [PMID: 38698734 DOI: 10.1111/bjc.12466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/18/2024] [Indexed: 05/05/2024]
Abstract
In 1993, the British Journal of Clinical Psychology published my paper titled 'Defence and safety: Their function in social behaviour and psychopathology'. The paper highlights that to understand people's sensitivity to threat, we also need to understand their ability to identify what is safe. This paper offers an update on these concepts, highlighting distinctions that were implicit but not clearly defined at the time. Hence, the paper seeks to clarify distinctions between: (i) threat detection and response, (ii) safety and safety seeking, (iii) safeness and (iv) their social and non-social functions and forms. Threat detection and response are to prevent or minimize harm (e.g., run from a predator or fire). Safety checking relates to monitoring for the absence and avoidance of threat, while safety seeking links to the destination of the defensive behaviour (e.g., running home). Safety seeking also relates to maintaining vigilance to the appearance of potential harms and doing things believed to avoid harm. Threat-defending and safety checking and seeking are regulated primarily through evolved threat processing systems that monitor the nature, presence, controllability and/or absence of threat (e.g., amygdala and sympathetic nervous system). Safeness uses different monitoring systems via different psychophysiological systems (e.g., prefrontal cortex, parasympathetic system) for the presence of internal and external resources that support threat-coping, risk-taking, resource exploration. Creating brain states that recruit safeness processing can impact how standard evidence-based therapies (e.g., exposure, distress tolerance and reappraisal) are experienced and produce long-term change.
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Affiliation(s)
- Paul Gilbert
- Centre of Compassion Research and Training, College of Health and Social Care Research Centre, University of Derby, Derby, UK
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3
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Aunjitsakul W, Jongbowonwiwat K, Lambe S, Freeman D, McLeod HJ, Gumley A. Exploring stigma, shame, and safety behaviours in social anxiety and paranoia amongst people diagnosed with schizophrenia. Behav Cogn Psychother 2024:1-15. [PMID: 39205504 DOI: 10.1017/s1352465824000225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
BACKGROUND Social anxiety and paranoia are connected by a shared suspicion framework. Based on cognitive-behavioural approaches, there is evidence for treating social anxiety and psychosis. However, mechanisms underlying the relationship between social anxiety and paranoia remain unclear. AIMS To investigate mediators between social anxiety and paranoia in schizophrenia such as negative social appraisals (i.e. stigma or shame; Hypothesis 1), and safety behaviours (i.e. anxious avoidance or in situ safety behaviours; Hypothesis 2). METHOD A cross-sectional study was conducted among Asian out-patients with schizophrenia (January-April 2020). Data on social anxiety, paranoia, depression, shame, stigma, anxious avoidance, and in situ behaviours were collected. Associations between social anxiety and paranoia were investigated using linear regressions. Mediation analysis via 10,000 bias-corrected bootstrap samples with 95% confidence intervals (CI) was used to test the indirect effects (ab) of mediators. RESULTS Participants (n=113, 59.3% male) with a mean age of 44.2 years were recruited. A linear relationship between social anxiety and paranoia was found. In multiple mediation analyses (co-varying for depression), stigma and shame (Hypothesis 1) did not show any significant indirect effects with ab=.004 (95%CI=-.013, .031) and -.003 (-.023, .017), respectively, whereas in situ behaviours (Hypothesis 2) showed a significant effect with ab=.110 (.038, .201) through the social anxiety-paranoia relationship. CONCLUSIONS Social anxiety and paranoia are positively correlated. In situ safety behaviours fully mediated the social anxiety and paranoia relationship. Targeted interventions focusing on safety behaviours could help reduce paranoia in psychosis. Symptom severity should be measured to help characterise the participants' characteristics.
