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Liao W, Luo X, Kong F, Sun Y, Ye Z. Association between non-restorative sleep and psychotic-like experiences among Chinese college students: A latent profile and moderated mediation analysis. Schizophr Res 2024; 270:295-303. [PMID: 38944976 DOI: 10.1016/j.schres.2024.06.038] [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: 04/22/2023] [Revised: 04/07/2024] [Accepted: 06/22/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Non-restorative sleep (NRS) is a core symptom of insomnia that has considerable consequences for daily life. However, the association between NRS and psychotic-like experiences (PLEs) remains unclear. The current study was designed to explore the relationship between NRS and PLEs as well as the mediation/moderation role of rumination and resilience among college students in China. METHODS 3060 college students were recruited from two universities in South China from September 21st to October 26th, 2022. Non-restorative Sleep Scale, 8-item Positive Subscale of the Community Assessment of Psychic Experiences, Ruminative Response Scale, and 10-item Connor-Davidson Resilience Scale were administered. Latent profile analysis and moderated mediation analysis were performed. RESULTS 11.3 % participants reported frequent PLEs in the past one month. Three profiles of rumination were identified and named as "low rumination" group (27.7 %), "medium rumination" group (55.3 %), and "high rumination" group (16.9 %). NRS directly predicted PLEs, and rumination played a significant mediation role between NRS and PLEs. Resilience significantly moderated the association between NRS and rumination as well as the association between NRS and PLEs. CONCLUSIONS NRS, rumination and resilience are important predictors to PLEs. Strategies on increasing restorative sleep, decreasing rumination, and enhancing resilience are of great significance in the prevention of PLEs.
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Affiliation(s)
- Wenna Liao
- Department of Public Teaching, Guangdong Open University, Guangzhou, China
| | - Xianghan Luo
- School of Nursing, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Fanxu Kong
- Department of Public Teaching, Guangdong Open University, Guangzhou, China
| | - Yongpeng Sun
- Department of Public Teaching, Guangdong Open University, Guangzhou, China
| | - Zengjie Ye
- School of Nursing, Guangzhou Medical University, Guangzhou, China.
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Paquin V, Ackerman RA, Depp CA, Moore RC, Harvey PD, Pinkham AE. Media Use and Its Associations With Paranoia in Schizophrenia and Bipolar Disorder: Ecological Momentary Assessment. JMIR Ment Health 2024; 11:e59198. [PMID: 38967418 PMCID: PMC11238023 DOI: 10.2196/59198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/22/2024] [Accepted: 05/26/2024] [Indexed: 07/06/2024] Open
Abstract
Background Paranoia is a spectrum of fear-related experiences that spans diagnostic categories and is influenced by social and cognitive factors. The extent to which social media and other types of media use are associated with paranoia remains unclear. Objective We aimed to examine associations between media use and paranoia at the within- and between-person levels. Methods Participants were 409 individuals diagnosed with schizophrenia spectrum or bipolar disorder. Measures included sociodemographic and clinical characteristics at baseline, followed by ecological momentary assessments (EMAs) collected 3 times daily over 30 days. EMA evaluated paranoia and 5 types of media use: social media, television, music, reading or writing, and other internet or computer use. Generalized linear mixed models were used to examine paranoia as a function of each type of media use and vice versa at the within- and between-person levels. Results Of the 409 participants, the following subgroups reported at least 1 instance of media use: 261 (63.8%) for using social media, 385 (94.1%) for watching TV, 292 (71.4%) for listening to music, 191 (46.7%) for reading or writing, and 280 (68.5%) for other internet or computer use. Gender, ethnoracial groups, educational attainment, and diagnosis of schizophrenia versus bipolar disorder were differentially associated with the likelihood of media use. There was a within-person association between social media use and paranoia: using social media was associated with a subsequent decrease of 5.5% (fold-change 0.945, 95% CI 0.904-0.987) in paranoia. The reverse association, from paranoia to subsequent changes in social media use, was not statistically significant. Other types of media use were not significantly associated with paranoia. Conclusions This study shows that social media use was associated with a modest decrease in paranoia, perhaps reflecting the clinical benefits of social connection. However, structural disadvantage and individual factors may hamper the accessibility of media activities, and the mental health correlates of media use may further vary as a function of contents and contexts of use.
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Affiliation(s)
- Vincent Paquin
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Robert A Ackerman
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
| | - Colin A Depp
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Raeanne C Moore
- Department of Psychiatry, University of California San Diego, La Jolla, CA, United States
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miami, FL, United States
| | - Amy E Pinkham
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, Richardson, TX, United States
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McDonald H, Valmaggia L, Antonova E, Chadwick P. Taking the edge off: a feasibility randomized controlled trial of an online mindfulness-based intervention to reduce suspiciousness/paranoia in high positive schizotypy. Front Psychol 2024; 15:1380077. [PMID: 38962229 PMCID: PMC11221385 DOI: 10.3389/fpsyg.2024.1380077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/16/2024] [Indexed: 07/05/2024] Open
Abstract
Positive schizotypy can uniquely predict the development of psychosis with suspiciousness/paranoia having emerged as a key risk factor, pointing to significant worth in reducing this aspect in individuals with high positive schizotypy. Reduced paranoia in the general population following brief online mindfulness training has been previously reported. This study investigated the feasibility of a 40-day online mindfulness-based intervention (MBI) (n = 12) in the individuals with high positive schizotypy characterized by high suspiciousness/paranoia and to estimate its effect on paranoia as compared with an active control condition using reflective journaling (n = 12). The outcome measures were self-reported trait and VR-induced state paranoia, completed at baseline, after 10 days and post-intervention. The feasibility criteria included retention, adherence, engagement, and acceptability. There was 100% retention, excellent adherence to content and engagement, with an average MBI session completion rate of 91%. Acceptability, indexed by a self-rated motivation to continue practice post-intervention, was also high. No MBI effect on trait paranoia was observed; however, the MBI group showed a reduction in the VR-induced state paranoia with a medium-to-large effect (d = 0.63). The findings support conducting larger-scale randomized controlled trials to evaluate the effects of online MBIs on reducing suspiciousness/paranoia to mitigate psychosis risk in individuals with high positive schizotypy. Clinical Trial Registration:https://www.isrctn.com/, identifier ISRCTN78697391.
