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Helyel ES, El-Sayed MM. Beyond the symptoms: Exploring attachment styles and reality-testing among schizophrenia clients from a nursing perspective. J Psychiatr Ment Health Nurs 2024. [PMID: 38958525 DOI: 10.1111/jpm.13081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 06/14/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: The insecure attachment styles are associated with mental health problems and can influence reality perception, particularly in individuals with schizophrenia. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper provides empirical evidence for the correlation between insecure attachment styles and reality-testing impairment in clients with schizophrenia. Higher reality testing impairment scores were observed in specific demographics: males who were unmarried and aged between 40 and 50 years old, as well as those with a duration of illness of less than 5 years. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The findings underscore the importance for nurses to understand insecure attachment styles, particularly anxious and avoidant styles, in clients with schizophrenia. Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Psycho-Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality-testing impairment. Imply early intervention through educating mothers on fostering secure bonds can potentially prevent future occurrences of schizophrenia. WHAT ARE THE IMPLICATIONS FOR FUTURE RESEARCH?: Conducting empirical studies to explore the associations between insecure attachment style, social functioning, and poor service engagement is essential. Research is needed to investigate specific techniques for managing insecure attachment styles, particularly the avoidant ones, and reality testing impairments within the therapeutic setting. ABSTRACT INTRODUCTION: Insecure attachment styles are associated with mental health problems and may influence reality perception. AIM This study investigated the link between attachment styles and reality-testing impairment in individuals with schizophrenia. METHODS A cross-sectional survey with 200 participants diagnosed with schizophrenia assessed their attachment styles (Psychosis Attachment Measure) and reality-testing abilities (Bell Reality Testing Inventory). RESULTS A significant positive correlation emerged between insecure attachment and poorer reality testing (r = .394, p < .001). Avoidant attachment was most prevalent (mean scores: 17.01, SD = 3.71), followed by anxious attachment (16.53, SD = 4.20). Reality-testing impairment manifested across all three domains: uncertainty of perception (7.16, SD = 2.45), reality distortion (3.52, SD = 1.21), and hallucinations/delusions (26.63, SD = 5.83). Interestingly, specific demographics (male, unmarried, 40-50 years old) and those with a duration of illness of less than 5 years had higher mean scores (27.35, SD = 5.61). DISCUSSION Insecure attachment styles, notably anxious and avoidant, are dominant among clients with schizophrenia, who also struggle with reality distortion, perceptual uncertainty, and hallucinations/delusions in all three domains. IMPLICATION FOR PRACTICE Healthcare providers and nurses should understand the psychological dynamics of clients with insecure attachment styles to establish effective therapeutic relationships. A secure, structured, and consistent environment is vital to modifying insecure attachment styles and promoting reality orientation. Secure Attachment Style Oriented Psycho-Educational Program, Mentalization, Cognitive Interpersonal Therapy, and Cognitive Analytic Therapy can help reduce reality-testing impairment. Fostering Maternal and Child Health (MCH) centers on empathizing secure bonds between mothers (and mothers-to-be) and their children to promote healthy attachment styles as a preventive measure.
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Affiliation(s)
- Eman Saad Helyel
- Psychiatric Nursing and Mental Health, Faculty of Nursing, Damanhour University, Damanhour, Egypt
| | - Mona Metwally El-Sayed
- Psychiatric Nursing and Mental Health, Faculty of Nursing, Alexandria University, Alexandria, Egypt
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Parkinson S, Cole B, Trevelyan C. Art and mentalizing in early intervention psychosis: rationale and therapist insights on a new psychoeducational course. Front Psychiatry 2024; 15:1243990. [PMID: 39011340 PMCID: PMC11248587 DOI: 10.3389/fpsyt.2024.1243990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 05/29/2024] [Indexed: 07/17/2024] Open
Abstract
In this paper, we explore the rationale for a combined art therapy and mentalization-based treatment (MBT) group course for those experiencing a first episode of psychosis (FEP). We discuss the theoretical background for how art and MBT theory can help us better understand and work with groups of individuals experiencing FEP, particularly focusing on avoidance and insecure attachment styles. We outline the delivery of a ten-week psychoeducational Art MBT course within an Early Intervention in Psychosis (EIP) Service and discuss our experiential insights into this new modality as co-therapists. We conclude by proposing that art therapy and mentalizing practice together offer an accessible, useful and practical group structure for EIP services, which could improve individuals' mentalizing capacity and overall social functioning.
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Affiliation(s)
| | - Bethany Cole
- *Correspondence: Sarah Parkinson, ; Bethany Cole,
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Skrobinska L, Newman-Taylor K, Carnelley K. Secure attachment imagery facilitates help-seeking and help-acceptance in psychosis. Psychol Psychother 2024. [PMID: 38943487 DOI: 10.1111/papt.12530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 05/05/2024] [Accepted: 05/07/2024] [Indexed: 07/01/2024]
Abstract
OBJECTIVES People with psychosis delay accessing recommended treatments, resulting in poor healthcare outcomes and increased risk of relapse. Means of improving help-seeking and help-acceptance could reduce duration of untreated psychosis (DUP). This study examined the role of attachment style in help-seeking and help-acceptance in psychosis. DESIGN We used an experimental design to test the effect of attachment imagery priming on help-seeking and help-acceptance intentions, in a sample with self-reported psychosis. The independent variables were attachment imagery condition (secure vs. avoidant) and time (pre- vs. post-prime). The dependent variables were state paranoia, help-seeking intentions and help-acceptance intentions. METHODS We used an online research platform to recruit people with psychosis (n = 61). Participants were randomly allocated to the secure or avoidant attachment priming condition. All completed measures of state paranoia, help-seeking, and help-acceptance, before and after priming. RESULTS In comparison with the avoidant condition, secure attachment imagery resulted in reduced paranoia and increased help-seeking and acceptance intentions, all with large effect sizes. CONCLUSIONS This is the first study to use an experimental design to assess the role of attachment style in help-seeking and help-acceptance in a clinical sample. Attachment style is causally linked to behavioural intentions that contribute to DUP. Clinicians should assess attachment and help-seeking and acceptance, highlight these in formulation, and prioritise in treatment planning. Interventions that enhance help-seeking and acceptance could improve access to recommended treatments and reduce DUP.
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Affiliation(s)
- Laura Skrobinska
- Psychology Department, University of Southampton, Southampton, UK
| | - Katherine Newman-Taylor
- Psychology Department, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
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Bayer S, Bröcker AL, Stuke F, Just S, Bertram G, Grimm I, Maaßen E, Büttner M, Heinz A, Bermpohl F, Lempa G, von Haebler D, Montag C. Level of structural integration in people with schizophrenia and schizoaffective disorders - applicability and associations with clinical parameters. Front Psychiatry 2024; 15:1388478. [PMID: 38911709 PMCID: PMC11192590 DOI: 10.3389/fpsyt.2024.1388478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/13/2024] [Indexed: 06/25/2024] Open
Abstract
Introduction The psychic structure of people with psychosis has been the subject of theoretical and qualitative considerations. However, it has not been sufficiently studied quantitatively. Therefore, the aim of this study was to explore the structural abilities of people diagnosed with schizophrenia and schizoaffective psychosis using the Levels of Structural Integration Axis of the Operationalized Psychodynamic Diagnosis System (OPD-2-LSIA). The study aimed to determine possible associations between the OPD-2-LSIA and central parameters of illness. Additionally, possible structural differences between people diagnosed with schizophrenia and schizoaffective psychosis were tested. Methods This cross-sectional study included 129 outpatients with schizophrenia or schizoaffective disorders. Measures of structural integration, symptom load, severity of illness, cognition, and social functioning were obtained. Descriptive statistics were used to analyze the overall structural level and the structural dimensions. Correlation coefficients were computed to measure the associations between OPD-2-LSIA and variables regarding the severity of illness and psychosocial functioning. Regression models were used to measure the influence of illness-related variables on OPD-2-LSIA, and the influence of OPD-2-LSIA on psychosocial functioning. Participants diagnosed with schizophrenia and schizoaffective disorders were examined with regard to possible group differences. Results The results of the OPD-2-LSIA showed that the overall structural level was between 'moderate to low' and 'low level of structural integration'. Significant correlations were found between OPD-2-LSIA and psychotic symptoms (but not depressive symptoms), as well as between OPD-2-LSIA and psychosocial functioning. It was found that variables related to severity of illness had a significant impact on OPD-2-LSIA, with psychotic, but not depressive symptoms being significant predictors. OPD-2-LSIA was found to predict psychosocial functioning beyond symptoms and cognition. No significant differences were found between participants with schizophrenia and schizoaffective psychosis. There was also no correlation found between OPD-2-LSIA and depressive symptomatology (except for the subdimension Internal communication). Discussion Contrary to theoretical assumptions, the results of the study show a heterogenous picture of the psychic structure of people with psychosis. The associations between OPD-2-LSIA and severity of illness, particularly psychotic symptomatology, as well as the influence of OPD-2-LSIA on psychosocial functioning, are discussed.
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Affiliation(s)
- Samuel Bayer
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Anna-Lena Bröcker
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Gianna Bertram
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Imke Grimm
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Eva Maaßen
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Marielle Büttner
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Andreas Heinz
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Dorothea von Haebler
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- International Psychoanalytic University Berlin, Berlin, Germany
| | - Christiane Montag
- Department of Psychiatry and Psychotherapy, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Maas IL, Bohlken MM, Gangadin SS, Rosema BS, Veling W, Boonstra N, de Haan L, Begemann MJH, Koops S. Personal recovery in first-episode psychosis: Beyond clinical and functional recovery. Schizophr Res 2024; 266:32-40. [PMID: 38367610 DOI: 10.1016/j.schres.2024.02.005] [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: 04/14/2023] [Revised: 01/24/2024] [Accepted: 02/10/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The concept of personal recovery after psychotic illness focuses more on patients' social and existential needs compared to traditional outcome measures including clinical and functional recovery. This research aims to contribute to a broad framework on (personal) recovery and associated factors. METHODS Data from 203 persons with symptomatic remission of their first-episode psychosis from the ongoing HAMLETT study were analyzed. To determine the relative importance of several biological, clinical, psychological, and social factors in explaining personal recovery as measured by the Recovery Assessment Scale (RAS), partial Spearman correlations (controlling for clinical recovery (PANSS) and functional recovery (WHODAS 2.0)) and a bootstrapped multiple regression were performed. Indirect effects on personal recovery within these factors, clinical recovery, and functional recovery were explored using a regularized partial correlation network. RESULTS Of the factors that explained personal recovery beyond the effects of clinical and functional recovery, social support was the strongest predictor, followed by self-esteem, internalized stigma, and insecure attachment, collectively explaining 48.2 % of the variance. Anhedonia/apathy showed a trend towards a negative correlation. Age at onset, sex, early trauma/neglect, cognition, and being married/cohabiting did not significantly correlate with personal recovery. The network (n = 143) was consistent with these findings and indicated possible mediation pathways for early trauma/neglect, insecure attachment, cognition, and being married/cohabiting. CONCLUSIONS Personal recovery is an important addition to traditional measures of outcome after psychosis. Various quality of life indicators, such as self-esteem and social support, explain variance in personal recovery over clinical and functional recovery.
