1
|
Jelinek L, Göritz AS, Miegel F, Schuurmans L, Moritz S, Yassari AH, Müller JC. Too much of a good thing? Hand hygiene and the long-term course of contamination-related obsessive-compulsive symptoms. Front Psychol 2024; 15:1279639. [PMID: 38524298 PMCID: PMC10959097 DOI: 10.3389/fpsyg.2024.1279639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 02/13/2024] [Indexed: 03/26/2024] Open
Abstract
Increased hygiene behavior may be a factor in the development of contamination-related obsessive-compulsive symptoms (C-OCS). We aimed at investigating (1) the course of C-OCS over 1 year after the start of the COVID-19 pandemic and (2) the effects of changes in hand hygiene (i.e., duration and frequency of handwashing) and related distress regulation on the long-term course of C-OCS. In a longitudinal study, we assessed 1,220 individuals from the German general population at the start of the COVID-19 pandemic (t1), 3 months later (t2), and 12 months later (t3). Pre-pandemic data were available in a subsample from 2014 (n = 430). A decrease in C-OCS over the first year of the pandemic emerged with a small effect size. Thirty-six percent of the participants scored above the clinical cut-off score at t1, 31% at t2, and 27% at t3. In 2014, only 11% scored above the clinical cut-off score. Hierarchical regression showed that C-OCS at t1 was the strongest predictor of a long-term increase in C-OCS. With small effect sizes, change in the duration (not frequency) of handwashing from t1 to t2, as well as the distress-reducing effect of handwashing served as additional predictors. Implications for information on hand hygiene guidelines are discussed.
Collapse
Affiliation(s)
- Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja S. Göritz
- Behavioral Health Technology, University Augsburg, Augsburg, Germany
| | - Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lea Schuurmans
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amir H. Yassari
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jana Christina Müller
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Gussmann E, Lucae S, Falkai P, Padberg F, Egli S, Kopf-Beck J. Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach. Front Psychiatry 2023; 14:1160075. [PMID: 37324820 PMCID: PMC10267344 DOI: 10.3389/fpsyt.2023.1160075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023] Open
Abstract
Background Treatment guidelines for psychosis recommend offering psychotherapy already in the acute illness phase. However, there is a lack of available interventions adapted to the specific needs and key change mechanisms of inpatients experiencing severe symptoms and crisis. In this article we outline the scientific development process of a needs-oriented and mechanism-based group intervention for acute psychiatric inpatients with psychosis (MEBASp). Methods To guide our intervention design, we used Intervention Mapping (IM), a six-step framework for developing evidence-based health interventions that consisted of an extensive literature review, an in-depth problem definition and needs analysis, the modeling of change mechanisms and outcomes and the production of an intervention prototype. Results Our low-threshold modularized group intervention consists of nine stand-alone sessions (two per week) within three modules and targets different aspects of metacognitive and social change mechanisms. Module I and II aim to reduce acute symptoms by fostering cognitive insight, Module III focuses on reducing distress via cognitive defusion. Therapy contents are adapted from existing metacognitive treatments such as the Metacognitive Training and presented in a destigmatizing, simply understandable and experience-oriented way. Conclusion MEBASp is currently evaluated in a single-arm feasibility trial. Using a systematic and rigorous development methodology and providing a detailed description of the development steps demonstrated to be invaluable in improving the intervention's scientific foundation, validity, and replicability for similar research.
Collapse
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, LMU University Hospital Munich, Munich, Germany
| | - Peter Falkai
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital 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
| |
Collapse
|
3
|
Arboleya-Faedo T, González-Menéndez A, González-Pando D, Paino M, Alonso-Pérez F. Experiences of Self-Stigma in People with Chronic Psychosis: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095688. [PMID: 37174206 PMCID: PMC10178090 DOI: 10.3390/ijerph20095688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023]
Abstract
We present the results of a phenomenological study understanding the personal meaning of self-stigma in people with chronic psychosis. Self-stigma is a frequent phenomenon in the lives of people with psychosis and their families and it functions as a barrier to recovery. Semi-structured in-depth interviews were conducted with fourteen outpatients that suffer from chronic psychosis during January 2020. Data analysis was carried out using an inductive approach as described by Graneheim and Lundman through the MAXQDA 2022 program. The themes observed were: "Contextual Stigma", "Components of Self-Stigma", "Skills Loss" and "Coping with Self-Stigma". The main categories and subcategories were avoidance and escape behaviours from their social environment, labelling, loss of social relationships, negative impact and self-concealment of the diagnosis. Our results revealed influence on each other, forming a looping effect that explains and amplifies the lived experience of self-stigma. These findings highlight the need to implement strategies in nursing practice aimed at training the acceptance and distancing necessary to minimize the impact of self-stigma on people with chronic psychosis. This study adheres to the EQUATOR guidelines for the Consolidated Criteria for Reporting Qualitative Research (COREQ).