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Affiliation(s)
- Heather McDonald
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ORYGEN, Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Elena Antonova
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Paul Chadwick
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, Bath Centre for Mindfulness and Compassion, University of Bath, Bath, United Kingdom
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Raffard S, de Connor A, Freeman D, Bortolon C. [Recent developments in the modeling and psychological management of persecutory ideation]. L'ENCEPHALE 2024; 50:99-107. [PMID: 37748987 DOI: 10.1016/j.encep.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/05/2023] [Accepted: 08/05/2023] [Indexed: 09/27/2023]
Abstract
Persecutory ideas are a major clinical problem and are associated with impaired functioning, reduced compliance with medication and increased risk of hospitalization. Persecutory ideation is defined as the false conviction that others are threatening or conspiring against one. Although persecutory delusions are mainly described and experienced in schizophrenia spectrum disorders, they also occur in other neurological and psychiatric diagnoses including Alzheimer disease, epilepsy, depression, mania, dementia and post-traumatic stress disorder. Moreover, epidemiological data from general and clinical populations indicated that paranoid beliefs occur on a hierarchy of severity and are present to a lesser degree in the general population, with paranoid delusions representing the severe end of a continuum. In this review we focus on the important advances following a decade of research from psychological sciences, and more particularly the work of Daniel Freeman and Philippa Garety in England. Their work has demonstrated that a range of causal factors are involved in the development and maintenance of delusions beyond the traditional cognitive and behavioural models. Indeed, there is now well-validated evidence that sleep disturbances, worry proneness, reasoning biases, such as failure to consider alternative explanations or belief confirmation bias, abnormal experiences such as hallucinations, negative self-beliefs, and safety behaviours, are central factors that contribute to the paranoid phenomenon. In this review, we describe each of these causal factors in detail as well as the clinical interventions developed by Freeman and his collaborators, including the integrative and modular "Feeling Safe" intervention. Broadly speaking, the aim of this psychological intervention is for patients to relearn safety by exposing them to situations they consider as potentially dangerous after reduction of the influence of the maintenance factors described above. A recent publication showed that the Feeling Safe program led to recovery in persecutory delusions for 50% of patients having poor response to antipsychotic medication, making the intervention as the most effective psychological treatment for persecutory delusions. Finally, we will critically discuss the efficacy data from the numerous clinical studies validating its effectiveness. Prospects for the implementation of the Feeling Safe program in France also is discussed.
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Affiliation(s)
- Stéphane Raffard
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France; Laboratoire Epsylon, EA 4556, université Paul-Valéry-Montpellier, 3, route de Mende, 34199 Montpellier cedex 5, France.
| | - Alexandre de Connor
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, Royaume-Uni; Oxford Health NHS Foundation Trust, Oxford, Royaume-Uni; NIHR Oxford Health Biomedical Research Centre, Oxford, Royaume-Uni
| | - Catherine Bortolon
- Départment de psychologie, université de Grenoble-Alpes, université Savoie-Mont-Blanc, LIP/PC2S, Grenoble, France; Département de psychologie, institut universitaire de France, Paris, France
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Ellett L, Varese F, Owens J, Rafiq S, Penn G, Berry K. Experimental studies of paranoid thinking in clinical and nonclinical populations: a systematic review and meta-analysis. Psychol Med 2023; 53:5933-5944. [PMID: 37427557 PMCID: PMC10520588 DOI: 10.1017/s0033291723001708] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/10/2023] [Accepted: 05/24/2023] [Indexed: 07/11/2023]
Abstract
Paranoia is common in clinical and nonclinical populations, consistent with continuum models of psychosis. A number of experimental studies have been conducted that attempt to induce, manipulate or measure paranoid thinking in both clinical and nonclinical populations, which is important to understand causal mechanisms and advance psychological interventions. Our aim was to conduct a systematic review and meta-analysis of experimental studies (non-sleep, non-drug paradigms) on psychometrically assessed paranoia in clinical and nonclinical populations. The review was conducted using PRISMA guidelines. Six databases (PsycINFO, PubMed, EMBASE, Web of Science, Medline and AMED) were searched for peer-reviewed experimental studies using within and between-subject designs to investigate paranoia in clinical and nonclinical populations. Effect sizes for each study were calculated using Hedge's g and were integrated using a random effect meta-analysis model. Thirty studies were included in the review (total n = 3898), which used 13 experimental paradigms to induce paranoia; 10 studies set out to explicitly induce paranoia, and 20 studies induced a range of other states. Effect sizes for individual studies ranged from 0.03 to 1.55. Meta-analysis found a significant summary effect of 0.51 [95% confidence interval 0.37-0.66, p < 0.001], indicating a medium effect of experimental paradigms on paranoia. Paranoia can be induced and investigated using a wide range of experimental paradigms, which can inform decision-making about which paradigms to use in future studies, and is consistent with cognitive, continuum and evolutionary models of paranoia.
