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Gussmann E, Lindner C, Lucae S, Falkai P, Padberg F, Egli S, Kopf-Beck J. Targeting metacognitive change mechanisms in acute inpatients with psychotic symptoms: feasibility and acceptability of a modularized group intervention. Eur Arch Psychiatry Clin Neurosci 2024; 274:963-979. [PMID: 37741946 PMCID: PMC11127867 DOI: 10.1007/s00406-023-01690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/26/2023] [Indexed: 09/25/2023]
Abstract
Emerging evidence suggests the usefulness of psychological interventions targeting metacognitive change mechanisms in patients experiencing psychosis. Although many of these patients are treated in acute psychiatric contexts, only few studies have adapted such interventions for acute inpatient settings. The present study aimed to assess the feasibility, acceptability, and preliminary clinical outcomes of a novel modularized group intervention focusing on different aspects of metacognitive change mechanisms. In particular, the intervention aims to reduce patients' acute symptoms by enhancing cognitive insight and to relieve distress via cognitive defusion (i.e. coping). A sample of 37 participants with acute psychosis received up to nine sessions of the intervention. Baseline and post-intervention assessments were conducted for general psychopathology, psychotic symptoms, global functioning, and symptom distress. Measures of change mechanisms were assessed before and after the respective treatment module. Participants' experiences were explored in feedback questionnaires and interviews. Recruitment, retention, and attendance rate met the pre-set feasibility benchmark of 80%. The intervention was well received by participants, who emphasised the group's clear structure, positive atmosphere, and helpful contents. Response rates were high and linear mixed models revealed significant medium-to-large time effects on all clinical outcomes. As expected, increase in hypothesised change mechanisms cognitive insight and decrease in cognitive fusion was found. However, the uncontrolled design limits interpreting clinical effects. The study provides evidence that an intervention based on a metacognitive model is feasible and acceptable for acute inpatients with psychosis. Positive results on clinical outcomes and change mechanisms warrant further exploration in a randomized controlled trial.
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Affiliation(s)
- Eva Gussmann
- Max Planck Institute of Psychiatry, Munich, Germany.
| | | | - Susanne Lucae
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychology, LMU Munich, Munich, Germany
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2
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Gawęda Ł, Kowalski J, Aleksandrowicz A, Bagrowska P, Dąbkowska M, Pionke-Ubych R. A systematic review of performance-based assessment studies on cognitive biases in schizophrenia spectrum psychoses and clinical high-risk states: A summary of 40 years of research. Clin Psychol Rev 2024; 108:102391. [PMID: 38301343 DOI: 10.1016/j.cpr.2024.102391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/05/2024] [Accepted: 01/12/2024] [Indexed: 02/03/2024]
Abstract
Cognitive models of psychosis have stimulated empirical studies on cognitive biases involved in schizophrenia spectrum psychoses and their symptoms. This systematic review aimed to summarize the studies on the role of cognitive biases as assessed in different performance-based tasks in schizophrenia spectrum psychoses and clinical high-risk states. We focused on five cognitive biases linked to psychosis, i.e., aberrant salience, attentional biases, source monitoring biases, jumping to conclusions, and bias against disconfirmatory evidence. We identified N = 324 studies published in N = 308 articles fulfilling inclusion criteria. Most studies have been cross-sectional and confirmed that the schizophrenia spectrum psychoses are related to exaggerated cognitive biases compared to healthy controls. On the contrary, less evidence suggests a higher tendency for cognitive biases in the UHR sample. The only exceptions were source monitoring and jumping to conclusions, which were confirmed to be exaggerated in both clinical groups. Hallucinations and delusions were the most frequent symptoms studied in the context of cognitive biases. Based on the findings, we presented a hypothetical model on the role of interactions between cognitive biases or additive effects of biases in shaping the risk of psychosis. Future research is warranted for further development of cognitive models for psychosis.
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Affiliation(s)
- Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
| | - Joachim Kowalski
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Adrianna Aleksandrowicz
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Paulina Bagrowska
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Małgorzata Dąbkowska
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Renata Pionke-Ubych
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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3
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Hutton P, Kelly J, Taylor CDJ, Williams B, Emsley R, Alexander CH, Vikram A, Saddington D, McCann A, Burke J, Eliasson E, Harper S, Karatzias T, Taylor PJ, Watson A, Dougall N, Stavert J, O'Rourke S, Glasgow A, Murphy R, Palmer K, Zaidi N, Bidwell P, Pritchard J, Carr L, Woodrow A. Accelerating the development of a psychological intervention to restore treatment decision-making capacity in patients with schizophrenia-spectrum disorder: a study protocol for a multi-site, assessor-blinded, pilot Umbrella trial (the DEC:IDES trial). Pilot Feasibility Stud 2023; 9:117. [PMID: 37422659 PMCID: PMC10329297 DOI: 10.1186/s40814-023-01323-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 05/26/2023] [Indexed: 07/10/2023] Open
Abstract
BACKGROUND A high proportion of patients diagnosed with schizophrenia-spectrum disorders will at some point in their lives be assessed as not having the capacity to make their own decisions about pharmacological treatment or inpatient care ('capacity'). Few will be helped to regain it before these interventions proceed. This is partly because effective and safe methods to do so are lacking. Our aim is to accelerate their development by testing, for the first time in mental healthcare, the feasibility, acceptability and safety of running an 'Umbrella' trial. This involves running, concurrently and under one multi-site infrastructure, multiple assessor-blind randomised controlled trials, each of which is designed to examine the effect on capacity of improving a single psychological mechanism ('mechanism'). Our primary objectives are to demonstrate feasibility of (i) recruitment and (ii) data retention on the MacArthur Competence Assessment Tool-Treatment (MacCAT-T; planned primary outcome for a future trial) at end-of-treatment. We selected three mechanisms to test: 'self-stigma', low self-esteem and the 'jumping to conclusions' bias. Each is highly prevalent in psychosis, responsive to psychological intervention, and hypothesised to contribute to impaired capacity. METHODS Sixty participants with schizophrenia-spectrum diagnoses, impaired capacity and one or more mechanism(s) will be recruited from outpatient and inpatient mental health services in three UK sites (Lothian, Scotland; Lancashire and Pennine; North West England). Those lacking capacity to consent to research could take part if the key criteria were met, including either proxy consent (Scotland) or favourable Consultee advice (England). They will be allocated to one of three randomised controlled trials, depending on which mechanism(s) they have. They will then be randomised to receive, over an 8-week period and in addition to treatment as usual (TAU), 6 sessions of either a psychological intervention which targets the mechanism, or 6 sessions of assessment of the causes of their incapacity (control condition). Participants are assessed at 0 (baseline), 8 (end-of-treatment) and 24 (follow-up) weeks post-randomisation using measures of capacity (MacCAT-T), mechanism, adverse events, psychotic symptoms, subjective recovery, quality of life, service use, anxiety, core schemata and depression. Two nested qualitative studies will be conducted; one to understand participant and clinician experiences and one to investigate the validity of MacCAT-T appreciation ratings. DISCUSSION This will be the first Umbrella trial in mental healthcare. It will produce the first 3 single-blind randomised controlled trials of psychological interventions to support treatment decision-making in schizophrenia-spectrum disorder. Demonstrating feasibility will have significant implications not only for those seeking to support capacity in psychosis, but also for those who wish to accelerate the development of psychological interventions for other conditions. TRIAL REGISTRATION ClinicalTrials.gov NCT04309435 . Pre-registered on 16 March 2020.