Collapse
Affiliation(s)
| | | | - David González-Pando
- ISPA-Health Research Institute of the Principality of Asturias, 33011 Oviedo, Spain
- Faculty of Nursing, University of Oviedo, 33394 Gijón, Spain
| | - Mercedes Paino
- Department of Psychology, University of Oviedo, 33003 Oviedo, Spain
| | - Fernando Alonso-Pérez
- ISPA-Health Research Institute of the Principality of Asturias, 33011 Oviedo, Spain
- Faculty of Nursing, University of Oviedo, 33394 Gijón, Spain
| |
Collapse
|
4
|
Park YH, Kim IH, Jeong YW. Stress, and coping strategy of university students during COVID-19 in Korea: The mediating role of ego-resiliency. Acta Psychol (Amst) 2022; 227:103615. [PMID: 35569204 PMCID: PMC9091160 DOI: 10.1016/j.actpsy.2022.103615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 05/09/2022] [Accepted: 05/09/2022] [Indexed: 01/31/2023] Open
Abstract
We aimed to identify the level of stress, ego-resiliency (ER), and coping strategies of university students during the onset of coronavirus disease 2019 (COVID-19) and examine the mediating role of ER in the relationship between stress and coping strategies (e.g., problem-solving, social support seeking, and avoidance). We analyzed responses from 160 university students and found that problem-solving was the most common coping strategy (26.02 ± 4.65), followed by social support-seeking (25.08 ± 5.23), and avoidance (19.21 ± 3.78). ER was negatively associated with stress and showed a mediating effect on the relationship between stress and social support, and stress and problem-solving coping strategies. These findings indicate that ER helps decrease stress caused by the pandemic among university students and should be considered a significant factor for developing adaptive stress coping strategies.
Collapse
|
5
|
van der Heijden HS, Schirmbeck F, Berry L, Simons CJP, Bartels-Velthuis AA, Bruggeman R, de Haan L, Vermeulen J. Impact of coping styles on substance use in persons with psychosis, siblings, and controls. Schizophr Res 2022; 241:102-109. [PMID: 35114638 DOI: 10.1016/j.schres.2022.01.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/14/2022] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Substance use is overrepresented in patients with psychosis. Maladaptive coping has been proposed as one of the mechanisms which might underlie this high prevalence. Patients are known to apply more maladaptive coping compared to the healthy population. However, it is unknown whether coping is associated with the use of different substances across those with different vulnerability for psychosis, and whether coping mediates the possible association between life events and substance use. METHODS In this multicenter, cohort study, 429 patients, 504 siblings, and 220 controls were included. We determined whether coping was associated with tobacco smoking, cannabis use, or alcohol consumption. Multivariable logistic regression models were applied whilst correcting for potential confounders. We performed post-hoc analyses to explore the association between negative life events, tobacco smoking, and the role of coping as a mediator in patients with psychosis. RESULTS A positive association was found in patients between passive coping and tobacco smoking (fully adjusted OR 1.65, 95% CI 1.18-2.31). Tobacco smoking patients experienced more negative life events compared to non-smoking patients and passive coping mediated this association. In siblings and controls, none of the coping strategies were associated with substance use. CONCLUSIONS The coping style of patients with psychosis is associated with tobacco smoking and mediates the association between negative events and tobacco smoking. No significant associations were found in siblings, controls or concerning other substance use. Future research is required to examine whether enhancing healthy coping strategies decreases tobacco use in patients with psychosis.
Collapse
Affiliation(s)
| | - Frederike Schirmbeck
- Department of Psychiatry Amsterdam UMC (location AMC), Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Liza Berry
- Department of Psychiatry Amsterdam UMC (location AMC), Amsterdam, the Netherlands
| | - Claudia J P Simons
- Maastricht University Medical Center, Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht, the Netherlands; GGzE Institute for Mental Health Care, Eindhoven, the Netherlands
| | - Agna A Bartels-Velthuis
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands
| | - Richard Bruggeman
- University of Groningen, University Medical Center Groningen, University Center for Psychiatry, Rob Giel Research Center, Groningen, the Netherlands; University of Groningen, Department of Clinical and Developmental Neuropsychology, Groningen, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry Amsterdam UMC (location AMC), Amsterdam, the Netherlands; Arkin Institute for Mental Health, Amsterdam, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry Amsterdam UMC (location AMC), Amsterdam, the Netherlands
| |
Collapse
|
6
|
Repetitive and Inflexible Active Coping and Addiction-like Neuroplasticity in Stressed Mice of a Helplessness-Resistant Inbred Strain. Behav Sci (Basel) 2021; 11:bs11120174. [PMID: 34940109 PMCID: PMC8698352 DOI: 10.3390/bs11120174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 11/23/2021] [Accepted: 11/30/2021] [Indexed: 01/02/2023] Open
Abstract
Dysfunctional coping styles are involved in the development, persistence, and relapse of psychiatric diseases. Passive coping with stress challenges (helplessness) is most commonly used in animal models of dysfunctional coping, although active coping strategies are associated with generalized anxiety disorder, social anxiety disorder, panic, and phobias as well as obsessive-compulsive and post-traumatic stress disorder. This paper analyzes the development of dysfunctional active coping strategies of mice of the helplessness–resistant DBA/2J (D2) inbred strain, submitted to temporary reduction in food availability in an uncontrollable and unavoidable condition. The results indicate that food-restricted D2 mice developed a stereotyped form of food anticipatory activity and dysfunctional reactive coping in novel aversive contexts and acquired inflexible and perseverant escape strategies in novel stressful situations. The evaluation of FosB/DeltaFosB immunostaining in different brain areas of food-restricted D2 mice revealed a pattern of expression typically associated with behavioral sensitization to addictive drugs and compulsivity. These results support the conclusion that an active coping style represents an endophenotype of mental disturbances characterized by perseverant and inflexible behavior.