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Affiliation(s)
- Isolde L Maas
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marc M Bohlken
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Shiral S Gangadin
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Bram-Sieben Rosema
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Nynke Boonstra
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands; NHL Stenden, University of Applied Sciences, Leeuwarden, the Netherlands; KieN VIP Mental Health Care Services, Leeuwarden, the Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, the Netherlands
| | - Marieke J H Begemann
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Sanne Koops
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
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Justo-Nunez M, Morris L, Berry K. The revised Psychosis Attachment Measure: further psychometric evidence. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02624-2. [PMID: 38503876 DOI: 10.1007/s00127-024-02624-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 01/16/2024] [Indexed: 03/21/2024]
Abstract
PURPOSE Disorganised attachment is a key concept in understanding the development of psychosis. However, existing questionnaires of adult attachment do not adequately measure this construct hindering future research into the psychosocial causes of psychosis. The most widely measure of adult attachment in people experiencing psychosis is the Psychosis Attachment Measure (PAM). The measure has recently been revised to include disorganised attachment items. This study develops previous research by providing a rigorous examination the psychometric properties of the revised questionnaire (PAM-R). METHODS A total of 407 participants with self-reported experiences of psychosis completed a battery of questionnaires which included the PAM-R and other measures which were conceptually related to the concept of disorganised attachment. RESULTS Confirmatory factor analysis (CFA) indicated a three-factor solution with factors corresponding to anxious, avoidant, and disorganised attachment. The majority of the fit statistics were acceptable with the exception of the RMSEA statistic. Internal consistency and test-retest reliability were good for all subscales. The disorganised subscale correlated in expected directions with other measures of attachment, dissociation, trauma, and psychotic experiences. CONCLUSION The PAM-R is a valid and reliable measure of adult attachment. It is a practical assessment tool for clinicians and researchers to measure insecure and disorganised attachment patterns that is acceptable to people experiencing psychosis.
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Affiliation(s)
- Miranda Justo-Nunez
- Division of Psychology and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Oxford, Manchester, M13 9PWL, UK
| | - Lydia Morris
- Division of Psychology and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Oxford, Manchester, M13 9PWL, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- Department of Research and Innovation, Greater Manchester Mental Health NHS Foundation Trust, Oxford, Manchester, M13 9PWL, UK.
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Strachan LP, Paulik G, Preece DA, McEvoy PM. Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation. Psychol Psychother 2023; 96:934-951. [PMID: 37493351 DOI: 10.1111/papt.12486] [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: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. AIMS This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. MATERIALS The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. METHODS We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. RESULTS Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). DISCUSSION Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. CONCLUSION Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Preece
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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Mason AJC, Jung P, Kim S, Sim H, Greene T, Burgess N, Brewin CR, Bisby J, Kim E, Bloomfield M. Associations between post-traumatic stress disorders and psychotic symptom severity in adult survivors of developmental trauma: a multisite cross-sectional study in the UK and South Korea. Lancet Psychiatry 2023; 10:760-767. [PMID: 37739583 DOI: 10.1016/s2215-0366(23)00228-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Childhood maltreatment is a risk factor for the development of post-traumatic stress disorders and psychosis. However, the association between post-traumatic stress disorder (PTSD), including complex PTSD, and psychotic symptoms is unknown. We investigated whether the presence of PTSD and complex PTSD was associated with psychotic symptom severity within survivors of developmental trauma. METHODS As part of the Investigating Mechanisms underlying Psychosis Associated with Childhood Trauma (IMPACT) study, from Aug 20, 2020, to Jan 24, 2021, and from Sept 9, 2022, to Feb 21, 2023, using study advertisement on online platforms we recruited adult (≥18 years) participants who had experienced developmental trauma without a psychiatric diagnosis in the UK and South Korea. We measured whether participants met diagnostic thresholds for PTSD and complex PTSD using the self-reported International Trauma Questionnaire, and psychotic symptoms using the self-reported Community Assessment of Psychic Experiences. We used linear regression, adjusting for sociodemographic variables such as age, sex, ethnicity, educational attainment, and socioeconomic status, to examine whether there was an association between PTSD and complex PTSD and psychotic symptoms. The study is registered in the UK (University College London Research Ethics Committee [14317/001] and the National Health Service Research Ethics Committee [22/YH/0096]) and South Korea (Institutional Review Board of Seoul National University Bundang Hospital [B-2011-648-306]), and is ongoing. FINDINGS Of the 2675 participants who took part in the study, 1273 had experienced developmental trauma and were included in the study in the UK (n=475) and South Korea (n=798), comprising 422 (33%) men and 851 (67%) women with a mean age of 26·9 years (SD 6, range 18-40), mostly of White British (n=328) or South Korean (n=798) ethnicity. We found no significant association between PTSD and psychotic symptom severity (total severity β=-2·40 [SE 3·28], p=0·47), compared with participants who did not meet PTSD or complex PTSD caseness. We found a significant relationship between complex PTSD and psychotic symptom severity (total severity β=22·62 [SE 1·65], p<0·0001), including for positive (β=12·07 [SE 0·99], p<0·0001) and negative symptoms (β=10·5 [SE 0·95], p<0·0001), compared with participants who did not meet PTSD or complex PTSD caseness. INTERPRETATION Health systems must assess individuals with previous developmental trauma for complex PTSD and treat those affected. These individuals should also be assessed for psychotic symptoms, and if necessary, preventative measures should be taken to reduce risk of conversion. Further work should assess whether treating complex PTSD modifies the risk of conversion to psychosis. FUNDING UKRI Future Leaders Fellowship, British Medical Association Margaret Temple Award for Schizophrenia Research, and the National Research Foundation of Korea-Korea Government.
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Affiliation(s)
- Ava J C Mason
- Division of Psychiatry, University College London, London, UK
| | - Paul Jung
- Division of Psychiatry, University College London, London, UK
| | - Seoyoung Kim
- Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Hyejin Sim
- Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, South Korea
| | - Talya Greene
- Clinical, Education and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - Neil Burgess
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Chris R Brewin
- Clinical, Education and Health Psychology, Division of Psychology and Language Sciences, University College London, London, UK
| | - James Bisby
- Division of Psychiatry, University College London, London, UK
| | - Euitae Kim
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, South Korea; Department of Brain and Cognitive Sciences, College of Natural Sciences, Seoul National University, Seoul, South Korea; Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
| | - Michael Bloomfield
- Division of Psychiatry, University College London, London, UK; University College London Hospitals National Institute for Health Research Biomedical Research Centre, London, UK
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Hennig-Fast K, Meissner D, Steuwe C, Dehning S, Blautzik J, Eilert DW, Zill P, Müller N, Meindl T, Reiser M, Möller HJ, Falkai P, Driessen M, Buchheim A. The Interplay of Oxytocin and Attachment in Schizophrenic Patients: An fMRI Study. Brain Sci 2023; 13:1125. [PMID: 37626482 PMCID: PMC10452454 DOI: 10.3390/brainsci13081125] [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: 06/03/2023] [Revised: 07/02/2023] [Accepted: 07/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Attachment theory offers an important framework for understanding interpersonal interaction experiences. In the present study, we examined the neural correlates of attachment patterns and oxytocin in schizophrenic patients (SZP) compared to healthy controls (HC) using fMRI. We assumed that male SZP shows a higher proportion of insecure attachment and an altered level of oxytocin compared to HC. On a neural level, we hypothesized that SZP shows increased neural activation in memory and self-related brain regions during the activation of the attachment system compared to HC. METHODS We used an event-related design for the fMRI study based on stimuli that were derived from the Adult Attachment Projective Picture System to examine attachment representations and their neural and hormonal correlates in 20 male schizophrenic patients compared to 20 male healthy controls. RESULTS A higher proportion of insecure attachment in schizophrenic patients compared to HC could be confirmed. In line with our hypothesis, Oxytocin (OXT) levels in SZP were significantly lower than in HC. We found increasing brain activations in SZP when confronted with personal relevant sentences before attachment relevant pictures in the precuneus, TPJ, insula, and frontal areas compared to HC. Moreover, we found positive correlations between OXT and bilateral dlPFC, precuneus, and left ACC in SZP only. CONCLUSION Despite the small sample sizes, the patients' response might be considered as a mode of dysregulation when confronted with this kind of personalized attachment-related material. In the patient group, we found positive correlations between OXT and three brain areas (bilateral dlPFC, precuneus, left ACC) and may conclude that OXT might modulate within this neural network in SZP.
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Affiliation(s)
- Kristina Hennig-Fast
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Dominik Meissner
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Carolin Steuwe
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Sandra Dehning
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Janusch Blautzik
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Dirk W. Eilert
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
| | - Peter Zill
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Norbert Müller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Thomas Meindl
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Maximilian Reiser
- Department of Radiology, Ludwig-Maximilians University, 81377 Munich, Germany
| | - Hans-Jürgen Möller
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians University, 80336 Munich, Germany (H.-J.M.); (P.F.)
| | - Martin Driessen
- Department of Psychiatry and Psychotherapy, University of Bielefeld, 33615 Bielefeld, Germany
| | - Anna Buchheim
- Department of Psychology, University Innsbruck, 6020 Innsbruck, Austria
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10
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Georgiades A, Almuqrin A, Rubinic P, Mouhitzadeh K, Tognin S, Mechelli A. Psychosocial stress, interpersonal sensitivity, and social withdrawal in clinical high risk for psychosis: a systematic review. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:38. [PMID: 37330526 DOI: 10.1038/s41537-023-00362-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 02/28/2023] [Indexed: 06/19/2023]
Abstract
Stress has repeatedly been implicated in the onset and exacerbation of positive symptoms of psychosis. Increasing interest is growing for the role of psychosocial stress in the development of psychosis symptoms in individuals at Clinical High Risk (CHR) for psychosis. A systematic review was therefore conducted to summarize the existing evidence base regarding psychosocial stress, interpersonal sensitivity, and social withdrawal in individuals at CHR for psychosis. An electronic search of Ovid (PsychINFO, EMBASE, MEDLINE, and GLOBAL HEALTH) was conducted until February 2022. Studies that examined psychosocial stress in CHR were included. Twenty-nine studies were eligible for inclusion. Psychosocial stress, interpersonal sensitivity, and social withdrawal were higher in CHR individuals compared to healthy controls and there was some evidence of their association with positive symptoms of psychosis. Two types of psychosocial stressors were found to occur more frequently with CHR status, namely daily stressors, and early and recent trauma, while significant life events did not appear to be significant. Greater exposure to psychosocial stress, emotional abuse, and perceived discrimination significantly increased risk of transition to psychosis in CHR. No studies examined the role of interpersonal sensitivity on transition to psychosis in CHR. This systematic review provides evidence for the association of trauma, daily stressors, social withdrawal, and interpersonal sensitivity with CHR status. Further studies investigating the impact of psychosocial stress on psychosis symptom expression in individuals at CHR and its effects on transition to psychosis are therefore warranted.
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Affiliation(s)
- A Georgiades
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK.
- Brent Early Intervention Service, CNWL, NHS Foundation Trust, 27-29 Fairlight Avenue, London, NW10 8AL, UK.
| | - A Almuqrin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - P Rubinic
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - K Mouhitzadeh
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - S Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
| | - A Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), King's College London, London, UK
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11
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de With J, de Haan L, Schirmbeck F. Attachment Style and Self-Experience: The Association Between Attachment Style and Self-Reported Altered Self-Experience in Patients With Psychotic Disorders, Unaffected Siblings, and Healthy Controls. J Nerv Ment Dis 2023; 211:440-447. [PMID: 36971431 DOI: 10.1097/nmd.0000000000001634] [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: 04/15/2023]
Abstract
ABSTRACT The present study aimed to examine the cross-sectional association between attachment style and self-reported disturbed self-awareness (disturbed sense of mineness of experiences) and depersonalization (disturbed sense of first-person perspective) in patients with psychotic disorders, unaffected siblings, and healthy controls. Data pertain to a subsample of the GROUP (Genetic Risk and Outcome of Psychosis) study. We found positive associations between anxious attachment and disturbed self-awareness and depersonalization across participants with different psychosis vulnerability. We also found a positive association between avoidant attachment and depersonalization, although on a trend level. Findings indicate that attachment style is associated with self-reported disturbed self-awareness and depersonalization over and above the influence of psychotic or depressive experiences in people across the vulnerability spectrum of psychosis. This supports the importance of attachment style, self-awareness, and depersonalization as potential targets in prevention and treatment interventions in patients with psychotic disorders or those with increased vulnerability.