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Affiliation(s)
- Paul Hutton
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK.
| | - James Kelly
- Faculty of Health & Medicine, Lancaster University, Lancaster, UK
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Christopher D J Taylor
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Brian Williams
- School of Health, Social Care & Life Sciences, University of the Highlands and Islands, Inverness, UK
| | - Richard Emsley
- Institute of Psychiatry, Psychology & Neuroscience, Kings College London, London, UK
| | | | - Anvita Vikram
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | | | - Andrea McCann
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Joseph Burke
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Emma Eliasson
- NHS Lothian, Edinburgh, UK
- NHS Research Scotland Mental Health Network, Edinburgh, UK
- National Centre for Suicide Research and Prevention, Karolinska Institutet, Stockholm, Sweden
| | - Sean Harper
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
- NHS Lothian, Edinburgh, UK
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
| | - Peter J Taylor
- Division of Psychology & Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | | | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Jill Stavert
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Suzanne O'Rourke
- School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | | | | | - Karen Palmer
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Nosheen Zaidi
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | - Polly Bidwell
- Lancashire & South Cumbria NHS Foundation Trust, Preston, UK
| | | | - Lucy Carr
- Pennine Care NHS Foundation Trust, Ashton-Under-Lyne, UK
| | - Amanda Woodrow
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
- Edinburgh Research & Innovation Centre for Complex and Acute Mental Health Problems, Edinburgh, UK
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Taylor KM, Orucu E, Nandha S, Cella M. Psychosis Early Intervention Across the Life Span: A Service Perspective. Community Ment Health J 2023; 59:266-274. [PMID: 35922655 PMCID: PMC9859847 DOI: 10.1007/s10597-022-01004-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 06/26/2022] [Indexed: 01/25/2023]
Abstract
Previously youth-orientated, UK early intervention in psychosis (EI) services expanded care in 2016 to adults of any age. To compare EI care offering, clinical characteristics, and potential benefits for under-35s and over-35s, an observational study considering anonymised data for users of London-based EI services between April 2016 and December 2019 was conducted. Descriptive statistics and between groups comparisons are reported. The analysis considered 692 service users (32.5% over-35). Over-35s were more likely to be female, of poorer physical health, with severer problems at intake (Health of the Nation Outcome Scale, HoNOS). Under-35s had poorer appointment attendance, required increased use of inpatient facilities, and demonstrated greater risks to themselves and others. At discharge, HoNOS ratings indicated improvements for both groups. Over-35s constitute a considerable proportion of EI service-users, their care may involve less crisis management, more recovery-oriented intervention and physical health needs consideration. Care offering should reflect these needs.
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Affiliation(s)
- Kathryn M Taylor
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ela Orucu
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Sunil Nandha
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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5
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Pilot study of a group worry intervention for recent onset psychosis. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Worry is common among individuals with psychosis and has been found to be a causal factor in the development of paranoia. Previous research has shown that a cognitive behavioural therapy protocol targeting worry helps to reduce persecutory delusions and associated distress in a population experiencing longstanding psychotic symptoms. However, there has yet to be a published adaptation of the protocol for individuals experiencing a recent onset of psychosis. The current study aims to examine the feasibility of adapting the worry intervention for recent onset psychosis in a group setting. Six young adults with a recent onset of psychosis, aged 18–32 years, participated in a pilot study of an 8-week group intervention covering cognitive behavioural strategies for managing worry, including worry periods, worry postponement techniques, mindfulness and relaxation, and problem solving. Pre- and post-intervention data were collected on worry, anxiety, depressive symptoms, psychotic symptoms, and perceived recovery from psychosis. In addition, qualitative feedback from group members was gathered during a post-intervention focus group. Feasibility of the group appeared promising, despite high participant attrition. All components of the intervention were successfully implemented, and group members provided positive feedback regarding acceptability of the group. Contrary to prediction, there was not a consistent decrease in worry from pre- to post-intervention. Findings from secondary symptom measures were mixed and may have been related to participants’ subjective experience of the group. Specifically, participants who experienced high levels of group cohesion seemed to benefit more from the intervention.
Key learning aims
(1)
To gain awareness of the gaps in treatment for early psychosis.
(2)
To understand the role of worry in psychosis.
(3)
To learn about the feasibility of implementing a group worry intervention for recent onset psychosis.
(4)
To consider the impact of group cohesion and symptom severity on treatment engagement.
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6
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Scott M, Rossell SL, Toh WL, Thomas N. Understanding the role of self in auditory verbal hallucinations using a self-discrepancy paradigm. Psychol Psychother 2021; 94 Suppl 2:268-285. [PMID: 32285626 PMCID: PMC8246718 DOI: 10.1111/papt.12276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 03/18/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Negative auditory verbal hallucination (AVH) content is a major predictor of distress and typically occurs more frequently than positive or neutral content. Recent research has found that negative views of self are associated with the negative content of AVHs. However, research investigating the role of self in AVH content is in its infancy and warrants further study. DESIGN The current study examined correspondence between negative voice content and internalized representations of self, using a self-discrepancy paradigm incorporating multiple domains of self (ideal, ought, and feared). It also considered the impact of depression and anxiety. METHOD An adapted self-discrepancy questionnaire was administered to a transdiagnostic clinical sample of 86 current voice-hearers. Participants rated how similar they believed themselves to be (actual self), and how similar their voices would say they are (voice self), to their ideal, ought, and feared self-concepts. RESULTS Voice content was related to how the person viewed themselves in relation to their ideal, ought, and feared self-concepts. Additionally, voices reflected negative feared self-concepts, particularly in people with anxiety. CONCLUSIONS These findings provide further insight into the phenomenon of hearing voices and have the potential to change the way we approach formulation and treatment of AVHs. In particular, treatment approaches that reduce discrepancies between how one views themselves and their positive and negative self-concepts, or alter the relationship one has with their self-concepts and negative voices, have the potential to reduce the impact of distressing voices. PRACTITIONER POINTS Voice experiences can be meaningfully related to how the person views themselves in relation to concepts of their ideal, ought, and feared selves Negative voice content might be understood as reflecting discrepancies from these self-representations, which may have a self-regulatory function in relation to goal-directed behaviour. Identifying how voice content relates to self could be useful in not only challenging the extent of perceived self-discrepancies, but also considering how to enact valued parts of self.
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Affiliation(s)
- Monique Scott
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Susan L. Rossell
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,PsychiatrySt Vincent's HospitalMelbourneVictoriaAustralia
| | - Wei Lin Toh
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Neil Thomas
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia,The Alfred HospitalMelbourneVictoriaAustralia
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7
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Feyaerts J, Henriksen MG, Vanheule S, Myin-Germeys I, Sass LA. Delusions beyond beliefs: a critical overview of diagnostic, aetiological, and therapeutic schizophrenia research from a clinical-phenomenological perspective. Lancet Psychiatry 2021; 8:237-249. [PMID: 33485408 DOI: 10.1016/s2215-0366(20)30460-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022]
Abstract
Delusions are commonly conceived as false beliefs that are held with certainty and which cannot be corrected. This conception of delusion has been influential throughout the history of psychiatry and continues to inform how delusions are approached in clinical practice and in contemporary schizophrenia research. It is reflected in the full psychosis continuum model, guides psychological and neurocognitive accounts of the formation and maintenance of delusions, and it substantially determines how delusions are approached in cognitive-behavioural treatment. In this Review, we draw on a clinical-phenomenological framework to offer an alternative account of delusion that incorporates the experiential dimension of delusion, emphasising how specific alterations to self-consciousness and reality experience underlie delusions that are considered characteristic of schizophrenia. Against that backdrop, we critically reconsider the current research areas, highlighting empirical and conceptual issues in contemporary delusion research, which appear to largely derive from an insufficient consideration of the experiential dimension of delusions. Finally, we suggest how the alternative phenomenological approach towards delusion could offer new ways to advance current research and clinical practice.