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Affiliation(s)
- Warut Aunjitsakul
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Kreuwan Jongbowonwiwat
- Department of Psychiatry, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Sinead Lambe
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Hamish J McLeod
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Andrew Gumley
- School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Schönig SN, Thompson E, Kingston J, Gaudiano BA, Ellett L, Krkovic K. The Apple Doesn't Fall Far from the Tree? Paranoia and Safety Behaviours in Adolescent-Parent-Dyads. Res Child Adolesc Psychopathol 2024; 52:267-275. [PMID: 37740777 PMCID: PMC10834552 DOI: 10.1007/s10802-023-01128-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 09/25/2023]
Abstract
Paranoia is a common experience in adolescence that may entail the use of safety behaviours (e.g. avoidance), which are assumed to maintain paranoia in the long run. As the development of paranoia and related safety behaviours in youth may be influenced by their caregivers, we aimed to investigate the associations of paranoia and safety behaviours in adolescents and their parents. Adolescents from the general population aged 14-17 and one of their parents (N = 142 dyads) were recruited via Qualtrics to complete online surveys including measures of paranoia, safety behaviour use, anxiety, and demographics. We fitted an Actor-Partner-Interdependence Model (APIM) for testing dyadic parent-child interaction by using structural equation modelling and controlled for adolescents' and parents' anxiety. Results indicated that paranoia positively predicted safety behaviour use in adolescents and in parents. There were significant positive intra-dyad (i.e. parent-adolescent) correlations for both paranoia and safety behaviour use. One partner effect was significant: parental paranoia positively predicted the safety behaviour use of their adolescent child. Conversely, adolescents' paranoia did not predict their parents' safety behaviour use. Our findings corroborate prior research demonstrating an association between paranoia and safety behaviours among adults, and extend this association to adolescents. Children of parents experiencing paranoia are at increased risk of developing paranoia and safety behaviours, which indicates the need for interventions that target paranoia and safety behaviours in family systems.
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Affiliation(s)
- Sven N Schönig
- Department of Clinical Psychology & Psychotherapy, Universität Hamburg, Hamburg, Germany.
| | - Elizabeth Thompson
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Jessica Kingston
- Department of Psychology, Royal Holloway, University of London, Surrey, UK
| | - Brandon A Gaudiano
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, USA
| | - Lyn Ellett
- School of Psychology, University of Southampton, Southampton, UK
| | - Katarina Krkovic
- Department of Clinical Psychology & Psychotherapy, Universität Hamburg, Hamburg, Germany
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Verma KK. Understanding and Managing Cognitive Distortions in Individuals With Schizophrenia. Cureus 2023; 15:e45268. [PMID: 37846265 PMCID: PMC10576840 DOI: 10.7759/cureus.45268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 09/12/2023] [Indexed: 10/18/2023] Open
Abstract
INTRODUCTION Schizophrenia is characterized by psychotic symptoms such as delusions, hallucinations, and disorganized thinking and speech. Patients suffering from schizophrenia incited by these delusions react violently in response to real or imagined threats; this engages them in violent behaviours and thus poses a threat. Sparse data are available for patients from India with regard to schizophrenia patients acting on their delusions. The aim of this study was to assess the prevalence of delusional action in patients suffering from schizophrenia and to identify the phenomenological characteristics of those delusions which are associated with action. MATERIAL METHODS This study was conducted on patients with a diagnosis of schizophrenia admitted to the indoor patient department (IPD) of the Department of Psychiatry, K.D. Medical College, Hospital & Research Centre, Mathura, India, during the period of February 2022 to July 2022. A semi-structured, semi-open-ended questionnaire was used for interviewing patients regarding demographics, the course of illness, past medical illness, the family history of psychiatric disturbances, and substance use. The study tool used for delusion was the Maudsley Assessment of Delusions Schedule (MADS). RESULTS Out of 56 selected subjects, 34 acted on delusion and out of these, 19 were male and 15 female. In our study gender did not play any significant role in acting on delusion. Literacy and nuclear living households played a significant role in influencing delusion-driven behaviours, while the distinction between urban and rural living, though noteworthy, fell just short of achieving statistical significance. An emotional state like anger was significantly important to the patient's acting on delusion, which led to violent behaviour or self-harm. CONCLUSION Positive responses are more likely to be associated with leading action on delusion as compared to negative responses, which were also associated with action on delusion; for example, anger was significantly important in the patient's acting on delusion, which led to violent behaviour or self-harm.
