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Smith KA, Hardy A, Vinnikova A, Blease C, Milligan L, Hidalgo-Mazzei D, Lambe S, Marzano L, Uhlhaas PJ, Ostinelli EG, Anmella G, Zangani C, Aronica R, Dwyer B, Torous J, Cipriani A. Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions. JMIR Ment Health 2024; 11:e57155. [PMID: 38717799 PMCID: PMC11112473 DOI: 10.2196/57155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/08/2024] [Accepted: 03/21/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). OBJECTIVE An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. METHODS The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. RESULTS Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. CONCLUSIONS The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation.
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Affiliation(s)
- Katharine A Smith
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | | | - Charlotte Blease
- Participatory eHealth and Health Data Research Group, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Lea Milligan
- MQ Mental Health Research, London, United Kingdom
| | - Diego Hidalgo-Mazzei
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Sinéad Lambe
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Lisa Marzano
- School of Science and Technology, Middlesex University, London, United Kingdom
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
- Department of Child and Adolescent Psychiatry, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Edoardo G Ostinelli
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Gerard Anmella
- Department of Psychiatry and Psychology, Institute of Neuroscience, Hospital Clínic de Barcelona, Barcelona, Spain
- Bipolar and Depressive Disorders Unit, Digital Innovation Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Department of Medicine, School of Medicine and Health Sciences, Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Caroline Zangani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
| | - Rosario Aronica
- Psychiatry Unit, Department of Neurosciences and Mental Health, Ospedale Maggiore Policlinico Ca' Granda, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Bridget Dwyer
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States
| | - Andrea Cipriani
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, United Kingdom
- Oxford Precision Psychiatry Lab, NIHR Oxford Health Biomedical Research Centre, Oxford, United Kingdom
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Hsu CW, Stahl D, Mouchlianitis E, Peters E, Vamvakas G, Keppens J, Watson M, Schmidt N, Jacobsen P, McGuire P, Shergill S, Kabir T, Hirani T, Yang Z, Yiend J. User-Centered Development of STOP (Successful Treatment for Paranoia): Material Development and Usability Testing for a Digital Therapeutic for Paranoia. JMIR Hum Factors 2023; 10:e45453. [PMID: 38064256 PMCID: PMC10746980 DOI: 10.2196/45453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Revised: 06/13/2023] [Accepted: 09/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Paranoia is a highly debilitating mental health condition. One novel intervention for paranoia is cognitive bias modification for paranoia (CBM-pa). CBM-pa comes from a class of interventions that focus on manipulating interpretation bias. Here, we aimed to develop and evaluate new therapy content for CBM-pa for later use in a self-administered digital therapeutic for paranoia called STOP ("Successful Treatment of Paranoia"). OBJECTIVE This study aimed to (1) take a user-centered approach with input from living experts, clinicians, and academics to create and evaluate paranoia-relevant item content to be used in STOP and (2) engage with living experts and the design team from a digital health care solutions company to cocreate and pilot-test the STOP mobile app prototype. METHODS We invited 18 people with living or lived experiences of paranoia to create text exemplars of personal, everyday emotionally ambiguous scenarios that could provoke paranoid thoughts. Researchers then adapted 240 suitable exemplars into corresponding intervention items in the format commonly used for CBM training and created 240 control items for the purpose of testing STOP. Each item included newly developed, visually enriching graphics content to increase the engagement and realism of the basic text scenarios. All items were then evaluated for their paranoia severity and readability by living experts (n=8) and clinicians (n=7) and for their item length by the research team. Items were evenly distributed into six 40-item sessions based on these evaluations. Finalized items were presented in the STOP mobile app, which was co-designed with a digital health care solutions company, living or lived experts, and the academic team; user acceptance was evaluated across 2 pilot tests involving living or lived experts. RESULTS All materials reached predefined acceptable thresholds on all rating criteria: paranoia severity (intervention items: ≥1; control items: ≤1, readability: ≥3, and length of the scenarios), and there was no systematic difference between the intervention and control group materials overall or between individual sessions within each group. For item graphics, we also found no systematic differences in users' ratings of complexity (P=.68), attractiveness (P=.15), and interest (P=.14) between intervention and control group materials. User acceptance testing of the mobile app found that it is easy to use and navigate, interactive, and helpful. CONCLUSIONS Material development for any new digital therapeutic requires an iterative and rigorous process of testing involving multiple contributing groups. Appropriate user-centered development can create user-friendly mobile health apps, which may improve face validity and have a greater chance of being engaging and acceptable to the target end users.
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Affiliation(s)
- Che-Wei Hsu
- Department of Psychological Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
- South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - George Vamvakas
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Jeroen Keppens
- Department of Informatics, King's College London, London, United Kingdom
| | - Miles Watson
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Nora Schmidt
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | | | - Philip McGuire
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sukhi Shergill
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Thomas Kabir
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Tia Hirani
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Ziyang Yang
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Jenny Yiend
- Department of Psychosis Studies, King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
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Saarinen A, Keltikangas-Järvinen L, Dobewall H, Cloninger CR, Ahola-Olli A, Lehtimäki T, Hutri-Kähönen N, Raitakari O, Rovio S, Ravaja N. Does social intolerance vary according to cognitive styles, genetic cognitive capacity, or education? Brain Behav 2022; 12:e2704. [PMID: 36047482 PMCID: PMC9480910 DOI: 10.1002/brb3.2704] [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: 08/11/2021] [Revised: 06/22/2022] [Accepted: 06/25/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Low education, low cognitive abilities, and certain cognitive styles are suggested to predispose to social intolerance and prejudices. Evidence is, however, restricted by comparatively small samples, neglect of confounding variables and genetic factors, and a narrow focus on a single sort of prejudice. We investigated the relationships of education, polygenic cognitive potential, cognitive performance, and cognitive styles with social intolerance in adulthood over a 15-year follow-up. METHODS We used data from the prospective population-based Young Finns Study (n = 960-1679). Social intolerance was evaluated with the Social Intolerance Scale in 1997, 2001, and 2011; cognitive performance with the Cambridge Neuropsychological Test Automated Battery in 2011; cognitive styles in 1997; and socioeconomic factors in 1980 (childhood) and 2011 (adulthood); and polygenic cognitive potential was calculated based on genome-wide association studies. RESULTS We found that nonrational thinking, polygenic cognitive potential, cognitive performance, or socioeconomic factors were not related to social intolerance. Regarding cognitive styles, low flexibility (B = -0.759, p < .001), high perseverance (B = 1.245, p < .001), and low persistence (B = -0.329, p < .001) predicted higher social intolerance consistently in the analyses. DISCUSSION When developing prejudice-reduction interventions, it should be considered that educational level or cognitive performance may not be crucial for development of social intolerance. Adopting certain cognitive styles may play more important roles in development of social intolerance.
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Affiliation(s)
- Aino Saarinen
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
| | | | - Henrik Dobewall
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland.,Research Unit of Psychology, University of Oulu, Oulu, Finland.,Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center, Tampere, Finland
| | | | - Ari Ahola-Olli
- Department of Internal Medicine, Satasairaala Central Hospital, Pori, Finland.,Psychiatric and Neurodevelopmental Genetics Unit, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories and Finnish Cardiovascular Research Center, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Nina Hutri-Kähönen
- Tampere Centre for Skills Training and Simulation, Tampere University, Tampere, Finland
| | - Olli Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Suvi Rovio
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Niklas Ravaja
- Faculty of Medicine, Department of Psychology and Logopedics, University of Helsinki, Helsinki, Finland
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4
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Samson C, Achim AM, Sicard V, Gilker A, Francoeur A, Franck N, Cloutier B, Giguère CE, Jean-Baptiste F, Lecomte T. Further validation of the Cognitive Biases Questionnaire for psychosis. BMC Psychiatry 2022; 22:560. [PMID: 35986316 PMCID: PMC9392283 DOI: 10.1186/s12888-022-04203-8] [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: 09/05/2021] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive biases are recognized as important treatment targets for reducing symptoms associated with severe mental disorders. Although cognitive biases have been linked to symptoms in most studies, few studies have looked at such biases transdiagnostically. The Cognitive Bias Questionnaire for psychosis (CBQp) is a self-reported questionnaire that assesses cognitive biases amongst individuals with a psychotic disorder, as well as individuals with other severe mental disorders. The current study aims to validate a French version of the CBQp and to explore transdiagnostic cognitive biases in individuals with psychotic disorders, individuals with depression, and in healthy controls. METHODS The CBQp was translated into French following a protocol based on international standards. Discriminant validity and internal consistency were determined for total score and each subscale score. Confirmatory factor analyses were performed to test construct validity. Finally, cluster analyses were conducted to investigate cognitive biases across diagnostic groups. RESULTS Our results were similar to those of the original authors, with the one-factor solution (assessment of a general thinking bias) being the strongest, but the two-factor solution (assessing biases within two themes relating to psychosis) and the five-factor solution (assessment of multiple distinct biases) being clinically more interesting. A six-cluster solution emerged, suggesting that individuals with similar diagnoses score differently on all cognitive biases, and that individuals with different diagnoses might have similar cognitive biases. CONCLUSIONS The current findings support the validity of the French translation of the CBQp. Our cluster analyses overall support the transdiagnostic presence of cognitive biases.
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Affiliation(s)
- Crystal Samson
- grid.14848.310000 0001 2292 3357Département de Psychologie, Laboratoire d’étude sur la schizophrénie et les psychoses orienté vers l’intervention et le rétablissement Pavillon Marie-Victorin, Université de Montréal, 90 Vincent D’Indy Ave, Outremont, QC, H2V 2S9 Canada ,grid.420732.00000 0001 0621 4067Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Québec, Canada
| | - Amélie M. Achim
- grid.23856.3a0000 0004 1936 8390Université Laval, Québec, Canada ,Centre de recherche CERVO, Québec, Canada ,Centre de recherche en santé durable VITAM, Québec, Canada
| | - Veronik Sicard
- grid.414148.c0000 0000 9402 6172Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Canada
| | - Andy Gilker
- grid.86715.3d0000 0000 9064 6198Département de Génie biotechnologique, Université de Sherbrooke, Québec, Canada
| | - Audrey Francoeur
- grid.14848.310000 0001 2292 3357Département de Psychologie, Laboratoire d’étude sur la schizophrénie et les psychoses orienté vers l’intervention et le rétablissement Pavillon Marie-Victorin, Université de Montréal, 90 Vincent D’Indy Ave, Outremont, QC, H2V 2S9 Canada ,grid.420732.00000 0001 0621 4067Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Québec, Canada
| | - Nicolas Franck
- grid.7849.20000 0001 2150 7757Faculté de Médecine Lyon-Sud Charles Mérieux, Université Claude Bernard Lyon 1, Lyon, France ,grid.420146.50000 0000 9479 661XPôle Centre rive gauche & Centre ressource de réhabilitation psychosociale, Centre hospitalier Le Vinatier, Lyon, France ,Centre National de la Recherche Scientifique (CNRS), Bron, France
| | - Briana Cloutier
- grid.14848.310000 0001 2292 3357Département de Psychologie, Laboratoire d’étude sur la schizophrénie et les psychoses orienté vers l’intervention et le rétablissement Pavillon Marie-Victorin, Université de Montréal, 90 Vincent D’Indy Ave, Outremont, QC, H2V 2S9 Canada ,grid.420732.00000 0001 0621 4067Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Québec, Canada
| | - Charles-Edouard Giguère
- grid.420732.00000 0001 0621 4067Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Québec, Canada
| | - Francelyne Jean-Baptiste
- grid.420732.00000 0001 0621 4067Centre de recherche de l’Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Québec, Canada
| | - Tania Lecomte
- Département de Psychologie, Laboratoire d'étude sur la schizophrénie et les psychoses orienté vers l'intervention et le rétablissement Pavillon Marie-Victorin, Université de Montréal, 90 Vincent D'Indy Ave, Outremont, QC, H2V 2S9, Canada. .,Centre de recherche de l'Institut Universitaire en Santé Mentale de Montréal (CR-IUSMM), Québec, Canada.