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Affiliation(s)
- Lyn Ellett
- School of Psychology, University of Southampton, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Jane Owens
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
- NHS Lothian, Edinburgh, UK
| | - Sonya Rafiq
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Georgia Penn
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, UK
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Bortolon C, Baeyens C, Raffard S. Hooked on a memory: How rumination about past positive events might contribute to grandiose ideas? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:556-572. [PMID: 37089072 DOI: 10.1111/bjc.12425] [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: 10/28/2022] [Revised: 03/03/2023] [Accepted: 04/05/2023] [Indexed: 04/25/2023]
Abstract
OBJECTIVES Dwelling about positive experiences has been found to be positively related to mania and grandiose ideas. Nevertheless, besides some important limitations, past research has also neglected the nature (or characteristics) of memories individuals dwell on, and that might be specifically associated with grandiose ideas. Thus, the present study aimed to replicate previous studies while considering the role of specificity and the importance of memory used to increase grandiose feelings. METHOD In total, 219 participants were included and, after completing the memory induction, were randomized to either the rumination condition or the distraction condition. They also completed different questionnaires assessing positive rumination and grandiose ideas. RESULTS Overall, rumination, compared to the distraction condition, led to the maintenance of grandiose ideas and positive affect from T2 to T3. Regression analysis showed that the specificity of memory was associated with grandiose ideas at T2, which predicted grandiose ideas at T3. CONCLUSIONS Our results confirm rumination's causal role in forming grandiose ideas. We also found that autobiographical memory and, more specifically, the capacity to recall past positive experiences coupled with repeatedly thinking about them might constitute a fundamental pathway leading to the persistence of such beliefs. The use of a non-clinical sample limits the results and needs replication in clinical samples.
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Affiliation(s)
- Catherine Bortolon
- Université Grenoble Alpes, Université Savoie Mont Blanc, LIP/PC2S, Grenoble, France
- C3R - Réhabilitation Psychosociale et Remédiation Cognitive, Centre Hospitalier Alpes Isère, Grenoble, France
- Institut Universitaire de France (IUF), Paris, France
| | - Céline Baeyens
- Université Grenoble Alpes, Université Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Stéphane Raffard
- Université Paul Valéry Montpellier 3, Montpellier, France
- University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France
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Zagaria A, Ballesio A, Vacca M, Lombardo C. Repetitive Negative Thinking as a Central Node Between Psychopathological Domains: a Network Analysis. Int J Cogn Ther 2023. [DOI: 10.1007/s41811-023-00162-4] [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: 04/03/2023]
Abstract
AbstractRepetitive negative thinking (RNT) may be defined as a reiterative, passive and uncontrollable thinking process. RNT has been recognized as a transdiagnostic phenomenon associated with the onset and maintenance of several clinical conditions including depression, generalised anxiety, psychosis and insomnia. We aimed to estimate a network model of mutual associations between RNT and the aforementioned indicators whilst controlling for other well-established transdiagnostic factors (i.e. perceived stress, loneliness). A total of 324 participants (Mage = 25.26 years, SD = 6.89; 69.3% females) completed a cross-sectional survey of self-report questionnaires. A Gaussian graphical model was estimated using the graphical LASSO in combination with the extended Bayesian information criterion. We found a dense network in which RNT exhibited substantial connections with the majority of the psychopathological domains. The centrality indices confirmed that RNT was one of the most important nodes in the network. Moreover, the estimated network showed satisfactory accuracy and stability. Findings emphasized RNT as a potentially good therapeutic target for psychopathology prevention and treatment protocols.
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Rigoli F, Martinelli C, Pezzulo G. I want to believe: delusion, motivated reasoning, and Bayesian decision theory. Cogn Neuropsychiatry 2021; 26:408-420. [PMID: 34558392 DOI: 10.1080/13546805.2021.1982686] [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] [Indexed: 10/20/2022]
Abstract
Introduction: Several arguments suggest that motivated reasoning (occurring when beliefs are not solely shaped by accuracy, but also by other motives such as promoting self-esteem or self-protection) is important in delusions. However, classical theories of delusion disregard the role of motivated reasoning. Thus, this role remains poorly understood.Methods: To explore the role of motivated reasoning in delusions, here we propose a computational model of delusion based on a Bayesian decision framework. This proposes that beliefs are not only evaluated based on their accuracy (as in classical theories), but also based on the cost (in terms of reward and punishment) of rejecting them.Results: The model proposes that, when the values at stake are high (as often it is the case in the context of delusion), a belief might be endorsed because rejecting it is evaluated as too costly, even if the belief is less accurate. This process might contribute to the genesis of delusions.Conclusions: Our account offers an interpretation of how motivated reasoning might shape delusions. This can inspire research on the affective and motivational processes supporting delusions in clinical conditions such as in psychosis, neurological disorders, and delusional disorder.
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Affiliation(s)
- Francesco Rigoli
- Department of Psychology, City, University of London, Northampton Square, London, UK
| | - Cristina Martinelli
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Department of Psychology, Kingston University, Surrey, UK
| | - Giovanni Pezzulo
- Institute of Cognitive Sciences and Technologies, National Research Council of Italy, Rome, Italy
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Bahlinger K, Lincoln TM, Clamor A. Are Acute Increases and Variability in Emotion Regulation Strategies Related to Negative Affect and Paranoid Thoughts in Daily Life? COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10253-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Abstract
Background
Negative affect reliably predicts paranoid thoughts. Previous studies point to the importance of emotion regulation for paranoid thoughts but have not yet focused on effects of acute increases and variability in strategy use.
Methods
We conducted an experience-sampling study for one week in a subclinical sample. Acute increases in the intensity of strategy use from one measurement point until the next, between-strategy variability (i.e., standard deviation between all strategies at one measurement point), and within-strategy variability (i.e., standard deviation of each strategy over one day) were analyzed for effects on negative affect and paranoid thoughts.
Results
Multi-level-models indicated that acute increases in acceptance and reappraisal are associated with less negative affect. Acute increases in acceptance, but not in reappraisal, were related to less paranoid thoughts. In contrast, acute increases in rumination and suppression were associated with more negative affect and paranoid thoughts. Between- and within-strategy variability were no significant predictors.
Conclusions
Acute increases in the intensity of but not variability in emotion regulation strategies are related to negative affect and paranoid thoughts in daily life. Future studies are needed to examine whether improving emotion regulation leads to sustainable reductions in symptoms.