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Affiliation(s)
- Kamal K Verma
- Psychiatry, K. D. (Kanti Devi) Medical College, Hospital & Research Center, Mathura, IND
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Meins IA, Muijsson-Bouwman DC, Nijman SA, Greaves-Lord K, Veling W, Pijnenborg GHM, van der Stouwe ECD. VR-SOAP, a modular virtual reality treatment for improving social activities and participation of young people with psychosis: a study protocol for a single-blind multi-centre randomized controlled trial. Trials 2023; 24:278. [PMID: 37061694 PMCID: PMC10105944 DOI: 10.1186/s13063-023-07241-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Accepted: 03/13/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Young people with a psychotic disorder have the same social goals as their healthy peers, but their social networks are smaller, they participate less often in leisure activities and are less successful in work and education. Causes of these problems are multifaceted, but culminate in difficulties with interacting in daily life social situations. Current treatments have only moderate effects on social functioning and often target one specific domain. Virtual reality (VR) has the potential to improve the treatment of social interaction difficulties. We developed a modular VR treatment for social functioning and participation (VR-SOAP). In this study, the effect of this intervention will be investigated in a randomized controlled trial (RCT). METHODS A total of 116 participants (age 18-40) with a DSM-5 diagnosis of schizophrenia spectrum or other psychotic disorder and problems with social functioning will be recruited from mental healthcare institutes in the Netherlands. Participants will be randomized to the experimental condition (VR-SOAP) or active VR control condition (VRelax). VR-SOAP consists of 14 sessions and 5 modules addressing causes of impaired social functioning: four optional modules (1-4) and one fixed module (5). Vrelax consists of 14 sessions that entail psychoeducation, stress management, relaxation techniques, and the exploration of relaxing environments in VR. Primary outcomes are quantity and quality of social contacts, leisure activities and social participation, measured with the experience sampling method (ESM). Secondary outcomes are psychiatric symptoms, social behaviour, social cognition, self-esteem, self-stigma and paranoid thoughts. Treatment effects will be compared at pre-treatment (baseline), post-treatment and at 6-month follow-up. DISCUSSION If VR-SOAP proves to be effective, it provides therapists with a much-needed tool to improve social functioning of young adults with a psychotic disorder. Additionally, since the treatment consists of multiple modules targeting different transdiagnostic factors, this trial might provide input for new treatments to improve social functioning in a range of symptoms and disorders, e.g. mood, autism spectrum and anxiety disorders. TRIAL REGISTRATION On the 10th of November 2021, this trial was registered prospectively in the Dutch Trial Register as NL9784 .
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Affiliation(s)
- Ivo Alexander Meins
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands.
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands.
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands.
| | | | - Saskia Anne Nijman
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands
| | | | - Wim Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Gerdina Hendrika Maria Pijnenborg
- Department of Clinical and Developmental Neuropsychology, University of Groningen, Groningen, Netherlands
- GGZ Drenthe, Langdurige Zorg, Assen, Netherlands
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Tashjian SM, Wise T, Mobbs D. Model-based prioritization for acquiring protection. PLoS Comput Biol 2022; 18:e1010805. [PMID: 36534704 PMCID: PMC9810162 DOI: 10.1371/journal.pcbi.1010805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 01/03/2023] [Accepted: 12/09/2022] [Indexed: 12/23/2022] Open
Abstract
Protection often involves the capacity to prospectively plan the actions needed to mitigate harm. The computational architecture of decisions involving protection remains unclear, as well as whether these decisions differ from other beneficial prospective actions such as reward acquisition. Here we compare protection acquisition to reward acquisition and punishment avoidance to examine overlapping and distinct features across the three action types. Protection acquisition is positively valenced similar to reward. For both protection and reward, the more the actor gains, the more benefit. However, reward and protection occur in different contexts, with protection existing in aversive contexts. Punishment avoidance also occurs in aversive contexts, but differs from protection because punishment is negatively valenced and motivates avoidance. Across three independent studies (Total N = 600) we applied computational modeling to examine model-based reinforcement learning for protection, reward, and punishment in humans. Decisions motivated by acquiring protection evoked a higher degree of model-based control than acquiring reward or avoiding punishment, with no significant differences in learning rate. The context-valence asymmetry characteristic of protection increased deployment of flexible decision strategies, suggesting model-based control depends on the context in which outcomes are encountered as well as the valence of the outcome.