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Guaiana G, Abbatecola M, Aali G, Tarantino F, Ebuenyi ID, Lucarini V, Li W, Zhang C, Pinto A. Cognitive behavioural therapy (group) for schizophrenia. Cochrane Database Syst Rev 2022; 7:CD009608. [PMID: 35866377 PMCID: PMC9308944 DOI: 10.1002/14651858.cd009608.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Schizophrenia is a disabling psychotic disorder characterised by positive symptoms of delusions, hallucinations, disorganised speech and behaviour; and negative symptoms such as affective flattening and lack of motivation. Cognitive behavioural therapy (CBT) is a psychological intervention that aims to change the way in which a person interprets and evaluates their experiences, helping them to identify and link feelings and patterns of thinking that underpin distress. CBT models targeting symptoms of psychosis (CBTp) have been developed for many mental health conditions including schizophrenia. CBTp has been suggested as a useful add-on therapy to medication for people with schizophrenia. While CBT for people with schizophrenia was mainly developed as an individual treatment, it is expensive and a group approach may be more cost-effective. Group CBTp can be defined as a group intervention targeting psychotic symptoms, based on the cognitive behavioural model. In group CBTp, people work collaboratively on coping with distressing hallucinations, analysing evidence for their delusions, and developing problem-solving and social skills. However, the evidence for effectiveness is far from conclusive. OBJECTIVES To investigate efficacy and acceptability of group CBT applied to psychosis compared with standard care or other psychosocial interventions, for people with schizophrenia or schizoaffective disorder. SEARCH METHODS On 10 February 2021, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, four other databases and two trials registries. We handsearched the reference lists of relevant papers and previous systematic reviews and contacted experts in the field for supplemental data. SELECTION CRITERIA We selected randomised controlled trials allocating adults with schizophrenia to receive either group CBT for schizophrenia, compared with standard care, or any other psychosocial intervention (group or individual). DATA COLLECTION AND ANALYSIS We complied with Cochrane recommended standard of conduct for data screening and collection. Where possible, we calculated risk ratio (RR) and 95% confidence interval (CI) for binary data and mean difference (MD) and 95% CI for continuous data. We used a random-effects model for analyses. We assessed risk of bias for included studies and created a summary of findings table using GRADE. MAIN RESULTS The review includes 24 studies (1900 participants). All studies compared group CBTp with treatments that a person with schizophrenia would normally receive in a standard mental health service (standard care) or any other psychosocial intervention (group or individual). None of the studies compared group CBTp with individual CBTp. Overall risk of bias within the trials was moderate to low. We found no studies reporting data for our primary outcome of clinically important change. With regard to numbers of participants leaving the study early, group CBTp has little or no effect compared to standard care or other psychosocial interventions (RR 1.22, 95% CI 0.94 to 1.59; studies = 13, participants = 1267; I2 = 9%; low-certainty evidence). Group CBTp may have some advantage over standard care or other psychosocial interventions for overall mental state at the end of treatment for endpoint scores on the Positive and Negative Syndrome Scale (PANSS) total (MD -3.73, 95% CI -4.63 to -2.83; studies = 12, participants = 1036; I2 = 5%; low-certainty evidence). Group CBTp seems to have little or no effect on PANSS positive symptoms (MD -0.45, 95% CI -1.30 to 0.40; studies =8, participants = 539; I2 = 0%) and on PANSS negative symptoms scores at the end of treatment (MD -0.73, 95% CI -1.68 to 0.21; studies = 9, participants = 768; I2 = 65%). Group CBTp seems to have an advantage over standard care or other psychosocial interventions on global functioning measured by Global Assessment of Functioning (GAF; MD -3.61, 95% CI -6.37 to -0.84; studies = 5, participants = 254; I2 = 0%; moderate-certainty evidence), Personal and Social Performance Scale (PSP; MD 3.30, 95% CI 2.00 to 4.60; studies = 1, participants = 100), and Social Disability Screening Schedule (SDSS; MD -1.27, 95% CI -2.46 to -0.08; studies = 1, participants = 116). Service use data were equivocal with no real differences between treatment groups for number of participants hospitalised (RR 0.78, 95% CI 0.38 to 1.60; studies = 3, participants = 235; I2 = 34%). There was no clear difference between group CBTp and standard care or other psychosocial interventions endpoint scores on depression and quality of life outcomes, except for quality of life measured by World Health Organization Quality of Life Assessment Instrument (WHOQOL-BREF) Psychological domain subscale (MD -4.64, 95% CI -9.04 to -0.24; studies = 2, participants = 132; I2 = 77%). The studies did not report relapse or adverse effects. AUTHORS' CONCLUSIONS Group CBTp appears to be no better or worse than standard care or other psychosocial interventions for people with schizophrenia in terms of leaving the study early, service use and general quality of life. Group CBTp seems to be more effective than standard care or other psychosocial interventions on overall mental state and global functioning scores. These results may not be widely applicable as each study had a low sample size. Therefore, no firm conclusions concerning the efficacy of group CBTp for people with schizophrenia can currently be made. More high-quality research, reporting useable and relevant data is needed.
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Affiliation(s)
- Giuseppe Guaiana
- Department of Psychiatry and Department of Epidemiology and Biostatistics, Western University, London, Canada
| | | | - Ghazaleh Aali
- Institute for Health Informatics Research, University College London, London, UK
| | | | - Ikenna D Ebuenyi
- IRIS Centre, School of Nursing, Midwifery & Health Systems, University College Dublin, Dublin, Ireland
- Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, USA
| | - Valeria Lucarini
- Institute of Psychiatry and Neuroscience of Paris, Université de Paris, Paris, France
| | - Wei Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Caidi Zhang
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ward T, Hardy A, Holm R, Collett N, Rus‐Calafell M, Sacadura C, McGourty A, Vella C, East A, Rea M, Harding H, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Garety P. SlowMo therapy, a new digital blended therapy for fear of harm from others: An account of therapy personalisation within a targeted intervention. Psychol Psychother 2022; 95:423-446. [PMID: 35019210 PMCID: PMC9306634 DOI: 10.1111/papt.12377] [Citation(s) in RCA: 2] [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: 05/08/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES SlowMo therapy is a pioneering blended digital therapy for paranoia, augmenting face-to-face therapy with an interactive 'webapp' and a mobile app. A recent large-scale trial demonstrated small-moderate effects on paranoia alongside improvements in self-esteem, worry, well-being and quality of life. This paper provides a comprehensive account of therapy personalisation within this targeted approach. DESIGN Case examples illustrate therapy delivery and descriptive data are presented on personalised thought content. METHOD Thought content was extracted from the webapp (n = 140 participants) and coded using newly devised categories: Worries: (1) Persecutory, (2) Negative social evaluation, (3) Negative self-concept, (4) Loss/life stresses, (5) Sensory-perceptual experiences and (6) Health anxieties. Safer thoughts: (1) Safer alternative (specific alternatives to worries), (2) Second-wave (generalised) coping, (3) Positive self-concept, (4) Positive activities and (5) Third-wave (mindfulness-based) coping. Data on therapy fidelity are also presented. RESULTS Worries: 'Persecutory' (92.9% of people) and 'Negative social evaluation' (74.3%) were most common. 'General worries/ life stresses' (31.4%) and 'Negative self-concept' (22.1%) were present in a significant minority; 'Health anxieties' (10%) and 'Sensory-perceptual' (10%) were less common. Safer thoughts: 'Second-wave (general) coping' (85%), 'Safer alternatives' (76.4%), 'Positive self-concept' (65.7%) and 'Positive activities' (64.3%) were common with 'Third-wave' (mindfulness) coping observed for 30%. Fidelity: Only three therapy withdrawals were therapy related. Session adherence was excellent (mean = 15.2/16; SD = 0.9). Behavioural work was conducted with 71% of people (119/168). CONCLUSION SlowMo therapy delivers a targeted yet personalised approach. Potential mechanisms of action extend beyond reasoning. Implications for cognitive models of paranoia and causal interventionist approaches are discussed.
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Affiliation(s)
- Thomas Ward
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Amy Hardy
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Rebecca Holm
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Nicola Collett
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,Oxford Institute of Clinical Psychology Training and ResearchOxford UniversityOxfordUK
| | - Mar Rus‐Calafell
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,Mental Health Research and Treatment CenterFaculty of PsychologyRuhr‐Universität BochumBochumGermany
| | | | | | - Claire Vella
- Sussex Partnership NHS Foundation TrustWorthingUK,School of PsychologyUniversity of SussexBrightonUK
| | - Anna East
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - Michaela Rea
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Helen Harding
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Richard Emsley
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | | | - Daniel Freeman
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - David Fowler
- Sussex Partnership NHS Foundation TrustWorthingUK,School of PsychologyUniversity of SussexBrightonUK
| | - Elizabeth Kuipers
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | | | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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7
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Catalan A, Tognin S, Kempton MJ, Stahl D, Salazar de Pablo G, Nelson B, Pantelis C, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Ruhrmann S, Sachs G, Rutten BPF, van Os J, de Haan L, van der Gaag M, Valmaggia LR, McGuire P. Relationship between jumping to conclusions and clinical outcomes in people at clinical high-risk for psychosis. Psychol Med 2022; 52:1569-1577. [PMID: 33019957 PMCID: PMC9226382 DOI: 10.1017/s0033291720003396] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/18/2020] [Accepted: 09/01/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Psychosis is associated with a reasoning bias, which manifests as a tendency to 'jump to conclusions'. We examined this bias in people at clinical high-risk for psychosis (CHR) and investigated its relationship with their clinical outcomes. METHODS In total, 303 CHR subjects and 57 healthy controls (HC) were included. Both groups were assessed at baseline, and after 1 and 2 years. A 'beads' task was used to assess reasoning bias. Symptoms and level of functioning were assessed using the Comprehensive Assessment of At-Risk Mental States scale (CAARMS) and the Global Assessment of Functioning (GAF), respectively. During follow up, 58 (16.1%) of the CHR group developed psychosis (CHR-T), and 245 did not (CHR-NT). Logistic regressions, multilevel mixed models, and Cox regression were used to analyse the relationship between reasoning bias and transition to psychosis and level of functioning, at each time point. RESULTS There was no association between reasoning bias at baseline and the subsequent onset of psychosis. However, when assessed after the transition to psychosis, CHR-T participants showed a greater tendency to jump to conclusions than CHR-NT and HC participants (55, 17, 17%; χ2 = 8.13, p = 0.012). There was a significant association between jumping to conclusions (JTC) at baseline and a reduced level of functioning at 2-year follow-up in the CHR group after adjusting for transition, gender, ethnicity, age, and IQ. CONCLUSIONS In CHR participants, JTC at baseline was associated with adverse functioning at the follow-up. Interventions designed to improve JTC could be beneficial in the CHR population.
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Affiliation(s)
- Ana Catalan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Deparment of Mental Health, Biocruces Bizkaia Health Research Institute. Basurto University Hospital. Facultad de Medicina y Odontología, Campus de Leioa, University of the Basque Country, UPV/EHU. Plaza de Cruces 12. 48903, Barakaldo, Bizkaia, Spain
| | - Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, Likondon, UK
| | - Matthew J. Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics, King´s College London, Institute of Psychiatry, Psychology, and Neuroscience, London, UK
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
| | - Barnaby Nelson
- Orygen, Parkville, Victoria, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Christos Pantelis
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne & Melbourne Health, Carlton South, Victoria, Australia
| | | | - Rodrigo Bressan
- Depto Psiquiatria, LiNC – Lab Integrative Neuroscience, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Madrid, Spain
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université de Paris, Institut de Psychiatrie (CNRS GDR 3557), Paris, France
- Faculté de Médecine Paris Descartes, GHU Paris – Sainte-Anne, Pôle Hospitalo Universitaire PEPIT C'JAAD, Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P. F. Rutten
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences, School for Mental Health and Neuroscience (MHeNS), Maastricht University, Maastricht, The Netherlands
- Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Early Psychosis Department, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark van der Gaag
- VU University, Faculty of Behavioural and Movement Sciences, Department of Clinical Psychology and Amsterdam Public Mental Health research institute, Amsterdam, The Netherlands
- Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - Lucia R. Valmaggia
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Outreach and Support in South London (OASIS) service, South London and Maudsley NHS Foundation Trust, Likondon, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
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8
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Applications of innovative technologies to the delivery of antipsychotics. Drug Discov Today 2021; 27:401-421. [PMID: 34601123 DOI: 10.1016/j.drudis.2021.09.019] [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: 04/01/2021] [Revised: 07/27/2021] [Accepted: 09/25/2021] [Indexed: 12/24/2022]
Abstract
Psychosis is a high-incidence pathology associated with a profound alteration in the perception of reality. The limitations of drugs available on the market have stimulated the search for alternative solutions to achieve effective antipsychotic therapies. In this review, we evaluate innovative formulations of antipsychotic drugs developed through the application of modern pharmaceutical technologies, including classes of micro and nanocarriers, such as lipid formulations, polymeric nanoparticles (NPs), solid dispersions, and cyclodextrins (CDs). We also consider alternative routes of administration to the oral and parenteral ones currently used. Improved solubility, stability of preparations, and pharmacokinetic (PK) and pharmacodynamic (PD) parameters confirm the potential of these new formulations in the treatment of psychotic disorders.