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Affiliation(s)
- Jasper Feyaerts
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium; Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium.
| | - Mads G Henriksen
- Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark; Mental Health Center Amager, Copenhagen, Denmark; Mental Health Center Glostrup, Brøndbyvester, Denmark
| | - Stijn Vanheule
- Department of Psychoanalysis and Clinical Consulting, Ghent University, Ghent, Belgium
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Leuven, Belgium
| | - Louis A Sass
- Department of Clinical Psychology, Graduate School of Applied and Professional Psychology, Rutgers University, New Brunswick, NJ, USA
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8
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Scott M, Rossell SL, Toh WL, Thomas N. The relationship between anxiety, depression, and subtypes of negative auditory verbal hallucination (AVH) content in affective and non-affective psychosis. Psychiatry Res 2020; 294:113500. [PMID: 33070107 DOI: 10.1016/j.psychres.2020.113500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 10/03/2020] [Indexed: 01/10/2023]
Abstract
The content of AVHs is a major predictor of distress. Although the relationship between mood and AVH content is considered of diagnostic relevance, research investigating the role of depression and anxiety in AVH content remains limited. This study investigated subtypes of negative AVH content, comprising critical, threatening, and self-harm commands in affective and non-affective psychosis. In addition, the study investigated relationships between negative, critical, threatening and self-harm related AVH content and depression and anxiety. Results showed that AVH content did not vary between affective and non-affective psychosis. Among affective voice-hearers, critical, threatening and self-harm content was predicted by anxiety. Whereas in non-affective voice-hearers, self-harm content was predicted by depression. Findings suggest that in affective psychosis, "mood" may be more relevant to whether people hear voices per se, given that by definition voices only arise in mood episodes, whereas anxiety appears to be important in influencing content. In contrast, anxiety and depression may have little influence over voice content in non-affective psychosis, with the exception of depression in self-harm commands. As such, anxiety should be considered in the formulation and treatment of negative AVHs in affective psychosis, and depression in non-affective voice-hearers with self-harm commands.
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Affiliation(s)
- Monique Scott
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Psychiatry, St Vincent's Hospital, Melbourne Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia.
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9
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Ward T, Garety PA, Jackson M, Peters E. Clinical and theoretical relevance of responses to analogues of psychotic experiences in people with psychotic experiences with and without a need-for-care: an experimental study. Psychol Med 2020; 50:761-770. [PMID: 30944059 DOI: 10.1017/s0033291719000576] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Certain ways of responding to psychotic experiences (PEs) appear more commonly associated with clinical distress (e.g. avoidance) and other ways with benign or positive outcomes (e.g. reappraisal and acceptance). Past research has largely been limited to retrospective self-report. We aimed to compare clinical and non-clinical individuals on experimental analogues of anomalous experiences. METHOD Response styles of two groups with persistent PEs (clinical n = 84; non-clinical n = 92) and a control group without PEs (n = 83) were compared following experimental analogues of thought interference (Cards Task, Telepath) and hearing voices (Virtual Acoustic Space Paradigm). RESULTS The non-clinical group with PEs were less likely to endorse unhelpful response styles, such as passive responding or attempts to avoid, suppress, worry about or control mental experiences, compared with the clinical group on all three tasks. The clinical group were more likely to endorse unhelpful response styles compared with controls on two out of three tasks (Cards Task and Telepath). The non-clinical group performed similarly to controls on unhelpful responding across all tasks. There were no group differences for helpful response styles, such as cognitive reappraisal or mindful acceptance of experiences. CONCLUSIONS In line with cognitive models of psychosis, the findings suggest that the way in which individuals respond to unusual experiences may be an important factor in understanding clinical distress, supporting the therapeutic rationale of targeting potentially unhelpful patterns of response.
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Affiliation(s)
- Thomas Ward
- 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
| | - 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
| | - Mike Jackson
- Bangor University, School of Psychology, North Wales, UK
- Betsi Cadwaladr University Health Board, North Wales, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychological Interventions Clinic for Outpatients with Psychosis (PICuP), South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, LondonSE5 8AZ, UK
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10
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Yiend J, Allen P, Lopez ND, Falkenberg I, Tseng HH, McGuire P. Negative Interpretation Biases Precede the Onset of Psychosis. Behav Ther 2019; 50:718-731. [PMID: 31208682 DOI: 10.1016/j.beth.2018.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/12/2018] [Accepted: 11/17/2018] [Indexed: 11/28/2022]
Abstract
This study investigated whether a negative interpretation bias was present in people at high risk for psychosis. People with an At Risk Mental State (ARMS; n = 21), patients with First Episode Psychosis (FEP; n = 20), and healthy controls (n = 20) performed three tasks, each of which was designed to measure interpretation bias. Both ARMS and FEP participants showed an attenuated positive bias compared to controls. These findings extend previous results investigating interpretation bias in psychosis by showing that interpretative biases are present before the onset of psychosis, and could therefore contribute to its development. Biased interpretation mechanisms could be a new target for clinical intervention in the early phase of psychosis.
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Affiliation(s)
| | | | | | - Irina Falkenberg
- King's College London; Department of Psychiatry & Psychotherapy, Philipps-University Marburg, Germany
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11
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Lincoln TM, Peters E. A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations. Schizophr Res 2019; 203:66-79. [PMID: 29352708 DOI: 10.1016/j.schres.2017.12.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 12/29/2022]
Abstract
Studies on cognitive behavioural therapy for psychosis (CBTp) have developed from evaluating generic approaches to focusing on specific symptoms. The evidence for targeted studies on delusions and hallucinations was reviewed. We included randomized controlled trials (RCTs) examining the effect of individualized CBT-based interventions focusing either on delusions or on hallucinations. Twelve suitable RCTs were identified. Four RCTs focused on delusions, of which three took a focused approach targeting mechanisms assumed causal to persecutory delusions. Eight RCTs focused on hallucinations, a common component of these studies being a focus on the perceived power imbalance between the voice(s) and the voice-hearer, to reduce distress and dysfunction. Only three RCTS were powered adequately; the remainder were pilot trials. All trials reported effect sizes against treatment-as-usual above d=0.4 on at least one primary outcome at post-therapy, with several effects in the large range. Effects on the primary outcome were maintained for five of the seven studies that had significant outcomes and reported a follow-up comparison, but most of the follow-up periods were brief. Although targeted studies are still in their infancy, the results are promising with a tendency towards higher effects compared to the small-to-moderate range found for generic CBTp. In clinical practice, CBTp will need to continue including a range of approaches that can be adapted to patients in a flexible manner according to the primary goals and prevalent combination of symptoms. However, symptom-focused and causal-interventionist approaches are informative research strategies to evaluate the efficacy of separate components or mechanisms of generic CBTp.
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Affiliation(s)
- Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany.
| | - Emmanuelle Peters
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, Psychological Interventions Clinic for outpatients with Psychosis (PICuP), London, UK
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12
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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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The Acceptability, Feasibility and Potential Outcomes of an Individual Mindfulness-Based Intervention for Hearing Voices. Behav Cogn Psychother 2018; 47:200-216. [PMID: 29983128 DOI: 10.1017/s1352465818000425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A prominent area of advancement in the psychological treatment for people with persisting psychosis has been the application of mindfulness-based therapies. Recent literature has recommended the investigation of focused mindfulness interventions for voices (auditory hallucinations) as a specific experience. To date, only mindfulness programs in group format have been examined. AIMS This non-randomized pilot study aimed to assess the acceptability, feasibility and potential outcomes of an individual mindfulness program for persistent voices on the negative impact of voices on the subjective experience of mental health and wellbeing, depression and voice-related distress and disruption. Also, it aimed to identify potential psychological and neurocognitive mechanisms of change. METHOD A new 4-week individual Mindfulness Program for Voices (iMPV) was developed, and piloted with a group of 14 participants with a schizophrenia-spectrum disorder and persisting voices. Participants completed clinical and neurocognitive measures pre- and post-intervention and at 2-month follow-up. RESULTS Results revealed low attrition rates, high formal practice engagement levels and positive participant feedback. Pre-post outcomes suggested small to moderate effects for a reduction in the negative impact of voices on experience, depression and disruption. Large effects for changes in mindful responding and attentional switching were also identified. CONCLUSIONS Our findings suggest that this novel treatment protocol is appropriate, engaging and safe for persistent voice hearers. Findings for mindful responding and attentional switching suggest these to be potential mechanisms of change for further investigation. Further RCTs are warranted to ascertain the feasibility and efficacy for focused mindfulness interventions for voices of individual format.