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Affiliation(s)
- Justine de With
- Early Psychosis Department, Amsterdam UMC (location AMC), Department of Psychiatry; and
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12
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de With J, Korver-Nieberg N, de Haan L, Schirmbeck F. The association between attachment style and social functioning in patients with non-affective psychotic disorders, unaffected siblings and healthy controls. Schizophr Res 2023; 252:96-102. [PMID: 36638690 DOI: 10.1016/j.schres.2022.12.038] [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: 02/17/2022] [Revised: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023]
Abstract
OBJECTIVE In patients with psychotic disorders, insecure attachment styles and impaired social functioning are highly prevalent. Our aim was to explore the multi-cross-sectional and longitudinal associations between attachment style and social functioning. METHODS This study was performed in a subsample of 119 patients with non-affective psychotic disorders, 128 unaffected siblings and 66 healthy controls within the Genetic Risk and Outcome of Psychosis (GROUP) Study. Attachment style (using the Psychosis Attachment Measure) and three social functioning domains, namely withdrawal, interpersonal behaviour and pro-social activities as measured with the Social Functioning Scale (SFS) were assessed on two moments in time. Generalized linear mixed models and linear regression models were used. Bonferroni correction for multiple testing was applied. RESULTS In the patient group, a significant negative association was found between avoidant attachment and pro-social functioning. In the sibling and control group, we found significant negative associations between avoidant attachment and the social functioning domains withdrawal and interpersonal behaviour. We also found a significant negative association between anxious attachment and the social functioning domain withdrawal in siblings. Higher levels of insecure anxious attachment at baseline predicted a reduction of the social functioning domain interpersonal behaviour in siblings over a period of three years on a trend level. CONCLUSIONS Findings indicate that levels of insecure attachment are elevated in patients with psychotic disorders and have a negative association with social functioning in both patients, siblings and controls. These findings warrant specific attention for attachment style in the treatment of patients with psychotic disorders and individuals with an increased vulnerability for developing psychosis.
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Affiliation(s)
- Justine de With
- Early Psychosis Department, Amsterdam UMC (location AMC), Department of Psychiatry, Amsterdam, the Netherlands.
| | | | - Lieuwe de Haan
- Early Psychosis Department, Amsterdam UMC (location AMC), Department of Psychiatry, Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Frederike Schirmbeck
- Early Psychosis Department, Amsterdam UMC (location AMC), Department of Psychiatry, Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
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13
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Trucharte A, Valiente C, Espinosa R, Chaves C. The role of insecure attachment and psychological mechanisms in paranoid and depressive symptoms: An exploratory model. Schizophr Res 2022; 243:9-16. [PMID: 35220038 DOI: 10.1016/j.schres.2022.02.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 02/10/2022] [Accepted: 02/13/2022] [Indexed: 12/01/2022]
Abstract
Attachment theory is considered an important theoretical framework for understanding the ontogenesis of psychopathology. In this regard, insecure attachment styles have been associated with the development and maintenance of paranoid and depressive symptoms. Furthermore, different psychological processes (i.e., self-esteem and experiential avoidance) have been identified as mediating mechanisms between the relationship of insecure attachment and these symptoms. Nowadays, there is a more positive view in psychology focusing on factors that contribute to well-being, although little is known about the role of these psychological well-being variables as mediators between insecure attachment and psychopathology. For thus, the aim of this study was to test one explorative structural equation model of insecure attachment on paranoid and depressive symptoms through psychological mediating mechanisms to elucidate the processes involved in each of them. To evaluate the model, 141 individuals with severe psychiatric conditions participated in the study. The results revealed good model fit, highlighting that avoidant attachment has a direct and indirect effect on the symptoms, while anxious attachment has only an indirect effect through mediating mechanisms. On the other hand, lower levels of self-acceptance and environmental mastery have been identified as important processes associated with paranoid and depressive symptoms. However, less positive relationships were a significant mediating mechanism only for paranoid ideation symptoms. These results have important clinical implications by shedding light on the relationship between insecure attachment, paranoid and depressive symptoms, and the psychological mediating mechanisms involved in this relationship, which may be considered key variables in clinical treatments.
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Affiliation(s)
- Almudena Trucharte
- Personality, Evaluation and Clinical Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain.
| | - Carmen Valiente
- Personality, Evaluation and Clinical Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
| | - Regina Espinosa
- Department of Psychology, Faculty of Health, Camilo Jose Cela University, Madrid, Spain
| | - Covadonga Chaves
- Personality, Evaluation and Clinical Psychology, Faculty of Psychology, Complutense University of Madrid, Madrid, Spain
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14
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Stramecki F, Misiak B, Gawęda Ł, Prochwicz K, Kłosowska J, Samochowiec J, Samochowiec A, Pawlak E, Szmida E, Skiba P, Cechnicki A, Frydecka D. The Moderating Role of the FKBP5 Gene Polymorphisms in the Relationship between Attachment Style, Perceived Stress and Psychotic-like Experiences in Non-Clinical Young Adults. J Clin Med 2022; 11:jcm11061614. [PMID: 35329940 PMCID: PMC8953491 DOI: 10.3390/jcm11061614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/04/2022] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
Numerous studies have reported that stressful life experiences increase the risk of psychosis and psychotic-like experiences (PLEs). Common variations of the FKBP5 gene have been reported to impact the risk of psychosis by moderating the effects of environmental exposures. Moreover, anxious and avoidant attachment styles have been shown to increase both the level of perceived stress and the risk for psychosis development. In the present cross-sectional study, we aimed to investigate whether variants of the FKBP5 gene moderate the effects of attachment styles and the level of perceived stress on the development of PLEs. A total of 535 non-clinical undergraduates were genotyped for six FKBP5 single nucleotide polymorphisms (SNPs) (rs3800373, rs9470080, rs4713902, rs737054, rs1360780 and rs9296158). The Psychosis Attachment Measure (PAM), the Perceived Stress Scale-10 (PSS-10) and the Prodromal Questionnaire 16 (PQ-16) were administered to assess attachment styles, the level of perceived stress and PLEs, respectively. Anxious attachment style, lower levels of perceived self-efficacy and higher levels of perceived helplessness were associated with a significantly higher number of PLEs. The main effects of attachment style on the severity of PLEs were significant in models testing for the associations with perceived self-efficacy and three FKBP5 SNPs (rs1360780, rs9296158 and rs9470080). The main effect of rs38003733 on the number of PLEs was observed, with GG homozygotes reporting a significantly higher number of PLEs in comparison to T allele carriers. In individuals with dominant anxious attachment style, there was a significant effect of the interaction between the FKBP5 rs4713902 SNP and self-efficacy on the severity of PLEs. Among rs4713902 TT homozygotes, a low level of perceived self-efficacy was associated with higher severity of PLEs. In subjects with non-dominant anxious attachment, a low level of perceived self-efficacy was associated with a higher number of PLEs, regardless of the genotype. Our results indicate that the FKBP5 gene might moderate the relationship between attachment, perceived stress and PLEs.
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Affiliation(s)
- Filip Stramecki
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
| | - Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza Street 1, 00-378 Warsaw, Poland;
| | - Katarzyna Prochwicz
- Institute of Psychology, Jagiellonian University, Ingardena 6 Street, 30-060 Krakow, Poland; (K.P.); (J.K.)
| | - Joanna Kłosowska
- Institute of Psychology, Jagiellonian University, Ingardena 6 Street, 30-060 Krakow, Poland; (K.P.); (J.K.)
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-457 Szczecin, Poland;
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, 71-017 Szczecin, Poland;
| | - Edyta Pawlak
- Department of Experimental Therapy, Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Weigla Street 12, 53-114 Wroclaw, Poland;
| | - Elżbieta Szmida
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland; (E.S.); (P.S.)
| | - Paweł Skiba
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland; (E.S.); (P.S.)
| | - Andrzej Cechnicki
- Department of Community Psychiatry, Medical College Jagiellonian University, Sikorskiego Place 2, 31-115 Krakow, Poland;
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland;
- Correspondence:
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15
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Pathways from insecure attachment to paranoia: the mediating role of emotion regulation. Behav Cogn Psychother 2022; 50:404-417. [DOI: 10.1017/s1352465822000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism.
Aims:
This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia.
Method:
Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point.
Results:
As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia.
Conclusion:
Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.
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16
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Lekka D, Richardson C, Madoglou A, Orlandou K, Arachoviti V, Karamanoli VI, Roubi A, Togas C, Tsaraklis A, Stalikas A. Study of the Association of Insecure Attachment With the Dehumanization and Self-Dehumanization of Patients Hospitalized With Psychotic Disorder and Organic Disease. Cureus 2022; 14:e21445. [PMID: 35223230 PMCID: PMC8857867 DOI: 10.7759/cureus.21445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Dehumanization is the phenomenon that concerns the non-attribution of humanness to other human beings and has two dimensions, animalistic and mechanistic. The aim of the present study is to study dehumanization and self-dehumanization in patients with psychosis and organic disease. Methods The sample consisted of 200 people who were hospitalized in Athens, Greece, in 2017. Participants were asked to answer the dehumanization questionnaire, the mechanistic self-dehumanization scale, the human nature and human uniqueness characteristics questionnaire, and the adult attachment questionnaire. Results It was found that patients with organic disease and patients with psychosis do not perform mechanistic and animalistic dehumanization of themselves. Still, it seems that insecure attachment (anxiety and obsession) contributes positively to their mechanistic dehumanization and negatively to their mechanistic self-dehumanization. From the insecure attachment, only the dimensions of stress and obsession affect the mechanistic dehumanization. Conclusions It is important to take measures to train specialists in the hospital so that they can establish a safe therapeutic relationship with the patient so that patients will not resort to dehumanization and self-dehumanization as a defense against the stress of hospitalization.
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17
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Kramarz E, Mok CLM, Westhead M, Riches S. Staff experience of team case formulation to address challenging behaviour on acute psychiatric wards: a mixed-methods study. J Ment Health 2022; 32:412-423. [PMID: 35037548 DOI: 10.1080/09638237.2021.2022611] [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: 10/19/2022]
Abstract
BACKGROUND Team case formulation on acute psychiatric wards aims to support staff to manage significant levels of challenging behaviour. However, there is limited research on staff experience of case formulation in this setting. AIM This study aimed to investigate staff experience of team case formulation sessions on acute psychiatric wards and their impact on staff wellbeing. METHODS Eighteen multidisciplinary staff (nurses, doctors, occupational therapists, support workers, activities coordinators) from five acute wards at a South London psychiatric hospital completed a semi-structured interview and visual analogue scales on their experience of attending case formulation. Thematic analysis was employed to analyse qualitative data. RESULTS Participants reported that case formulation supported staff to develop a holistic understanding of service users, provided a safe space for staff to discuss the impact of challenging behaviour and improved teamwork and communication. Participants reported that these benefits increased their ability to identify and support the needs of service users and improved therapeutic relationships. Challenges with establishing continuity of care were highlighted. CONCLUSION Team case formulation is an important intervention to support ward staff and has significant benefits to staff wellbeing and quality of care. Greater integration with existing ward practices may benefit both staff and service users.