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9
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Garety P, Ward T, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Rus-Calafell M, McGourty A, Sacadura C, Collett N, James K, Hardy A. Effects of SlowMo, a Blended Digital Therapy Targeting Reasoning, on Paranoia Among People With Psychosis: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:714-725. [PMID: 33825827 PMCID: PMC8027943 DOI: 10.1001/jamapsychiatry.2021.0326] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Persistent paranoia is common among patients with psychosis. Cognitive-behavioral therapy for psychosis can be effective. However, challenges in engagement and effectiveness remain. OBJECTIVE To investigate the effects on paranoia and mechanisms of action of SlowMo, a digitally supported reasoning intervention, plus usual care compared with usual care only. DESIGN, SETTING, AND PARTICIPANTS This parallel-arm, assessor-blinded, randomized clinical trial recruited participants at UK community health services from May 1, 2017, to May 14, 2019. Eligible participants consisted of a referral sample with schizophrenia-spectrum psychosis and distressing, persistent (≥3 months) paranoia. INTERVENTIONS Individuals were randomized 1:1 to SlowMo, consisting of 8 digitally supported face-to-face sessions and a mobile app, plus usual care (n = 181) and usual care only (n = 181). MAIN OUTCOMES AND MEASURES The primary outcome was paranoia, measured by the Green et al Paranoid Thoughts Scale (GPTS) total score at 24 weeks. Secondary outcomes included GPTS total score at 12 weeks and GPTS Part A (reference) and Part B (persecutory) scores, the Psychotic Symptom Rating Scales (PSYRATS Delusion subscale), reasoning (belief flexibility, possibility of being mistaken [Maudsley Assessment of Delusions, rated 0%-100%]), and jumping to conclusions (Beads Task). RESULTS A total of 361 participants were included in intention-to-treat analysis, of whom 252 (69.8%) were male and 249 (69.0%) were White; the mean (SD) age was 42.6 (11.6) years. At 24 weeks, 332 participants (92.0%) provided primary outcome data. Of 181 participants in the SlowMo group, 145 (80.1%) completed therapy. SlowMo plus usual care was not associated with greater reductions than usual care in GPTS total score at 24 weeks (Cohen d, 0.20; 95% CI, -0.02 to 0.40; P = .06). There were significant effects on secondary paranoia outcomes at 12 weeks, including GPTS total score (Cohen d, 0.30; 95% CI, 0.09-0.51; P = .005), Part A score (Cohen d, 0.22; 95% CI, 0.06-0.39; P = .009), and Part B score (Cohen d, 0.32; 95% CI, 0.08-0.56; P = .009), and at 24 weeks, including Part B score (Cohen d, 0.25; 95% CI, 0.01-0.49; P = .04) but not Part A score (Cohen d, 0.12; 95% CI, -0.05 to 0.28; P = .18). Improvements were observed in an observer-rated measure of persecutory delusions (PSYRATS delusion) at 12 weeks (Cohen d, 0.47; 95% CI, 0.17-0.78; P = .002) and 24 weeks (Cohen d, 0.50; 95% CI, 0.20-0.80; P = .001) and belief flexibility at 12 weeks (Cohen d, 0.29; 95% CI, 0.09-0.49; P = .004) and 24 weeks (Cohen d, 0.28; 95% CI, 0.08-0.49; P = .005). There were no significant effects on jumping to conclusions. Improved belief flexibility and worry mediated paranoia change (range mediated, 36%-56%). CONCLUSIONS AND RELEVANCE SlowMo did not demonstrate significant improvements in the primary measure of paranoia at 24 weeks; however, a beneficial effect of SlowMo on paranoia was indicated by the results on the primary measure at an earlier point and on observer-rated paranoia and self-reported persecution at 12 and 24 weeks. Further work to optimize SlowMo's effects is warranted. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN 32448671.
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Affiliation(s)
- Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kathryn Greenwood
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - David Fowler
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Alison McGourty
- Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | | | - Nicola Collett
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, United Kingdom
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
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10
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Sauvé G, Lavigne KM, Pochiet G, Brodeur MB, Lepage M. Efficacy of psychological interventions targeting cognitive biases in schizophrenia: A systematic review and meta-analysis. Clin Psychol Rev 2020; 78:101854. [DOI: 10.1016/j.cpr.2020.101854] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/14/2022]
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11
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Korkmaz ŞA, Can SS. The jumping to conclusions bias associated with symptoms in schizophrenia: which factors influence this bias? JOURNAL OF COGNITIVE PSYCHOLOGY 2020. [DOI: 10.1080/20445911.2020.1764570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
| | - Serdar Süleyman Can
- Department of Psychiatry, School of Medicine affiliated with of Ankara City Hospital, Ankara Yıldırım Beyazıt University, Ankara, Turkey
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12
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Serrano-Guerrero E, Ruiz-Veguilla M, Martín-Rodríguez A, Rodríguez-Testal JF. Inflexibility of beliefs and jumping to conclusions in active schizophrenia. Psychiatry Res 2020; 284:112776. [PMID: 31981941 DOI: 10.1016/j.psychres.2020.112776] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Jumping to conclusions (JTC) has been questioned as sufficient cognitive bias for the onset, maintenance, and severity of delusions compared to the bias of inflexibility of beliefs. The WIT (What is this?) test was designed to evaluate JTC and its capacity for classifying participants into a group of patients with active schizophrenia and a comparison group. It was also attempted to determine whether the presence/absence of answer choices, considered a measure of induced inflexibility of beliefs, influences decision-making and is related to the tendency to repeat the first decision, or spontaneous inflexibility of beliefs. The sample was made up of 160 participants, 80 patients with schizophrenia diagnosed at hospital admission and 80 healthy controls. The Beads Task and the WIT test were administered. The WIT classified the participants reasonably well (82.7%) compared to the Beads Task (86.3%). The presence of answer choices favored JTC (d = 0.33), decreasing the number of lines necessary to make a decision (d = 1.78), and influencing keeping to the original answer (d = 1.36), in interaction with the group (d = 0.42). The WIT test overcame some limitations of the Beads Task. The presence/absence of answer choices influenced decision-making and how thinking was flexibilized, more clearly in the case of controls.
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Affiliation(s)
- Estrella Serrano-Guerrero
- U.G.C. Salud Mental, Hospital Universitario Virgen Macarena, C/ Dr. Fedriani, n° 3, CP: 41009, Sevilla, España.
| | - Miguel Ruiz-Veguilla
- U.G.C. Salud Mental, Hospital Universitario Virgen del Rocío/CIBERSAM/IBIS/CSIC/Universidad de Sevilla, Unidad de Hospitalización de Salud Mental, Avenida Manuel Siurot, s/n, CP: 41013, Sevilla, España.
| | - Agustín Martín-Rodríguez
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Sevilla, C/ Camilo José Cela, s/n, CP: 41018, Sevilla, España.
| | - Juan F Rodríguez-Testal
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Sevilla, C/ Camilo José Cela, s/n, CP: 41018, Sevilla, España.
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13
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Rodriguez V, Ajnakina O, Stilo SA, Mondelli V, Marques TR, Trotta A, Quattrone D, Gardner-Sood P, Colizzi M, Wiffen BD, Dazzan P, Di Forti M, Falcone MA, David AS, Murray RM. Jumping to conclusions at first onset of psychosis predicts longer admissions, more compulsory admissions and police involvement over the next 4 years: the GAP study. Psychol Med 2019; 49:2256-2266. [PMID: 30392491 DOI: 10.1017/s0033291718003197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case-control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years. METHODS One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning 'Beads' Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment - the Mental Health Act (MHA) - and inpatient days). RESULTS FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92-83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68-83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91-13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions. CONCLUSIONS JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.
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Affiliation(s)
- Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olesya Ajnakina
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simona A Stilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tiago Reis Marques
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Antonella Trotta
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Diego Quattrone
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Benjamin D Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Aurora Falcone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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14
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Reininghaus U, Rauschenberg C, Ten Have M, de Graaf R, van Dorsselaer S, Simons CJP, Gunther N, Pries LK, Guloksuz S, Radhakrishnan R, Bak M, van Os J. Reasoning bias, working memory performance and a transdiagnostic phenotype of affective disturbances and psychotic experiences in the general population. Psychol Med 2019; 49:1799-1809. [PMID: 30160228 DOI: 10.1017/s0033291718002209] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The jumping to conclusions (JTC) reasoning bias and decreased working memory performance (WMP) are associated with psychosis, but associations with affective disturbances (i.e. depression, anxiety, mania) remain inconclusive. Recent findings also suggest a transdiagnostic phenotype of co-occurring affective disturbances and psychotic experiences (PEs). This study investigated whether JTC bias and decreased WMP are associated with co-occurring affective disturbances and PEs. METHODS Data were derived from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Trained interviewers administered the Composite International Diagnostic Interview (CIDI) at three time points in a general population sample (N = 4618). The beads and digit-span task were completed to assess JTC bias and WMP, respectively. CIDI was used to measure affective disturbances and an add-on instrument to measure PEs. RESULTS Compared to individuals with neither affective disturbances nor PEs, the JTC bias was more likely to occur in individuals with co-occurring affective disturbances and PEs [moderate psychosis (1-2 PEs): adjusted relative risk ratio (RRR) 1.17, 95% CI 0.98-1.41; and high psychosis (3 or more PEs or psychosis-related help-seeking behaviour): adjusted RRR 1.57, 95% CI 1.19-2.08], but not with affective disturbances and PEs alone, whereas decreased WMP was more likely in all groups. There was some evidence of a dose-response relationship, as JTC bias and decreased WMP were more likely in individuals with affective disturbances as the level of PEs increased or help-seeking behaviour was reported. CONCLUSION The findings suggest that JTC bias and decreased WMP may contribute to a transdiagnostic phenotype of co-occurring affective disturbances and PEs.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Christian Rauschenberg
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Margreet Ten Have
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Ron de Graaf
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Rajiv Radhakrishnan
- Department of Psychiatry,Yale University School of Medicine,New Haven, CT,USA
| | - Maarten Bak
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
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15
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Polese D, Fornaro M, Palermo M, De Luca V, de Bartolomeis A. Treatment-Resistant to Antipsychotics: A Resistance to Everything? Psychotherapy in Treatment-Resistant Schizophrenia and Nonaffective Psychosis: A 25-Year Systematic Review and Exploratory Meta-Analysis. Front Psychiatry 2019; 10:210. [PMID: 31057434 PMCID: PMC6478792 DOI: 10.3389/fpsyt.2019.00210] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 03/22/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Roughly 30% of schizophrenia patients fail to respond to at least two antipsychotic trials. Psychosis has been traditionally considered to be poorly sensitive to psychotherapy. Nevertheless, there is increasing evidence that psychological interventions could be considered in treatment-resistant psychosis (TRP). Despite the relevance of the issue and the emerging neurobiological underpinnings, no systematic reviews have been published. Here, we show a systematic review of psychotherapy interventions in TRP patients of the last 25 years. Methods: The MEDLINE/PubMed, ISI WEB of Knowledge, and Scopus databases were inquired from January 1, 1993, to August 1, 2018, for reports documenting augmentation or substitution with psychotherapy for treatment-resistant schizophrenia (TRS) and TRP patients. Quantitative data fetched by Randomized Controlled Trials (RCTs) were pooled for explorative meta-analysis. Results: Forty-two articles have been found. Cognitive behavioral therapy (CBT) was the most frequently recommended psychotherapy intervention for TRS (studies, n = 32, 76.2%), showing efficacy for general psychopathology and positive symptoms as documented by most of the studies, but with uncertain efficacy on negative symptoms. Other interventions showed similar results. The usefulness of group therapy was supported by the obtained evidence. Few studies focused on negative symptoms. Promising results were also reported for resistant early psychosis. Limitations: Measurement and publication bias due to the intrinsic limitations of the appraised original studies. Conclusions: CBT, psychosocial intervention, supportive counseling, psychodynamic psychotherapy, and other psychological interventions can be recommended for clinical practice. More studies are needed, especially for non-CBT interventions and for all psychotherapies on negative symptoms.
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Affiliation(s)
- Daniela Polese
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
- Department of Neuroscience, Psychiatric Unit, Sant’Andrea University Hospital, “Sapienza” University of Rome, Rome, Italy
| | - Michele Fornaro
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
| | - Mario Palermo
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
| | - Vincenzo De Luca
- Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Andrea de Bartolomeis
- Treatment Resistant Psychosis Unit and Laboratory of Molecular and Translational Psychiatry, Section of Psychiatry, University School of Medicine of Naples “Federico II”, Naples, Italy
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Ward T, Garety PA. Fast and slow thinking in distressing delusions: A review of the literature and implications for targeted therapy. Schizophr Res 2019; 203:80-87. [PMID: 28927863 PMCID: PMC6336980 DOI: 10.1016/j.schres.2017.08.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
The recent literature on reasoning biases in psychosis and delusions is reviewed. The state-of-the-art knowledge from systematic reviews and meta-analyses on the evidence for jumping to conclusions is briefly summarised, before a fuller discussion of the more recent empirical literature on belief flexibility as applied to delusions. The methodology and evidence in relation to studies of belief flexibility and the Bias Against Disconfirmatory Evidence (BADE) across the delusional continuum will be critically appraised, and implications drawn for improving cognitive therapy. It will be proposed that dual process models of reasoning, which Kahneman (Kahneman, 2011) popularised as 'fast and slow thinking', provide a useful theoretical framework for integrating further research and informing clinical practice. The emergence of therapies which specifically target fast and slow thinking in people with distressing delusions will be described.