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Affiliation(s)
- Sarah M. Tashjian
- Humanities and Social Sciences, California Institute of Technology, Pasadena, California, United States of America
| | - Toby Wise
- Humanities and Social Sciences, California Institute of Technology, Pasadena, California, United States of America
- Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Dean Mobbs
- Humanities and Social Sciences, California Institute of Technology, Pasadena, California, United States of America
- Computation and Neural Systems, California Institute of Technology, Pasadena, California, United States of America
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Lazaridou FB, Schubert SJ, Ringeisen T, Kaminski J, Heinz A, Kluge U. Racism and psychosis: an umbrella review and qualitative analysis of the mental health consequences of racism. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01468-8. [PMID: 36001139 PMCID: PMC9400567 DOI: 10.1007/s00406-022-01468-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 08/02/2022] [Indexed: 11/30/2022]
Abstract
Black people and People of Color are disproportionately affected by racism and show increased rates of psychosis. To examine whether racialized migrant groups are particularly exposed to racism and therefore have higher risks for psychosis, this paper (1) systematically assesses rates of psychosis among racialized migrant groups concerning the country of origin, and (2) analyzes interviews regarding the association of racism experiences with psychosis-related symptoms in racialized Black people and People of Color populations in Germany. We present an umbrella review of meta-analyses that report the incidence of positive symptoms (e.g., hallucinations and delusions) and negative symptoms (e.g., apathy and incoherent speech) of diagnosed schizophrenia, other non-affective psychotic disorders (e.g., schizoaffective disorder) or first-episode psychosis among migrants by country of origin. We also report 20 interviews with first- and second-generation migrants racialized as Black and of Color in Germany to capture and classify their experiences of racism as well as racism-associated mental health challenges. In the umbrella review, psychosis risk was greatest when migration occurred from developing countries. Effect size estimates were even larger among Caribbean and African migrants. In the qualitative study, the application of the constant comparative method yielded four subordinate themes that form a subclinical psychosis symptomatology profile related to experiences of racism: (1) a sense of differentness, (2) negative self-awareness, (3) paranoid ideation regarding general persecution, and (4) self-questioning and self-esteem instability. We here provide converging evidence from a quantitative and qualitative analysis that the risk of poor mental health and psychotic experiences is related to racism associated with minority status and migration.
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Affiliation(s)
- Felicia Boma Lazaridou
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany. .,National Discrimination and Racism Monitor, German Institute for Integration and Migration Research - DeZIM, Berlin, Germany. .,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany.
| | | | | | - Jakob Kaminski
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany ,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany ,Department of Psychiatry and Psychotherapy, Charité University Medicine, Alexianer St. Hedwig-Hospital, Berlin, Germany
| | - Ulrike Kluge
- Department of Psychiatry and Psychotherapy, Charité University Medicine, Campus Mitte, Berlin, Germany ,Department of Migration, Mental and Physical Health and Health Promotion, Berlin Institute of Integration and Migration Research (BIM), Humboldt University, Berlin, Germany
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Fett AKJ, Hanssen E, Eemers M, Peters E, Shergill SS. Social isolation and psychosis: an investigation of social interactions and paranoia in daily life. Eur Arch Psychiatry Clin Neurosci 2022; 272:119-127. [PMID: 34129115 PMCID: PMC8803722 DOI: 10.1007/s00406-021-01278-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 06/01/2021] [Indexed: 01/01/2023]
Abstract
Social isolation has been suggested to foster paranoia. Here we investigate whether social company (i.e., being alone vs. not) and its nature (i.e., stranger/distant vs. familiar other) affects paranoia differently depending on psychosis risk. Social interactions and paranoid thinking in daily life were investigated in 29 patients with clinically stable non-affective psychotic disorders, 20 first-degree relatives, and 26 controls (n = 75), using the experience sampling method (ESM). ESM was completed up to ten times daily for 1 week. Patients experienced marginally greater paranoia than relatives [b = 0.47, p = 0.08, 95% CI (- 0.06, 1.0)] and significantly greater paranoia than controls [b = 0.55, p = 0.03, 95% CI (0.5, 1.0)], but controls and relatives did not differ [b = 0.07, p = 0.78, 95% CI (- 0.47, 0.61)]. Patients were more often alone [68.5% vs. 44.8% and 56.2%, respectively, p = 0.057] and experienced greater paranoia when alone than when in company [b = 0.11, p = 0.016, 95% CI (0.02, 0.19)]. In relatives this was reversed [b = - 0.17, p < 0.001, 95% CI (- 0.28, - 0.07)] and in controls non-significant [b = - 0.02, p = 0.67, 95% CI (- 0.09, 0.06)]. The time-lagged association between being in social company and subsequent paranoia was non-significant and paranoia did not predict the likelihood of being in social company over time (both p's = 0.68). All groups experienced greater paranoia in company of strangers/distant others than familiar others [X2(2) = 4.56, p = 0.03] and being with familiar others was associated with lower paranoia over time [X2(2) = 4.9, p = 0.03]. Patients are frequently alone. Importantly, social company appears to limit their paranoia, particularly when being with familiar people. The findings stress the importance of interventions that foster social engagement and ties with family and friends.