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Pondering on how great I am: Does rumination play a role in grandiose ideas? J Behav Ther Exp Psychiatry 2021; 70:101596. [PMID: 32841922 DOI: 10.1016/j.jbtep.2020.101596] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND & OBJECTIVES A recent psychological model proposed that rumination might be involved in grandiose delusions (GD) by amplifying positive mood triggered by the occurrence of a positive event or the recall of positive autobiographical memories. This is the first study whose aim is to explore the role of rumination in the development and maintenance of grandiose ideas in a nonclinical sample. METHODS Following a grandiose ideas induction task, 109 nonclinical participants completed a rumination and distraction condition. Participants also completed a questionnaire designed to measure GD. RESULTS Rumination induction was associated with maintained levels of grandiose ideas and positive affect, while distraction led to reduced levels of grandiose ideas. Our findings showed that grandiose ideas after the rumination condition, but not after the distraction condition, was associated with trait grandiosity. LIMITATIONS This study needs to be replicated in clinical samples. CONCLUSIONS Our findings suggest that ruminative thinking style might play a role in the maintenance of grandiose ideas. Consequently, interventions targeting rumination might be useful when targeting grandiose delusions in clinical samples.
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Lebert L, Turkington D, Freeston M, Dudley R. Rumination, intolerance of uncertainty and paranoia in treatment resistant psychosis. PSYCHOSIS 2021. [DOI: 10.1080/17522439.2020.1798489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- L. Lebert
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - D. Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
| | - M. Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - R. Dudley
- School of Psychology, Newcastle University, Newcastle upon Tyne, UK
- Gateshead Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS, Newcastle upon Tyne, UK
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12
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Effects of antipsychotics on rumination in patients with first-episode psychosis. Prog Neuropsychopharmacol Biol Psychiatry 2020; 103:109983. [PMID: 32464239 DOI: 10.1016/j.pnpbp.2020.109983] [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: 04/06/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Rumination is a well-known risk factor for depression. It is also associated with negative and positive symptoms and suicidality in patients suffering from psychosis. However, no studies have addressed the effect of antipsychotics on rumination. METHODS Using the Brooding Scale (BS), we investigated the effect of antipsychotics on rumination at the 6-month follow up in patients with first-episode psychosis (n = 257). The relationship between rumination and other clinical variables was explored by conducting a correlation analysis and structural equation modeling (SEM). The clinical characteristics and short-term outcomes were compared between high and low ruminators at 6 months. RESULTS Significant reductions in rumination and various clinical variables were observed at the 6-month follow-up. A significant correlation was observed between rumination and the score on the positive subscale of the Positive and Negative Syndrome Scale (PANSS). A direct path between the PANSS score and rumination was identified by SEM. High ruminators had more severe psychopathology, experienced more childhood traumas, and took less exercise than low ruminators. The recovery rate at 6 months was higher in low ruminators than in high ruminators. CONCLUSIONS Our findings suggest that antipsychotics are beneficial for reducing rumination in patients with first-episode psychosis. The outcomes at the 6-month follow-up were better in low ruminators than high ruminators.
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Lüdtke T, Pfuhl G, Moritz S, Rüegg NL, Berger T, Westermann S. Sleep problems and worrying precede psychotic symptoms during an online intervention for psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:48-67. [PMID: 33305386 DOI: 10.1111/bjc.12270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Experience sampling assessments (multiple assessments per day for approximately one week) indicate that positive symptoms fluctuate over time in psychosis. Precursors, such as sleep problems or worrying, predict these fluctuations. To date, it remains unclear whether the same precursors predict symptom variability also during treatment in an online intervention for psychosis, using assessments lying temporally further apart. METHODS Participants completed brief intermediate online self-report assessments on their computers (up to every 7 days during a 2-month waiting period and up to twice every 6 days during a 2-month intervention period) within a randomized controlled trial. We monitored the course of paranoia, auditory verbal hallucinations, and their theory-driven precursors worrying, negative affect, self-esteem, self-reported cognitive biases, and quality of sleep in n = 124 participants (M = 10.32 assessments per participant; SD = 6.07). We tested group differences regarding the course of the composite of precursors, group differences regarding the effect of the composite on subsequent momentary psychotic symptoms, and the effect of each individual precursor on subsequent psychotic symptoms, using (lagged) linear mixed models. RESULTS The course composite precursors over time and their lagged effect on subsequent momentary psychotic symptoms did not differ between groups. During the intervention, increased worrying and decreased quality of sleep preceded heightened momentary psychotic symptoms. CONCLUSION The regression-based design does not allow drawing causal conclusions. However, worrying and sleep problems likely represent underlying mechanisms of psychotic symptom variability during online psychosis treatment, indicating that experience sampling findings from everyday life generalize to interventions with assessments lying several days apart. PRACTITIONER POINTS Worrying and sleep problems represent important mechanisms of symptom fluctuations during an online intervention for people with psychosis. Our findings further support the notion that worrying and sleep problems are important treatment targets in psychological interventions for people with psychosis. Momentary levels of worrying and quality of sleep can signal subsequent fluctuations of psychotic symptom severity so practitioners should monitor these variables during treatment. Worrying seems to predict subsequent paranoia specifically during treatment whereas quality of sleep predicts both paranoia and auditory verbal hallucinations.
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Affiliation(s)
- Thies Lüdtke
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Gerit Pfuhl
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Nina Lee Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stefan Westermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.,Department of Clinical Psychology and Psychotherapy, MSH Medical School Hamburg, Germany
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Cui Y, Piao Y, Kim SW, Lee BJ, Kim JJ, Yu JC, Lee KY, Won SH, Lee SH, Kim SH, Kang SH, Kim E, Kim N, Chung YC. Psychological factors intervening between childhood trauma and suicidality in first-episode psychosis. Psychiatry Res 2020; 293:113465. [PMID: 32980715 DOI: 10.1016/j.psychres.2020.113465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
Several studies have investigated childhood trauma (ChT) and suicidality in psychosis. However, psychological factors intervening between ChT and suicidality are not well understood. The aims of this study were to explore the roles of negative schema and rumination in the relationship between ChT and suicidality in first-episode psychosis (FEP). Participants were 306 patients with FEP who were enrolled in the Korean Early Psychosis Cohort Study, a prospective naturalistic observational cohort study. ChT, suicidality, negative schema, and rumination were evaluated using the Early Trauma Inventory Self Report-Short Form, Columbia Suicide Severity Rating Scale, Brief Core Schema Scale, and Brooding Scale. In addition, psychopathology and depression were evaluated. Structural equation model and a phantom approach were employed to analyze the pathway from ChT to suicidality. We found close associations between ChT, rumination, negative schema, and suicidality. Importantly, negative schema played a direct intervening role in the relationship between ChT and suicidality in patients with FEP. Our findings suggest that targeting negative schema in individuals with FEP exposed to ChT will be an effective strategy for reducing suicidality.