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Affiliation(s)
- Thomas Ward
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Philippa A Garety
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
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17
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Hardy A, Wojdecka A, West J, Matthews E, Golby C, Ward T, Lopez ND, Freeman D, Waller H, Kuipers E, Bebbington P, Fowler D, Emsley R, Dunn G, Garety P. How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo. JMIR Ment Health 2018; 5:e11222. [PMID: 30518514 PMCID: PMC6300708 DOI: 10.2196/11222] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. OBJECTIVE This study aimed to optimize the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface. METHODS We conducted inclusive, user-centered design research characterized by purposive sampling of extreme users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's double diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping, and a mood board; define, consisting of workshops to synthesize findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded. RESULTS Consistent with our previous work, the Thinking Well case series showed medium to large effects on paranoia and well-being and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia, and provide tailored interpersonal support from therapists and peers, although they reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalization and normalization, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with 2 key concepts of thoughts visualized as bubbles and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A Web app supports the delivery of 8 face-to-face sessions, which are synchronized to a native mobile app. CONCLUSIONS SlowMo makes use of personalization, ambient information, and visual metaphors to tailor the appeal, engagement, and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multicentered randomized controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface to optimize its impact in daily life.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Wojdecka
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Jonathan West
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Ed Matthews
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | | | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Natalie D Lopez
- Department of Psychology, Royal Holloway, Egham, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Helen Waller
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Graham Dunn
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
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18
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Hurley J, Hodgekins J, Coker S, Fowler D. Persecutory delusions: effects of Cognitive Bias Modification for Interpretation and the Maudsley Review Training Programme on social anxiety, jumping to conclusions, belief inflexibility and paranoia. J Behav Ther Exp Psychiatry 2018; 61:14-23. [PMID: 29883776 DOI: 10.1016/j.jbtep.2018.05.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 03/26/2018] [Accepted: 05/07/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVES The Threat Anticipation Model (Freeman, 2007) implicates social anxiety, jumping to conclusions (JTC) and belief inflexibility in persecutory delusions. We investigated whether Cognitive Bias Modification for Interpretation (CBM-I; Turner et al., 2011) improves social anxiety by targeting negative interpretation bias of ambiguous social information. We determined whether the Maudsley Review Training Programme (MRTP; Waller et al., 2011) improves JTC, belief inflexibility and paranoia. We also explored effects of CBM-I on JTC/belief inflexibility and paranoia, as well as the MRTP on social anxiety. METHODS Twelve participants from Early Intervention and Recovery Services in East Anglia completed measures of social anxiety, paranoia, JTC and belief inflexibility. A concurrent multiple baseline case series design was used. RESULTS Three of twelve participants improved in social anxiety following CBM-I, paranoia improved in 6/12 cases. CBM-I had no effect on JTC/belief inflexibility. The MRTP improved JTC and/or belief inflexibility in 9/12 cases, while improving paranoia for 6/12 individuals. The MRTP improved social anxiety in one case. LIMITATIONS The small sample size and large effects necessary for single case series designs limit the generality of findings. These are discussed in more detail. CONCLUSIONS This study suggests that whilst both CBM-I and the MRTP may have a positive impact on paranoia and social anxiety, the effects on JTC/belief inflexibility are largely specific to the MRTP. Relationships between social anxiety, JTC, belief inflexibility and paranoia existed in 10/12 individuals, supporting the Threat Anticipation Model.
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Affiliation(s)
- James Hurley
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk NR4 7TJ, UK; Tower Hamlets Early Intervention Service, East London NHS Foundation Trust, 51 Three Colts Lane, London E2 6BF, UK.
| | - Jo Hodgekins
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk NR4 7TJ, UK.
| | - Sian Coker
- Norwich Medical School, University of East Anglia, Norwich Research Park, Norfolk NR4 7TJ, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Sussex House, Brighton BN1 9RH, UK.
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19
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Andreou C, Steinmann S, Leicht G, Kolbeck K, Moritz S, Mulert C. fMRI correlates of jumping-to-conclusions in patients with delusions: Connectivity patterns and effects of metacognitive training. NEUROIMAGE-CLINICAL 2018; 20:119-127. [PMID: 30094162 PMCID: PMC6077165 DOI: 10.1016/j.nicl.2018.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Abstract
Background Reasoning biases such as the jumping-to-conclusions bias (JTC) are thought to contribute to delusions. Interventions targeting these biases such as metacognitive training (MCT) may improve delusions. So far, it is not clear whether JTC depends on dopaminergic reward areas that constitute the main action locus of antipsychotic drugs, or on additional cortical areas. The present study aimed to investigate fMRI activation and functional connectivity patterns underlying JTC, and their changes following MCT, in patients with delusions. Methods Participants were 25 healthy individuals and 26 patients with current delusions who were either medication-free or on stable medication without sufficient response. We assessed (1) BOLD activity in the task-positive (TPN), task-negative (TNN), and subcortical reward network (RN); (2) Psychophysiological interactions (PPI) of peak activation areas. Results Presence of JTC (irrespective of group) was associated with lower RN activity during conclusion events, and with increased effective connectivity between TPN and TNN during draw events. Following MCT, changes were observed in TPN activity and in effective connectivity of inferior parietal cortex (part of the TPN) with all three target networks. Conclusion JTC is associated not only with reward system areas that constitute the main target of antipsychotic drugs, but also with cortical areas, particularly of the TPN. Faulty evidence gathering (jumping to conclusions, JTC) is associated with delusions. We assessed data gathering with fMRI in patients with delusions vs healthy controls. JTC was associated with abnormal activity and connectivity patterns. Changes in the task-positive network were observed following metacognitive training.
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Affiliation(s)
- Christina Andreou
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Saskia Steinmann
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Kolbeck
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre for Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
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20
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Mehl S, Schlier B, Lincoln TM. Does CBT for Psychosis Have an Impact on Delusions by Improving Reasoning Biases and Negative Self-Schemas? ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000335] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Abstract. Cognitive-behavioral therapy for psychosis (CBTp) builds on theoretical models that postulate reasoning biases and negative self-schemas to be involved in the formation and maintenance of delusions. However, it is unclear whether CBTp induces change in delusions by improving these proposed causal mechanisms. This study reports on a mediation analysis of a CBTp effectiveness trial in which delusions were a secondary outcome. Patients with psychosis were randomized to individualized CBTp (n = 36) or a waiting list condition (WL; n = 34). Reasoning biases (jumping to conclusions, theory of mind, attribution biases) and self-schemas (implicit and explicit self-esteem; self-schemas related to different domains) were assessed pre- and post-therapy/WL. The results reveal an intervention effect on two of four measures of delusions and on implicit self-esteem. Nevertheless, the intervention effect on delusions was not mediated by implicit self-esteem. Changes in explicit self-schemas and reasoning biases did also not mediate the intervention effects on delusions. More focused interventions may be required to produce change in reasoning and self-schemas that have the potential to carry over to delusions.
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Affiliation(s)
- Stephanie Mehl
- Department of Social Work and Health, University of Applied Sciences Frankfurt am Main, Germany
- Department of Psychiatry and Psychotherapy & Marburg Center for Mind, Brain and Behavior (MCMBB), Philipps-Universität Marburg, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
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21
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McLean BF, Mattiske JK, Balzan RP. Towards a reliable repeated-measures beads task for assessing the jumping to conclusions bias. Psychiatry Res 2018; 265:200-207. [PMID: 29730540 DOI: 10.1016/j.psychres.2018.04.043] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
The jumping to conclusions bias (JTC), in which some people gather less information than others before making a decision, has been linked to delusions in psychosis. JTC is usually identified via the beads task, in which a sequence of beads (the "target" sequence) is used to measure the amount of evidence participants require before making a decision. Yet, despite its common use, the reliability of the task has never been properly investigated. We investigated its reliability, and tested an alternate version which used distractor sequences to obfuscate the target sequence. Healthy participants (N = 212) were randomised into two groups. One group completed ten trials using the target sequence, while the other completed ten trials of the target sequence and three distractor sequences. Our data indicated the standard task may not be reliable over repeated measures, but that by including distractor sequences, the task becomes more believable, repeatable, and reliable. Additionally, excluding first-trial data (a "silent" practice trial) also improves repeatability. These improvements to the task are relevant to single trial studies, and will be especially useful to repeated-measures longitudinal, experimental, and treatment studies. Such repeated-measures studies are important for investigating the causal link between JTC and delusions.
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Affiliation(s)
- Benjamin F McLean
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia.
| | - Julie K Mattiske
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.
| | - Ryan P Balzan
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
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22
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Garety P, Freeman D, Jolley S, Ross K, Waller H, Dunn G. Jumping to conclusions: the psychology of delusional reasoning. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/apt.bp.109.007104] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SummaryDelusions are a key symptom of psychosis and they are frequently distressing and disabling. Existing treatments, both pharmacological and psychological, are only partially effective. It is important to develop new treatment approaches based on theoretically derived and empirically tested processes. Delusions are associated with a reasoning bias: the jumping to conclusions (JTC) bias involves gathering limited information to reach decisions. It is proposed that this bias influences appraisals of psychotic experiences leading to the formation and persistence of delusions. Existing treatments do not influence JTC. A new intensive treatment approach – ‘reasoning training’ – is described. It aims to encourage participants to gather information, consider alternative explanations for events and review the evidence before reaching a decision. Preliminary data suggest that it is possible to change the JTC bias and that this improves belief flexibility and may reduce delusional conviction. The concepts and methods of this new approach have implications for clinical practice.
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23
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Ward T, Peters E, Jackson M, Day F, Garety PA. Data-Gathering, Belief Flexibility, and Reasoning Across the Psychosis Continuum. Schizophr Bull 2018; 44:126-136. [PMID: 28338872 PMCID: PMC5768047 DOI: 10.1093/schbul/sbx029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is evidence for a group of nonclinical individuals with full-blown, persistent psychotic experiences (PEs) but no need-for-care: they are of particular importance in identifying risk and protective factors for clinical psychosis. The aim of this study was to investigate whether reasoning biases are related to PEs or need-for-care. METHOD Two groups with persistent PEs (clinical; n = 74; nonclinical; n = 92) and a control group without PEs (n = 83) were compared on jumping-to-conclusions (JTC) and belief flexibility. A randomly selected subset of interviews (n = 104) was analyzed to examine differences in experiential and rational reasoning. RESULTS As predicted JTC was more common in the clinical than the other 2 groups. Unexpectedly no group differences were observed between clinical and nonclinical groups on measures of belief flexibility. However, the clinical group was less likely to employ rational reasoning, while the nonclinical group was more likely to use experiential reasoning plus a combination of both types of reasoning processes, compared to the other 2 groups. CONCLUSIONS Reasoning biases differ in groups with PEs with and without need-for-care. JTC is associated with need-for-care rather than with PEs. The ability to invoke rational reasoning processes, together with an absence of JTC, may protect against pathological outcomes of persistent PEs. However, marked use of experiential reasoning is associated with the occurrence of PEs in both clinical and nonclinical groups. Implications for theory development, intervention and further research are discussed.