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Affiliation(s)
- Anne-Kathrin J Fett
- Department of Psychology, City, University of London, London, ECIV 0HB, UK.
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK.
- Department of Developmental and Clinical Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 1s, 1081 BT, Amsterdam, The Netherlands.
| | - Esther Hanssen
- Department of Developmental and Clinical Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 1s, 1081 BT, Amsterdam, The Netherlands
| | - Marlie Eemers
- Department of Developmental and Clinical Psychology, Faculty of Behavioural and Movement Sciences, VU Amsterdam, Van der Boechorststraat 1s, 1081 BT, Amsterdam, The Netherlands
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Sukhi S Shergill
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology and Neuroscience, De Crespigny Park, London, SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
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Bennetts A. How does yoga practice and therapy yield psychological benefits? A review and model of transdiagnostic processes. Complement Ther Clin Pract 2021; 46:101514. [PMID: 34837807 DOI: 10.1016/j.ctcp.2021.101514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Revised: 10/12/2021] [Accepted: 11/14/2021] [Indexed: 11/03/2022]
Abstract
Interest in yoga as an intervention for psychological wellbeing has increased in recent years, with literature investigating beneficial effects in a variety of presentations and settings. The theoretical understanding of this benefit has previously focused on physiological changes involved in yoga practice, however interest has turned to the potential psychological mechanisms eliciting psychological wellbeing. The current paper builds on previous theory and argues that yoga practice targets transdiagnostic psychological processes; mechanisms that feature commonly across a wide range of presentations, thus reducing distress and increasing wellbeing across clinical and non-clinical populations. Features of yoga practice are discussed in relation to these transdiagnostic processes and the features of modern talking therapies. A new model is proposed positing specific aspects of yoga practice correlate with specific transdiagnostic processes to elicit psychological change and argues that the mechanisms by which change occurs are directly compared with the changes observed in talking therapies. The implications for future research and the potential for this to support the commissioning of holistic approaches in clinical practice are discussed.
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Affiliation(s)
- Alison Bennetts
- School of Psychology, The University of Southampton, Southampton, England, SO17 1BJ, UK.
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Poupart F, Bouscail M, Sturm G, Bensoussan A, Galliot G, Gozé T. Acting on delusion and delusional inconsequentiality: A review. Compr Psychiatry 2021; 106:152230. [PMID: 33581447 DOI: 10.1016/j.comppsych.2021.152230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/01/2021] [Accepted: 01/30/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Two of Europe's most influential psychopathologists at the start of the twentieth century (Eugen Bleuler and Karl Jaspers) pointed out the fact that patients rarely act according to their delusions. This study proposes an investigation of how this issue is addressed in psychopathological literature. METHODS This article offers a critical review of psychopathological literature which focuses on the influence of delusional ideation on behaviour. RESULTS Phenomenological psychiatry has relied on the paradox pointed out by Bleuler and Jaspers to emphasize disorders of self-experience in psychosis whereas analytical philosophy of delusion has focused on the psychological status of delusion, regarded as belief, certainty, or imagination. The empirical studies conducted during the past three decades - which were devoted to acting on delusion - focused on violent and safety-seeking behaviours. These studies have shown that these behavioural disorders are motivated by an emotional outburst (anger and/or fear) rather than by delusional content. CONCLUSION Delusional inconsequentiality can be clarified by conceptual research in phenomenological psychiatry and analytical philosophy, even though its role in the psychopathological processes has not yet been clearly identified or conceptualised. Empirical psychopathology on acting on delusion confirms the delusional inconsequentiality, but only implicitly, by highlighting the role of affectivity (rather than beliefs) in delusional actions. Given the major implications of better understanding this phenomenon, in terms of psychopathology and clinical practices, we suggest considering delusional inconsequentiality as a promising concept which could guide further research in contemporary psychopathology.