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Affiliation(s)
- Yin Cui
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, P R China
| | - YanHong Piao
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Bong Ju Lee
- Department of Psychiatry, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Jung Jin Kim
- Department of Psychiatry, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Je-Chun Yu
- Department of Psychiatry, Eulji University School of Medicine, Eulji University Hospital, Daejeon, Republic of Korea
| | - Kyu Young Lee
- Department of Psychiatry, Nowon Eulji Medical Center, Eulji University, Seoul, Republic of Korea
| | - Seung-Hee Won
- Department of Psychiatry, Kyungpook National University School of Medicine, Daegu, Republic of Korea
| | - Seung-Hwan Lee
- Department of Psychiatry, Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Seung-Hyun Kim
- Department of Psychiatry, Korea University College of Medicine, Guro Hospital, Seoul, Republic of Korea
| | - Shi Hyun Kang
- Department of Social Psychiatry and Rehabilitation, National Center for Mental Health, Seoul, Republic of Korea
| | - Euitae Kim
- Department of Psychiatry, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Namhee Kim
- Jeonnam Welfare Foundation, Gwangju, Republic of Korea
| | - Young-Chul Chung
- Department of Psychiatry, Jeonbuk National University Medical School, Jeonju, Republic of Korea; Research Institute of Clinical Medicine of Jeonbuk National University, Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju 561-756, Korea.
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15
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Clara DL, Frank L, Stéphane R, Etienne Q, Julien L. Exploration of the paranoia hierarchy in the general population: evidence of an age effect mediated by maladaptive emotion regulation strategies. Cogn Neuropsychiatry 2020; 25:387-403. [PMID: 33016249 DOI: 10.1080/13546805.2020.1824868] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Introduction: Positive psychotic symptoms are suggested to be more prevalent in early adulthood. However, no previous study has examined a potential age effect especially for paranoia considering social reference and persecution as separated hierarchical dimension. Moreover, no previous study has examined the mechanisms involved in the decrease of paranoia with age. This study aims to explore (1) the age effect on paranoia and (2) whether the age effect is mediated by maladaptive emotion regulation strategies (MERS). Methods: A sample of 1644 participants from the general population completed the Green et al., Paranoid Thoughts Scale with measures of MERS and was split into three age groups (18-29; 30-54; 55-82). Results: Age groups comparisons revealed a significant decrease of social reference with age but not of persecution. Mediation analyses indicated that this age effect was partially mediated by MERS. Additional analyses suggested that social reference moderated the relation between age and persecution. Conclusions: The present study showed that social reference and persecution are not equally affected by age and that MERS are important factors to consider when trying to understand the nature of paranoia. Finally, a younger age and the use of MERS are suggested to be risk factors for developing paranoia.
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Affiliation(s)
- Della Libera Clara
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Larøi Frank
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Norwegian Center for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Raffard Stéphane
- University Paul Valéry Montpellier 3 & University Department of Adult Psychiatry, Laboratory Epsylon, EA 4556, CHU Montpellier, Montpellier, France
| | - Quertemont Etienne
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Laloyaux Julien
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Norwegian Center for Mental Disorders Research, University of Oslo, Oslo, Norway
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16
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Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behav Res Ther 2020; 127:103573. [DOI: 10.1016/j.brat.2020.103573] [Citation(s) in RCA: 129] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 11/23/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022]
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17
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Ascone L, Schlier B, Sundag J, Lincoln TM. Pathways from insecure attachment dimensions to paranoia: The mediating role of hyperactivating emotion regulation versus blaming others. Psychol Psychother 2020; 93:72-87. [PMID: 30618099 DOI: 10.1111/papt.12208] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/13/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES There is evidence of associations between insecure attachment and paranoia, but we do not yet fully understand the mediating mechanisms. Attachment theory emphasizes differential relatedness of insecure attachment dimensions (i.e., anxiety vs. avoidance) with specific emotion regulation styles (ER). We tested whether the associations between attachment anxiety versus avoidance and paranoia were mediated specifically by hyperactivating (i.e., the use of emotion-amplifying strategies: self-blame, rumination, catastrophization) versus blaming others ER, respectively. In addition, we explored whether self-blame versus blaming others ER differentially mediated the associations between attachment anxiety versus avoidance and paranoia. METHOD We included 60 patients with psychosis and 40 healthy controls (HCs) with whom we conducted standardized diagnostic interviews. We assessed paranoia, attachment, and ER via questionnaires. A structural equation mediation model including attachment anxiety and avoidance (predictor), the ER styles (mediators), and paranoia (outcome) was calculated. RESULTS Compared with HCs, patients exhibited significantly more attachment anxiety and avoidance, and used more hyperactivating ER as well as strategies of blaming others. We found a significant indirect effect between attachment anxiety and paranoia via hyperactivating ER in patients with psychosis. However, no significant indirect effects involving blaming others or self-blame in any of the groups were found. CONCLUSIONS Our study provides a starting point for further investigation of how paranoid delusions in psychosis could emerge from insecure attachment via ER. This might inspire further research into attachment theories of ER in paranoia. In the long term, this could provide a basis to develop interpersonally oriented interventions for this target group. PRACTITIONER POINTS In individuals with psychosis, there appears to be an attachment-specific emotion regulation (ER) pathway from attachment anxiety via hyperactivating ER to paranoia. Blaming others did not explain the significant association between attachment avoidance and paranoia. Attachment-specific therapeutic approaches to paranoia, that focus on hyperactivating ER, could be a valid way to ameliorate paranoid delusions.