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Affiliation(s)
- Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,To whom correspondence should be addressed; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, PO77, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK; tel: 44-207-848-0594, fax: 44-207-848-5006, e-mail:
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mike Jackson
- School of Psychology, Bangor University, North Wales, UK,Betsi Cadwaladr University Health Board, North Wales, UK
| | - Fern Day
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philippa A Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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24
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Garety PA, Ward T, Freeman D, Fowler D, Emsley R, Dunn G, Kuipers E, Bebbington P, Waller H, Greenwood K, Rus-Calafell M, McGourty A, Hardy A. SlowMo, a digital therapy targeting reasoning in paranoia, versus treatment as usual in the treatment of people who fear harm from others: study protocol for a randomised controlled trial. Trials 2017; 18:510. [PMID: 29096681 PMCID: PMC5667466 DOI: 10.1186/s13063-017-2242-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 10/04/2017] [Indexed: 02/07/2023] Open
Abstract
Background Paranoia is one of the most common symptoms of schizophrenia-spectrum disorders, and is associated with significant distress and disruption to the person’s life. Developing more effective and accessible psychological interventions for paranoia is a clinical priority. Our research team has approached this challenge in two main ways: firstly, by adopting an interventionist causal approach to increase effectiveness and secondly, by incorporating user-centred inclusive design methods to enhance accessibility and usability. Our resultant new digital intervention, SlowMo, intensively targets a reasoning style associated with paranoia, fast thinking, characterised by jumping to conclusions and belief inflexibility. It consists of an easy-to-use, enjoyable and memorable digital interface. An interactive web-based app facilitates delivery of face-to-face meetings which is then synchronised with an innovative mobile app for use in daily life. Methods/Design We aim to test the clinical efficacy of SlowMo over 24 weeks to determine the mechanisms through which it reduces paranoia, and to identify participant characteristics that moderate its effectiveness. In a parallel-group randomised controlled trial, with 1:1 allocation, 360 participants with distressing persecutory beliefs will be independently randomised to receive either the SlowMo intervention added to treatment as usual (TAU) or TAU, using randomly varying permuted blocks, stratified by paranoia severity and site. Research workers will be blind to therapy allocation. The primary outcome is paranoia severity over 24 weeks; our hypothesised mechanism of change is reasoning; moderators include negative symptoms and working memory; and secondary outcomes include wellbeing, quality of life, and service use. The accessibility, usability and acceptability of the digital platform will be assessed. Discussion SlowMo has been developed as the first blended digital therapy to target fears of harm from others through an inclusive design approach. In addition to testing its efficacy, this trial will add to our understanding of psychological mechanisms in paranoia. The study will examine the usability and adherence of a novel digital therapy, including an app for self-management, in a large sample of people affected by severe mental health difficulties. Trial registration ISRCTN registry, ID: ISRCTN32448671. Registered prospectively on 30 January 2017. Date assigned 2 February 2017. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2242-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Philippa A Garety
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Thomas Ward
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Richard Emsley
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Elizabeth Kuipers
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, UK
| | - Helen Waller
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, UK.,Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, P077 Henry Wellcome Building, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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25
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The relationship between cognitive biases and psychological dimensions of delusions: The importance of jumping to conclusions. J Behav Ther Exp Psychiatry 2017; 56:51-56. [PMID: 27527489 DOI: 10.1016/j.jbtep.2016.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/04/2016] [Accepted: 08/05/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Cognitive biases play a role in the development and maintenance of delusions. However, delusions are multidimensional (i.e., emotional and cognitive facets) and often co-occur with auditory hallucinations. Therefore, further refinement of the precise relationship between cognitive biases, delusions, and hallucinatory experiences is warranted. METHODS A total sample of 167 patients with schizophrenia spectrum disorders was split into two groups consisting of patients with active delusions (n = 127) and active hallucinations (n = 92). All patients were assessed for delusions and hallucinations using the semi-structured psychotic symptom rating scales (PSYRATS), which assesses the emotional (i.e., distress) and cognitive (i.e., conviction, preoccupation) dimensions of these symptoms. Cognitive biases were assessed with the Cognitive Biases Questionnaire for Psychosis (CBQp) self-report questionnaire (assessing jumping to conclusions, intentionalising, catastrophising, emotional reasoning, and dichotomous thinking biases). Multiple stepwise regressions were performed to investigate the relationship between delusions and cognitive biases, while controlling for auditory hallucinations (and vice-versa). RESULTS The only cognitive bias to significantly predict delusions after controlling for the severity of auditory hallucinations was the jumping to conclusions (JTC) bias (predicted both emotional and cognitive dimensions). Only the emotional dimension of auditory hallucinations was predicted by the intentionalising and dichotomous thinking biases, after delusional severity was controlled for. LIMITATIONS The cross-sectional design precludes causal inferences. Only positive psychotic symptoms were assessed and no wider psychopathology assessment was utilised (e.g., negative symptoms, anxiety, depression). CONCLUSIONS The jumping to conclusions bias is associated with both delusional conviction and emotional distress.
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Andreou C, Wittekind CE, Fieker M, Heitz U, Veckenstedt R, Bohn F, Moritz S. Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study. J Behav Ther Exp Psychiatry 2017; 56:144-151. [PMID: 27919404 DOI: 10.1016/j.jbtep.2016.11.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Revised: 11/19/2016] [Accepted: 11/24/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases. METHODS 92 patients with current or past delusions were randomized to receive 12 twice-weekly sessions of either MCT+ or a control intervention within a randomized controlled rater-blind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted. RESULTS At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability thresholds to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up. LIMITATIONS Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group. CONCLUSIONS The result pattern suggests that MCT+ led to earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects.
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Affiliation(s)
- Christina Andreou
- Center for Gender Research and Early Detection, University Psychiatric Clinics Basel, Switzerland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
| | - Charlotte E Wittekind
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Martina Fieker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Ulrike Heitz
- Center for Gender Research and Early Detection, University Psychiatric Clinics Basel, Switzerland
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Francesca Bohn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
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Toh WL, Castle DJ, Mountjoy RL, Buchanan B, Farhall J, Rossell SL. Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: Revisiting this issue in light of DSM-5. Compr Psychiatry 2017. [PMID: 28651226 DOI: 10.1016/j.comppsych.2017.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION In DSM-5, body dysmorphic disorder (BDD) was reclassified under the obsessive-compulsive and related disorders (OCRDs), but little is known about the nature of BDD beliefs. This study aimed to compare level of insight in BDD and consider related implications for DSM-5 classification. METHOD Participants were 27 BDD, 19 obsessive-compulsive disorder (OCD), and 20 psychosis (SZ) participants as well as 42 non-clinical controls (NC), who completed the Brown Assessment of Beliefs Scale (BABS) and Peters Delusions Inventory (PDI). RESULTS For total (and most individual) BABS items, BDD and SZ participants scored significantly higher than OCD and NC participants. On the PDI, there were significant group differences in number of questions endorsed, with clinical groups scoring significantly higher than the NC group on dimensions of distress and preoccupation, but not conviction. CONCLUSION These findings suggest appearance-related concerns in BDD somewhat resemble delusions seen in psychosis (and not OCD), and convey important nosological and therapeutic implications.
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Affiliation(s)
- Wei Lin Toh
- Centre for Mental Health, Swinburne University, Australia; Cognitive Neuropsychiatry, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia.
| | - David J Castle
- Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia; Department of Psychiatry, St. Vincent's Mental Health, Australia
| | - Rachel L Mountjoy
- Mental Health Clinical Services Unit, Austin Health, Australia; The Melbourne Clinic, Australia; Department of Psychology and Counselling, La Trobe University, Australia
| | - Ben Buchanan
- Cognitive Neuropsychiatry, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Australia; Cognitive Neuropsychiatry, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia; Department of Psychiatry, St. Vincent's Mental Health, Australia
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Yiend J, Trotta A, Meek C, Dzafic I, Baldus N, Crane B, Kabir T, Stahl D, Heslin M, Shergill S, McGuire P, Peters E. Cognitive Bias Modification for paranoia (CBM-pa): study protocol for a randomised controlled trial. Trials 2017; 18:298. [PMID: 28662715 PMCID: PMC5492504 DOI: 10.1186/s13063-017-2037-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Persecutory delusions are the most common type of delusions in psychosis and present in around 10-15% of the general population. Persecutory delusions are thought to be sustained by biased cognitive and emotional processes. Recent advances favour targeted interventions, focussing on specific symptoms or mechanisms. Our aim is to test the clinical feasibility of a novel psychological intervention, which manipulates biased interpretations toward more adaptive processing, in order to reduce paranoia in patients. METHODS The 'Cognitive Bias Modification for paranoia' (CBM-pa) study is a feasibility, double-blind, randomised controlled trial (RCT) for 60 stabilised outpatients with persistent, distressing paranoid symptoms. Patients will be randomised at a 50:50 ratio, to computerised CBM-pa or a text-reading control intervention, receiving one 40-min session per week, for 6 weeks. CBM-pa involves participants reading stories on a computer screen, completing missing words and answering questions about each story in a way that encourages more helpful beliefs about themselves and others. Treatment as Usual will continue for patients in both groups. Patients will be assessed by a researcher blind to allocation, at baseline, each interim session, post treatment and 1- and 3-month follow-up post treatment. The primary outcome is the feasibility parameters (trial design, recruitment rate and acceptability) of the intervention. The secondary outcomes are clinical symptoms (including severity of paranoia) as assessed by a clinical psychologist, and 'on-line' measurement of interpretation bias and stress/distress. The trial is funded by the NHS National Institute for Health Research. DISCUSSION This pilot study will test whether CBM-pa has the potential to be a cost-effective, accessible and flexible treatment. If the trial proves feasible and demonstrates preliminary evidence of efficacy, a fully powered RCT will be warranted. TRIAL REGISTRATION Current Controlled Trials ISRCTN: 90749868 . Retrospectively registered on 12 May 2016.
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Affiliation(s)
- Jenny Yiend
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Antonella Trotta
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Christopher Meek
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ilvana Dzafic
- Queensland Brain Institute, University of Queensland, Brisbane, QLD Australia
| | - Nora Baldus
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Bryony Crane
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | | | - Daniel Stahl
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Margaret Heslin
- Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sukhwinder Shergill
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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McLean BF, Mattiske JK, Balzan RP. Association of the Jumping to Conclusions and Evidence Integration Biases With Delusions in Psychosis: A Detailed Meta-analysis. Schizophr Bull 2017; 43:344-354. [PMID: 27169465 PMCID: PMC5605251 DOI: 10.1093/schbul/sbw056] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We completed a meta-analysis to investigate the relationship between delusions in psychosis and 4 cognitive biases: "jumping to conclusions" (JTC), the "bias against disconfirmatory evidence" (BADE), the "bias against confirmatory evidence" (BACE), and "liberal acceptance" (LA). Building on recent meta-analyses we compared more narrowly defined groups. We identified 35 JTC, 8 BADE, 7 BACE, and 6 LA studies for inclusion. Groups with schizophrenia who were currently experiencing delusions demonstrated greater JTC, BADE, BACE, and LA than groups with schizophrenia who were not currently experiencing delusions, who in turn demonstrated no more JTC than healthy control groups. Hence JTC, BADE, BACE, and LA co-vary with delusions in cross-sectional samples of people with schizophrenia. Groups who were experiencing delusions due to other psychiatric illnesses also demonstrated greater JTC than healthy controls, and equivalent JTC to groups with schizophrenia currently experiencing delusions. Hence JTC is associated with delusions across a range of diagnoses. Groups with other, non-delusional psychiatric illnesses demonstrated less JTC, BADE, BACE, and LA than groups with schizophrenia currently experiencing delusions, less JTC than groups experiencing delusions due to other diagnoses, and no more JTC, BADE, BACE, or LA than healthy control groups. Hence JTC, BADE, BACE, and LA were not associated with psychiatric illnesses in general. Our results indicate all 4 biases are associated with delusions specifically rather than merely with a diagnosis of schizophrenia or with being psychiatrically ill, consistent with the possibility that they contribute to delusional severity.
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Affiliation(s)
- Benjamin F. McLean
- School of Psychology, Flinders University, Adelaide, Australia;,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | | | - Ryan P. Balzan
- School of Psychology, Flinders University, Adelaide, Australia;,ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
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Schneider BC, Brüne M, Bohn F, Veckenstedt R, Kolbeck K, Krieger E, Becker A, Drommelschmidt KA, Englisch S, Eisenacher S, Lee-Grimm SI, Nagel M, Zink M, Moritz S. Investigating the efficacy of an individualized metacognitive therapy program (MCT+) for psychosis: study protocol of a multi-center randomized controlled trial. BMC Psychiatry 2016; 16:51. [PMID: 26921116 PMCID: PMC4769526 DOI: 10.1186/s12888-016-0756-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 02/18/2016] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Psychological interventions are increasingly recommended as adjunctive treatments for psychosis, but their implementation in clinical practice is still insufficient. The individualized metacognitive therapy program (MCT+; www.uke.de/mct_plus ) represents a low-threshold psychotherapeutic approach that synthesizes group metacognitive training (MCT) and cognitive behavioral therapy for psychosis, and addresses specific cognitive biases that are involved in the onset and maintenance of psychosis. It aims to "plant the seed of doubt" regarding rigid delusional convictions and to encourage patients to critically reflect, extend and change their approach to problem solving. Its second edition also puts more emphasis on affective symptoms. A recent meta-analysis of metacognitive interventions (MCT, MCT+) indicate small to moderate effects on positive symptoms and delusions, as well as high rates of acceptance. Nonetheless, no long-term studies of MCT+ involving large samples have been conducted. METHODS The goal of the present multi-center, observer-blind, parallel-group, randomized controlled trial is to compare the efficacy of MCT+ against an active control (cognitive remediation; MyBrainTraining(©)) in 328 patients with psychosis at three time points (baseline, immediately after intervention [6 weeks] and 6 months later). The primary outcome is change in psychosis symptoms over the 6-month follow-up period as assessed by the delusion subscale of the Psychotic Symptom Rating Scale. Secondary outcomes include jumping to conclusions, other positive symptoms of schizophrenia, depressive symptoms, self-esteem, quality of life, and cognitive insight. The study also seeks to elucidate mediating factors that promote versus impede symptom improvement across time. DISCUSSION This is the first multi-center randomized controlled trial to test the efficacy of individualized MCT+ in a large sample of patients with psychosis. The rationale for the trial, the design, and the strengths and limitations of the study are discussed. TRIAL REGISTRATION The trial is registered through the German Clinical Trials Register ( www.drks.de ) as DRKS00008001 . Registered 6 May 2015.