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Affiliation(s)
- Florent Poupart
- Psychopathological and Intercultural Clinics Laboratory (LCPI, EA 4591), Toulouse University, France; Department of Psychiatry, Psychotherapy and Art-Therapy, Toulouse University Hospital, France.
| | - Manon Bouscail
- Psychopathological and Intercultural Clinics Laboratory (LCPI, EA 4591), Toulouse University, France; Toulouse Psychiatric Hospital Gérard Marchant, Toulouse, France
| | - Gesine Sturm
- Psychopathological and Intercultural Clinics Laboratory (LCPI, EA 4591), Toulouse University, France; Department of Child and Adolescent Psychiatry (SUPEA), Toulouse University Hospital, France
| | - Adrien Bensoussan
- Psychopathological and Intercultural Clinics Laboratory (LCPI, EA 4591), Toulouse University, France
| | - Gaël Galliot
- Psychopathological and Intercultural Clinics Laboratory (LCPI, EA 4591), Toulouse University, France; Department of Psychiatry, Psychotherapy and Art-Therapy, Toulouse University Hospital, France
| | - Tudi Gozé
- Department of Psychiatry, Psychotherapy and Art-Therapy, Toulouse University Hospital, France; Philosophical Rationalities and Knowledges Laboratory (ERRAPHIS, EA 3051), Toulouse University, France
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The Infinity Formulation: how transdiagnostic behaviours and endeavours for behavioural change serve to maintain co-morbid mental health presentations. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Treatment recommendations for mental health are often founded on diagnosis-specific models; however, there are high rates of co-morbidity of mental health presentations and growing recognition of the presence of ‘transdiagnostic processes’ (cognitive, emotional or behavioural features) seen across a range of mental health presentations. This model proposes a novel conceptualisation of how transdiagnostic behaviours may maintain co-morbid mental health presentations by acting as a trigger event for the cognitive biases specific to each presentation. Drawing on existing evidence, psychological theory and the author’s clinical experience, the model organises complex presentations in a theory-driven yet accessible manner for use in clinical practice. The model offers both theoretical and clinical implications for the treatment of mental health presentations using cognitive behavioural approaches, positing that transdiagnostic behaviours be the primary treatment target in co-morbid presentations.
Key learning aims
(1)
To understand the strengths and limitations of existing transdiagnostic CBT formulation models.
(2)
To learn about a novel, transdiagnostic and behaviourally focused formulation for use in clinical practice.
(3)
To understand how to use the tool in clinical practice and future research.
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Penzenstadler L, Chatton A, Lecomte T, Huguelet P, Lecardeur L, Azoulay S, Bartolomei J, Brazo P, Murys E, Poupart F, Rouvière S, Parabiaghi A, Saoud M, Favrod J, Khazaal Y. Does the Beck Cognitive Insight Scale predict change in delusional beliefs? Psychol Psychother 2020; 93:690-704. [PMID: 31583824 DOI: 10.1111/papt.12253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 08/31/2019] [Accepted: 09/09/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The Beck Cognitive Insight Scale (BCIS) is composed of two subscales, self-reflectiveness and self-certainty, assessing reflectiveness and openness to feedback, and mental flexibility. Delusions have previously been associated with low cognitive insight. The aim of this study was to determine whether changes in BCIS scores predict changes in delusional beliefs. METHODS The study is a secondary analysis of a previously published randomized controlled trial. All participants had a psychotic disorder diagnosis and received treatment as usual, with half of them also receiving the cognitive restructuring intervention 'Michael's game'. Participants were assessed at three different times: at baseline (T1), at 3 months (T2), and at 9 months (T3). Cognitive insight was measured with the BCIS, belief flexibility with the Maudsley assessment of delusions schedule (MADS), and psychotic symptoms with the Brief Psychiatric Rating Scale (BPRS). RESULTS A total of 172 participants took part in the trial. After using generalized estimating equation (GEE) modelling, we observed (1) significant main effects of BCIS self-certainty and Time and (2) significant Time × BCIS self-certainty and Time × treatment group interaction effects on belief flexibility. Improvements in self-certainty (i.e., decrease in scores) were associated with more changes in conviction over time, more accommodation, improved ability in ignoring or rejecting a hypothetical contradiction and increased use of verification of facts. Medication and BPRS total scores were controlled for in the GEE analyses at their baseline values. CONCLUSIONS Overall improvement in BCIS self-certainty scores over time predicted better treatment outcomes as assessed with MADS items. PRACTITIONER POINTS Treatments for patients with psychosis should focus on improving cognitive insight as this seems to improve overall treatment outcomes and recovery. The Beck Cognitive Insight Scale can be used to measure changes during treatment and can predict treatment outcomes.