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Affiliation(s)
- Emilia Kramarz
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Che Ling Michelle Mok
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Division of Psychology and Language Sciences, Faculty of Brain Sciences, University College London, London, UK
| | - Megan Westhead
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Simon Riches
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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18
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Degnan A, Shattock L, Edge D, Muller C, Berry K. Associations between attachment, therapeutic alliance, and engagement in black people with psychosis living in the UK. J Ment Health 2022; 31:716-723. [PMID: 35014930 DOI: 10.1080/09638237.2021.2022613] [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: 10/19/2022]
Abstract
BACKGROUND Compared to other ethnic groups in the UK, Black people have the highest rates of psychosis. This may partly be explained by both assessment bias and structural racism. Mental health services often find it difficult to develop therapeutic relationships with Black people with psychosis. Attachment theory posits that the quality of previous caregiving experiences influence current interpersonal functioning and emotional regulation. In this study, we applied the theory to improve the understanding of therapeutic relationships with people with psychosis. AIMS This is the first study to examine associations between attachment difficulties, therapeutic alliance, and service engagement in a Black sample with psychosis. METHOD Fifty-one participants completed self-report measures of attachment and alliance. Staff completed measures of alliance and service engagement. RESULTS Higher attachment avoidance was related to poorer alliance ratings. These significant findings were not upheld in a regression model controlling for total symptom scores and perceived ethnic/racial discrimination in services. Attachment anxiety was generally not associated with alliance ratings. Neither attachment anxiety nor attachment avoidance was significantly associated with service engagement. CONCLUSIONS Staff should be supported to better understand the needs of service users with avoidant attachment behaviours and to develop mutually-agreed treatment goals and therapeutic bonds.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Lucy Shattock
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Trust, Rawnsley Building, Oxford Road, Manchester, UK
| | - Dawn Edge
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Trust, Rawnsley Building, Oxford Road, Manchester, UK
| | - Claire Muller
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Trust, Rawnsley Building, Oxford Road, Manchester, UK
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Degnan A, Berry K, Humphrey C, Bucci S. The role of attachment and dissociation in the relationship between childhood interpersonal trauma and negative symptoms in psychosis. Clin Psychol Psychother 2022; 29:1692-1706. [PMID: 35218114 PMCID: PMC9790513 DOI: 10.1002/cpp.2731] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/17/2022] [Accepted: 02/23/2022] [Indexed: 12/30/2022]
Abstract
Negative symptoms have an adverse impact on quality of life and functioning in psychosis. Service users with psychosis have identified negative symptoms as a priority for their recovery. Despite this, there is a lack of effective and targeted psychological interventions for negative symptoms and their underlying mechanisms remain poorly understood. Childhood trauma is a robust risk factor for positive symptoms in psychosis, but the association with negative symptoms is less well established. Our aim was to examine the association between childhood interpersonal trauma and negative symptoms and the psychological mediators of this relationship. Two hundred and forty participants experiencing psychosis completed validated self-report measures of childhood trauma, attachment, dissociation, compartmentalization, and symptoms. Mediation analyses showed that disorganized attachment and dissociative experiences mediated the association between childhood trauma and negative symptoms, when analysed individually and in a combined model. Models adjusted for age and positive and depressive symptoms. Avoidant attachment and compartmentalization were independently associated with negative symptoms but not childhood trauma and thus were not significant mediators. Childhood trauma was not independently associated with negative symptoms. This paper is the first to present empirical data to support a model implicating attachment and dissociation as important psychological processes in the link between childhood trauma and negative symptoms. These exploratory findings suggest that it may be beneficial to consider these relationships in trauma-informed formulations and interventions. Further longitudinal research is required to establish causality and test theoretical models of mechanisms in the pathway to negative symptoms.
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Affiliation(s)
- Amy Degnan
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Charlotte Humphrey
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchester Academic Health Sciences Centre, The University of ManchesterManchesterUK
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20
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Lekka D, Richardson C, Madoglou A, Orlandou K, Karamanoli VI, Roubi A, Pezirkianidis C, Arachoviti V, Tsaraklis A, Stalikas A. Dehumanization of Hospitalized Patients and Self-Dehumanization by Health Professionals and the General Population in Greece. Cureus 2021; 13:e20182. [PMID: 35004006 PMCID: PMC8726745 DOI: 10.7759/cureus.20182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 11/15/2022] Open
Abstract
Introduction Dehumanization is defined as the denial to people of their humanness. It is distinguished into animalistic and mechanistic dehumanization. The aim of this study is to examine whether professionals in a public hospital dehumanize the patient and self-dehumanize. Methods We used the Dehumanization Questionnaire, the Mechanistic Self-Dehumanization Scale, the Human Nature and Human Uniqueness Characteristics Questionnaire, the General Causality Orientation Scale and the Adult Attachment Questionnaire. The sample consisted of 135 mental health professionals (20 from a general hospital and 115 from a psychiatric hospital), 134 other health professionals from the general hospital and 84 people from the general population. Results Health professionals dehumanize the hospitalized patient more than the general population. The secure attachment acts protectively on self-dehumanization and negatively on the dehumanization of the hospitalized patient. Finally, autonomous people are not self-dehumanized. Conclusions Our findings indicate that measures should be taken for health professionals so that they do not dehumanize the patient.
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21
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Sood M, Carnelley K, Newman-Taylor K. How does attachment imagery for paranoia work? Cognitive fusion and beliefs about self and others mediate the impact on paranoia and anxiety. Psychol Psychother 2021; 94:973-993. [PMID: 34145722 DOI: 10.1111/papt.12354] [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: 02/02/2021] [Revised: 03/22/2021] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Paranoia describes unfounded and distressing interpersonal threat beliefs. Secure attachment imagery has been shown to attenuate paranoia and anxiety in non-clinical and clinical groups, but little is known about the differential effects of anxious and avoidant imagery or mechanisms of change. In this study, we tested the impact of secure, anxious, and avoidant attachment imagery on paranoia, anxiety, and help-seeking intentions. We also examined hypothesized mechanisms of change, specifically whether cognitive fusion and negative self- and other-beliefs mediate these relationships. DESIGN This study utilized an experimental, cross-sectional design. METHODS A large (N = 303), international general population sample with high levels of non-clinical paranoia completed a series of measures before and after engaging in secure, anxious, or avoidant imagery. RESULTS Relative to anxious and avoidant attachment imagery, secure attachment imagery reduced paranoia and anxiety and increased help-seeking intentions. Cognitive fusion and negative self- and other-beliefs mediated the impact of attachment imagery on paranoia and anxiety, but not help-seeking. CONCLUSIONS In line with attachment and cognitive theory, secure attachment imagery is effective in reducing paranoia and anxiety and works by reducing cognitive fusion and negative self- and other-beliefs. These novel findings suggest that the secure imagery task could be incorporated into cognitive and behavioural therapies to reduce distressing interpersonal threat beliefs and associated negative affect, and increase help-seeking intentions. PRACTITIONER POINTS When working with people experiencing paranoia, secure attachment imagery may be effective in reducing state paranoia and anxiety and improving help-seeking intentions. Attachment imagery works by influencing beliefs about self and others, and the degree to which people are fused with their beliefs. In clinical practice, the rationale for the imagery task fits well with psychological models of paranoia and the secure imagery task can be introduced as a way to cope when struggling with distressing beliefs about self and others, and feeling overwhelmed by these fears.
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Affiliation(s)
- Monica Sood
- School of Psychology, University of Southampton, UK
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22
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The Impact of Repeated Attachment Priming on Paranoia, Mood and Help-Seeking Intentions in an Analogue Sample. Brain Sci 2021; 11:brainsci11101257. [PMID: 34679322 PMCID: PMC8533775 DOI: 10.3390/brainsci11101257] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/16/2022] Open
Abstract
Attachment security priming effects therapeutic change in people with depression and anxiety. Preliminary studies indicate that visualising secure attachment memories also reduces paranoia in non-clinical and clinical groups, probably due to a decrease in cognitive fusion. Benefits to clinical populations depend on the sustainability of these effects and the impact on help-seeking behaviours. The combination of paranoia and an insecure-avoidant attachment style is likely to be a particular barrier to help seeking. We used a longitudinal experimental design to test the impact of repeated attachment priming on paranoia, mood and help-seeking intentions and whether cognitive fusion mediates these effects. Seventy-nine people with high levels of non-clinical paranoia, aged 18-50 years (M = 20.53, SD = 4.57), were randomly assigned to a secure or insecure-avoidant priming condition. Participants rehearsed the visualisation prime on four consecutive days and were assessed on standardised measures of paranoia, positive and negative affect, help-seeking intentions and cognitive fusion. A series of mixed-model analyses of variance showed that security priming decreases paranoia, negative affect and cognitive fusion and increases positive affect and help seeking, compared to insecure-avoidant priming. Examining the impact of primed attachment (rather than measured attachment style) allows us to draw conclusions about the causal processes involved; mediation analyses showed indirect effects of the primes on paranoia and negative affect through cognitive fusion. With a growing understanding of (1) the impact of security priming on paranoia, affect and help-seeking behaviours, (2) causal mechanisms and (3) sustainability of effects, security priming may be developed into a viable intervention for clinical populations.
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Tjaden CD, Mulder CL, Delespaul PA, Arntz AR, Kroon H. Attachment as a framework to facilitate empowerment for people with severe mental illness. Psychol Psychother 2021; 94:407-425. [PMID: 33124185 PMCID: PMC8451854 DOI: 10.1111/papt.12316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 08/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Recovery and empowerment have evolved into key objectives in the treatment and care of people with severe mental illness (SMI), and interest has grown in the role of social relationships in recovery. This study is the first to explore whether attachment styles are related to levels of empowerment, and secondly, whether attachment anxiety and attachment avoidance are associated with lower empowerment levels, independently of quality and frequency of social contact. DESIGN We used a cross-sectional design. METHODS In a sample of 157 participants with SMI in outpatient care, associations between attachment (Revised Adult Attachment Scale), self-reported social functioning, and empowerment (Netherlands Empowerment List) were assessed. RESULTS Attachment anxiety and attachment avoidance were both associated with lower levels of empowerment. A stepwise multiple regression analysis showed that the prediction of empowerment was significantly improved by adding attachment anxiety and attachment avoidance to quality and frequency of social contact. Attachment anxiety, attachment avoidance, and quality of social contact were significant predictors; frequency of social contact was not. CONCLUSIONS Although our design does not allow causal conclusions, our results highlight the importance of interpersonal processes and behaviours as routes to improving empowerment for people with SMI. A promising approach might thus consist of securing attachment bonds with significant others so that the self and the other are perceived as reliable resources. Our findings also feature the importance of reciprocity and equality in social relationships. Taken together, our study emphasizes the value of social, contextualized interventions in recovery work for people with SMI. PRACTITIONER POINTS Working towards attachment safety in interpersonal relations may be important in recovery-oriented treatment and care for people with severe mental illness (SMI). Helping people with SMI to recognize and change how they tend to relate themselves to others may promote engagement and effectiveness of recovery-oriented treatment and care. Reciprocity and equality in social relationships as vital complements to the more one-sided nature of 'standing alongside' and offering support may be important requisites for empowerment.