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Opoka SM, Ludwig L, Lincoln TM. A Systematic Review of Trials Targeting Depression and Anxiety in Patients With Delusions. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Abstract. Negative affect and impaired emotion regulation skills are prevalent in patients with delusions and contribute to delusion formation and maintenance. This review evaluates existing research on interventions targeting negative affect and emotional processes as a causal mechanism on the pathway to delusions. A MEDLINE and PsycINFO search identified 7,909 articles. Five studies with randomized-controlled designs and three with uncontrolled designs met the inclusion criteria. Interventions comprised cognitive-behavioral and compassion-focused techniques. Overall, the review studies found positive intervention effects on negative affect and delusions. Where significant, controlled effect sizes ranged from small to large for negative affect and from moderate to large for delusions. Thus, existing research indicates that negative affect in patients with delusions can be modified by psychological therapy and points toward a carryover effect from the reduction of negative affect to a reduction of delusions. More large-scale randomized-controlled studies are needed to be able to draw valid conclusions on which types of interventions are most beneficial.
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Affiliation(s)
- Sandra M. Opoka
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Lea Ludwig
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
| | - Tania M. Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Germany
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Gollwitzer A, Wilczynska M, Jaya ES. Targeting the link between loneliness and paranoia via an interventionist-causal model framework. Psychiatry Res 2018. [PMID: 29524907 DOI: 10.1016/j.psychres.2018.02.050] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Targeting the antecedents of paranoia may be one potential method to reduce or prevent paranoia. For instance, targeting a potential antecedent of paranoia - loneliness - may reduce paranoia. Our first research question was whether loneliness heightens subclinical paranoia and whether negative affect may mediate this effect. Second, we wondered whether this potential effect could be targeted via two interventionist pathways in line with an interventionist-causal model approach: (1) decreasing loneliness, and (2) intervening on the potential mediator - negative affect. In Study 1 (N = 222), recollecting an experience of companionship reduced paranoia in participants high in pre-manipulation paranoia but not in participants low in pre-manipulation paranoia. Participants recollecting an experience of loneliness, on the other hand, exhibited increased paranoia, and this effect was mediated by negative affect. In Study 2 (N = 196), participants who utilized an emotion-regulation strategy, cognitive reappraisal, to regulate the negative affect associated with loneliness successfully attenuated the effect of loneliness on paranoia. Targeting the effect of loneliness on paranoia by identifying interventionist pathways may be one promising route for reducing and preventing subclinical paranoia.
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Affiliation(s)
- Anton Gollwitzer
- Department of Psychology, Yale University, 2 Hillhouse Ave, New Haven, CT 06511, USA.
| | - Magdalena Wilczynska
- Priority Research Centre for Physical Activity and Nutrition, The University of Newcastle, Advance Technology Centre, Level 3, Callaghan, New South Wales, Australia
| | - Edo S Jaya
- Faculty of Psychology, Universitas Indonesia, Depok 16424, Indonesia; Clinical Psychology and Psychotherapy, Universität Hamburg, Von-Melle-Park 5, D-20146 Hamburg, Germany
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Grezellschak S, Jansen A, Westermann S. Emotion regulation in patients with psychosis: A link between insomnia and paranoid ideation? J Behav Ther Exp Psychiatry 2017; 56:27-32. [PMID: 27527490 DOI: 10.1016/j.jbtep.2016.08.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 01/08/2023]
Affiliation(s)
- Sarah Grezellschak
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany.
| | - Andreas Jansen
- Department of Psychiatry and Psychotherapy, Philipps-University Marburg, Germany; Core-Unit Brainimaging, Phillips-University Marburg, Germany.
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland.
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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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Brand RM, Rossell SL, Bendall S, Thomas N. Can We Use an Interventionist-Causal Paradigm to Untangle the Relationship between Trauma, PTSD and Psychosis? Front Psychol 2017; 8:306. [PMID: 28316580 PMCID: PMC5334316 DOI: 10.3389/fpsyg.2017.00306] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/17/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rachel M Brand
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia; Psychiatry, St. Vincent's HospitalFitzroy, VIC, Australia
| | - Sarah Bendall
- Orygen: The National Centre of Excellence in Youth Mental HealthParkville, VIC, Australia; The Centre for Youth Mental Health, The University of MelbourneParkville, VIC, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia
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Farrelly S, Peters E, Azis M, David A, Hunter EC. A brief CBT intervention for depersonalisation/derealisation in psychosis: study protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2016; 2:47. [PMID: 27965864 PMCID: PMC5154060 DOI: 10.1186/s40814-016-0086-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/26/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Depersonalisation is the experience of being detached or disconnected from one's experience. Studies suggest that clinically significant levels of depersonalisation are common in individuals who have psychotic symptoms and are associated with increased impairment. However, to date, there have been no studies that have investigated an intervention designed to target clinically significant depersonalisation in such patient groups. This study aims to determine the feasibility and acceptability of a brief intervention targeting clinically significant depersonalisation in those who also have current psychotic symptoms. METHODS/DESIGN The feasibility of delivering six sessions of cognitive behavioural therapy for depersonalisation in psychosis patients will be evaluated using a single-blinded randomised controlled trial with a treatment as usual control condition. Participants will be assessed at baseline and then randomised to either the treatment or control arm. Participants randomised to the treatment arm will be offered six sessions of individual cognitive behavioural therapy delivered over a maximum of 10 weeks. Therapy will focus on an individualised shared formulation of depersonalisation experiences and behavioural, cognitive, emotional regulation and thinking process strategies to decrease distress associated with depersonalisation. Participants will be assessed again at a 10-week (post-randomisation) follow-up assessment. The primary outcomes of interest will be those assessing the feasibility and acceptability of the intervention including rates of referral, eligibility and acceptance to participate; attendance at therapy sessions and completion of homework tasks; satisfaction with the intervention; maintenance of blinding; and therapist competence. Secondary outcomes will be data on clinical outcome measures of depersonalisation and positive symptoms of psychosis, anxiety, depression and post-traumatic stress. DISCUSSION This study will determine the feasibility of delivering six sessions of cognitive behavioural therapy for individuals with current psychotic symptoms who also experience clinically significant levels of depersonalisation. The results will provide information to inform a larger randomised trial to assess intervention efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT02427542.
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Affiliation(s)
- Simone Farrelly
- Department of Psychology, 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
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony David
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elaine C Hunter
- 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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20
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Reininghaus U, Kempton MJ, Valmaggia L, Craig TKJ, Garety P, Onyejiaka A, Gayer-Anderson C, So SH, Hubbard K, Beards S, Dazzan P, Pariante C, Mondelli V, Fisher HL, Mills JG, Viechtbauer W, McGuire P, van Os J, Murray RM, Wykes T, Myin-Germeys I, Morgan C. Stress Sensitivity, Aberrant Salience, and Threat Anticipation in Early Psychosis: An Experience Sampling Study. Schizophr Bull 2016; 42:712-22. [PMID: 26834027 PMCID: PMC4838104 DOI: 10.1093/schbul/sbv190] [Citation(s) in RCA: 196] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
While contemporary models of psychosis have proposed a number of putative psychological mechanisms, how these impact on individuals to increase intensity of psychotic experiences in real life, outside the research laboratory, remains unclear. We aimed to investigate whether elevated stress sensitivity, experiences of aberrant novelty and salience, and enhanced anticipation of threat contribute to the development of psychotic experiences in daily life. We used the experience sampling method (ESM) to assess stress, negative affect, aberrant salience, threat anticipation, and psychotic experiences in 51 individuals with first-episode psychosis (FEP), 46 individuals with an at-risk mental state (ARMS) for psychosis, and 53 controls with no personal or family history of psychosis. Linear mixed models were used to account for the multilevel structure of ESM data. In all 3 groups, elevated stress sensitivity, aberrant salience, and enhanced threat anticipation were associated with an increased intensity of psychotic experiences. However, elevated sensitivity to minor stressful events (χ(2)= 6.3,P= 0.044), activities (χ(2)= 6.7,P= 0.036), and areas (χ(2)= 9.4,P= 0.009) and enhanced threat anticipation (χ(2)= 9.3,P= 0.009) were associated with more intense psychotic experiences in FEP individuals than controls. Sensitivity to outsider status (χ(2)= 5.7,P= 0.058) and aberrantly salient experiences (χ(2)= 12.3,P= 0.002) were more strongly associated with psychotic experiences in ARMS individuals than controls. Our findings suggest that stress sensitivity, aberrant salience, and threat anticipation are important psychological processes in the development of psychotic experiences in daily life in the early stages of the disorder.