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Affiliation(s)
- Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Francesca Bohn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Katharina Kolbeck
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
| | - Eva Krieger
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
| | - Anna Becker
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Kim Alisha Drommelschmidt
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Susanne Englisch
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sarah Eisenacher
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Sie-In Lee-Grimm
- LWL University Hospital Bochum, Department of Psychiatry, Psychotherapy and Preventative Medicine, Division of Cognitive Neuropsychiatry and Psychiatric Preventative Medicine, Ruhr-University Bochum, Bochum, Germany.
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios North-Wandsbek, Hamburg, Germany.
- Department of Psychiatry and Psychotherapy, University of Lübeck, Lübeck, Germany.
| | - Mathias Zink
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Peters E, Crombie T, Agbedjro D, Johns LC, Stahl D, Greenwood K, Keen N, Onwumere J, Hunter E, Smith L, Kuipers E. The long-term effectiveness of cognitive behavior therapy for psychosis within a routine psychological therapies service. Front Psychol 2015; 6:1658. [PMID: 26579041 PMCID: PMC4625031 DOI: 10.3389/fpsyg.2015.01658] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 10/14/2015] [Indexed: 11/18/2022] Open
Abstract
Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have considered its long-term effectiveness in routine services. This study reports the outcomes of clients seen in a psychological therapies clinic, set up following positive results obtained from an RCT (Peters et al., 2010). The aims were to evaluate the effectiveness of CBTp, using data from the service’s routine assessments for consecutive referrals over a 12 years period, and assess whether gains were maintained at a 6+ months’ follow-up. Of the 476 consenting referrals, all clients (N = 358) who received ≥5 therapy sessions were offered an assessment at four time points (baseline, pre-, mid-, and end of therapy) on measures assessing current psychosis symptoms, emotional problems, general well-being and life satisfaction. A sub-set (N = 113) was assessed at a median of 12 months after finishing therapy. Following the waiting list (median of 3 months) clients received individualized, formulation-based CBTp for a median number of 19 sessions from 121 therapists with a range of experience receiving regular supervision. Clients showed no meaningful change on any measure while on the waiting list (Cohen’s d <= 0.23). In contrast, highly significant improvements following therapy, all of which were significantly greater than changes during the waiting list, were found on all domains assessed (Cohen’s d: 0.44–0.75). All gains were maintained at follow-up (Cohen’s d: 0.29–0.82), with little change between end of therapy and follow-up (Cohen’s d <= 0.18). Drop-out rate from therapy was low (13%). These results demonstrate the positive and potentially enduring impact of psychological therapy on a range of meaningful outcomes for clients with psychosis. The follow-up assessments were conducted on only a sub-set, which may not generalize to the full sample. Nevertheless this study is the largest of its kind in psychosis, and has important implications for the practice of CBTp in clinical services.
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Affiliation(s)
- Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK ; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, King's College London London, UK
| | - Tessa Crombie
- Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Deborah Agbedjro
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Louise C Johns
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Daniel Stahl
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK
| | - Kathryn Greenwood
- Department of Psychology, Sussex University Sussex, UK ; Sussex Partnership NHS Foundation Trust Sussex, UK
| | - Nadine Keen
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Juliana Onwumere
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Elaine Hunter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Laura Smith
- Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London London, UK ; Psychological Interventions Clinic for Outpatients with Psychosis, South London and Maudsley NHS Trust London, UK ; NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Trust, King's College London London, UK
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Waller H, Emsley R, Freeman D, Bebbington P, Dunn G, Fowler D, Hardy A, Kuipers E, Garety P. Thinking Well: A randomised controlled feasibility study of a new CBT therapy targeting reasoning biases in people with distressing persecutory delusional beliefs. J Behav Ther Exp Psychiatry 2015; 48:82-9. [PMID: 25770671 PMCID: PMC4429971 DOI: 10.1016/j.jbtep.2015.02.007] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 02/11/2015] [Accepted: 02/15/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Delusional beliefs with persecutory content are common in psychosis, but difficult to treat. Interventions targeting hypothesised causal and maintaining factors have been proposed as a way of improving therapy. The current study is a feasibility randomised controlled trial of the 'Thinking Well (TW)' intervention: This novel approach combines the recently developed Maudsley Review Training Programme (MRTP), with additional, focussed cognitive-behavioural therapy sessions. METHODS 31 participants with distressing persecutory delusions and schizophrenia spectrum disorders were randomised to TW or to treatment as usual in a 2:1 ratio. Participants completed outcome assessments at 0 (baseline), 1 (post-MRTP), 6 (post-TW) and 8 (follow-up) weeks. Key outcomes included belief flexibility, paranoia, and delusional conviction and distress. Participants allocated to TW completed the MRTP package and four CBT sessions with a clinical psychologist. RESULTS Recruitment proved feasible. Participants reported the intervention was relevant and had resulted in positive changes in thinking and mood, which they could use in everyday life. Treatment effects were moderate-large for key outcomes including belief flexibility, paranoia conviction and distress. The additional TW sessions appeared to confer benefits over MRTP alone. LIMITATIONS Assessments were not carried out blind to treatment condition. Recruitment was opportunistic, from an identified pool of research participants. Finally, a few participants had already completed the MRTP as part of a previous study. CONCLUSIONS The TW intervention appears to be feasible and acceptable to participants, and the effects of treatment are promising. A fully powered randomised controlled trial of the intervention is warranted.
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Affiliation(s)
- Helen Waller
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, UK
| | | | - Paul Bebbington
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | - Amy Hardy
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Elizabeth Kuipers
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK
| | - Philippa Garety
- King's College London, The Institute of Psychiatry, Psychology & Neuroscience, UK
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Moritz S, Göritz AS, Gallinat J, Schafschetzy M, Van Quaquebeke N, Peters MJV, Andreou C. Subjective competence breeds overconfidence in errors in psychosis. A hubris account of paranoia. J Behav Ther Exp Psychiatry 2015; 48:118-24. [PMID: 25817242 DOI: 10.1016/j.jbtep.2015.02.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 02/20/2015] [Accepted: 02/23/2015] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Overconfidence in errors is a well-replicated cognitive bias in psychosis. However, prior studies have sometimes failed to find differences between patients and controls for more difficult tasks. We pursued the hypothesis that overconfidence in errors is exaggerated in participants with a liability to psychosis relative to controls only when they feel competent in the respective topic and/or deem the question easy. Whereas subjective competence likely enhances confidence in those with low psychosis liability as well, we still expected to find more 'residual' caution in the latter group. METHODS We adopted a psychometric high-risk approach to circumvent the confounding influence of treatment. A total of 2321 individuals from the general population were administered a task modeled after the "Who wants to be a millionaire" quiz. Participants were requested to endorse one out of four response options, graded for confidence, and were asked to provide ratings regarding subjective competence for the knowledge domain as well as the subjective difficulty of each item. RESULTS In line with our assumption, overconfidence in errors was increased overall in participants scoring high on the Paranoia Checklist core paranoia subscale (2 SD above the mean). This pattern of results was particularly prominent for items for which participants considered themselves competent and which they rated as easy. LIMITATIONS Results need to be replicated in a clinical sample. DISCUSSION In support of our hypothesis, subjective competence and task difficulty moderate overconfidence in errors in psychosis. Trainings that teach patients the fallibility of human cognition may help reduce delusional ideation.
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Affiliation(s)
- Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany.
| | - Anja S Göritz
- Occupational and Consumer Psychology, Freiburg University, Freiburg, Germany
| | - Jürgen Gallinat
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Milena Schafschetzy
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
| | - Niels Van Quaquebeke
- Department of Management and Economics, Kuehne Logistics University, Hamburg, Germany
| | - Maarten J V Peters
- Clinical Psychological Science, Section Forensic Psychology, Faculty of Psychology and Neuroscience, Maastricht University, the Netherlands
| | - Christina Andreou
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Germany
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Hassanali N, Ruffell T, Browning S, Bracegirdle K, Ames C, Corrigall R, Laurens KR, Hirsch C, Kuipers E, Maddox L, Jolley S. Cognitive bias and unusual experiences in childhood. Eur Child Adolesc Psychiatry 2015; 24:949-57. [PMID: 25395382 DOI: 10.1007/s00787-014-0644-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 10/31/2014] [Indexed: 10/24/2022]
Abstract
Cognitive therapy is recommended for children with psychotic-like, or unusual, experiences associated with distress or impairment (UEDs; UK National Institute for Health and Care Excellence, 2013 [1]). Accurate models of the psychological underpinnings of childhood UEDs are required to effectively target therapies. Cognitive biases, such as the jumping to conclusions data-gathering bias (JTC), are implicated in the development and maintenance of psychosis in adults. In this study, we aimed to establish the suitability for children of a task developed to assess JTC in adults. Eighty-six participants (aged 5-14 years) were recruited from Child and Adolescent Mental Health Service (CAMHS) and community (school) settings, and completed the probabilistic reasoning ('Beads') task, alongside measures of intellectual functioning, general psychopathology, and UEDs. Self-reported reasoning strategy was coded as 'probabilistic' or 'other'. Younger children (5-10 years) were more likely than older children (11-14 years) to JTC (OR = 2.7, 95 % CI = 1.1-6.5, p = 0.03); and to use non-probabilistic reasoning strategies (OR = 9.4, 95 % CI = 1.7-48.8, p = 0.008). Both UED presence (OR = 5.1, 95 % CI = 1.2-21.9, p = 0.03) and lower IQ (OR = 0.9, 95 % CI = 0.9-1.0, p = 0.02) were significantly and independently associated with JTC, irrespective of age and task comprehension. Findings replicate research in adults, indicating that the 'Beads' task can be reliably employed in children to assess cognitive biases. Psychological treatments for children with distressing unusual experiences might usefully incorporate reasoning interventions.
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Affiliation(s)
- Nedah Hassanali
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, SE5 8AF, UK
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Falcone MA, Murray RM, O'Connor JA, Hockey LN, Gardner-Sood P, Di Forti M, Freeman D, Jolley S. Jumping to conclusions and the persistence of delusional beliefs in first episode psychosis. Schizophr Res 2015; 165:243-6. [PMID: 25956634 DOI: 10.1016/j.schres.2015.04.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 02/28/2015] [Accepted: 04/15/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Cognitive biases may contribute to delusion persistence. We tested this in a longitudinal study of first episode psychosis (FEP). METHODS 34 FEP patients completed assessments of delusions and Jumping to Conclusions (JTC) at baseline and 12-month follow-up. RESULTS JTC was associated with baseline delusion severity (t(32)=2.7, p=0.01). Baseline delusions persisted at follow-up for 8/20 participants (40%), who all jumped to conclusions (8/8, 100%), compared to half of those with no or changeable delusions (14/26, 54%; χ(2) (df=1)=5.7, p=0.03; Phi=0.4). CONCLUSION Findings implicate cognitive biases in delusion persistence, and support the potential to reduce delusions through reasoning-focused interventions.
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Affiliation(s)
- M Aurora Falcone
- King's College, London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK; King's College, London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK.
| | - Robin M Murray
- King's College, London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Jennifer A O'Connor
- King's College, London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Leanne N Hockey
- King's College, London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Poonam Gardner-Sood
- King's College, London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Marta Di Forti
- King's College, London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Daniel Freeman
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford, UK
| | - Suzanne Jolley
- King's College, London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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So SHW, Chan AP, Chong CSY, Wong MHM, Lo WTL, Chung DWS, Chan SS. Metacognitive training for delusions (MCTd): effectiveness on data-gathering and belief flexibility in a Chinese sample. Front Psychol 2015; 6:730. [PMID: 26124726 PMCID: PMC4467068 DOI: 10.3389/fpsyg.2015.00730] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 05/16/2015] [Indexed: 01/06/2023] Open
Abstract
Metacognitive training (MCT) was developed to promote awareness of reasoning biases among patients with schizophrenia. While MCT has been translated into 31 languages, most MCT studies were conducted in Europe, including newer evidence recommending an individualized approach of delivery. As reasoning biases covered in MCT are separable processes and are associated with different symptoms, testing the effect of selected MCT modules would help to develop a targeted and cost-effective intervention for specific symptoms and associated mechanisms. This study tested the efficacy of a four-session metacognitive training for delusions, MCTd (in Traditional Chinese with cultural adaptations, provided individually), as an adjunct to antipsychotics in reducing severity and conviction of delusions, jumping to conclusions (JTC) bias and belief inflexibility. Forty-four patients with delusions were randomized into the MCTd or the wait-list control condition. Patients on wait-list received the same MCTd after 4 weeks of treatment as usual (TAU). Assessment interviews took place before and after the treatment, and at 4-week follow-up. There was an additional baseline assessment for the controls. JTC and belief flexibility were measured by the beads tasks and the Maudsley Assessment of Delusions Scale. Attendance rate of the MCTd was satisfactory (84.5%). Compared to TAU, there was a greater reduction in psychotic symptoms, delusional severity and conviction following MCTd. There was a large treatment effect size in improvement in belief flexibility. Improvement in reaction to hypothetical contradiction predicted treatment effect in positive symptoms and delusions. JTC bias was reduced following MCTd, although the treatment effect was not significantly larger than TAU. Our results support the use of process-based interventions that target psychological mechanisms underlying specific psychotic symptoms as adjuncts to more conventional approaches.