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Affiliation(s)
- Cathelijn D. Tjaden
- Department of Reintegration and Community CareTrimbos InstituteUtrechtThe Netherlands,Department of Social and Behavioral SciencesTranzo Scientific Center for Care and WelfareTilburg UniversityThe Netherlands
| | - Cornelis L. Mulder
- Department of PsychiatryErasmus Medical CenterRotterdamThe Netherlands,AntesParnassia Psychiatric InstituteRotterdamThe Netherlands
| | - Philippe A.E.G. Delespaul
- School of Mental Health and NeuroSciencesMaastricht UniversityThe Netherlands,Mondriaan Mental Health TrustMaastricht/HeerlenThe Netherlands
| | - Arnoud R. Arntz
- Department of Clinical PsychologyUniversity of AmsterdamThe Netherlands
| | - Hans Kroon
- Department of Reintegration and Community CareTrimbos InstituteUtrechtThe Netherlands,Department of Social and Behavioral SciencesTranzo Scientific Center for Care and WelfareTilburg UniversityThe Netherlands
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Berry K, Haddock G, Barrowclough C, Gregg L. The role of attachment, coping style and reasons for substance use in substance users with psychosis. Clin Psychol Psychother 2021; 29:725-732. [PMID: 34432340 DOI: 10.1002/cpp.2666] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/10/2022]
Abstract
Seventy substance users with psychosis who were participating in a clinical trial of a psychological therapy for psychosis were additionally assessed for attachment, coping styles and self-reported reasons for substance use in order to test a hypothesized sequential mediation model. In this model the relationship between insecure attachment and problematic substance use was assumed to be sequentially mediated by dysfunctional coping and the use of substances to cope with distress. Hypothesized associations between insecure-avoidant attachment and substance use were not supported, but the relationship between insecure-anxious attachment and problematic substance use was confirmed and found to be fully mediated by dysfunctional coping and coping reasons for use. Findings suggest that fostering secure attachments in people with psychosis might promote more successful coping and could prevent or reduce substance use related problems in this group.
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Affiliation(s)
- Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Gillian Haddock
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Christine Barrowclough
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Lynsey Gregg
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
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25
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Michelini G, Palumbo IM, DeYoung CG, Latzman RD, Kotov R. Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience. Clin Psychol Rev 2021; 86:102025. [PMID: 33798996 PMCID: PMC8165014 DOI: 10.1016/j.cpr.2021.102025] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.
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Affiliation(s)
- Giorgia Michelini
- Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90024, United States of America.
| | - Isabella M Palumbo
- Department of Psychology, Georgia State University, Atlanta, GA 30303, United States of America
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Robert D Latzman
- Department of Psychology, Georgia State University, Atlanta, GA 30303, United States of America
| | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY 11790, United States of America
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Tang W, Xu D, Yang Y, Xu J. Psychotic-like experiences in Chinese children and adolescents: The effect of earthquake exposure, maltreatment and negative life events. Early Interv Psychiatry 2021; 15:536-546. [PMID: 32500658 DOI: 10.1111/eip.12976] [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: 01/02/2020] [Revised: 04/02/2020] [Accepted: 04/28/2020] [Indexed: 02/05/2023]
Abstract
AIM Psychotic-like experiences (PLEs) are common in adolescents who have experienced or are experiencing trauma. However, the potential relationships between exposure to a major earthquake, negative life events or maltreatment and PLEs in Chinese adolescents are poorly understood. Therefore, this study explored the prevalence of PLEs and the psychosocial correlates in adolescent earthquake survivors. METHODS A total of 6132 adolescents from 11 primary and high schools in the areas most severely affected by the Ya'an earthquake completed questionnaires on earthquake exposure, maltreatment, negative life events and PLEs, which included paranoid ideation and psychoticism. RESULTS It was found that earthquake exposure significantly contributed to the PLEs, child maltreatment explained a significant amount of the PLE variances, emotional abuse had the most important PLE role and negative life events also explained a large amount of the PLE variances, of which interpersonal difficulties and academic pressure had the greatest effects. CONCLUSIONS Interventions should seek to reduce parental emotional abuse, reduce academic performance pressure, improve interpersonal skills and resolve interpersonal difficulties, and specific interventions should target children and adolescents exposed to the earthquake to prevent PLEs, schizophrenia or other mental illnesses arising from multiple traumas.
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Affiliation(s)
- Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China.,Institute of Emergency Management and Post-Disaster Reconstruction, Sichuan University, Chengdu, China
| | - Dun Xu
- Institute of Emergency Management and Post-Disaster Reconstruction, Sichuan University, Chengdu, China
| | - Yanchun Yang
- Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Jiuping Xu
- Institute of Emergency Management and Post-Disaster Reconstruction, Sichuan University, Chengdu, China
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27
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Alareqe NA, Roslan S, Taresh SM, Nordin MS. Universality and Normativity of the Attachment Theory in Non-Western Psychiatric and Non-Psychiatric Samples: Multiple Group Confirmatory Factor Analysis (CFA). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5770. [PMID: 34072158 PMCID: PMC8198184 DOI: 10.3390/ijerph18115770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 05/11/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
This study tests for the first time the validity of universality and normativity assumptions related to the attachment theory in a non-Western culture, using a novel design including psychiatric and non-psychiatric samples as part of a comprehensive exploratory and advanced confirmatory framework. Three attachment assessments were distributed to 212 psychiatric outpatients and 300 non-psychiatric samples in Yemen. The results of the fourteen approaches of exploratory factor analysis (EFA) produce a similar result and assertion that the psychiatric outpatients tend to explore attachment outcomes based on multi-methods, while the non-psychiatric samples suggest an attachment orientation based on multi-traits (self-other). The multiple group-confirmatory factor analysis (MG-CFA) demonstrates that the multi-method model fits the psychiatric samples better than the non-psychiatric samples. Equally, the MG-CFA suggests that the multi-traits model also fits the psychiatric samples better than the non-psychiatric samples. Implications of the results are discussed.
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Affiliation(s)
| | - Samsilah Roslan
- Department of Foundations of Education, Faculty of Educational Studies, Universiti Putra Malaysia (UPM), Selangor 43400, Malaysia;
| | - Sahar Mohammed Taresh
- Department of Foundations of Education, Faculty of Educational Studies, Universiti Putra Malaysia (UPM), Selangor 43400, Malaysia;
| | - Mohamad Sahari Nordin
- Department of Educational Psychology and Counseling, International Islamic University Malaysia (IIUM), Selangor 53100, Malaysia;
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28
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Pipkin A, Hogg L, Armitage S. 'Someone on my level': A Meta-Ethnographic Review of Therapeutic Relationships in Cognitive Behavioural Therapy for Psychosis. Clin Psychol Psychother 2021; 28:1297-1313. [PMID: 33605515 DOI: 10.1002/cpp.2578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cognitive Behavioural Therapy for Psychosis (CBTp) demonstrates variable and at times mild to moderate effect sizes; thus, its therapeutic processes are important to explore. Establishing a secure therapeutic relationship is one such key process where barriers may exist, including those related to psychotic symptoms and associated stigma. This review synthesizes the available qualitative research pertaining to the experience of the therapeutic relationship from the perspective of those experiencing psychosis. METHODS A systematic review was undertaken using PRISMA guidelines. Search terms included variants of 'psychosis', 'therapy' and 'qualitative'. PsycInfo, CINAHL, EmBase, MedLine and Web of Science were searched, and reference lists were hand-scanned. Yardley's quality appraisal tool was utilized and Noblit and Hare's seven-stage process for conducting a meta-ethnographic review. A line-of-argument synthesis is presented. RESULTS Fourteen papers were identified using inclusion and exclusion criteria. Twelve papers were deemed to have satisfactory quality. The line-of-argument synthesis used attachment theory to propose four semi-distinct stages to establishing a therapeutic relationship: beginning; safety, hope and trust; the practicalities of therapy; and branching out. Findings suggest that the therapist's persona and use of CBTp techniques such as collaboration and shared agency over the process were important in establishing for the patient a sense of self as normal, equal and worthwhile. CONCLUSIONS Attachment security may be an important strand of CBTp and warrants further research and clinical investigation as a process and an outcome. Future research can benefit from increased transparency regarding researcher positionality as a potential source of bias.
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Affiliation(s)
- Alastair Pipkin
- Senior Clinical Psychologist, Northamptonshire Gender Service, Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK
| | - Lorna Hogg
- Deputy Director and Consultant Clinical Psychologist, Oxford Institute of Clinical Psychology Training, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Armitage
- Clinical Psychologist, Berkshire Early Intervention in Psychosis Service, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
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Nasiriavanaki Z, Barbour T, Farabaugh AH, Fava M, Holmes AJ, Tootell RBH, Holt DJ. Anxious attachment is associated with heightened responsivity of a parietofrontal cortical network that monitors peri-personal space. NEUROIMAGE-CLINICAL 2021; 30:102585. [PMID: 33773165 PMCID: PMC8024770 DOI: 10.1016/j.nicl.2021.102585] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 12/17/2020] [Accepted: 01/29/2021] [Indexed: 12/13/2022]
Abstract
A parietofrontal cortical network is more active when stimuli are near the body. Responses of this network were positively correlated with “attachment anxiety”. No other types of attachment or symptoms accounted for this association. Connectivity strength within this network was not linked with attachment anxiety.
Background Attachment, or affiliative bonding among conspecifics, is thought to involve neural mechanisms underlying behavioral responses to threat and reward-related social signals. However, attachment-oriented responses may also rely on basic sensorimotor processes. One sensorimotor system that may play a role in attachment is the parietofrontal cortical network that responds to stimuli that are near or approaching the body, the peripersonal space (PPS) monitoring system. We hypothesized that this network may vary in responsivity to such potentially harmful stimuli, particularly those with social salience, based on individual differences in attachment styles. Methods Young adults viewed images of human faces or cars that appeared to move towards or away from them, while functional magnetic resonance imaging data were collected. Correlations between each of four adult attachment styles, measured using the Relationship Questionnaire, and responses of the PPS network to approaching (versus withdrawing) stimuli were measured. Results A region-of-interest (ROI) analysis, focused on six cortical regions of the PPS network that showed significant responses to approaching versus withdrawing face stimuli in an independent sample (n = 80), revealed that anxious attachment style (but not the other 3 attachment styles) was significantly positively correlated with responses to faces (but not to cars) in all six ROIs (r = 0.33–0.49, p = 0.01–0.0001, n = 50). Conclusions These findings suggest that anxious attachment is associated with over-responsivity of a sensorimotor network involved in attending to social stimuli near the body.
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Affiliation(s)
- Zahra Nasiriavanaki
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Tracy Barbour
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Amy H Farabaugh
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Maurizio Fava
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States; Harvard Medical School, Boston, MA, United States
| | - Avram J Holmes
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Roger B H Tootell
- Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Department of Radiology, Massachusetts General Hospital, Charlestown, MA, United States
| | - Daphne J Holt
- Department of Psychiatry, Massachusetts General Hospital, Charlestown, MA, United States; Harvard Medical School, Boston, MA, United States; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States.
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Coughlan H, Walton-Ball E, Carey E, Healy C, O’Regan-Murphy G, Uidhir AN, Clarke MC, Cannon M. Self-reported interpersonal and educational/vocational difficulties in young adults with a history of transient psychotic experiences: findings from a population-based study. BMC Psychiatry 2021; 21:30. [PMID: 33430829 PMCID: PMC7802220 DOI: 10.1186/s12888-020-03022-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 12/22/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Psychotic experiences (PEs) are not uncommon in young people and are associated with both psychopathology and compromised global functioning. Although psychotic experiences are transient (short-lived, self-resolving and non-recurring) for most people who report them, few studies have examined the association between early transient PEs and later functioning in population samples. Additionally, studies using self-report measures of interpersonal and educational/ vocational difficulties are lacking. The aim of this study was to examine the relationship between transient psychotic experiences and self-reported interpersonal and educational/vocational difficulties in adolescence and young adulthood. METHODS Participants were 103 young people from a longitudinal population-based study cohort of mental health in Ireland. They attended for baseline clinical interviews in childhood (age 11-13) and were followed up in young adulthood (age 19-25). Participants who reported psychotic experiences at baseline but not at follow-up were classified as having transient psychotic experiences. Data from both time-points were used to examine the association between transient psychotic experiences and self-reported interpersonal and educational/ vocational difficulties in young adulthood using poisson regression modelling. RESULTS Young people with a history of transient psychotic experiences reported significantly higher interpersonal (adj IRR: 1.83, 95%ileCI: 1.10-3.02, p = .02) and educational/vocational (adj IRR: 2.28, 95%ileCI: 1.43-3.64, p = .001) difficulties during adolescence. However, no significant differences in interpersonal (adj IRR: 0.49, 95%ileCI: 0.10-2.30, p = .37) or educational/vocational (adj IRR: 0.88, 95%ileCI: 0.37-2.08, p = .77) difficulties were found in young adulthood. Self-reported interpersonal and educational/vocational difficulties in young people both with and without a history of transient psychotic experiences decreased between adolescence and young adulthood. CONCLUSIONS Young people with transient psychotic experiences have increased interpersonal and educational/vocational difficulties in adolescence but these may not persist into the young adult years. This finding indicates that early psychotic experiences may not confer high risk for long-term interpersonal or educational/vocational deficits among young people who experience these phenomena transiently.