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Affiliation(s)
- Ulrich Reininghaus
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands;
| | - Matthew J Kempton
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Lucia Valmaggia
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tom K J Craig
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Philippa Garety
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Adanna Onyejiaka
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Charlotte Gayer-Anderson
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suzanne H So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Kathryn Hubbard
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephanie Beards
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Carmine Pariante
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valeria Mondelli
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Helen L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John G Mills
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Philip McGuire
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Robin M Murray
- Psychosis Studies Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Til Wykes
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
| | - Inez Myin-Germeys
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Center for Contextual Psychiatry, Department of Neuroscience, Catholic University of Leuven, Leuven, Belgium
| | - Craig Morgan
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
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Reininghaus U, Depp CA, Myin-Germeys I. Ecological Interventionist Causal Models in Psychosis: Targeting Psychological Mechanisms in Daily Life. Schizophr Bull 2016; 42:264-9. [PMID: 26707864 PMCID: PMC4753613 DOI: 10.1093/schbul/sbv193] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Integrated models of psychotic disorders have posited a number of putative psychological mechanisms that may contribute to the development of psychotic symptoms, but it is only recently that a modest amount of experience sampling research has provided evidence on their role in daily life, outside the research laboratory. A number of methodological challenges remain in evaluating specificity of potential causal links between a given psychological mechanism and psychosis outcomes in a systematic fashion, capitalizing on longitudinal data to investigate temporal ordering. In this article, we argue for testing ecological interventionist causal models that draw on real world and real-time delivered, ecological momentary interventions for generating evidence on several causal criteria (association, time order, and direction/sole plausibility) under real-world conditions, while maximizing generalizability to social contexts and experiences in heterogeneous populations. Specifically, this approach tests whether ecological momentary interventions can (1) modify a putative mechanism and (2) produce changes in the mechanism that lead to sustainable changes in intended psychosis outcomes in individuals' daily lives. Future research using this approach will provide translational evidence on the active ingredients of mobile health and in-person interventions that promote sustained effectiveness of ecological momentary interventions and, thereby, contribute to ongoing efforts that seek to enhance effectiveness of psychological interventions under real-world conditions.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands; Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK;
| | - Colin A Depp
- Department of Psychiatry, University of California, San Diego, CA; VA San Diego Healthcare System, San Diego, CA
| | - Inez Myin-Germeys
- Center for Contextual Psychiatry, Department of Neuroscience, KU Leuven, Belgium
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Catone G, Pisano S, Broome M, Lindau JF, Pascotto A, Gritti A. Continuity between Stressful Experiences and Delusion Content in Adolescents with Psychotic Disorders – A Pilot Study. Scand J Child Adolesc Psychiatr Psychol 2016. [DOI: 10.21307/sjcapp-2016-004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Koyanagi A, Stickley A. The Association between Sleep Problems and Psychotic Symptoms in the General Population: A Global Perspective. Sleep 2015; 38:1875-85. [PMID: 26085291 PMCID: PMC4667394 DOI: 10.5665/sleep.5232] [Citation(s) in RCA: 130] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 04/24/2015] [Indexed: 12/18/2022] Open
Abstract
STUDY OBJECTIVES To assess the prevalence of sleep problems and their association with psychotic symptoms using a global database. DESIGN Community-based cross-sectional study. SETTING Data were analyzed from the World Health Organization's World Health Survey (WHS), a population-based survey conducted in 70 countries between 2002 and 2004. PATIENTS OR PARTICIPANTS 261,547 individuals aged ≥ 18 years from 56 countries. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS The presence of psychotic symptoms in the past 12 months was established using 4 questions pertaining to positive symptoms from the psychosis screening module of the Composite International Diagnostic Interview. Sleep problems referred to severe or extreme sleep problems in the past 30 days. Multivariable logistic regression was used to estimate the associations. The overall prevalence of sleep problems was 7.6% and ranged from 1.6% (China) to 18.6% (Morocco). Sleep problems were associated with significantly higher odds for at least one psychotic symptom in the vast majority of countries. In the pooled sample, after adjusting for demographic factors, alcohol consumption, smoking, and chronic medical conditions, having sleep problems resulted in an odds ratio (OR) for at least one psychotic symptom of 2.41 (95% confidence interval [CI] 2.18-2.65). This OR was 1.59 (1.40-1.81) when further adjusted for anxiety and depression. CONCLUSIONS A strong association between sleep problems and psychotic symptoms was observed globally. These results have clinical implications and serve as a basis for future studies to elucidate the causal association between psychotic symptoms and sleep problems.
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Affiliation(s)
- Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Déu, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Andrew Stickley
- The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden
- Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Department of Child and Adolescent Mental Health, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Menon M, Andersen DR, Quilty LC, Woodward TS. Individual factors predicted to influence outcome in group CBT for psychosis (CBTp) and related therapies. Front Psychol 2015; 6:1563. [PMID: 26578995 PMCID: PMC4623397 DOI: 10.3389/fpsyg.2015.01563] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 09/28/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mahesh Menon
- Department of Psychiatry, University of British Columbia Vancouver, BC, Canada ; Vancouver Coastal Health Vancouver, BC, Canada
| | - Devon R Andersen
- Department of Psychiatry, University of British Columbia Vancouver, BC, Canada ; BC Mental Health and Addiction Research Institute Vancouver, BC, Canada ; Department of Psychology, University of Saskatchewan Saskatoon, SK, Canada
| | - Lena C Quilty
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health Toronto, ON, Canada ; Department of Psychiatry, University of Toronto Toronto, ON, Canada
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia Vancouver, BC, Canada ; BC Mental Health and Addiction Research Institute Vancouver, BC, Canada
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25
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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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26
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Fielding-Smith SF, Hayward M, Strauss C, Fowler D, Paulik G, Thomas N. Bringing the "self" into focus: conceptualising the role of self-experience for understanding and working with distressing voices. Front Psychol 2015; 6:1129. [PMID: 26300821 PMCID: PMC4528282 DOI: 10.3389/fpsyg.2015.01129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/20/2015] [Indexed: 01/22/2023] Open
Abstract
A primary goal of cognitive behavior therapy for psychosis (CBTp) is to reduce distress and disability, not to change the positive symptoms of psychosis, such as hearing voices. Despite demonstrated associations between beliefs about voices and distress, the effects of CBTp on reducing voice distress are disappointing. Research has begun to explore the role that the psychological construct of "self" (which includes numerous facets such as self-reflection, self-schema and self-concept) might play in causing and maintaining distress and disability in voice hearers. However, attempts to clarify and integrate these different perspectives within the voice hearing literature, or to explore their clinical implications, are still in their infancy. This paper outlines how the self has been conceptualised in the psychosis and CBT literatures, followed by a review of the evidence regarding the proposed role of this construct in the etiology of and adaptation to voice hearing experiences. We go on to discuss some of the specific intervention methods that aim to target these aspects of self-experience and end by identifying key research questions in this area. Notably, we suggest that interventions specifically targeting aspects of self-experience, including self-affection, self-reflection, self-schema and self-concept, may be sufficient to reduce distress and disruption in the context of hearing voices, a suggestion that now requires further empirical investigation.