Collapse
|
7
|
Kasznia J, Pytel A, Stańczykiewicz B, Samochowiec J, Waszczuk K, Kulik M, Cyran A, Misiak B. The Impact of Adverse Childhood Experiences on Coping Strategies in Schizophrenia Spectrum Disorders: A Case-Control Study. Psychol Res Behav Manag 2021; 14:1315-1323. [PMID: 34466040 PMCID: PMC8403075 DOI: 10.2147/prbm.s324152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/18/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose Several studies have shown that individuals with schizophrenia-spectrum disorders (SSD) employ ineffective coping styles. However, it remains unknown whether a history of adverse childhood experiences (AC Es), associated with a risk of SSD, contributes to these observations. Therefore, in this study, we aimed to investigate whether exposure to ACEs is associated with coping styles in subjects with SSD. Patients and Methods We recruited 127 inpatients with SSD and 56 healthy controls. Coping styles and ACEs were recorded using self-reports. Results Individuals with SSD had significantly higher use of using avoidance coping. A history of parental antipathy, physical and sexual abuse was significantly more frequent in subjects with SSD compared to controls. Subjects with SSD had significantly higher multiplicity and severity of ACEs. Individuals with SSD and a history of parental loss had significantly higher use of avoidance coping compared to controls with and without a history of parental loss. Other characteristics of ACEs (age at first exposure, severity and multiplicity) were not associated with using specific coping strategies. Conclusion These findings imply that higher use of using avoidance coping by individuals with SSD might be related to a history of parental loss.
Collapse
Affiliation(s)
- Justyna Kasznia
- Inpatient Psychiatric Unit, Municipal General Hospital, Ostrów Wielkopolski, Poland
| | - Aleksandra Pytel
- Department of Nervous System Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Katarzyna Waszczuk
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Małgorzata Kulik
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Agnieszka Cyran
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Wroclaw, Poland
| | - Błażej Misiak
- Department of Psychiatry, Division of Consultation Psychiatry and Neuroscience, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
8
|
Predictors of trajectories of obsessive-compulsive symptoms during the COVID-19 pandemic in the general population in Germany. Transl Psychiatry 2021; 11:323. [PMID: 34045444 PMCID: PMC8155650 DOI: 10.1038/s41398-021-01419-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 03/19/2021] [Accepted: 03/31/2021] [Indexed: 02/04/2023] Open
Abstract
The COVID-19 pandemic has been associated with an increase in obsessive-compulsive disorder/symptoms (OCD/OCS). However, knowledge is limited regarding the trajectories of OCS during the pandemic, as well as their predictors and mechanisms (e.g., experiential avoidance, EA). The aim of this study was to describe the trajectories of OCS and the identification of associated factors. We assessed 1207 participants of the general population in March 2020 (t1) and June 2020 (t2). Pre-pandemic data was available from March 2014 for a subsample (n = 519). To define trajectories, we determined OCS status (OCS+/-). We performed a hierarchical multinomial logistic regression to investigate predictors of trajectories. Between t1 and t2, 66% of participants had an asymptomatic trajectory (OCS-/OCS-); 18% had a continuously symptomatic trajectory (OCS+/OCS+). Ten percent had a delayed-onset trajectory (OCS-/OCS+), and the recovery trajectory group (OCS+/OCS-) was the smallest group (6%). Higher education reduced the odds of an OCS+/OCS- trajectory. OCS in 2014 was associated with increased odds of showing an OCS+/OCS+ or OCS-/OCS+ trajectory. When EA at t1 and change in EA from t1 to t2 were added to the model, higher EA at t1 was associated with increased odds of scoring above the cut score on one or more of the assessments. A higher decrease in EA from t1 to t2 reduced the probability of showing an OCS+/OCS+ and an OCS-/OCS+ trajectory. While the current data supports a slight increase in OCS during the pandemic, trajectories differed, and EA seems to represent an important predictor for an unfavorable development.
Collapse
|
9
|
Popa CO, Predatu R, Lee WC, Blaga P, Sirbu E, Rus AV, Clark A, Cojocaru C, Schenk A, Vacaras V, Szasz S, Muresan S, Bredicean C. Thought Suppression in Primary Psychotic Disorders and Substance/Medication Induced Psychotic Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:ijerph18010116. [PMID: 33375300 PMCID: PMC7795668 DOI: 10.3390/ijerph18010116] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/22/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022]
Abstract
Introduction: First episode-psychosis (FEP) represents a stressful/traumatic event for patients. To our knowledge, no study to date has investigated thought suppression involved in FEP in a Romanian population. Our objective was to investigate thought suppression occurring during FEP within primary psychotic disorders (PPD) and substance/medication induced psychotic disorders (SMIPD). Further, we examined the relationship between thought suppression and negative automatic thoughts within PPD and SMIPD. Methods: The study included 30 participants (17 females) with PPD and 25 participants (10 females) with SMIPD. Psychological scales were administered to assess psychotic symptoms and negative automatic thoughts, along a psychiatric clinical interview and a biochemical drug test. Results: Participants in the PPD group reported higher thought suppression compared to SMIPD group. For the PPD group, results showed a positive correlation between thought suppression and automatic thoughts. For the SMIPD group, results also showed a positive correlation between thought suppression and automatic thoughts. Conclusions: Patients with PPD rely more on thought suppression, as opposed to SMIPD patients. Thought suppression may be viewed as an unhealthy reaction to FEP, which is associated with the experience of negative automatic thoughts and might be especially problematic in patients with PPD. Cognitive behavioral therapy is recommended to decrease thought suppression and improve patients’ functioning.