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Affiliation(s)
- Helen Coughlan
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Erin Walton-Ball
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Eleanor Carey
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Colm Healy
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Grace O’Regan-Murphy
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Aoife Nic Uidhir
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland
| | - Mary C. Clarke
- grid.414315.60000 0004 0617 6058Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland ,grid.4912.e0000 0004 0488 7120Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, RCSI Education and Research Centre, Beaumont Hospital, Dublin, Ireland. .,Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland.
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van Bussel EMM, Nguyen NHM, Wierdsma AI, van Aken BC, Willems IEMG, Mulder CL. Adult Attachment and Personal, Social, and Symptomatic Recovery From Psychosis: Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:641642. [PMID: 33716835 PMCID: PMC7943841 DOI: 10.3389/fpsyt.2021.641642] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022] Open
Abstract
Despite growing evidence for the role of attachment in psychosis, no quantitative review has yet been published on the relationship in this population between insecure attachment and recovery in a broad sense. We therefore used meta-analytic techniques to systematically appraise studies on the relationship between attachment and symptomatic, social and personal recovery in clients with a psychotic disorder. Using the keywords attachment, psychosis, recovery and related terms, we searched six databases: Embase, Medline Epub (OVID), Psycinfo (OVID), Cochrane Central (trials), Web of Science, and Google Scholar. This yielded 28 studies assessing the associations between adult attachment and recovery outcome in populations with a psychotic disorder. The findings indicated that insecure anxious and avoidant attachment are both associated with less symptomatic recovery (positive and general symptoms), and worse social and personal recovery outcomes in individuals diagnosed with a psychotic disorder. The associations were stronger for social and personal recovery than for symptomatic recovery. Attachment style is a clinically relevant construct in relation to the development and course of psychosis and recovery from it. Greater attention to the relationship between attachment and the broad scope of recovery (symptomatic, social, and personal) will improve our understanding of the illness and efficacy of treatment for this population.
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Affiliation(s)
- E M M van Bussel
- Geestelijke gezondheidszorg Oost Brabant, Institute for Mental Health, Oss, Netherlands
| | - N H M Nguyen
- Geestelijke gezondheidszorg Oost Brabant, Institute for Mental Health, Oss, Netherlands
| | - A I Wierdsma
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, Netherlands
| | - B C van Aken
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, Netherlands
| | - I E M G Willems
- GGZ Breburg, Institute for Mental Health, Tilburg, Netherlands
| | - C L Mulder
- Department of Psychiatry, Erasmus Medical Centre, Epidemiological and Social Psychiatric Research Institute, Rotterdam, Netherlands.,Parnassia Psychiartric Institute, Rotterdam, Netherlands
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Bosmans G, Verschueren K, Cuyvers B, Minnis H. Current Perspectives on the Management of Reactive Attachment Disorder in Early Education. Psychol Res Behav Manag 2020; 13:1235-1246. [PMID: 33376419 PMCID: PMC7755333 DOI: 10.2147/prbm.s264148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 12/08/2020] [Indexed: 11/23/2022] Open
Abstract
Children with Reactive Attachment Disorder (RAD) have special educational needs that are challenging for teachers in early education. In the current contribution, we will discuss a large body of research suggesting that stimulating these children's attachment development is feasible for teachers and potentially a successful strategy to ensure that these children thrive better in the classroom and socially. The current overview discusses research and theory on RAD and RAD treatment and results in the formulation of specific recommendations for the successful management of children with RAD in the classroom.
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Affiliation(s)
- Guy Bosmans
- Department of Clinical Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Karine Verschueren
- Department of School Psychology and Development in Context, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Bien Cuyvers
- Department of Clinical Psychology, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Helen Minnis
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
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33
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Cuyvers B, Vervoort E, Bosmans G. Reactive attachment disorder symptoms and prosocial behavior in middle childhood: the role of Secure Base Script knowledge. BMC Psychiatry 2020; 20:524. [PMID: 33148195 PMCID: PMC7641862 DOI: 10.1186/s12888-020-02931-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 10/26/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children with attachment disorder show prosocial behavior problems. Children with a reactive attachment disorder show inhibited and emotionally withdrawn behavior. Consequently, these children typically display prosocial behavior problems. However, the underlying mechanism between reactive attachment disorder and prosocial behavior problems is still unclear and findings in literature are mixed. METHODS The current study investigated the role of children's attachment representations in this association. Attachment representations reflect knowledge about a cognitive script regarding the attachment figure as a source for support (Secure Base Script). We tested whether secure base script knowledge 1) mediates or 2) moderates the link between reactive attachment disorder and prosocial behavior problems in 83 children (6-11 years; 83.1% boys) recruited from special education schools for children with behavioral problems. Children completed a pictorial Secure Base Script Test. Their reactive attachment disorder symptoms were assessed during an interview with the primary caregivers. Primary caregivers and teachers filled out a prosocial behavior questionnaire about the child. RESULTS Results did not support the mediation hypothesis, but evidence for the moderation hypothesis was found. Secure base script knowledge attenuated the negative association between attachment disorder symptoms and prosocial behavior. CONCLUSIONS These findings contribute to the discussion about the link between attachment representations and attachment disorders.
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Affiliation(s)
- Bien Cuyvers
- Department of Clinical Psychology, Katholieke Universiteit Leuven, Tiensestraat 102, 3000, Leuven, Belgium.
| | | | - Guy Bosmans
- grid.5596.f0000 0001 0668 7884Department of Clinical Psychology, Katholieke Universiteit Leuven, Tiensestraat 102, 3000 Leuven, Belgium
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Kielan-Cebo J, Krężołek M, Pionke R, Gawęda Ł. The role of insecure attachment and cognitive biases in the social functioning of schizophrenia spectrum patients. J Clin Psychol 2020; 77:846-854. [PMID: 33051868 DOI: 10.1002/jclp.23072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 08/31/2020] [Accepted: 09/19/2020] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The study investigates the relationship between cognitive biases and attachment styles and social functioning. METHOD Fifty-three patients (28 females, age M = 41.73, SD = 11.71) with the diagnosis of schizophrenia participated in the study. We measured attachment styles, cognitive biases, and social functioning using self-report questionnaires. Relationships among variables were investigated with correlational and regression analyses. RESULTS Correlation analysis indicated that social engagement, interpersonal behavior, pro-social activities, and independence-performance significantly correlate with both attachment styles and cognitive biases. However, in regression analysis, after controlling for attachment styles, only subjective cognitive problems turned out to be a significant predictor of social functioning. CONCLUSIONS These preliminary findings might suggest that both attachment styles and cognitive biases are associated with social functioning. Nonetheless, when considered together it might suggest attachment styles have a higher contribution than cognitive biases to social engagement, interpersonal behavior, and pro-social activities decline in schizophrenia spectrum disorders.
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Affiliation(s)
- Joanna Kielan-Cebo
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Warsaw, Poland
| | - Martyna Krężołek
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Warsaw, Poland
| | - Renata Pionke
- Psychopathology and Early Intervention Lab, II Department of Psychiatry, The Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Scott M, Rossell SL, Meyer D, Toh WL, Thomas N. Childhood trauma, attachment and negative schemas in relation to negative auditory verbal hallucination (AVH) content. Psychiatry Res 2020; 290:112997. [PMID: 32470717 DOI: 10.1016/j.psychres.2020.112997] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
Auditory verbal hallucinations (AVHs, or hearing voices) are particularly characterized by negative content such as criticism and threats. The extent of negative content is a major predictor of distress, yet there is limited research on what contributes to the content of AVHs. The current study aimed to assess the relationships between childhood trauma, attachment styles (anxious and avoidant) and negative self schemas as plausible mechanisms underlying negative AVH content. Structural equation modelling was used to test a theoretical model, including these constructs, in a transdiagnostic sample of 140 people with AVHs. Findings indicated that collectively, emotional trauma during childhood, insecure anxious attachment and negative self schemas predicted the proportion of negative AVH content experienced by voice hearers. Whereby, trauma predicted attachment, which predicted schemas and in turn negative AVH content. This study marks an important step towards understanding the underlying mechanisms involved in negative AVHs. The results highlight the importance of recognising early experiences of trauma, adult attachment styles and self schemas in developing formulations and effective treatments for negative and distressing AVHs. Psychological interventions that target these underlying mechanisms of negative AVHs may lead to a reduction in negative content, thereby reducing voice related distress.
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Affiliation(s)
- Monique Scott
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Psychiatry, St Vincent's Hospital Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Alfred Health, Melbourne, Australia.
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Coughlan H, Healy C, Ní Sheaghdha Á, Murray G, Humphries N, Clarke M, Cannon M. Early risk and protective factors and young adult outcomes in a longitudinal sample of young people with a history of psychotic-like experiences. Early Interv Psychiatry 2020; 14:307-320. [PMID: 31310453 DOI: 10.1111/eip.12855] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/28/2019] [Accepted: 06/09/2019] [Indexed: 12/13/2022]
Abstract
AIM Psychotic-like experiences (PEs) have been associated with childhood adversity and psychopathology. However, few studies have examined the dynamic interplay between risk and protective factors and later life outcomes in people with PEs. This study aimed to explore and compare patterns of early adverse and protective experiences and young adult outcomes in a sample of young people with a history of PEs. METHOD Longitudinal qualitative data spanning nine years were collected from a general population sample of seventeen young adults who had reported PEs in early adolescence. A qualitative comparative case study design was used to explore patterns of early life experiences and young adult outcomes. RESULTS Four archetypal profiles of early life experiences and later outcomes were identified. Qualitative differences between types of early adverse experiences and the quality of attachment relationships were dominant discriminating factors between low-risk and at-risk archetypes for poor young adult outcomes. Experiences of multiple adversities, which included childhood trauma and occurred in the absence of secure attachment relationships was associated with the poorest young adult outcomes. The presence of secure attachment relationships was protective, even among individuals who had experienced adversity. CONCLUSIONS Not all young people who report PEs have high levels of adversity. Those who experience multiple early adversities, childhood trauma and insecure attachment relationships are at highest risk for reoccurring PEs and poor young adult outcomes. Developing trusted attachment relationships and engaging in corrective experiences may be protective and could promote positive outcomes in youth with PEs.