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Affiliation(s)
| | - Mark Hayward
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - Clara Strauss
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - David Fowler
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - Georgie Paulik
- School of Psychology, University of Western Australia , Perth, WA, Australia ; Schizophrenia Research Institute, Darlinghurst , NSW, Australia
| | - Neil Thomas
- Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne , VIC, Australia ; Monash Alfred Psychiatry Research Centre, The Alfred, Melbourne , VIC, Australia
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27
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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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28
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Thomas N. What's really wrong with cognitive behavioral therapy for psychosis? Front Psychol 2015; 6:323. [PMID: 25870572 PMCID: PMC4375916 DOI: 10.3389/fpsyg.2015.00323] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/06/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
- Neil Thomas
- School of Health Sciences, Swinburne University Melbourne, VIC, Australia ; Monash Alfred Psychiatry Research Centre, Monash University Melbourne, VIC, Australia
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29
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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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30
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Freeman D, Dunn G, Murray RM, Evans N, Lister R, Antley A, Slater M, Godlewska B, Cornish R, Williams J, Di Simplicio M, Igoumenou A, Brenneisen R, Tunbridge EM, Harrison PJ, Harmer CJ, Cowen P, Morrison PD. How cannabis causes paranoia: using the intravenous administration of ∆9-tetrahydrocannabinol (THC) to identify key cognitive mechanisms leading to paranoia. Schizophr Bull 2015; 41:391-9. [PMID: 25031222 PMCID: PMC4332941 DOI: 10.1093/schbul/sbu098] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Paranoia is receiving increasing attention in its own right, since it is a central experience of psychotic disorders and a marker of the health of a society. Paranoia is associated with use of the most commonly taken illicit drug, cannabis. The objective was to determine whether the principal psychoactive ingredient of cannabis-∆(9)-tetrahydrocannabinol (THC)-causes paranoia and to use the drug as a probe to identify key cognitive mechanisms underlying paranoia. A randomized, placebo-controlled, between-groups test of the effects of intravenous THC was conducted. A total of 121 individuals with paranoid ideation were randomized to receive placebo, THC, or THC preceded by a cognitive awareness condition. Paranoia was assessed extensively via a real social situation, an immersive virtual reality experiment, and standard self-report and interviewer measures. Putative causal factors were assessed. Principal components analysis was used to create a composite paranoia score and composite causal variables to be tested in a mediation analysis. THC significantly increased paranoia, negative affect (anxiety, worry, depression, negative thoughts about the self), and a range of anomalous experiences, and reduced working memory capacity. The increase in negative affect and in anomalous experiences fully accounted for the increase in paranoia. Working memory changes did not lead to paranoia. Making participants aware of the effects of THC had little impact. In this largest study of intravenous THC, it was definitively demonstrated that the drug triggers paranoid thoughts in vulnerable individuals. The most likely mechanism of action causing paranoia was the generation of negative affect and anomalous experiences.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK;
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
| | - Nicole Evans
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Rachel Lister
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Angus Antley
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mel Slater
- Department of Computer Science, University College London, London, UK;,Institució Catalana de Recerca i Estudis Avançats (ICREA), University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Artemis Igoumenou
- Queen Mary University of London, Violence Prevention Research Unit, Barts and the London School of Medicine and Dentistry, Wolfson Institute of Preventive Medicine, London, UK
| | | | | | | | | | - Philip Cowen
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Paul D. Morrison
- Department of Psychosis Studies, Institute of Psychiatry, King’s College London, London, UK
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31
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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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32
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Balzan RP, Delfabbro PH, Galletly CA, Woodward TS. Metacognitive training for patients with schizophrenia: preliminary evidence for a targeted, single-module programme. Aust N Z J Psychiatry 2014; 48:1126-36. [PMID: 24159051 DOI: 10.1177/0004867413508451] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Metacognitive training is an eight-module, group-based treatment programme for people with schizophrenia that targets the cognitive biases (i.e. problematic thinking styles) thought to contribute to the genesis and maintenance of delusions. The present article is an investigation into the efficacy of a shorter, more targeted, single-module metacognitive training programme, administered individually, which focuses specifically on improving cognitive biases that are thought to be driven by a 'hypersalience of evidence-hypothesis matches' mechanism (e.g. jumping to conclusions, belief inflexibility, reasoning heuristics, illusions of control). It was hypothesised that a more targeted metacognitive training module could still improve performance on these bias tasks and reduce delusional ideation, while improving insight and quality of life. METHOD A sample of 28 patients diagnosed with schizophrenia and mild delusions either participated in the hour-long, single-session, targeted metacognitive training programme (n = 14), or continued treatment as usual (n = 14). All patients were assessed using clinical measures gauging overall positive symptomology, delusional ideation, quality of life and insight, and completed two cognitive bias tasks designed to elucidate the representativeness and illusion of control biases. RESULTS After a 2-week, post-treatment interval, targeted metacognitive training patients exhibited significant decreases in delusional severity and conviction, significantly improved clinical insight, and significant improvements on the cognitive bias tasks, relative to the treatment-as-usual controls. Performance improvements on the cognitive bias tasks significantly correlated with the observed reductions in overall positive symptomology. Patients also evaluated the training positively. CONCLUSIONS Although interpretations of these results are limited due to the lack of an optimally designed, randomised controlled trial and a small sample size, the results are promising and warrant further investigation into targeted versions of the metacognitive training programme.
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Affiliation(s)
- Ryan P Balzan
- School of Psychology, Flinders University, Australia School of Psychology, University of Adelaide, Australia Discipline of Psychiatry, University of Adelaide, Australia
| | | | | | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Canada
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33
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Freeman D, Garety P. Advances in understanding and treating persecutory delusions: a review. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1179-89. [PMID: 25005465 PMCID: PMC4108844 DOI: 10.1007/s00127-014-0928-7] [Citation(s) in RCA: 228] [Impact Index Per Article: 22.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 06/30/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE Persecutory delusions are a central psychotic experience, at the severe end of a paranoia spectrum in the general population. The aim of the review is to provide an introduction to the understanding of persecutory delusions, highlight key putative causal factors that have the potential to be translated into efficacious treatment, and indicate future research directions. METHODS A narrative literature review was undertaken to highlight the main recent areas of empirical study concerning non-clinical and clinical paranoia. RESULTS Six main proximal causal factors are identified: a worry thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Each has plausible mechanistic links to the occurrence of paranoia. These causal factors may be influenced by a number of social circumstances, including adverse events, illicit drug use, and urban environments. CONCLUSIONS There have been numerous replicated empirical findings leading to a significant advance in the understanding of persecutory delusions, now beginning to be translated into cognitive treatments. The first trials specifically focussed on patients who have persecutory delusions in the context of psychotic diagnoses are occurring. Initial evidence of efficacy is very promising.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, OX3 7JX, UK,
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Thomas N, Hayward M, Peters E, van der Gaag M, Bentall RP, Jenner J, Strauss C, Sommer IE, Johns LC, Varese F, García-Montes JM, Waters F, Dodgson G, McCarthy-Jones S. Psychological therapies for auditory hallucinations (voices): current status and key directions for future research. Schizophr Bull 2014; 40 Suppl 4:S202-12. [PMID: 24936081 PMCID: PMC4141318 DOI: 10.1093/schbul/sbu037] [Citation(s) in RCA: 132] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (1) moving beyond the focus on overall efficacy to understand specific therapeutic processes targeting voices, (2) better targeting psychological processes associated with voices such as trauma, cognitive mechanisms, and personal recovery, (3) more focused measurement of the intended outcomes of therapy, (4) understanding individual differences among voice hearers, (5) extending beyond a focus on voices and schizophrenia into other populations and sensory modalities, and (6) shaping interventions for service implementation.