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Affiliation(s)
| | - Anne Chatton
- Hôpitaux Universitaires Genève, Switzerland.,Faculty of Medicine, Geneva University, Switzerland
| | - Tania Lecomte
- Department of Psychology, University of Montreal, Quebec, Canada
| | - Philippe Huguelet
- Hôpitaux Universitaires Genève, Switzerland.,Faculty of Medicine, Geneva University, Switzerland
| | - Laurent Lecardeur
- Normandie Univ, UNICAEN, Imagerie et Strategies Therapeutiques de la schizophrenie (ISTS), EA4766, Caen, France
| | - Silke Azoulay
- Soins Psychiatriques Ambulatoires, Bienne, Switzerland
| | | | - Perrine Brazo
- Normandie Univ, UNICAEN, CHU de Caen Normandie, Service de Psychiatrie d'adultes, Centre Esquirol, Caen, France.,Normandie Univ, UNICAEN, Imagerie et Stratégies Thérapeutiques de la Schizophrénie (ISTS), EA:7466, Caen, France
| | - Elodie Murys
- Unité Mobile de Psychiatrie, Centre Hospitalier Princess Grace, Monaco, Monaco
| | - Florent Poupart
- Laboratoire Clinique Psychopathologique et Interculturelle, Université de Toulouse, France.,Centre Hospitalo-Universitaire de Toulouse, France
| | | | | | - Mohamed Saoud
- PsyR², INSERM U1028, CNRS UMR5292, PSYR2 Team, Lyon Neuroscience Research Center, France Department of Consultation-Liaison Psychiatry, Université Claude Bernard Lyon 1, France
| | - Jérôme Favrod
- La Source, School of Nursing Sciences, HES-SO University of Applied Sciences and Arts of Western Switzerland, Lausanne, Switzerland
| | - Yasser Khazaal
- Addiction Medicine, Department of Psychiatry, Lausanne University Hospitals, Switzerland.,Research Center, Montreal University Institute of Mental Health, Quebec, Canada
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Baumann PS, Söderström O, Abrahamyan Empson L, Söderström D, Codeluppi Z, Golay P, Birchwood M, Conus P. Urban remediation: a new recovery-oriented strategy to manage urban stress after first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:273-283. [PMID: 31667561 DOI: 10.1007/s00127-019-01795-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/09/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Urban living is a major risk factor for psychosis. Considering worldwide increasing rates of urbanization, new approaches are needed to enhance patients' wellbeing in cities. Recent data suggest that once psychosis has emerged, patients struggle to adapt to urban milieu and that they lose access to city centers, which contributes to isolation and reduced social contacts. While it is acknowledged that there are promising initiatives to improve mental health in cities, concrete therapeutic strategies to help patients with psychosis to better handle urban stress are lacking. We believe that we should no longer wait to develop and test new therapeutic approaches. METHOD In this review, we first focus on the role of urban planning, policies, and design, and second on possible novel therapeutic strategies at the individual level. We review how patients with psychosis may experience stress in the urban environment. We then review and describe a set of possible strategies, which could be proposed to patients with the first-episode psychosis. RESULTS We propose to group these strategies under the umbrella term of 'urban remediation' and discuss how this novel approach could help patients to recover from their first psychotic episode. CONCLUSION The concepts developed in this paper are speculative and a lot of work remains to be done before it can be usefully proposed to patients. However, considering the high prevalence of social withdrawal and its detrimental impact on the recovery process, we strongly believe that researchers should invest this new domain to help patients regain access to city centers.