Collapse
Affiliation(s)
- Cosmin O. Popa
- Department of Ethics and Social Sciences, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania;
| | - Razvan Predatu
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania;
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, 400015 Cluj-Napoca, Romania
- Correspondence: (R.P.); (S.M.)
| | - Wesley C. Lee
- Department of Social and Behavioral Sciences, Southwestern Christian University, Bethany, OK 73008, USA; (W.C.L.); (A.V.R.)
| | - Petronela Blaga
- International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania;
- Doctoral School “Evidence-based Assessment and Psychological Interventions”, Babeș-Bolyai University, 400015 Cluj-Napoca, Romania
| | - Eliza Sirbu
- Doctoral School of George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania; (E.S.); (C.C.); (A.S.)
| | - Adrian V. Rus
- Department of Social and Behavioral Sciences, Southwestern Christian University, Bethany, OK 73008, USA; (W.C.L.); (A.V.R.)
| | - Alexander Clark
- College of Education and Professional Studies, University of Central Oklahoma, Edmond, OK 73034, USA;
| | - Cristiana Cojocaru
- Doctoral School of George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania; (E.S.); (C.C.); (A.S.)
| | - Alina Schenk
- Doctoral School of George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania; (E.S.); (C.C.); (A.S.)
| | - Vitalie Vacaras
- Neurology Department, Cluj Emergency County Hospital, 400006 Cluj-Napoca, Romania;
| | - Simona Szasz
- Department of Rheumatology, Physical and Rehabilitation Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania;
| | - Simona Muresan
- Department of Internal Medicine, George Emil Palade University of Medicine, Pharmacy, Sciences and Technology, 540142 Tirgu-Mures, Romania
- Correspondence: (R.P.); (S.M.)
| | - Cristina Bredicean
- Department of Neuroscience, Victor Babeș University of Medicine and Pharmacy, 300041 Timișoara, Romania;
| |
Collapse
|
10
|
Piotrowski P, Rymaszewska J, Stańczykiewicz B, Małecka M, Kotowicz K, Samochowiec J, Samochowiec A, Plichta P, Kalinowska S, Misiak B. Stress coping strategies and their clinical correlates in patients with psychosis at various stages of illness: A case-control study. Early Interv Psychiatry 2020; 14:559-567. [PMID: 31625284 DOI: 10.1111/eip.12880] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/13/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022]
Abstract
AIMS There is evidence that individuals with psychosis adopt inefficient coping styles. Moreover, it has been hypothesized that inefficient coping styles might serve as trait-dependent characteristics of psychosis. Therefore, we aimed to explore coping styles and their clinical correlates at various stages of psychosis. METHODS We recruited 37 individuals at familial high risk of psychosis (FHR-P), 42 individuals with first-episode psychosis (FEP), 28 acutely relapsed schizophrenia (SCZ-AR) subjects and 40 healthy controls. Coping strategies were assessed using the Coping Inventory for Stressful Situations. RESULTS Individuals with FEP were less likely to use task-focused coping, while SCZ-AR subjects preferred using distraction when compared to controls. Both groups of participants did not differ significantly in terms of using specific coping styles. No significant differences in the use of various coping strategies between FHR-P individuals and controls were found. Higher odds of using emotion-focused coping and distraction were associated with more severe depressive symptoms in individuals with psychosis. Moreover, higher frequency of using distraction was associated with worse functioning in individuals with psychosis. However, this association appeared to be insignificant after adjustment for multiple testing. CONCLUSIONS Coping styles are similar in FEP and SCZ-AR subjects. However, decreased use of task-focused coping is more specific for FEP individuals while a preference of distraction might be more typical for SCZ-AR individuals. The use of various coping styles is similar in FHR-P individuals and controls. Preference of distraction and emotion-focused coping might be related to more severe depressive symptoms and poor functioning in individuals with psychosis.
Collapse
Affiliation(s)
- Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | | | | | - Monika Małecka
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Agnieszka Samochowiec
- Department of Clinical Psychology, Institute of Psychology, University of Szczecin, Szczecin, Poland
| | - Piotr Plichta
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Sylwia Kalinowska
- Department of Psychiatry, Pomeranian Medical University, Szczecin, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Wroclaw, Poland
| |
Collapse
|
11
|
Piotrowski P, Frydecka D, Kotowicz K, Stańczykiewicz B, Samochowiec J, Szczygieł K, Misiak B. A history of childhood trauma and allostatic load in patients with psychotic disorders with respect to stress coping strategies. Psychoneuroendocrinology 2020; 115:104645. [PMID: 32171901 DOI: 10.1016/j.psyneuen.2020.104645] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 03/03/2020] [Accepted: 03/03/2020] [Indexed: 12/14/2022]
Abstract
Elevated allostatic load (AL) index, which is a cumulative measure of biological dysregulations associated with stress exposure, has been demonstrated in patients with psychosis. However, it remains unknown whether a history of childhood trauma (CT) might contribute to elevated AL index in psychosis. Therefore, we aimed to investigate the association between AL index, a history of CT and coping styles in patients with psychotic disorders. Participants were 65 patients with schizophrenia-spectrum disorders and 56 healthy controls (HCs). The AL index was computed based on percentile distributions of 15 biomarkers in HCs. The AL index was significantly higher in patients with psychosis. A history of parental antipathy was associated with elevated AL index in both groups of participants. A history of any categories of CT and sexual abuse were associated with higher AL index only in patients with psychosis. Social diversion (seeking social interactions in case of stressful experiences) mediated the association between sexual abuse and the AL index in the group of patients. There was a significant direct effect of sexual abuse on the AL index (this specific CT was associated with higher AL index). However, indirect effect of sexual trauma on AL through social diversion was opposite to direct effect. Childhood adversities, especially sexual abuse and parental antipathy, might contribute to elevated AL index in patients with psychosis. The effect of sexual abuse on the AL index might be specific to psychosis. Engagement in social interactions in case of stressful situations might alleviate biological dysregulations associated with CT.