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Affiliation(s)
- Neil Thomas
- Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, The Alfred, Melbourne, Australia;
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton, UK;,Research & Development Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, King’s College London, Department of Psychology, London, UK;,National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust (SLaM), London, UK;,Psychological Interventions Clinic for Outpatients With Psychosis (PICuP),SLaM, London, UK
| | - Mark van der Gaag
- VU University and EMGO+ Institute for Health and Care Research, VU University, Amsterdam, The Netherlands;,Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Richard P. Bentall
- School of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Jack Jenner
- Jenner Consult, AUDITO, Groningen, The Netherlands
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK;,Research & Development Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Iris E. Sommer
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Louise C. Johns
- Institute of Psychiatry, King’s College London, Department of Psychology, London, UK;,Psychological Interventions Clinic for Outpatients With Psychosis (PICuP),SLaM, London, UK
| | - Filippo Varese
- School of Psychological Sciences, University of Manchester, Manchester, UK
| | | | - Flavie Waters
- School of Psychiatry and Clinical Neurosciences, University of Western Australia, Perth, Australia;,Clinical Research Centre, North Metro Health Service Mental Health,Perth,Australia
| | - Guy Dodgson
- Early Intervention in Psychosis, Greenacre Centre, Ashington, UK
| | - Simon McCarthy-Jones
- ARC Centre of Excellence in Cognition and Its Disorders, Department of Cognitive Science, Macquarie University, Sydney, Australia;,Department of Psychology, Durham University, Durham, UK
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35
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Freeman D, Dunn G, Fowler D, Bebbington P, Kuipers E, Emsley R, Jolley S, Garety P. Current paranoid thinking in patients with delusions: the presence of cognitive-affective biases. Schizophr Bull 2013; 39:1281-7. [PMID: 23223342 PMCID: PMC3796079 DOI: 10.1093/schbul/sbs145] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND There has been renewed interest in the influence of affect on psychosis. Psychological research on persecutory delusions ascribes a prominent role to cognitive processes related to negative affect: anxiety leads to the anticipation of threat within paranoia; depressive negative ideas about the self create a sense of vulnerability in which paranoid thoughts flourish; and self-consciousness enhances feelings of the self as a target. The objective of this study was to examine such affective processes in relation to state paranoia in patients with delusions. METHODS 130 patients with delusions in the context of a nonaffective psychosis diagnosis (predominately schizophrenia) were assessed for contemporaneous levels of persecutory ideation on 5 visual analog scales. Measures were taken of anxiety, depression, threat anticipation, interpretation of ambiguity, self-focus, and negative ideas about the self. RESULTS Of the patients, 85% report paranoid thinking at testing. Symptoms of anxiety and depression were highly prevalent. Current paranoid thinking was associated with anxiety, depression, greater anticipation of threat events, negative interpretations of ambiguous events, a self-focused cognitive style, and negative ideas about the self. CONCLUSIONS The study provides a clear demonstration that a range of emotion-related cognitive biases, each of which could plausibly maintain delusions, are associated with current paranoid thinking in patients with psychosis. We identified biases both in the contents of cognition and in the processing of information. Links between affect and psychosis are central to the understanding of schizophrenia. We conclude that treatment of emotional dysfunction should lead to reductions in current psychotic experiences.
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Affiliation(s)
- Daniel Freeman
- To whom correspondence should be addressed; Oxford Cognitive Approaches to Psychosis, University Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, UK, OX3 7JX; tel: +44 (0) 1865 226490, fax: +44 (0) 1865 793101, e-mail:
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester, UK
| | - David Fowler
- School of Medicine, Health Policy and Practice, University of East Anglia, East Anglia, UK
| | - Paul Bebbington
- Mental Health Sciences Unit, Faculty of Brain Sciences, University College London, London, UK
| | - Elizabeth Kuipers
- Department of Psychology, King’s College London, Institute of Psychiatry, London, UK; ,Biomedical Research Centre at South London and Maudsley NHS Foundation Trust
| | - Richard Emsley
- Centre for Biostatistics, Institute of Population Health, Manchester University, Manchester, UK
| | - Suzanne Jolley
- Department of Psychology, King’s College London, Institute of Psychiatry, London, UK;
| | - Philippa Garety
- Department of Psychology, King’s College London, Institute of Psychiatry, London, UK; ,Biomedical Research Centre at South London and Maudsley NHS Foundation Trust
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36
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Garety PA, Freeman D. The past and future of delusions research: from the inexplicable to the treatable. Br J Psychiatry 2013; 203:327-33. [PMID: 24187067 DOI: 10.1192/bjp.bp.113.126953] [Citation(s) in RCA: 231] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Problems with the diagnosis and treatment of schizophrenia have led for a call to change strategy and focus on individual psychotic experiences. In recent years, research on delusions has led the way. AIMS To update our 1999 review of almost 40 studies on delusions. METHOD A systematic literature search was conducted of reasoning and affective processes related to delusions. RESULTS Over 200 studies were identified. The presence of 'jumping to conclusions' in individuals with delusions has been substantiated, the theory of mind account has not stood up to subsequent testing, and there is a promising new focus on the ways that affective processes contribute to delusional experience. CONCLUSIONS Theoretical work rendering delusions understandable can be translated into treatment; future clinical trials should focus on individual psychotic experiences as outcomes.
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Affiliation(s)
- P A Garety
- P. A. Garety, MA, MPhil, MA (Ed), PhD, FBPsS, Department of Psychology, Institute of Psychiatry, King's College London; D. Freeman, PhD, DClinPsy, CPsychol, FBPsS, Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK
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Urbanicity, persecutory delusions, and clinical intervention: the development of a brief CBT module for helping patients with persecutory delusions enter social urban environments. Behav Cogn Psychother 2013; 43:42-51. [PMID: 23930939 PMCID: PMC4005778 DOI: 10.1017/s1352465813000660] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Substantial epidemiological research has shown that psychotic experiences are more common in densely populated areas. Many patients with persecutory delusions find it difficult to enter busy social urban settings. The stress and anxiety caused by being outside lead many patients to remain in-doors. We therefore developed a brief CBT intervention, based upon a formulation of the way urban environments cause stress and anxiety, to help patients with paranoid thoughts to feel less distressed when outside in busy streets. Aims: The aim was to pilot the new intervention for feasibility and acceptability and gather preliminary outcome data. Method: Fifteen patients with persecutory delusions in the context of a schizophrenia diagnosis took part. All patients first went outside to test their reactions, received the intervention, and then went outside again. Results: The intervention was considered useful by the patients. There was evidence that going outside after the intervention led to less paranoid responses than the initial exposure, but this was only statistically significant for levels of distress. Conclusions: Initial evidence was obtained that a brief CBT module specifically focused on helping patients with paranoia go outside is feasible, acceptable, and may have clinical benefits. However, it could not be determined from this small feasibility study that any observed improvements were due to the CBT intervention. Challenges in this area and future work required are outlined.