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Affiliation(s)
- Philipp S Baumann
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland. .,Center for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.
| | - Ola Söderström
- Institute of Geography, University of Neuchâtel, Espace Louis-Agassiz, 2000, Neuchâtel, Switzerland
| | - Lilith Abrahamyan Empson
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland
| | | | - Zoe Codeluppi
- Institute of Geography, University of Neuchâtel, Espace Louis-Agassiz, 2000, Neuchâtel, Switzerland
| | - Philippe Golay
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Philippe Conus
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland
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15
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Reconceptualising Exposure and Some Implications for Cognitive-Behavioural and Psychodynamic Practice. BEHAVIOUR CHANGE 2019. [DOI: 10.1017/bec.2019.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractThe concept of exposure is ubiquitous in the research and practice of clinical psychology, most notably in cognitive-behavioural models. Yet there remains confusion and ambiguity around how exposure in ‘exposure therapy’ is characterised. Current definitions are found to be inadequate, as each identifies certain features of the exposure process but omits others. As such, an elaborated model of exposure is presented, referred to here as the re-exposure-extinction learning process. This process involves a complex causal situation consisting of clinical features (the cause/causes, C), acting upon a person (the field, F), to bring about re-exposure to anxiety-provoking stimuli and then extinction learning, leading, over time, to therapeutic change (the effect/effects, E). Importantly, re-exposure and extinction learning are two processes distinct from the therapeutic procedures (i.e., techniques and methods) used to bring them about. Furthermore, these processes are not inherently tied to a particular model of therapy or clinical intervention. They are, therefore, logically independent of the procedures used to facilitate them. Considering this reconceptualisation, we propose that working in the transference, a cornerstone of psychodynamic psychotherapy, can be understood as a complementary and effective method of facilitating the re-exposure-extinction learning process. We argue that this is achieved through enabling a person to repeatedly re-evaluate their fearful expectations as they manifest in the unfolding dynamics of the therapeutic relationship. Finally, some clinical implications indicated by this elaborated model are explored.
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Mankiewicz PD. Cognitive Restructuring and Graded Behavioral Exposure for Persecutory Paranoia and Agoraphobic Anxiety in Complex Psychosis. Clin Case Stud 2019. [DOI: 10.1177/1534650119826713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive behavioral models of psychosis assert the notion of cognitive mediation, in which threat-oriented subjective misinterpretations of anomalous experiences lead to increased levels of emotional distress. Thus, paranoid appraisals of auditory hallucinations often result in hypervigilance and associated anxiety. The prevalence of diagnostic comorbidity between psychosis and anxiety disorders has been shown to be considerable. Among the evidence-based psychological treatments for complex mental ill-health, Cognitive Behavioral Therapy for psychosis (CBTp) has been supported with particularly promising research outcomes. Yet, despite such encouraging empirical data, the treatment provision often remains insufficient, predominantly among individuals with more acute presentations. Likewise, literature demonstrating the actual utilization of CBTp with complex psychoses appears above all relevant to the daily clinical practice in the specialism of severe mental ill-health. This methodologically rigorous case study describes a successful implementation of CBTp undertaken with a socially withdrawn individual diagnosed with paranoid schizophrenia and comorbid agoraphobic anxiety disorder. The intervention focused on cognitive restructuring of paranoid appraisals of voices and graded behavioral exposure to anxiety-inducing stimuli. Standardized measurement, behavior frequency sampling, and subjective data were utilized to evaluate the outcomes, indicating a considerable reduction in both paranoia and associated anxiety, and an overall improvement in the client’s behavioral and interpersonal functioning. The article highlights the importance of direct intellectual engagement with the content of paranoia, alongside methodically facilitated graded behavioral exposure and response prevention in the treatment of severe, socially debilitating psychoses with comorbid mood disorders.
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Westermann S, Gantenbein V, Caspar F, Cavelti M. Maintaining Delusional Beliefs to Satisfy and Protect Psychological Needs. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000337] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Abstract. Affiliation, control, and self-esteem are psychological needs that human beings attempt to satisfy and protect ( Epstein, 2003 ; Grawe, 2004 ). From a motivational perspective, behaviors, attentional and cognitive biases as well as symptoms can have an instrumental function for need satisfaction and protection ( Caspar, 2011 ). In this opinion paper, we elaborate the idea that the maintenance of delusions could be a motivated process. This approach helps to view the maintenance of delusional beliefs as a purposeful, yet mostly nonconscious, and not completely adaptive attempt to satisfy and protect psychological needs. Conclusions for case formulations, therapy planning, and therapeutic relationship building are drawn within the framework of cognitive-behavioral therapy for psychosis. In addition, limitations of the approach and future research avenues are discussed.
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Affiliation(s)
- Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
| | - Vivien Gantenbein
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
| | - Franz Caspar
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Switzerland
| | - Marialuisa Cavelti
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland
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