Collapse
Affiliation(s)
- Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Bartłomiej Stańczykiewicz
- Department of Nervous System Diseases, Wroclaw Medical University, Bartla 5 Street, 51-618 Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Krzysztof Szczygieł
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Vallath S, Ravikanth L, Regeer B, Borba PC, Henderson DC, Scholte WF. Traumatic loss and psychosis - reconceptualising the role of trauma in psychosis. Eur J Psychotraumatol 2020; 11:1725322. [PMID: 32341762 PMCID: PMC7170325 DOI: 10.1080/20008198.2020.1725322] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 01/10/2020] [Accepted: 01/14/2020] [Indexed: 02/05/2023] Open
Abstract
Literature suggests that the occurrence of psychological trauma (PT) from various negative life experiences beyond events mentioned in the DSM-criterion A, receives little to no attention when comorbid with psychosis. In fact, despite research indicating the intricate interplay between PT and psychosis, and the need for trauma-focused interventions (TFI), there continue to be mixed views on whether treating PT would worsen psychosis, with many practitioners hesitating to initiate treatment for this reason. This study, therefore, aimed to understand patient perspectives on the role of PT in psychosis and related treatment options. A qualitative exploratory approach was adopted using in-depth interviews with individuals experiencing psychosis. The Global Assessment of Functioning (GAF) scale was administered on a predetermined maximum variation sample resulting in two groups of participants- those with moderate-mild disability (GAF 54-80; n = 10) and those experiencing moderate-severe disability (GAF 41-57; n = 10). With the former group, a semi-structured interview schedule was used, while with the latter, owing to multiple symptoms and difficulty in cognitive processing, a structured interview schedule was used. Results from interpretative phenomenological analysis (IPA) indicated that traumatic loss was central to experienced PT, but received no attention; this often contributed to the psychotic experience and/or depression, through maintenance factors such as cognitive distortions and attenuated affective responses. Further, the experience of loss seems to be more consequential to trauma-related symptoms than the event itself. Participants opined strongly the need for TFI and the role of it in promoting recovery from psychosis.
Collapse
Affiliation(s)
- S. Vallath
- Department of Psychology, The Banyan, Chennai, India
- The Banyan Academy of Leadership in Mental Health (BALM), Centre for Social Action and Research, Kanchipuram, India
- Faculty of Science, Athena Institute for Research on Innovation and Communication in the Health & Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - L. Ravikanth
- The Banyan Academy of Leadership in Mental Health (BALM), Centre for Social Action and Research, Kanchipuram, India
| | - B. Regeer
- Faculty of Science, Athena Institute for Research on Innovation and Communication in the Health & Life Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - P. C. Borba
- Department of Psychiatry, Boston School of Medicine, MA, USA
| | - D. C. Henderson
- Department of Psychiatry, Boston School of Medicine, MA, USA
| | - W. F. Scholte
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- ARQ National Psychotrauma Centre, Diemen, Netherlands
| |
Collapse
|
14
|
Emotion regulation as a moderator of the interplay between self-reported and physiological stress and paranoia. Eur Psychiatry 2020; 49:43-49. [DOI: 10.1016/j.eurpsy.2017.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 11/24/2017] [Accepted: 12/05/2017] [Indexed: 11/22/2022] Open
Abstract
AbstractExperience sampling method (ESM) studies have found an association between daily stress and paranoid symptoms, but it is uncertain whether these findings generalize to physiological indicators of stress. Moreover, the temporality of the association and its moderating factors require further research. Here, we investigate whether physiological and self-rated daily stress predict subsequent paranoid symptoms and analyze the role of emotion regulation as a putative moderator. We applied ESM during 24 h to repeatedly assess heart rate, self-rated stress, and subclinical paranoia in a sample of 67 psychosis-prone individuals as measured with Community Assessment for Psychotic Experiences (CAPE). Adaptive and maladaptive emotion regulation was assessed at baseline with the Emotion Regulation Skills Questionnaire (ERSQ-ES) and the Cognitive Emotion Regulation Questionnaire (CERQ). Linear mixed models were used to analyze the data. Heart rate (b = 0.004, p < 0.05) and self-rated stress (b = 0.238, p < 0.001) predicted subsequent paranoia. The reverse effect, paranoia as a predictor of subsequent heart rate (b = 0.230, p = 0.615) or self-rated stress (b = –0.009, p = 0.751) was non-significant. Maladaptive emotion regulation was a significant predictor of paranoia (b = 0.740, p < 0.01) and moderated the path from self-rated stress to paranoia (b = 0.188, p < 0.05) but not the path from heart rate to paranoia (b = 0.005, p = 0.09). Our findings suggest a one-way temporal link between daily stress and paranoia and highlight the importance of emotion regulation as a vulnerability factor relevant to this process.