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Affiliation(s)
- Leonie Ascone
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität of Hamburg, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität of Hamburg, Germany
| | - Johanna Sundag
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität of Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität of Hamburg, Germany
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18
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Ludwig L, Mehl S, Schlier B, Krkovic K, Lincoln TM. Awareness and rumination moderate the affective pathway to paranoia in daily life. Schizophr Res 2020; 216:161-167. [PMID: 31892492 DOI: 10.1016/j.schres.2019.12.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/03/2019] [Accepted: 12/15/2019] [Indexed: 12/27/2022]
Abstract
Numerous cross-sectional studies found psychosis to be associated with less awareness of emotions, a decreased use of adaptive (e.g. reappraisal) and an increased use of maladaptive emotion regulation (ER) strategies (e.g. suppression). In this study, we tested whether state levels of emotion awareness and momentary use of specific ER strategies moderate the link between negative affect at one timepoint (t-1) and paranoia at the next timepoint (t) in a six-day experience sampling study. Individuals with psychotic disorders (n = 71) reported on the presence of paranoia, negative affect, emotion awareness and the use of six ER strategies (reappraisal, acceptance, social sharing, distraction, suppression and rumination) ten times per day. Multilevel regression analysis revealed that higher awareness at t-1 reduced the association of negative affect at t-1 and paranoia at t, whereas rumination had an opposite, amplifying moderation effect. Our results provide novel insight into the conditions under which negative affect translates into delusional beliefs. The finding that emotion awareness and rumination have a relevant role corresponds with current psychological conceptualisations of psychosis and with the attempt to treat delusions by focusing on reducing ruminative thoughts. To investigate the causal effect, treatment trials with a focus on enhancing these components of emotion regulation are needed.
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Affiliation(s)
- Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany.
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Marburg, 35039 Marburg, Germany; Faculty of Health and Social Work, Frankfurt University of Applied Sciences, 60318 Frankfurt am Main, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Katarina Krkovic
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, 20146 Hamburg, Germany
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19
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Kami M, Moloodi R, Mazidi M, Ehring T, Mansoori AK, Nodooshan MB, Mazinani Z, Molavi MR, Momeni F. Measuring repetitive thinking in Iran: Psychometric properties of Persian version of Perseverative Thinking Questionnaire. PERSONALITY AND INDIVIDUAL DIFFERENCES 2019. [DOI: 10.1016/j.paid.2019.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Perchtold CM, Weiss EM, Rominger C, Fink A, Weber H, Papousek I. Cognitive reappraisal capacity mediates the relationship between prefrontal recruitment during reappraisal of anger-eliciting events and paranoia-proneness. Brain Cogn 2019; 132:108-117. [PMID: 30980988 DOI: 10.1016/j.bandc.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023]
Abstract
Difficulties in emotion regulation, particularly in using adaptive regulation strategies such as cognitive reappraisal, are a commonly observed correlate of paranoia. While it has been suggested that poor implementation of cognitive reappraisal in dealing with aversive events precedes the onset of subclinical paranoid thinking, there is little empirical research on neural activation patterns during cognitive reappraisal efforts that might indicate vulnerability towards paranoid thinking. Prefrontal EEG alpha asymmetry changes were recorded while n = 57 participants were generating alternative appraisals of anger-eliciting events, and were linked to a behavioral measure of basic cognitive reappraisal capacity and self-reported paranoia proneness (assessed by personality facets of hostility and suspiciousness; Personality Inventory for DSM-5). Mediation analysis revealed that less left-lateralized activation at ventrolateral prefrontal sites during reappraisal efforts predicted a higher degree of paranoia proneness. This relationship was mediated through poorer cognitive reappraisal capacity. Matching previous evidence, findings suggest that inappropriate brain activation during reappraisal efforts impairs individuals' capacity to come up with effective alternative interpretations for anger-evoking situations, which may accentuate personality features related to increased paranoid thinking. The findings add to our understanding of neurally underpinned impairments in the capacity to generate cognitive reappraisals and their link to maladaptive personality and behavior.
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Affiliation(s)
| | | | | | - Andreas Fink
- Department of Psychology, University of Graz, Austria.
| | - Hannelore Weber
- Department of Psychology, University of Greifswald, Germany.
| | - Ilona Papousek
- Department of Psychology, University of Graz, Austria. https://psychologie.uni-graz.at/en/biological-psychology/team/
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21
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Luca M. Maladaptive Rumination as a Transdiagnostic Mediator of Vulnerability and Outcome in Psychopathology. J Clin Med 2019; 8:314. [PMID: 30841644 PMCID: PMC6463018 DOI: 10.3390/jcm8030314] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Maladaptive rumination is a form of negative repetitive thinking which has attracted the interest of researchers, as it is considered a cognitive vulnerability to depression. Some of the original beliefs regarding rumination, in particular its exclusive link with depression, have been questioned in the light of research findings. At present, the very concept of rumination is still unclear, so research has been investigating this topic from different, and somewhat inconsistent, perspectives. METHODS A literature review was performed in order to outline some core characteristics of rumination, explain its determinants, and discuss its possible role as a transdiagnostic mediator of vulnerability and outcome in psychopathology. RESULTS Maladaptive rumination could be interpreted as a dysfunctional coping strategy strictly linked to emotion regulation and metacognition that may occur in several psychopathological conditions, such as psychosis, eating disorders, and alcohol dependence. CONCLUSION Evidence allows the interpretation of maladaptive rumination as a transdiagnostic mediator of vulnerability and outcome in psychopathology. Therefore, investigating it from a dimensional perspective may represent a valid research strategy.
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Affiliation(s)
- Maria Luca
- Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, Via S. Sofia 78, 95125 Catania, Italy.