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Affiliation(s)
- Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong Hong Kong, China
| | - Arthur P Chan
- Early Intervention Service for First Episode Psychosis, Kwai Chung Hospital Hong Kong, China
| | | | | | - William Tak-Lam Lo
- Early Intervention Service for First Episode Psychosis, Kwai Chung Hospital Hong Kong, China
| | | | - Sandra S Chan
- Department of Psychiatry, The Chinese University of Hong Kong Hong Kong, China
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The Benefits of Doubt: Cognitive Bias Correction Reduces Hasty Decision-Making in Schizophrenia. COGNITIVE THERAPY AND RESEARCH 2015. [DOI: 10.1007/s10608-015-9690-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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38
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Metakognitives Training bei Schizophrenie. PSYCHOTHERAPEUT 2015. [DOI: 10.1007/s00278-015-0003-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Premkumar P, Fannon D, Sapara A, Peters ER, Anilkumar AP, Simmons A, Kuipers E, Kumari V. Orbitofrontal cortex, emotional decision-making and response to cognitive behavioural therapy for psychosis. Psychiatry Res 2015; 231:298-307. [PMID: 25659473 PMCID: PMC4834460 DOI: 10.1016/j.pscychresns.2015.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 11/06/2014] [Accepted: 01/13/2015] [Indexed: 12/19/2022]
Abstract
Grey matter volume (GMV) in the orbitofrontal cortex (OFC) may relate to better response to cognitive behavioural therapy for psychosis (CBTp) because of the region׳s role in emotional decision-making and cognitive flexibility. This study aimed to determine the relation between pre-therapy OFC GMV or asymmetry, emotional decision-making and CBTp responsiveness. Emotional decision-making was measured by the Iowa Gambling task (IGT). Thirty patients received CBTp+standard care (CBTp+SC; 25 completers) for 6-8 months. All patients (before receiving CBTp) and 25 healthy participants underwent structural magnetic resonance imaging. Patients׳ symptoms were assessed before and after therapy. Pre-therapy OFC GMV was measured using a region-of-interest approach, and IGT performance was measured as overall learning, attention to reward, memory for past outcomes and choice consistency. Both these measures, were comparable between patient and healthy groups. In the CBTp+SC group, greater OFC GMV correlated with positive symptom improvement, specifically hallucinations and persecution. Greater rightward OFC asymmetry correlated with improvement in several negative and general psychopathology symptoms. Greater left OFC GMV was associated with lower IGT attention to reward. The findings suggest that greater OFC volume and rightward asymmetry, which maintain the OFC׳s function in emotional decision-making and cognitive flexibility, are beneficial for CBTp responsiveness.
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Affiliation(s)
- Preethi Premkumar
- Division of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK.
| | - Dominic Fannon
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK
| | - Adegboyega Sapara
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK
| | - Emmanuelle R. Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Andrew Simmons
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK,Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Veena Kumari
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King׳s College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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40
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So SHW, Kwok NTK. Jumping to conclusions style along the continuum of delusions: delusion-prone individuals are not hastier in decision making than healthy individuals. PLoS One 2015; 10:e0121347. [PMID: 25793772 PMCID: PMC4367987 DOI: 10.1371/journal.pone.0121347] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 01/30/2015] [Indexed: 11/18/2022] Open
Abstract
Literature comparing 'jumping to conclusions' (JTC) between patients and healthy controls has demonstrated the importance of the reasoning bias in the development of delusions. When groups that vary along the entire delusional continuum are included, the relationship between JTC and delusionality is less clear. This study compared JTC and delusional dimensions between 28 patients with delusions, 35 delusion-prone individuals and 32 non-delusion-prone individuals. Delusion proneness was defined by an established threshold based on the Peters et al. Delusions Inventory. Two versions of the beads task (85:15 and 60:40) were used to measure JTC. As hypothesized, patients manifested hastier data gathering than the two non-clinical groups on both beads tasks. However, delusion-prone individuals did not manifest a hastier decision making style than non-delusion prone individuals. Instead, non-delusion-prone participants showed more JTC bias than delusion-prone individuals on the easier beads task. There was no evidence for a dose-response relationship between JTC and delusional dimensions, with correlations between JTC and PDI scores found in the non-delusion-prone group only. The present finding confirms the link between an extreme JTC bias and the presence of clinical delusions, and argues against a linear relationship between JTC and delusionality along the symptomatic continuum.
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Affiliation(s)
- Suzanne Ho-wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
- * E-mail:
| | - Nate Tsz-kit Kwok
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong SAR, China
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41
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Garety P, Waller H, Emsley R, Jolley S, Kuipers E, Bebbington P, Dunn G, Fowler D, Hardy A, Freeman D. Cognitive mechanisms of change in delusions: an experimental investigation targeting reasoning to effect change in paranoia. Schizophr Bull 2015; 41:400-10. [PMID: 25053650 PMCID: PMC4332945 DOI: 10.1093/schbul/sbu103] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. METHODS One hundred and one participants with current delusions and schizophrenia spectrum psychosis were randomly allocated to a brief computerized reasoning training intervention or to a control condition involving computer-based activities of similar duration. The primary hypotheses tested were that the reasoning training intervention, would improve (1) data gathering and belief flexibility and (2) delusional thinking, specifically paranoia. We then tested whether the changes in paranoia were mediated by changes in data gathering and flexibility, and whether working memory and negative symptoms moderated any intervention effects. RESULTS On an intention-to-treat analysis, there were significant improvements in state paranoia and reasoning in the experimental compared with the control condition. There was evidence that changes in reasoning mediated changes in paranoia, although this effect fell just outside the conventional level of significance after adjustment for baseline confounders. Working memory and negative symptoms significantly moderated the effects of the intervention on reasoning. CONCLUSION The study demonstrated the effectiveness of a brief reasoning intervention in improving both reasoning processes and paranoia. It thereby provides proof-of-concept evidence that reasoning is a promising intermediary target in interventions to ameliorate delusions, and thus supports the value of developing this approach as a longer therapeutic intervention.
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Affiliation(s)
- Philippa Garety
- Department of Psychology, Institute of Psychiatry, King's College London, London, UK;
| | - Helen Waller
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
| | - Paul Bebbington
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, London, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - David Fowler
- Department of Psychology, University of Sussex, Brighton, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
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Falcone MA, Murray RM, Wiffen BDR, O’Connor JA, Russo M, Kolliakou A, Stilo S, Taylor H, Gardner-Sood P, Paparelli A, Jichi F, Di Forti M, David AS, Freeman D, Jolley S. Jumping to conclusions, neuropsychological functioning, and delusional beliefs in first episode psychosis. Schizophr Bull 2015; 41:411-8. [PMID: 25053654 PMCID: PMC4332946 DOI: 10.1093/schbul/sbu104] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The "jumping to conclusions" (JTC) data-gathering bias is implicated in the development and maintenance of psychosis but has only recently been studied in first episode psychosis (FEP). In this study, we set out to establish the relationship of JTC in FEP with delusions and neuropsychological functioning. METHODS One hundred and eight FEP patients and 101 age-matched controls completed assessments of delusions, general intelligence (IQ), working memory (WM), and JTC (the probabilistic reasoning "beads" task). RESULTS Half the FEP participants jumped to conclusions on at least 1 task, compared with 25% of controls (OR range 2.1 to 3.9; 95% CI range 1.5 to 8.0, P values ≤ .02). JTC was associated with clinical, but not nonclinical delusion severity, and with neuropsychological functioning, irrespective of clinical status. Both IQ and delusion severity, but not WM, were independently associated with JTC in the FEP group. CONCLUSIONS JTC is present in FEP. The specific association of JTC with clinical delusions supports a state, maintaining role for the bias. The associations of JTC with neuropsychological functioning indicate a separable, trait aspect to the bias, which may confer vulnerability to psychosis. The work has potential to inform emerging interventions targeting reasoning biases in early psychosis.
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Affiliation(s)
- M. Aurora Falcone
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK;,Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,*To whom correspondence should be addressed; Department of Psychosis Studies, PO 52, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK; tel: +44-(0)207-848-0100, fax: +44-(0)207848-0287, e-mail:
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Benjamin D. R. Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Jennifer A. O’Connor
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Manuela Russo
- Department of Psychiatry, Mount Sinai School of Medicine, New York, NY
| | - Anna Kolliakou
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Simona Stilo
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK;,Department of Health Service and Population Research, Institute of Psychiatry, King’s College London, London, UK
| | - Heather Taylor
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Alessandra Paparelli
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Fatima Jichi
- Department of Biostatistics, King’s College London, Institute of Psychiatry, London, UK
| | - Marta Di Forti
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Anthony S. David
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
| | - Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, King’s College London, London, UK
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Moritz S, Ramdani N, Klass H, Andreou C, Jungclaussen D, Eifler S, Englisch S, Schirmbeck F, Zink M. Overconfidence in incorrect perceptual judgments in patients with schizophrenia. SCHIZOPHRENIA RESEARCH-COGNITION 2014; 1:165-170. [PMID: 29379749 PMCID: PMC5779164 DOI: 10.1016/j.scog.2014.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 09/05/2014] [Indexed: 12/25/2022]
Abstract
Background Patients with schizophrenia show overconfidence in memory and social cognition errors. The present investigation examined whether this cognitive distortion also manifests in perceptual tasks. Methods A total of 55 individuals with schizophrenia, 58 with obsessive–compulsive disorder (OCD) as well as 45 non-clinical controls were presented 24 blurry black and white pictures, half of which contained a hidden object; the other half contained (“snowy”) visual noise. Participants had to judge whether the pictures depicted an object or not and how confident they were in this judgment. Results Participants with schizophrenia showed overconfidence in errors and an enhanced knowledge corruption index (i.e. rate of high-confident errors on all high-confident responses) relative to both control groups. In contrast, accuracy scores did not differ between clinical groups. Metacognitive parameters were correlated with self-rated levels of current paranoia. Discussion To the best of our knowledge, this is the first study to demonstrate overconfidence in errors among individuals with psychosis using a visual perception task. Speaking to the specificity of this abnormality for schizophrenia and its pathogenetic relevance, overconfidence in errors and knowledge corruption were elevated in patients with schizophrenia relative to both control groups and were correlated with paranoia.
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Affiliation(s)
- Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany
| | - Nora Ramdani
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany
| | - Helena Klass
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany
| | - Christina Andreou
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany
| | - David Jungclaussen
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Martinistr. 52, D-20246 Hamburg, Germany
| | - Sarah Eifler
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, D-68072 Mannheim, Germany
| | - Susanne Englisch
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, D-68072 Mannheim, Germany
| | - Frederike Schirmbeck
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, D-68072 Mannheim, Germany
| | - Mathias Zink
- Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Heidelberg University, PO Box 12 21 20, D-68072 Mannheim, Germany
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Jolley S, Ferner H, Bebbington P, Garety P, Dunn G, Freeman D, Fowler D, Kuipers E. Delusional belief flexibility and informal caregiving relationships in psychosis: a potential cognitive route for the protective effect of social support. Epidemiol Psychiatr Sci 2014; 23:389-97. [PMID: 24160466 PMCID: PMC7192175 DOI: 10.1017/s2045796013000553] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 08/25/2013] [Accepted: 08/29/2013] [Indexed: 11/07/2022] Open
Abstract
Aims. For people with psychosis, contact with informal caregivers is an important source of social support, associated with recovery, and with better outcomes following individual cognitive therapy (CBTp). In this study, we tested whether increased flexibility in delusional thinking, an established predictor of positive outcome following CBTp, was a possible mechanism underlying this effect. Methods. 219 participants with delusions (mean age 38 years; 71% male; 75% White) were grouped according to the presence of a caregiver (37% with a caregiver) and caregiver level of expressed emotion (High/Low EE, 64% Low). Delusional belief flexibility was compared between groups, controlling for interpersonal functioning, severity of psychotic symptoms, and other hypothesised outcome predictors. Results. Participants with caregivers were nearly three times more likely than those without to show flexibility (OR = 2.7, 95% CI 1.5 to 5.0, p = 0.001), and five times more likely if the caregiving relationship was Low EE (OR = 5.0, 95% CI 2.0-13.0, p = 0.001). ORs remained consistent irrespective of controlling for interpersonal functioning and other predictors of outcome. Conclusions. This is the first evidence that having supportive caregiving relationships is associated with a specific cognitive attribute in people with psychosis, suggesting a potential cognitive mechanism by which outcomes following CBTp, and perhaps more generally, are improved by social support.