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Affiliation(s)
- Helen Coughlan
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colm Healy
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Áine Ní Sheaghdha
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gareth Murray
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Niamh Humphries
- Research Department, Royal College of Physicians of Ireland, Dublin, Ireland
| | - Mary Clarke
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Psychiatry, Beaumont Hospital Dublin, Dublin, Ireland
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Pollard C, Bucci S, MacBeth A, Berry K. The revised Psychosis Attachment Measure: Measuring disorganized attachment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:335-353. [PMID: 32415698 PMCID: PMC7496745 DOI: 10.1111/bjc.12249] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/03/2020] [Indexed: 11/30/2022]
Abstract
Objectives The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample. Methods Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self‐reported diagnosis of, or treatment for, a psychosis‐related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment. Results An exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test–retest reliability and the disorganized factor displayed good construct validity with related measures and constructs. Conclusions These results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed. Practitioner points We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity. These results provide preliminary evidence that disorganized attachment can be measured using a simple self‐report measure with individuals with psychosis. Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis. Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma‐related conditions and borderline personality disorder.
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Affiliation(s)
- Catherine Pollard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Angus MacBeth
- School of Health in Social Science, University of Edinburgh, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
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Montag C, Schöner J, Speck LG, Just S, Stuke F, Rentzsch J, Gallinat J, Majić T. Peripheral oxytocin is inversely correlated with cognitive, but not emotional empathy in schizophrenia. PLoS One 2020; 15:e0231257. [PMID: 32255800 PMCID: PMC7138301 DOI: 10.1371/journal.pone.0231257] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/19/2020] [Indexed: 12/05/2022] Open
Abstract
Endogenous oxytocin has been associated with different aspects of social cognition in healthy subjects and patients with schizophrenia. In this pilot study, we investigated the relationship between plasma oxytocin and oxytocin level changes induced by empathy-eliciting, attachment-related movie scenes with correlates of cognitive and emotional empathy in patients and healthy controls. The Multifaceted Empathy Test (MET) and the Interpersonal Reactivity Index (IRI) were administered to patients with schizophrenia (N = 35, 12 females) and healthy controls (N = 35, 12 females) to estimate dimensions of cognitive and emotional empathy. Peripheral basal oxytocin concentrations and oxytocin responses to movie-based emotional stimuli were assessed using radioimmunoassay with sample extraction. In patients, induced oxytocin level changes were inversely correlated with MET cognitive empathy regarding negative emotional states. Controlling for non-social cognition and age revealed a significant negative association between basal oxytocin levels and MET cognitive empathy for positive emotions. In healthy subjects, oxytocin reactivity was inversely correlated with the IRI subscale "fantasy". Oxytocin was not related to any measure of emotional empathy. A hyper-reactive oxytocin system might be linked to impaired cognitive empathy as a part of a dysfunctional regulative circuit of attachment-related emotions and interpersonal stressors or threats by attribution of meaning. Healthy adults with a disposition to identify with fictional characters showed lower oxytocin reactivity, possibly indicating familiarity with movie-based stimuli. The oxytocinergic system may be involved in maladaptive coping mechanisms in the framework of impaired mentalizing and associated dysfunctional responses to interpersonal challenges in schizophrenia.
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Affiliation(s)
- Christiane Montag
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Johanna Schöner
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Lucas Guilherme Speck
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Sandra Just
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Frauke Stuke
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
| | - Johannes Rentzsch
- Department of Psychiatry, Psychotherapy and Psychosomatics, Brandenburg Medical School ‘Theodor Fontane’, Neurupppin, Germany
| | - Jürgen Gallinat
- Clinic and Policlinic for Psychiatry and Psychotherapy, University Clinic Hamburg-Eppendorf, Hamburg, Germany
| | - Tomislav Majić
- Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Campus Charité Mitte, Berlin, Germany
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Determinants of Therapeutic Alliance With People With Psychotic Disorders: A Systematic Literature Review. J Nerv Ment Dis 2020; 208:329-339. [PMID: 32221188 DOI: 10.1097/nmd.0000000000001125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Therapeutic alliance determines medical treatment adherence, the success of psychotherapy, and the effectiveness of care. This systematic review aims at better understanding its determinants. The electronic databases Pubmed, Cochrane Library, and Web of Science were searched, using combinations of terms relating to psychosis and therapeutic alliance. Studies were selected and data were extracted using a PRISMA statement. Forty-one studies were selected, including 20 cross-sectional studies, 10 cohort studies, five randomized controlled trials, four literature reviews, and two retrospective studies. The quality of therapeutic alliance correlates with clinical symptoms, insight, social and family support, the therapist's qualities, the availability of shared therapeutic decision making, and the types of hospitalization. Although current evidence needs to be completed with further studies, it is already clear that group and family psychoeducation, cognitive remediation, community-based psychiatric services, and shared therapeutic decision making are essential approaches in the management of patients with psychosis.
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Murphy R, Goodall K, Woodrow A. The relationship between attachment insecurity and experiences on the paranoia continuum: A meta‐analysis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:290-318. [DOI: 10.1111/bjc.12247] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/18/2020] [Indexed: 11/29/2022]
Affiliation(s)
| | - Karen Goodall
- School of Health in Social Science University of Edinburgh UK
| | - Amanda Woodrow
- School of Health and Social Care Edinburgh Napier University UK
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41
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Stuke F, Bröcker AL, Bayer S, Heinz A, Bermpohl F, Lempa G, von Haebler D, Montag C. Between a rock and a hard place: Associations between Mentzos' "dilemma", self-reported interpersonal problems, and psychosocial functioning in individuals with non-affective psychoses. Clin Psychol Psychother 2020; 27:528-541. [PMID: 32100357 DOI: 10.1002/cpp.2437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 02/12/2020] [Accepted: 02/13/2020] [Indexed: 01/13/2023]
Abstract
Primary aim of this study was to determine the extent and type of self-reported interpersonal problems in patients with non-affective psychoses and their impact on psychosocial functioning. Furthermore, we aimed to explore potential links with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma", which describes an insufferable inner tension caused by an individual's struggle of being torn between "self-oriented" and "object-oriented" tendencies. In a cross-sectional study among 129 patients with non-affective psychoses, measures of cognition, symptom load and social functioning as well as a tentative, psychodynamic assessment of Mentzos' "dilemma" were obtained during a clinical research visit. Self-report data on interpersonal problems were gathered using the Inventory of Interpersonal Problems (IIP-64D) and compared with a German representative standard sample. Second, IIP-64D scores were compared between groups with or without Mentzos' "dilemma". Hierarchical regression analyses were performed to test for the impact of interpersonal problems on psychosocial functioning, while controlling for cognitive deficits and psychopathology. Results showed that IIP-64D scores differed significantly from healthy controls, except for "self-centred" and "intrusive" interpersonal styles. Participants with a potential "psychotic dilemma" scored significantly higher on the subscales: "domineering", "self-centred", "cold", and "socially avoidant" than the group without a "psychotic dilemma". The total amount of interpersonal problems, and particularly high scores on the IIP-64D "socially avoidant" subscale, predicted psychosocial dysfunction, whereas a "cold" interpersonal style had an opposite effect. In conclusion, specific interpersonal problems may predict psychotherapeutic outcome measures like psychosocial functioning and are partly compatible with the psychodynamic construct of Stavros Mentzos' "psychotic dilemma".
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Affiliation(s)
- Frauke Stuke
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Anna-Lena Bröcker
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Samuel Bayer
- International Psychoanalytic University Berlin (IPU), Berlin, Germany
| | - Andreas Heinz
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Bermpohl
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | | | - Dorothea von Haebler
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,International Psychoanalytic University Berlin (IPU), Berlin, Germany
| | - Christiane Montag
- Psychiatric University Clinic at Hospital St. Hedwig, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Begemann MJH, Thompson IA, Veling W, Gangadin SS, Geraets CNW, van 't Hag E, Müller-Kuperus SJ, Oomen PP, Voppel AE, van der Gaag M, Kikkert MJ, Van Os J, Smit HFE, Knegtering RH, Wiersma S, Stouten LH, Gijsman HJ, Wunderink L, Staring ABP, Veerman SRT, Mahabir AGS, Kurkamp J, Pijnenborg GHM, Veen ND, Marcelis M, Grootens KP, Faber G, van Beveren NJ, Been A, van den Brink T, Bak M, van Amelsvoort TAMJ, Ruissen A, Blanke C, Groen K, de Haan L, Sommer IEC. To continue or not to continue? Antipsychotic medication maintenance versus dose-reduction/discontinuation in first episode psychosis: HAMLETT, a pragmatic multicenter single-blind randomized controlled trial. Trials 2020; 21:147. [PMID: 32033579 PMCID: PMC7006112 DOI: 10.1186/s13063-019-3822-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 10/22/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Antipsychotic medication is effective for symptomatic treatment in schizophrenia-spectrum disorders. After symptom remission, continuation of antipsychotic treatment is associated with lower relapse rates and lower symptom severity compared to dose reduction/discontinuation. Therefore, most guidelines recommend continuation of treatment with antipsychotic medication for at least 1 year. Recently, however, these guidelines have been questioned as one study has shown that more patients achieved long-term functional remission in an early discontinuation condition-a finding that was not replicated in another recently published long-term study. METHODS/DESIGN The HAMLETT (Handling Antipsychotic Medication Long-term Evaluation of Targeted Treatment) study is a multicenter pragmatic single-blind randomized controlled trial in two parallel conditions (1:1) investigating the effects of continuation versus dose-reduction/discontinuation of antipsychotic medication after remission of a first episode of psychosis (FEP) on personal and social functioning, psychotic symptom severity, and health-related quality of life. In total 512 participants will be included, aged between 16 and 60 years, in symptomatic remission from a FEP for 3-6 months, and for whom psychosis was not associated with severe or life-threatening self-harm or violence. Recruitment will take place at 24 Dutch sites. Patients are randomized (1:1) to: continuation of antipsychotic medication until at least 1 year after remission (original dose allowing a maximum reduction of 25%, or another antipsychotic drug in similar dose range); or gradual dose reduction till eventual discontinuation of antipsychotics according to a tapering schedule. If signs of relapse occur in this arm, medication dose can be increased again. Measurements are conducted at baseline, at 3, and 6 months post-baseline, and yearly during a follow-up period of 4 years. DISCUSSION The HAMLETT study will offer evidence to guide patients and clinicians regarding questions concerning optimal treatment duration and when to taper off medication after remission of a FEP. Moreover, it may provide patient characteristics associated with safe dose reduction with a minimal risk of relapse. TRIAL STATUS Protocol version 1.3, October 2018. The study is active and currently recruiting patients (since September 2017), with the first 200 participants by the end of 2019. We anticipate completing recruitment in 2022 and final assessments (including follow-up 3.5 years after phase one) in 2026. TRIAL REGISTRATION European Clinical Trials Database, EudraCT number 2017-002406-12. Registered 7 June 2017.