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22
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‘Twisting the lion's tail’: Manipulationist tests of causation for psychological mechanisms in the occurrence of delusions and hallucinations. Clin Psychol Rev 2019; 68:25-37. [DOI: 10.1016/j.cpr.2018.12.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 12/26/2022]
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23
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Bortolon C, Lopes B, Capdevielle D, Macioce V, Raffard S. The roles of cognitive avoidance, rumination and negative affect in the association between abusive supervision in the workplace and non-clinical paranoia in a sample of workers working in France. Psychiatry Res 2019; 271:581-589. [PMID: 30554106 DOI: 10.1016/j.psychres.2018.11.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Abstract
This study examined the relationship between abusive supervision and non-clinical paranoia and explored which cognitive mechanisms are mediating this association (i.e. rumination, cognitive avoidance and negative affect). A sample of two hundred and five French-speaking workers currently in employment in France was recruited to fill in a battery of online questionnaires comprising of the French adaptations of the Abusive Supervision Scale, the State Social Paranoia Scales, the Depression and Anxiety and Stress Scales, the Cognitive Avoidance Questionnaire and the Mini-Cambridge Exeter Repetitive Thought Scale. Mediation analyses showed that the experience of supervisory abuse directly influences state paranoia, however, there were significant mediation effects. Abusive supervision impacted on cognitive avoidance that led to more rumination, which in its turn increased negative affect and this increased state paranoia. Rumination impacted on state paranoia but through the effect of negative affect only. This study showed that abusive supervision works together with cognitive and affective factors to impact on non-clinical paranoia. It is recommended that Cognitive and Behavioural therapy (CBT) is tailored to help workers to cope with experiences of supervisory abuse and associated paranoid thoughts by focusing on replacing rumination and cognitive avoidance strategies for more adaptive cognitive strategies and on how to manage depression.
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Affiliation(s)
- Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social - Université Grenoble Alpes, Grenoble, France; CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France.
| | - Bárbara Lopes
- Center for Research in Neuropsychology and Cognitive Behavioral Intervention (CINEICC), Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Apartado 602, 3001-802, Coimbra, Portugal.
| | - Delphine Capdevielle
- CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France; French National Institute of Health and Medical Research (INSERM), U1061Pathologies of the Nervous System: Epidemiological and Clinical Research, Montpellier, France
| | - Valéry Macioce
- Department of Medical Information, CHU Montpellier, Clinical Research and Epidemiology Unity, Montpellier, France
| | - Stéphane Raffard
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, F34000, Montpellier, France; CHU Montpellier, Epsylon Laboratory, University Department of Adult Psychiatry, Rue du Pr. Henri Serre, 34000, Montpellier, EA 4556, France
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24
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Tonna M, Paglia F, Ottoni R, Ossola P, De Panfilis C, Marchesi C. Delusional disorder: The role of personality and emotions on delusional ideation. Compr Psychiatry 2018; 85:78-83. [PMID: 30005180 DOI: 10.1016/j.comppsych.2018.07.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 06/26/2018] [Accepted: 07/03/2018] [Indexed: 11/26/2022] Open
Abstract
The relationship between personality and Delusional Disorder in still debated. The present study aimed to evaluate the role of personality features and emotional dispositions on the proneness to delusional beliefs, through the lens of a dimensional approach. 91 outpatients were administered the Structured Interview for DSM-IV Personality Disorders, the Pathological Narcissism Inventory, the Positive and Negative Affect Schedule and the Peters et al. Delusions Inventory. Delusion proneness was positively related to the "Hiding the Self" domain of narcissistic vulnerability and to paranoid traits and negatively related to "Positive Affect". Paranoid traits and "Hiding the Self" significantly interacted in influencing delusion ideation. These data suggest that proneness to delusion depends, at least in part, on a complex interplay between specific emotional and paranoid dispositions within personality.
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Affiliation(s)
- Matteo Tonna
- Department of Mental Health, Local Health Service, Parma, Italy.
| | - Francesca Paglia
- Department of Neuroscience, Psychiatric Unit, University of Parma, Italy
| | - Rebecca Ottoni
- Department of Neuroscience, Psychiatric Unit, University of Parma, Italy
| | - Paolo Ossola
- Department of Neuroscience, Psychiatric Unit, University of Parma, Italy
| | - Chiara De Panfilis
- Department of Neuroscience, Psychiatric Unit, University of Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy
| | - Carlo Marchesi
- Department of Neuroscience, Psychiatric Unit, University of Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy
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25
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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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26
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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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27
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Martinelli C, Rigoli F, Averbeck B, Shergill SS. The value of novelty in schizophrenia. Schizophr Res 2018; 192:287-293. [PMID: 28495493 PMCID: PMC5890442 DOI: 10.1016/j.schres.2017.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 04/27/2017] [Accepted: 05/06/2017] [Indexed: 11/15/2022]
Abstract
Influential models of schizophrenia suggest that patients experience incoming stimuli as excessively novel and motivating, with important consequences for hallucinatory experience and delusional belief. However, whether schizophrenia patients exhibit excessive novelty value and whether this interferes with adaptive behaviour has not yet been formally tested. Here, we employed a three-armed bandit task to investigate this hypothesis. Schizophrenia patients and healthy controls were first familiarised with a group of images and then asked to repeatedly choose between familiar and unfamiliar images associated with different monetary reward probabilities. By fitting a reinforcement-learning model we were able to estimate the values attributed to familiar and unfamiliar images when first presented in the context of the decision-making task. In line with our hypothesis, we found increased preference for newly introduced images (irrespective of whether these were familiar or unfamiliar) in patients compared to healthy controls and this to correlate with severity of hallucinatory experience. In addition, we found a correlation between value assigned to novel images and task performance, suggesting that excessive novelty value may interfere with optimal learning in patients, putatively through the disruption of the mechanisms regulating exploration versus exploitation. Our results suggest excessive novelty value in patients, whereby even previously seen stimuli acquire higher value as the result of their exposure in a novel context - a form of 'hyper novelty' which may explain why patients are often attracted by familiar stimuli experienced as new.