Collapse
|
15
|
Ludwig L, Werner D, Lincoln TM. The relevance of cognitive emotion regulation to psychotic symptoms – A systematic review and meta-analysis. Clin Psychol Rev 2019; 72:101746. [DOI: 10.1016/j.cpr.2019.101746] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 04/26/2019] [Accepted: 06/11/2019] [Indexed: 12/24/2022]
|
16
|
Seitz R, Vracotas N, Bechard-Evans L, King S, Abadi S, Joober R, Shah JL, Malla AK, Pruessner M. The Trier Social Stress Test in first episode psychosis patients: Impact of perceived stress, protective factors and childhood trauma. Psychoneuroendocrinology 2019; 105:155-163. [PMID: 30658856 DOI: 10.1016/j.psyneuen.2019.01.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/06/2019] [Accepted: 01/10/2019] [Indexed: 11/17/2022]
Abstract
Psychosis has been associated with abnormalities in hypothalamic-pituitary-adrenal axis functioning, which may emerge through heightened stress sensitivity following early life adversity - ultimately resulting in illness onset and progression. The present study assessed cortisol levels during an established psychosocial stress task and their association with current stress perception, putative protective factors and adverse childhood experiences in patients with a first episode of psychosis (FEP). A total of 100 volunteers participated in the study, 57 of whom were patients with a FEP (mean age 23.9 ± 3.8) and 43 healthy community controls (mean age 23.2 ± 3.9). Salivary cortisol, heart rate and blood pressure were measured at eight time points before and after the Trier Social Stress Test. Subjective stress and protective factors were assessed with the Perceived Stress Scale, the Self-Esteem Rating Scale and the Brief COPE. Early life adversity was assessed with the Childhood Trauma Questionnaire. Patients compared to controls showed significantly lower cortisol levels (F = 7.38; p = .008) throughout the afternoon testing period, but no difference in the cortisol response to the TSST. Heart rate was elevated and protective factors were lower in patients compared to controls. Attenuated cortisol levels were associated with higher levels of perceived stress, poor protective factors and more physical neglect during childhood. Our results suggest that attenuated baseline cortisol levels and not a blunted response during an acute stress task might be an indicator of heightened stress vulnerability and poor resilience in psychosis. The possible influence of childhood adversity and antipsychotic medication is discussed.
Collapse
Affiliation(s)
- Raffaela Seitz
- Department of Psychology, University of Konstanz, Konstanz, Germany
| | - Nadia Vracotas
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Laura Bechard-Evans
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Suzanne King
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, McGill University, Montreal, Quebec, Canada
| | - Sherezad Abadi
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Ridha Joober
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Jai L Shah
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Ashok K Malla
- Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada
| | - Marita Pruessner
- Department of Psychology, University of Konstanz, Konstanz, Germany; Prevention and Early Intervention Program for Psychosis, Douglas Mental Health University Institute, McGill University, Department of Psychiatry, Montreal, Quebec, Canada.
| |
Collapse
|
17
|
Perchtold CM, Weiss EM, Rominger C, Fink A, Weber H, Papousek I. Cognitive reappraisal capacity mediates the relationship between prefrontal recruitment during reappraisal of anger-eliciting events and paranoia-proneness. Brain Cogn 2019; 132:108-117. [PMID: 30980988 DOI: 10.1016/j.bandc.2019.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 03/26/2019] [Accepted: 04/02/2019] [Indexed: 01/19/2023]
Abstract
Difficulties in emotion regulation, particularly in using adaptive regulation strategies such as cognitive reappraisal, are a commonly observed correlate of paranoia. While it has been suggested that poor implementation of cognitive reappraisal in dealing with aversive events precedes the onset of subclinical paranoid thinking, there is little empirical research on neural activation patterns during cognitive reappraisal efforts that might indicate vulnerability towards paranoid thinking. Prefrontal EEG alpha asymmetry changes were recorded while n = 57 participants were generating alternative appraisals of anger-eliciting events, and were linked to a behavioral measure of basic cognitive reappraisal capacity and self-reported paranoia proneness (assessed by personality facets of hostility and suspiciousness; Personality Inventory for DSM-5). Mediation analysis revealed that less left-lateralized activation at ventrolateral prefrontal sites during reappraisal efforts predicted a higher degree of paranoia proneness. This relationship was mediated through poorer cognitive reappraisal capacity. Matching previous evidence, findings suggest that inappropriate brain activation during reappraisal efforts impairs individuals' capacity to come up with effective alternative interpretations for anger-evoking situations, which may accentuate personality features related to increased paranoid thinking. The findings add to our understanding of neurally underpinned impairments in the capacity to generate cognitive reappraisals and their link to maladaptive personality and behavior.
Collapse
Affiliation(s)
| | | | | | - Andreas Fink
- Department of Psychology, University of Graz, Austria.
| | - Hannelore Weber
- Department of Psychology, University of Greifswald, Germany.
| | - Ilona Papousek
- Department of Psychology, University of Graz, Austria. https://psychologie.uni-graz.at/en/biological-psychology/team/
| |
Collapse
|
18
|
Stramecki F, Kotowicz K, Piotrowski P, Beszłej JA, Rymaszewska J, Samochowiec J, Samochowiec A, Moustafa AA, Jabłoński M, Podwalski P, Waszczuk K, Wroński M, Misiak B. Coping styles and symptomatic manifestation of first-episode psychosis: Focus on cognitive performance. Psychiatry Res 2019; 272:246-251. [PMID: 30590279 DOI: 10.1016/j.psychres.2018.12.083] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 11/18/2018] [Accepted: 12/16/2018] [Indexed: 01/09/2023]
Abstract
Cognitive deficits are widely observed in patients with psychosis and represent one of most important determinants of functional outcomes. It has been shown that patients with psychosis prefer maladaptive coping strategies over active coping styles. However, it remains unknown whether cognitive impairments are related to coping styles in psychotic disorders. Therefore, the aim of this study was to assess whether cognitive deficits observed in patients with first-episode psychosis (FEP) might impact the use of specific coping strategies. We recruited 40 FEP patients and 35 healthy controls. In our study, FEP patients were more likely to use maladaptive coping styles after adjustment for education level and medication effects. The use of maladaptive coping strategies was associated with greater impairments of visuospatial/constructional abilities and language skills in FEP patients. In addition, lower odds of using adaptive coping were related to higher levels of depressive symptoms in the group of patients. Adaptive coping was associated with better global cognitive performance in healthy controls. Our results indicate that cognitive impairments, especially worse performance of visuospatial/constructional abilities and language skills, might be related to the preference of maladaptive coping strategies. Lower odds of using adaptive coping styles might be associated with more severe depressive symptomatology.