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Affiliation(s)
- Marieke J H Begemann
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands.
| | - Ilse A Thompson
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Wim Veling
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Shiral S Gangadin
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Chris N W Geraets
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erna van 't Hag
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sanne J Müller-Kuperus
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Priscilla P Oomen
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Alban E Voppel
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Martijn J Kikkert
- Department of Research, Arkin Mental Health Care, Amsterdam, The Netherlands
| | - Jim Van Os
- Department of Psychiatry, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - H Filip E Smit
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
- Centre of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health), Utrecht, The Netherlands
| | - Rikus H Knegtering
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
- Rob Giel Research Center, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sybren Wiersma
- Early Intervention Psychosis Team, GGZ inGeest Specialized Mental Health Care, Hoofddorp, The Netherlands
| | - Luyken H Stouten
- Centre for Early Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Harm J Gijsman
- Program for Psychosis & Severe Mental Illness, Pro Persona Mental Health, Wolfheze, The Netherlands
| | - Lex Wunderink
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Education and Research, Friesland Mental Health Care Services, Leeuwarden, The Netherlands
| | - Anton B P Staring
- Department ABC, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Selene R T Veerman
- Community Mental Health, Mental Health Service Noord-Holland Noord, Alkmaar, The Netherlands
| | | | - Jörg Kurkamp
- Center for Youth with Psychosis, Mediant ABC Twente, Enschede, The Netherlands
| | | | - Natalie D Veen
- GGZ Delfland, Delfland Institute for Mental Health Care, Delft, The Netherlands
| | - Machteld Marcelis
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Institute for Mental Health Care Eindhoven (GGzE), Eindhoven, The Netherlands
| | - Koen P Grootens
- Reinier van Arkel Institute for Mental Health Care, 's Hertogenbosch, The Netherlands
- Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Gunnar Faber
- Yulius, Mental Health Institute, Dordrecht, The Netherlands
| | - Nico J van Beveren
- Antes Center for Mental Health Care, Rotterdam, The Netherlands
- Department of Neuroscience, Erasmus MC, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Agaath Been
- Center for Developmental Disorders, Dimence Institute for Mental Health, Deventer, The Netherlands
| | | | - Maarten Bak
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | - Therese A M J van Amelsvoort
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, EURON, Maastricht University Medical Center, Maastricht, The Netherlands
- Mondriaan Mental Health Care, Heerlen, The Netherlands
| | | | - Christine Blanke
- Anoiksis, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Karin Groen
- MIND Ypsilon, Organization of Relatives and Carers of People with a Vulnerability to Psychosis, The Hague, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Academic Medical Center, Amsterdam, The Netherlands
| | - Iris E C Sommer
- Department of Biomedical Sciences of Cells & Systems, Cognitive Neurosciences, University of Groningen, University Medical Center Groningen (UMCG), Groningen, The Netherlands
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43
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Mentalization and Psychosis: A Rationale for the Use of Mentalization Theory to Understand and Treat Non-affective Psychotic Disorder. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-019-09449-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AbstractSocial functioning can be severely impaired in non-affective psychotic disorder (NAPD). Current models of psychosis pathogenesis do not tend to focus on social dysfunction and pharmacological treatment fails to ameliorate it. In this article, we propose that mentalization theory provides a valuable contribution to the understanding and treatment of NAPD. Impaired mentalizing may contribute to both positive and negatives symptoms as well as social dysfunction observed in NAPD. Furthermore, impaired mentalizing may help explain the relation between childhood abuse, insecure attachment and psychosis. Mentalization based treatment may contribute to the functional recovery of NAPD patients as it targets the social cognitive processes underlying social interaction. The article includes a description of the principles of MBT in general, specific characteristics of using MBT with patients with NAPD and a clinical vignette to illustrate these principles.
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Marlowe NI, Nicholson Perry K, Lee J. Ontological insecurity II: Relationship to attachment, childhood trauma, and subclinical psychotic-like experiences. J Clin Psychol 2019; 76:440-460. [PMID: 31800105 DOI: 10.1002/jclp.22905] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To examine ontological insecurity as a predictor of positive psychotic-like experiences (PLEs) relative to concepts of childhood trauma, parental bonding, and adult attachment style. METHODS A nonclinical sample (N = 298) completed the Ontological Insecurity Scale (OIS-34), a new measure of ontological insecurity, along with measures of the above concepts. RESULTS The OIS-34 accounted for a significantly greater proportion of unique variance in positive PLEs than any other theoretical variable. Anxious and avoidant adult attachment were also strongly associated with positive PLEs, but these relationships were mediated by the OIS-34, ceasing to be significant once this latter variable entered the hierarchical regression equation. CONCLUSIONS The results are consistent with R. D. Laing's theory that ontological insecurity plays a significant role in psychosis. Moreover, the results suggest that this concept may mediate the established relationship between anxious/avoidant adult attachment and positive PLEs. Implications for psychological approaches to clinical psychosis are discussed.
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Affiliation(s)
| | - Kathryn Nicholson Perry
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
| | - Jacob Lee
- Discipline of Psychological Science, Australian College of Applied Psychology, Sydney, New South Wales, Australia
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Lavin R, Bucci S, Varese F, Berry K. The relationship between insecure attachment and paranoia in psychosis: A systematic literature review. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:39-65. [PMID: 31390076 PMCID: PMC7028113 DOI: 10.1111/bjc.12231] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/05/2019] [Indexed: 12/15/2022]
Abstract
Objectives Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment theory has been proposed as a key model in explaining this causal pathway. Previous reviews highlight evidence of associations between insecure attachment styles and overall severity of psychotic symptoms. Studies report on associations between insecure attachment and paranoia, but to date, this literature has not been adequately synthesized. The aim of the current review was to report the strength and consistency of associations between paranoia and insecure attachment across published studies, and provide systematic appraisal of study quality. Method We carried out a systematic review of electronic databases using search terms to capture concepts of adult attachment, paranoia, and psychosis. We pre‐registered the review protocol and followed PRISMA guidelines. Results Significant associations were reported in 11 out of 12 studies between an insecure attachment and paranoia, with associations remaining significant in studies that controlled for comorbid symptoms. The strongest, most commonly reported relationship was between an anxious attachment style and paranoia. Conclusions The findings support the proposed role of attachment insecurity in the development and maintenance of paranoia in psychosis and highlight the need to address insecure attachment representations in the treatment of paranoia. Practitioner points There is consistent evidence of associations between insecure attachment style and paranoia. Insecure anxious attachment is more consistently associated with paranoia than an insecure avoidant attachment. Associations between attachment and paranoia remain significant when key confounders are controlled for in the analyses. Interventions that address insecure attachment representations and promote a more secure attachment are likely to help reduce paranoia.
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Affiliation(s)
- Rachel Lavin
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
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46
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Speck LG, Schöner J, Bermpohl F, Heinz A, Gallinat J, Majic T, Montag C. Endogenous oxytocin response to film scenes of attachment and loss is pronounced in schizophrenia. Soc Cogn Affect Neurosci 2019; 14:109-117. [PMID: 30481342 PMCID: PMC6318471 DOI: 10.1093/scan/nsy110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 11/21/2018] [Indexed: 12/27/2022] Open
Abstract
Background Oxytocin (OXT) is critically involved in the regulation of attachment and interpersonal function. In this study, emotional children’s movies were used to stimulate OXT secretion in patients with schizophrenia and healthy controls (HCs). Furthermore, associations of OXT levels with measures of attachment style (Psychosis Attachment Measure), childhood adversity (Childhood Trauma Questionnaire) and symptom severity [Positive and Negative Syndrome Scale (PANSS)] were considered. Methods In 35 patients with schizophrenia and 35 matched HCs, radioimmunoassay with sample extraction was used to determine OXT plasma levels before and after viewing of movie scenes portraying emotional bonding and loss and compared to a non-emotional condition. Results Statistical analysis indicated lower baseline OXT levels in female patients than in all other groups. OXT reactivity during emotional movies was significantly higher in patients when compared to HCs. OXT reactivity during the control movie related to PANSS `general psychopathology’. No significant associations appeared between baseline or induced OXT levels and other PANSS subscales, attachment style or childhood adversity in patients. Conclusions Our findings suggest differences of baseline OXT and a higher OXT reactivity toward strong emotional stimuli in patients with schizophrenia, suggesting a role of OXT as a gender- and context-dependent modulator of socio-emotional function.
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Affiliation(s)
- Lucas G Speck
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin.,Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Johanna Schöner
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin.,Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Felix Bermpohl
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin.,Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Andreas Heinz
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin.,Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Jürgen Gallinat
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tomislav Majic
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin.,Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
| | - Christiane Montag
- Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin.,Department of Psychiatry and Psychotherapy, Berlin Institute of Health, Campus Charité Mitte Charité Universitätsmedizin Berlin, Charitéplatz, Berlin, Germany
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47
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Browne J, Nagendra A, Kurtz M, Berry K, Penn DL. The relationship between the therapeutic alliance and client variables in individual treatment for schizophrenia spectrum disorders and early psychosis: Narrative review. Clin Psychol Rev 2019; 71:51-62. [PMID: 31146249 DOI: 10.1016/j.cpr.2019.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 03/30/2019] [Accepted: 05/19/2019] [Indexed: 12/31/2022]
Abstract
Given the high rates of treatment disengagement and medication nonadherence in individuals with schizophrenia spectrum disorders and early psychosis, fostering a strong alliance in treatment is critical. Moreover, the role of the therapeutic alliance extends beyond that in traditional psychotherapy because of the multifaceted nature of treatment. Thus, this review provides a comprehensive discussion of the relationship between the alliance and client variables across various provider types and individual treatments. This review summarizes existing research on (a) client correlates/predictors of the therapeutic alliance and on (b) the relationship between the alliance and client treatment outcomes in individual treatment for schizophrenia spectrum disorders and early psychosis. Parallel literature searches were conducted using PubMed and PsycINFO databases, which yielded 1202 potential studies with 84 studies meeting inclusion criteria. With regard to correlates/predictors, the existing evidence suggests that better insight, medication adherence, social support, and recovery variables were related to better client-rated alliance. Better medication adherence and recovery variables as well as less severe symptoms were related to better provider-rated alliance. In terms of alliance-outcome relationships, evidence suggests that a strong provider-rated alliance was predictive of improved functioning and medication and treatment adherence. There was some limited evidence that better client-rated alliance was related to improved recovery outcomes. Despite mixed results and heterogeneity among studies, this review suggests that a strong alliance can be beneficial in individual schizophrenia treatment. Thus, training and supervision of providers should emphasize developing a positive alliance, particularly with clients for whom developing an alliance may be difficult.
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Affiliation(s)
- Julia Browne
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA.
| | - Arundati Nagendra
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Matthew Kurtz
- Department of Psychology and Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA
| | - Katherine Berry
- School of Health Sciences, University of Manchester, Manchester, UK
| | - David L Penn
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Psychology, Australian Catholic University, Melbourne, VIC, Australia
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48
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McGonagle G, Bucci S, Varese F, Raphael J, Berry K. Is adult attachment associated with engagement with services? A systematic literature review. J Ment Health 2019; 30:607-618. [DOI: 10.1080/09638237.2019.1608922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- G. McGonagle
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - S. Bucci
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - F. Varese
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - J. Raphael
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - K. Berry
- Faculty of Biology, Medicine and Health, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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49
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Rea S, Dallos R. Good Intentions: Exploring Narratives of Preferred Parenting in Families of a Young Person Who Has Experienced a First Episode of Psychosis (FEP). JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2019. [DOI: 10.1080/10720537.2018.1547993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sophie Rea
- South Hereford Recovery Team, Hereford, England
| | - Rudi Dallos
- School of Psychology, Plymouth University, Plymouth, England
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50
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Hayden MC, Müllauer PK, Gaugeler R, Senft B, Andreas S. Mentalization as Mediator between Adult Attachment and Interpersonal Distress. Psychopathology 2019; 52:10-17. [PMID: 30904904 DOI: 10.1159/000496499] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 12/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate the mediating role of mentalization in the association between adult attachment and interpersonal problems. METHODS The sample consisted of 89 patients with different types of mental disorders who were at the beginning of treatment in one of two medical centers. Both mediational analysis and path analysis were used to test the model. RESULTS The proposed model revealed a good model fit. The data indicate that mentalization fully mediates the effect of attachment on interpersonal distress. Symptom severity proved to be a strong confounding variable that influenced all other variables and reduced existing effects. CONCLUSION We conclude that both mentalization and symptom distress are key components in the association of adult attachment and interpersonal problems. Therefore, we recommend research on integrative psychotherapy concepts rather than unilateral approaches.
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Affiliation(s)
| | | | | | - Birgit Senft
- Reha-Klinik für Seelische Gesundheit und Prävention, Klagenfurt, Austria
| | - Sylke Andreas
- Alpen-Adria-Universität Klagenfurt, Klagenfurt, Austria.,Universität Witten/Herdecke, Witten, Germany
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