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Freeman D, Startup H, Myers E, Harvey A, Geddes J, Yu LM, Zaiwalla Z, Luengo-Fernandez R, Foster R, Lister R. The effects of using cognitive behavioural therapy to improve sleep for patients with delusions and hallucinations (the BEST study): study protocol for a randomized controlled trial. Trials 2013; 14:214. [PMID: 23845104 PMCID: PMC3717119 DOI: 10.1186/1745-6215-14-214] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 07/01/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with psychosis frequently report difficulties getting or staying asleep (insomnia). Dissatisfaction with sleep is high. Insomnia should be treated in this group, but typically it is not even assessed. Importantly, recent evidence indicates that insomnia triggers and exacerbates delusions and hallucinations. The clinical implication is that if the insomnia is treated then the psychotic symptoms will significantly lessen. In a case series with 15 patients with persecutory delusions resistant to previous treatment this is exactly what we found: cognitive behavioural therapy for insomnia (CBT-I) led to large reductions in both the insomnia and delusions. The clear next step is a pilot randomized controlled test. The clinical aim is to test whether CBT-I can reduce both insomnia and psychotic symptoms. The trial will inform decisions for a definitive large-scale evaluation. METHODS/DESIGN We will carry out a randomized controlled trial (the Better Sleep Trial, or the BEST study) with 60 patients with distressing delusions or hallucinations in the context of a schizophrenia spectrum diagnosis. Half of the participants will be randomized to receive CBT-I, in addition to their standard treatment, for up to eight sessions over 12 weeks. The other half will continue with treatment as usual. Blind assessments will take place at 0 weeks, 12 weeks (post-treatment) and 24 weeks (follow-up). The primary outcome hypotheses are that CBT-I added to treatment as usual will improve sleep, delusions and hallucinations compared with only treatment as usual. All main analyses will be carried out at the end of the last follow-up assessments and will be based on the intention-to-treat principle. The trial is funded by the NHS National Institute for Health Research (NIHR) Research for Patient Benefit Programme. Data collection will be complete by the end of 2014. DISCUSSION This will be the first controlled test of CBT-I for patients with delusions and hallucinations. It will provide significant evidence for an easily administered intervention that is likely to prove very popular with patients experiencing the difficult-to-treat problems of delusions and hallucinations. TRIAL REGISTRATION Current Controlled Trials ISRCTN 33695128.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Helen Startup
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Elissa Myers
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Allison Harvey
- Department of Psychology, University of California, Berkeley, 3210 Tolman Hall, Berkeley CA 94720-1650, USA
| | - John Geddes
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
| | - Ly-Mee Yu
- Centre for Statistics in Medicine, University of Oxford, Wolfson College Annexe, Linton Road, Oxford OX2 6UD, UK
| | - Zenobia Zaiwalla
- Oxford Non-respiratory Sleep Disorder Service, Oxford University Hospitals NHS Trust, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Ramon Luengo-Fernandez
- Health Economics Research Centre, Department of Public Health, University of Oxford, Old Road Campus, Headington, Oxford OX3 7LF, UK
| | - Russell Foster
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Rachel Lister
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford OX3 7JX, UK
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Freeman D, Dunn G, Garety P, Weinman J, Kuipers E, Fowler D, Jolley S, Bebbington P. Patients' beliefs about the causes, persistence and control of psychotic experiences predict take-up of effective cognitive behaviour therapy for psychosis. Psychol Med 2013; 43:269-277. [PMID: 22781166 PMCID: PMC3544544 DOI: 10.1017/s0033291712001225] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is evidence that patients with schizophrenia benefit from standard cognitive behaviour therapy (CBT) only if active techniques are used ('full therapy'). By contrast, attending sessions but not proceeding beyond engagement and assessment strategies ('partial therapy'), or simply not attending sessions ('no therapy'), is not associated with better outcomes. The factors leading to full therapy are unknown. We hypothesized that patients' initial ideas about the nature and extent of their problems would predict use of CBT. A match between patients' views of their problems and the principles underlying treatment would lead to better outcomes. METHOD Ninety-two patients with a recent relapse of psychosis completed the Illness Perception Questionnaire (IPQ) before receiving CBT. We examined whether their illness perceptions predicted the take-up of therapy. RESULTS Patients who did not attend sessions believed their problems would not last as long as those who attended them. Those who attended sessions but did not proceed to full therapy had a lower sense of control over their problems and a more biological view of their causes. Patients who took up full therapy were more likely to attribute the cause of their problems to their personality and state of mind. The take-up of therapy was predicted neither by levels of psychiatric symptoms nor by insight. CONCLUSIONS People with psychosis who have psychologically orientated views of their problems, including the potential to gain control over them, may be more likely to engage fully and do well with standard CBT for psychosis, irrespective of the severity of their problems.
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Affiliation(s)
- D Freeman
- Department of Psychiatry, Oxford University, UK.
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Freeman D, Dunn G, Startup H, Kingdon D. The effects of reducing worry in patients with persecutory delusions: study protocol for a randomized controlled trial. Trials 2012; 13:223. [PMID: 23171601 PMCID: PMC3551833 DOI: 10.1186/1745-6215-13-223] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 11/02/2012] [Indexed: 11/10/2022] Open
Abstract
Background Our approach to advancing the treatment of psychosis is to focus on key single symptoms and develop interventions that target the mechanisms that maintain them. In our theoretical research we have found worry to be an important factor in the development and maintenance of persecutory delusions. Worry brings implausible ideas to mind, keeps them there, and makes the experience distressing. Therefore the aim of the trial is to test the clinical efficacy of a cognitive-behavioral intervention for worry for patients with persecutory delusions and determine how the worry treatment might reduce delusions. Methods/Design An explanatory randomized controlled trial - called the Worry Intervention Trial (WIT) - with 150 patients with persecutory delusions will be carried out. Patients will be randomized to the worry intervention in addition to standard care or to standard care. Randomization will be carried out independently, assessments carried out single-blind, and therapy competence and adherence monitored. The study population will be individuals with persecutory delusions and worry in the context of a schizophrenia spectrum diagnosis. They will not have responded adequately to previous treatment. The intervention is a six-session cognitive-behavioral treatment provided over eight weeks. The control condition will be treatment as usual, which is typically antipsychotic medication and regular appointments. The principal hypotheses are that a worry intervention will reduce levels of worry and that it will also reduce the persecutory delusions. Assessments will be carried out at 0 weeks (baseline), 8 weeks (post treatment) and 24 weeks (follow-up). The statistical analysis strategy will follow the intention-to-treat principle and involve the use of linear mixed models to evaluate and estimate the relevant between- and within-subjects effects (allowing for the possibility of missing data). Both traditional regression and newer instrumental variables analyses will examine mediation. The trial is funded by the UK Medical Research Council (MRC)/NHS National Institute of Health Research (NIHR) Efficacy and Mechanism Evaluation (EME) Programme. Discussion This will be the first large randomized controlled trial specifically focused upon persecutory delusions. The project will produce a brief, easily administered intervention that can be readily used in mental health services. Trial registration Current Controlled Trials ISRCTN23197625
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, UK.
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Can Paranoid Thoughts be Reduced by Targeting Negative Emotions and Self-Esteem? An Experimental Investigation of a Brief Compassion-Focused Intervention. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9470-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1195-203. [PMID: 21928153 DOI: 10.1007/s00127-011-0433-1] [Citation(s) in RCA: 165] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 09/02/2011] [Indexed: 02/07/2023]
Abstract
PURPOSE Our theoretical model proposes that insomnia, worry, and negative affect are important determinants of paranoid thinking. Anxiety produces anticipation of threat, depression increases the sense of vulnerability, worry leads to implausible ideas, and insomnia exacerbates negative affect and creates an altered perceptual state. The study objective was to examine for the first time these factors as predictors of the onset of new paranoid thinking and of the persistence of existing paranoid thinking. METHOD A total of 2,382 participants in the 2000 British National Psychiatric Morbidity Survey were followed-up 18 months after their first assessment. Baseline assessments were used to predict the development and persistence of paranoid thinking at follow-up. Data were weighted to be representative of the general household population. RESULTS Insomnia, worry, anxiety, depression and depressive ideas were each substantial predictors both of new inceptions of paranoia and of the persistence of existing paranoid thinking. Worry and insomnia were the strongest predictors. For example, insomnia at the first assessment led to a more than threefold increase in later inceptions of paranoid thinking. CONCLUSIONS The study indicates that insomnia, worry, anxiety and depression are potential risk factors for new inceptions of paranoid thinking. The results also corroborate an emerging literature indicating that anxiety, worry and depression may encourage the persistence of paranoid thinking. The study provides the first longitudinal evidence linking insomnia and paranoia. The important clinical implication is that the use of interventions for common mental health difficulties in people with psychosis may have the additional benefit of reducing paranoia.
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Freeman D, Evans N, Lister R. Gut feelings, deliberative thought, and paranoid ideation: a study of experiential and rational reasoning. Psychiatry Res 2012; 197:119-22. [PMID: 22406393 PMCID: PMC3584280 DOI: 10.1016/j.psychres.2011.12.031] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 11/07/2011] [Accepted: 12/21/2011] [Indexed: 11/19/2022]
Abstract
Rapid intuitive hunches or gut feelings may be a compelling source of evidence for paranoid ideas. Conversely, a failure to apply effortful analytic thinking may contribute to the persistence of such thoughts. Our main aim was to examine for the first time the associations of persecutory thinking with experiential and rational thinking styles. Five hundred individuals recruited from the general population completed self-report assessments of current persecutory ideation, general reasoning styles and personality traits. Persecutory ideation was independently associated with greater use of experiential reasoning and less use of rational reasoning. The correlations were small. Persecutory ideation was also positively associated with neuroticism and negatively correlated with extraversion, agreeableness and conscientiousness. There was no evidence of an interaction between neuroticism and experiential reasoning in the prediction of paranoia, but high experiential reasoning in the context of low rational reasoning was particularly associated with persecutory ideation. Overall, the study provides rare evidence of self-reported general reasoning styles being associated with delusional ideation. Perceived reliance on intuition is associated with paranoid thinking, while perceived reliance on deliberation is associated with fewer such thoughts. The dual process theory of reasoning may provide a framework to contribute to the understanding of paranoid thinking.
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