Collapse
Affiliation(s)
- Filip Stramecki
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Kamila Kotowicz
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Patryk Piotrowski
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Jan Aleksander Beszłej
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Joanna Rymaszewska
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367 Wroclaw, Poland
| | - Jerzy Samochowiec
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Agnieszka Samochowiec
- Institute of Psychology, Department of Clinical Psychology, University of Szczecin, Krakowska 69 Street, 71-017 Szczecin, Poland
| | - Ahmed A Moustafa
- School of Social Sciences and Psychology, Marcs Institute of Brain and Behaviour, Western Sydney University, Penrith, NSW, Australia; Department of Social Sciences, College of Arts & sciences, Qatar University, Doha, Qatar
| | - Marcin Jabłoński
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Piotr Podwalski
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Katarzyna Waszczuk
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Michał Wroński
- Department of Psychiatry, Pomeranian Medical University, Broniewskiego 26 Street, 71-460 Szczecin, Poland
| | - Błażej Misiak
- Department of Genetics, Wroclaw Medical University, Marcinkowskiego 1 Street, 50-368 Wroclaw, Poland.
| |
Collapse
|
19
|
Lincoln TM, Sundag J, Schlier B, Karow A. The Relevance of Emotion Regulation in Explaining Why Social Exclusion Triggers Paranoia in Individuals at Clinical High Risk of Psychosis. Schizophr Bull 2018; 44:757-767. [PMID: 29878274 PMCID: PMC6007363 DOI: 10.1093/schbul/sbx135] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Vulnerability-stress models postulate that social stress triggers psychotic episodes in vulnerable individuals. However, experimental evidence for the proposed causal pathway is scarce and the translating mechanisms are insufficiently understood. The study assessed the impact of social exclusion on paranoid beliefs in a quasi-experimental design and investigated the role of emotion regulation (ER) as a vulnerability indicator and emotional responses as a putative translating mechanism. METHODS Participants fulfilling criteria for clinical high risk of psychosis (CHR, n = 25), controls with anxiety disorders (AC, n = 40), and healthy controls (HC, n = 40) were assessed for dysfunctional (eg, rumination, catastrophizing, blaming) and functional ER-strategies (eg, reappraising, accepting, refocusing). They were then exposed to social exclusion during a virtual ball game (Cyberball) and assessed for changes in self-reported emotions and paranoid beliefs. RESULTS The CHR sample showed a significantly stronger increase in paranoid beliefs from before to after the social exclusion than both control groups. This was accounted for by lower levels of functional and higher levels of dysfunctional ER (compared to HC) and by a stronger increase in self-reported negative emotion in the CHR group (compared to AC and HC). CONCLUSIONS The results confirm the role of negative emotion on the pathway from social stressors to psychotic symptoms and indicate that both the use of dysfunctional ER strategies and difficulties in employing functional strategies add to explaining why people at risk of psychosis respond to a social stressor with increased paranoia.
Collapse
Affiliation(s)
- Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
- To whom correspondence should be addressed; tel: 0049-40-428385360, fax: 0049-40-428386170, e-mail:
| | - Johanna Sundag
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Anne Karow
- Department for Psychiatry and Psychotherapy, Psychosis Centre, Centre for Psychosocial Medicine, Universitätsklinik Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
20
|
Obsessive–Compulsive Disorder is Characterized by a Lack of Adaptive Coping Rather than an Excess of Maladaptive Coping. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9902-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
|
21
|
Nittel CM, Lincoln TM, Lamster F, Leube D, Rief W, Kircher T, Mehl S. Expressive suppression is associated with state paranoia in psychosis: An experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:291-312. [PMID: 29460461 DOI: 10.1111/bjc.12174] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 01/09/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Although emotional instability and problems in emotion regulation (ER) are known to be linked to the formation and maintenance of psychosis and paranoia, it remains unclear whether the use of specific ER strategies is associated with it. The first aim of the study was to explore the association between emotional instability and paranoia. The second and third aims were to investigate whether the use of maladaptive ER strategies leads to paranoia in patients with psychosis in daily life and whether the use of more adaptive ER strategies reduces paranoia. DESIGN A prospective momentary assessment study over the course of 6 days was performed. METHOD Participants with psychosis (n = 32) reported repeatedly over six consecutive days on the presence and instability of positive and negative emotions, their use of adaptive (reappraisal, acceptance, distraction, social sharing, reflection) and maladaptive ER strategies (rumination, expressive suppression) and momentary paranoia in their daily life. RESULTS Hierarchical linear regression analysis revealed that patients with psychosis who presented pronounced instability of negative emotions showed more severe levels of state paranoia. In addition, patients with psychosis who used expressive suppression when confronted with negative emotions at one point in time presented more pronounced levels of state paranoia at the following point in time. CONCLUSION The results presented here suggest that both emotional instability and the use of expressive suppression might cause state paranoia and thus add to our understanding of causal mechanisms related to paranoia such as instability of negative emotions and the use of less adaptive ER strategies. PRACTITIONER POINTS Maladaptive emotion regulation strategies and more pronounced instability of negative emotions are relevant to paranoia in patients with psychosis and should be a special focus of CBTp interventions. Future interventions designed for patients suffering from paranoia should promote coping with unstable negative emotions and replacing or reducing maladaptive emotion regulation strategies with adaptive ones.