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Affiliation(s)
- Cristina Martinelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF London, United Kingdom.
| | - Francesco Rigoli
- Wellcome Trust Centre for Neuroimaging, University College London, 12 Queen's Square, WC1N 3BG London, United Kingdom
| | - Bruno Averbeck
- Laboratory of Neuropsychology, National Institute of Mental Health, National Institute of Health, Bethesda, MD 20892-4415, USA
| | - Sukhwinder S Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF London, United Kingdom
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Kaltsi M, Bucci S, Morrison AP. Experimental manipulation of metacognitive beliefs and paranoia in a non-clinical population. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1413128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Maria Kaltsi
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony P. Morrison
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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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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McKie A, Askew K, Dudley R. An experimental investigation into the role of ruminative and mindful self-focus in non-clinical paranoia. J Behav Ther Exp Psychiatry 2017; 54:170-177. [PMID: 27569740 DOI: 10.1016/j.jbtep.2016.07.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 05/18/2016] [Accepted: 07/28/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND & OBJECTIVES Ruminative self-focus is a maladaptive form of emotional processing and is linked to distress, whereas mindful self-focus is adaptive and linked to low distress. However, the effects of these different modes of self-focus have not yet been examined in symptoms associated with psychotic disorders, such as paranoid ideation. This study aimed to explore whether inducing ruminative self-focus maintains paranoid ideation whilst inducing mindful self-focus reduces paranoid ideation. METHOD Thirty-two non-clinical participants engaged in a paranoia induction prime and then took part in an eight-minute ruminative self-focus induction and an eight-minute mindful self-focus induction. RESULTS Following an induction of paranoia, mindful self-focus significantly decreased levels of paranoia, whereas ruminative self-focus had no significant impact on levels of paranoia, and therefore was interpreted as having maintained paranoia. LIMITATIONS The study used non clinical participants and the level of paranoid ideation experienced was fairly mild, which limits generalisation to clinical levels of distress. Additionally, the mechanism by which rumination and mindful self-focus have their effects was not examined. CONCLUSIONS The results add to the growing body of evidence that there are two distinct modes of self-focus that have differential effects on emotional processing. These findings also demonstrate the potential benefit of interventions targeting rumination in paranoid ideation with mindful self-focus.
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Affiliation(s)
- Ashley McKie
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK; The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Kristina Askew
- The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Robert Dudley
- School of Psychology, Newcastle University, Newcastle Upon Tyne, UK; Early Intervention in Psychosis Service, Northumberland, Tyne and Wear NHS Foundation Trust, UK.
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31
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A comparison of cognitive biases between schizophrenia patients with delusions and healthy individuals with delusion-like experiences. Eur Psychiatry 2015; 30:943-9. [PMID: 26647870 DOI: 10.1016/j.eurpsy.2015.08.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 08/08/2015] [Accepted: 08/11/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The role of psychosis-related cognitive biases (e.g. jumping to conclusions) in a delusion continuum is well-established. Little is known about the role of types of cognitive biases. The aim of this study was to investigate the role of psychosis-related and "Beckian" (i.e. anxiety- and depression-related) cognitive biases assessed with a clinical questionnaire in the delusion continuum and its dimensions. METHODS Schizophrenia patients with (n=57) and without (n=35) delusions were compared to healthy subjects who had a low (n=53) and high (n=57) level of delusion-like experiences (DLEs) on the Cognitive Biases Questionnaire for Psychosis (CBQp). Delusion dimensions in the clinical sample were assessed with the semi-structured interview PSYRATS. DLEs were measured with the Peters Delusion Inventory (PDI). RESULTS High DLEs participants scored significantly higher than low DLEs, and patients with delusions scored higher than patients without delusions on the total scores of the CBQp. High DLEs participants scored significantly higher than low DLEs on catastrophisation and JTC. Schizophrenia patients with delusions scored significantly higher when compared to patients without delusions on intentionalising, dichotomous thinking, JTC and emotional reasoning. Patients with delusions and high DLEs participants scored similarly on JTC. Stepwise regression analysis revealed that catastrophising predicted total severity of clinical delusions and JTC predicted the cognitive dimension of clinical delusions. Both JTC and catastrophisation predicted the frequency and conviction associated with DLEs. CONCLUSIONS Both "Beckian" and psychosis-related cognitive biases may underlie delusions. Different aspects of clinical delusions and delusion-like experiences may be related to different cognitive biases.
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Abstract
BACKGROUND Ruminative negative thinking has typically been considered as a factor maintaining common emotional disorders and has recently been shown to maintain persecutory delusions in psychosis. The Perseverative Thinking Questionnaire (PTQ) (Ehring et al., 2011) is a transdiagnostic measure of ruminative negative thinking that shows promise as a "content-free" measure of ruminative negative thinking. AIMS The PTQ has not previously been studied in a psychosis patient group. In this study we report for the first time on the psychometric properties of Ehring et al.'s PTQ in such a group. METHOD The PTQ was completed by 142 patients with current persecutory delusions and 273 non-clinical participants. Participants also completed measures of worry and paranoia. A confirmatory factor analysis was performed on the clinical group's PTQ responses to assess the factor structure of the measure. Differences between groups were used to assess criterion reliability. RESULTS A three lower-order factor structure of the PTQ (core characteristics of ruminative negative thinking, perceived unproductiveness, and capturing mental capacity) was replicated in the clinical sample. Patients with persecutory delusions were shown to experience significantly higher levels of ruminative negative thinking on the PTQ than the general population sample. The PTQ demonstrated high internal reliability. CONCLUSIONS This study did not include test-retest data, and did not compare the PTQ against a measure of depressive rumination but, nevertheless, lends support for the validity of the PTQ as a measure of negative ruminative thinking in patients with psychosis.
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Freeman D, Garety P. Advances in understanding and treating persecutory delusions: a review. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1179-89. [PMID: 25005465 PMCID: PMC4108844 DOI: 10.1007/s00127-014-0928-7] [Citation(s) in RCA: 231] [Impact Index Per Article: 23.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/30/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions. METHODS A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia. RESULTS Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments. CONCLUSIONS There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK,
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