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Affiliation(s)
- S. Jolley
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
| | - H. Ferner
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
| | - P. Bebbington
- Department of Mental Health Sciences, UCL, London, UK
| | - P. Garety
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
| | - G. Dunn
- Health Sciences Research Group, School of Community Based Medicine, University of Manchester, UK
| | - D. Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - D. Fowler
- School of Medicine, Health Policy and Practice, University of East Anglia, UK
| | - E. Kuipers
- King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
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45
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Marcus E, Garety P, Weinman J, Emsley R, Dunn G, Bebbington P, Freeman D, Kuipers E, Fowler D, Hardy A, Waller H, Jolley S. A pilot validation of a modified Illness Perceptions Questionnaire designed to predict response to cognitive therapy for psychosis. J Behav Ther Exp Psychiatry 2014; 45:459-66. [PMID: 25011076 PMCID: PMC4157321 DOI: 10.1016/j.jbtep.2014.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/18/2014] [Accepted: 06/06/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions Questionnaire (M-IPQ) designed to predict response following CBTp. METHODS Fifty-six participants with persistent, distressing delusions completed the M-IPQ; forty before a brief CBT intervention targeting persecutory ideation and sixteen before and after a control condition. Additional predictors of outcome (delusional conviction, symptom severity and belief inflexibility) were assessed at baseline. Outcomes were assessed at baseline and at follow-up four to eight weeks later. RESULTS The M-IPQ comprised two factors measuring problem duration and therapy-specific perceptions of Cure/Control. Associated subscales, formed by summing the relevant items for each factor, were reliable in their structure. The Cure/Control subscale was also reliable over time; showed convergent validity with other predictors of outcome; predicted therapy outcomes; and differentially predicted treatment effects. LIMITATIONS We measured outcome without an associated measure of engagement, in a small sample. Findings are consistent with hypothesis and existing research, but require replication in a larger, purposively recruited sample. CONCLUSIONS The Cure/Control subscale of the M-IPQ shows promise as a predictor of response to therapy. Specifically targeting these illness perceptions in the early stages of cognitive behavioural therapy may improve engagement and, consequently, outcomes.
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Affiliation(s)
- Elena Marcus
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Philippa Garety
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - John Weinman
- King's College London, Institute of Pharmaceutical Science, 5th Floor Franklin Wilkins Building, 150 Stamford Street, London SE1 9NH, UK.
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 4.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester, Manchester Academic Health Science Centre, 4.304 Jean McFarlane Building, Oxford Road, Manchester M13 9PL, UK.
| | - Paul Bebbington
- Division of Psychiatry, University College, London, 67-73 Riding House Street, London W1W 7EJ, UK.
| | - Daniel Freeman
- University of Oxford, Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, UK.
| | - Elizabeth Kuipers
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Pevensey Building, Falmer BN1 9QH, UK.
| | - Amy Hardy
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Helen Waller
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - Suzanne Jolley
- King's College London, Institute of Psychiatry, Department of Psychology, PO77, De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
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Freeman D, Lister R, Evans N. The use of intuitive and analytic reasoning styles by patients with persecutory delusions. J Behav Ther Exp Psychiatry 2014; 45:454-8. [PMID: 25000504 DOI: 10.1016/j.jbtep.2014.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Revised: 06/07/2014] [Accepted: 06/10/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVES A previous study has shown an association of paranoid thinking with a reliance on rapid intuitive ('experiential') reasoning and less use of slower effortful analytic ('rational') reasoning. The objectives of the new study were to replicate the test of paranoia and reasoning styles in a large general population sample and to assess the use of these reasoning styles in patients with persecutory delusions. METHOD 30 Patients with persecutory delusions in the context of a non-affective psychotic disorder and 1000 non-clinical individuals completed self-report assessments of paranoia and reasoning styles. RESULTS The patients with delusions reported lower levels of both experiential and analytic reasoning than the non-clinical individuals (effect sizes small to moderate). Both self-rated ability and engagement with the reasoning styles were lower in the clinical group. Within the non-clinical group, greater levels of paranoia were associated with lower levels of analytic reasoning, but there was no association with experiential reasoning. LIMITATIONS The study is cross-sectional and cannot determine whether the reasoning styles contribute to the occurrence of paranoia. It also cannot be determined whether the patient group's lower reasoning scores are specifically associated with the delusions. CONCLUSIONS Clinical paranoia is associated with less reported use of analytic and experiential reasoning. This may reflect patients with current delusions being unconfident in their reasoning abilities or less aware of decision-making processes and hence less able to re-evaluate fearful cognitions. The dual process theory of reasoning may provide a helpful framework in which to discuss with patients decision-making styles.
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Affiliation(s)
| | | | - Nicole Evans
- Department of Psychiatry, University of Oxford, UK
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47
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Bell V, Freeman D. A pilot trial of cognitive behavioural therapy for interpersonal sensitivity in individuals with persecutory delusions. J Behav Ther Exp Psychiatry 2014; 45:441-6. [PMID: 24974215 DOI: 10.1016/j.jbtep.2014.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/04/2014] [Accepted: 06/04/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Advances in understanding delusions may be used to improve clinical interventions. Interpersonal sensitivity - feeling vulnerable in the presence of others due to the expectation of criticism or rejection - has been identified as a potential causal factor in the occurrence of persecutory delusions. The purpose of this study was to examine the potential impact on persecutory delusions of a (newly devised) cognitive behavioural intervention targeting interpersonal sensitivity (CBT-IPS). METHODS CBT-IPS was tested in an uncontrolled pilot study with eleven patients with persistent persecutory delusions in the context of a psychotic disorder. Patients had two baseline assessments over a fortnight period to establish the stability of the delusions, which was followed by six sessions of CBT-IPS, a post-therapy assessment, and a further follow-up assessment one month later. RESULTS Interpersonal sensitivity and the persecutory delusions were stable during the baseline period. At the post-therapy assessment there were significant reductions of large effect size for both interpersonal sensitivity and the persecutory delusions. These gains were maintained at follow-up. LIMITATIONS The main limitation is that in this initial test there was no control group. The intervention may not have caused the reduction in delusions. Further, bias may have been introduced by the outcome data being collected by the therapist. CONCLUSIONS The findings from this evaluation are consistent with the hypothesised causal role for interpersonal sensitivity in the occurrence of persecutory delusions. CBT-IPS shows promise as a therapeutic intervention but requires a rigorous test of its efficacy.
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Affiliation(s)
- Victoria Bell
- Oxford Doctoral Course in Clinical Psychology, University of Oxford, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK.
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48
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Jolley S, Thompson C, Hurley J, Medin E, Butler L, Bebbington P, Dunn G, Freeman D, Fowler D, Kuipers E, Garety P. Jumping to the wrong conclusions? An investigation of the mechanisms of reasoning errors in delusions. Psychiatry Res 2014; 219:275-82. [PMID: 24958065 PMCID: PMC4118018 DOI: 10.1016/j.psychres.2014.05.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 02/15/2014] [Accepted: 05/27/2014] [Indexed: 10/27/2022]
Abstract
Understanding how people with delusions arrive at false conclusions is central to the refinement of cognitive behavioural interventions. Making hasty decisions based on limited data ('jumping to conclusions', JTC) is one potential causal mechanism, but reasoning errors may also result from other processes. In this study, we investigated the correlates of reasoning errors under differing task conditions in 204 participants with schizophrenia spectrum psychosis who completed three probabilistic reasoning tasks. Psychotic symptoms, affect, and IQ were also evaluated. We found that hasty decision makers were more likely to draw false conclusions, but only 37% of their reasoning errors were consistent with the limited data they had gathered. The remainder directly contradicted all the presented evidence. Reasoning errors showed task-dependent associations with IQ, affect, and psychotic symptoms. We conclude that limited data-gathering contributes to false conclusions but is not the only mechanism involved. Delusions may also be maintained by a tendency to disregard evidence. Low IQ and emotional biases may contribute to reasoning errors in more complex situations. Cognitive strategies to reduce reasoning errors should therefore extend beyond encouragement to gather more data, and incorporate interventions focused directly on these difficulties.
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Affiliation(s)
- Suzanne Jolley
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK.
| | - Claire Thompson
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - James Hurley
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
| | - Evelina Medin
- School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK
| | - Lucy Butler
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | | | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, The University of Manchester and Manchester Academic Health Science Centre, Manchester, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - David Fowler
- School of Psychology, University of Sussex, Sussex, UK
| | - Elizabeth Kuipers
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
| | - Philippa Garety
- King׳s College London, Institute of Psychiatry, Department of Psychology, London, UK
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49
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Freeman D, Startup H, Dunn G, Černis E, Wingham G, Pugh K, Cordwell J, Mander H, Kingdon D. Understanding jumping to conclusions in patients with persecutory delusions: working memory and intolerance of uncertainty. Psychol Med 2014; 44:3017-3024. [PMID: 25066636 DOI: 10.1017/s0033291714000592] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Persecutory delusions are a key psychotic experience. A reasoning style known as 'jumping to conclusions' (JTC) - limited information gathering before reaching certainty in decision making - has been identified as a contributory factor in the occurrence of delusions. The cognitive processes that underpin JTC need to be determined in order to develop effective interventions for delusions. In the current study two alternative perspectives were tested: that JTC partially results from impairment in information-processing capabilities and that JTC is a motivated strategy to avoid uncertainty. METHOD A group of 123 patients with persistent persecutory delusions completed assessments of JTC (the 60:40 beads task), IQ, working memory, intolerance of uncertainty, and psychiatric symptoms. Patients showing JTC were compared with patients not showing JTC. RESULTS A total of 30 (24%) patients with delusions showed JTC. There were no differences between patients who did and did not jump to conclusions in overall psychopathology. Patients who jumped to conclusions had poorer working memory performance, lower IQ, lower intolerance of uncertainty and lower levels of worry. Working memory and worry independently predicted the presence of JTC. CONCLUSIONS Hasty decision making in patients with delusions may partly arise from difficulties in keeping information in mind. Interventions for JTC are likely to benefit from addressing working memory performance, while in vivo techniques for patients with delusions will benefit from limiting the demands on working memory. The study provides little evidence for a contribution to JTC from top-down motivational beliefs about uncertainty.
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Affiliation(s)
- D Freeman
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - H Startup
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - G Dunn
- Centre for Biostatistics, Institute of Population Health,University of Manchester,Manchester,UK
| | - E Černis
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - G Wingham
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
| | - K Pugh
- Department of Psychiatry,University of Oxford,Oxford,UK
| | - J Cordwell
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
| | - H Mander
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
| | - D Kingdon
- Academic Department of Psychiatry, Faculty of Medicine,University of Southampton,Southampton,UK
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50
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Andreou C, Treszl A, Roesch-Ely D, Köther U, Veckenstedt R, Moritz S. Investigation of the role of the jumping-to-conclusions bias for short-term functional outcome in schizophrenia. Psychiatry Res 2014; 218:341-7. [PMID: 24836199 DOI: 10.1016/j.psychres.2014.04.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/07/2014] [Accepted: 04/27/2014] [Indexed: 11/30/2022]
Abstract
Symptom severity and neuropsychological deficits negatively influence functional outcomes in patients with schizophrenia. Recent research implicates specific types of biased thinking styles (e.g. jumping-to-conclusions) in the pathogenesis of schizophrenia. This is the first study to test the impact of jumping-to-conclusions on functional outcome in schizophrenia. The aim of the study was to investigate the association of psychopathology, neuropsychology and JTC with subjective quality of life, vocational outcome and housing status in schizophrenia. Analyses were carried out both cross-sectionally at baseline, and longitudinally over the course of symptomatic improvement in the immediate aftermath of a psychotic exacerbation. Seventy-nine patients with schizophrenia were included in the study. Data concerning the variables of interest were collected at baseline, after one month, and after six months. Positive symptomatology was the most significant predictor of subjective and vocational outcome and changes across time. Verbal memory deficits were associated with functional status cross-sectionally, whereas general cognitive capacity significantly predicted functional changes over time. Improvement of the jumping-to-conclusions bias positively affected vocational outcome. Though limited, the observed effect of this bias on real-world functioning highlights the possible usefulness of interventions aimed at improving (meta)cognitive deficits in schizophrenia.
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Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - András Treszl
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Daniela Roesch-Ely
- Department of General Psychiatry, Center for Psychosocial Medicine, Department of Experimental Psychopathology and Neurophysiology, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany
| | - Ulf Köther
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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