Collapse
Affiliation(s)
- Clara Marie Nittel
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tania Marie Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany
| | - Fabian Lamster
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany.,Center for Acute Psychiatric Disorders, University Hospital of Psychiatry Zurich, Switzerland
| | - Dirk Leube
- AWO Center of Mental Health, Halle, Germany
| | - Winfried Rief
- Department of Clinical Psychology and Psychotherapy, Philipps-University of Marburg, Germany
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany
| | - Stephanie Mehl
- Department of Psychiatry and Psychotherapy, Marburg Center for Mind, Brain and Behavior, Philipps-University of Marburg, Germany.,Department of Health and Social Work, University of Applied Science, Frankfurt am Main, Germany
| |
Collapse
|
22
|
Moritz S, Mahlke CI, Westermann S, Ruppelt F, Lysaker PH, Bock T, Andreou C. Embracing Psychosis: A Cognitive Insight Intervention Improves Personal Narratives and Meaning-Making in Patients With Schizophrenia. Schizophr Bull 2018; 44:307-316. [PMID: 29106693 PMCID: PMC5814991 DOI: 10.1093/schbul/sbx072] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Schizophrenia is a complex psychiatric disorder with unknown and presumably heterogeneous etiology. While the disorder can have various outcomes, research is predominantly "deficit-oriented" emphasizing the hardship that the disorder inflicts on sufferers as well as their families and society. Beyond symptom reduction, imparting patients with hope and meaning in life is increasingly considered an important treatment target, which may raise self-esteem, and reduce self-stigma and suicidal ideation. The present study compared a psychotherapeutic treatment aimed at improving cognitive insight, individualized metacognitive intervention (MCT+), with an active control in order to elucidate if personal meaning-making and hope can be improved in patients with psychosis across time. A total of 92 patients were randomized to either individualized metacognitive therapy (MCT+) or CogPack (neuropsychological training) and followed up for up to 6 months. The "Subjective Sense in Psychosis Questionnaire" (SUSE) was administered which covers different salutogenetic vs pathogenetic views of the disorder, valence of symptom experiences and the consequences of psychosis. Patients in the MCT+ group showed a significant positive shift in attitudes towards the consequences of their illness over time relative to patients in the active control condition. There was some evidence that MCT+ also enhanced meaning-making. The perceived negative consequences of psychosis were highly correlated with depression and low self-esteem, as well as suicidality. The study shows that a cognitive insight training can improve meaning-making in patients and help them come to terms with their diagnosis.
Collapse
Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Candelaria I Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Bern, Switzerland
| | - Friederike Ruppelt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paul H Lysaker
- Department of Psychiatry, Roudebush VA Medical Center and The Indiana University School of Medicine, Indianapolis, IN
| | - Thomas Bock
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Center for Gender Research and Early Detection, University of Basel Psychiatric Clinics, Basel, Switzerland
| |
Collapse
|
23
|
Campus P, Canterini S, Orsini C, Fiorenza MT, Puglisi-Allegra S, Cabib S. Stress-Induced Reduction of Dorsal Striatal D2 Dopamine Receptors Prevents Retention of a Newly Acquired Adaptive Coping Strategy. Front Pharmacol 2017; 8:621. [PMID: 28955227 PMCID: PMC5601053 DOI: 10.3389/fphar.2017.00621] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/24/2017] [Indexed: 11/14/2022] Open
Abstract
The inability to learn an adaptive coping strategy in a novel stressful condition leads to dysfunctional stress coping, a marker of mental disturbances. This study tested the involvement of dorsal striatal dopamine receptors in the dysfunctional coping with the Forced Swim test fostered by a previous experience of reduced food availability. Adult male mice were submitted to a temporary (12 days) reduction of food availability [food-restricted (FR)] or continuously free-fed (FF). Different groups of FF and FR mice were used to evaluate: (1) dorsal striatal mRNA levels of the two isoforms of the dopamine D2 receptor (D2S, D2L). (2) Forced Swim-induced c-fos expression in the dorsal striatum; (3) acquisition and 24 h retention of passive coping with Forced Swim. Additional groups of FF mice were tested for 24 h retention of passive coping acquired during a first experience with Forced Swim immediately followed by intra-striatal infusion of vehicle or two doses of the dopamine D2/D3 receptors antagonist sulpiride or the D1/D5 receptors antagonist SCH23390. Previous restricted feeding selectively reduced mRNA levels of both D2 isoforms and abolished Forced Swim-induced c-fos expression in the left Dorsolateral Striatum and selectively prevented 24 h retention of the coping strategy acquired in a first experience of Forced Swim. Finally, temporary blockade of left Dorsolateral Striatum D2/D3 receptors immediately following the first Forced Swim experience selectively reproduced the behavioral effect of restricted feeding in FF mice. In conclusion, the present results demonstrate that mice previously exposed to a temporary reduction of food availability show low striatal D2 receptors, a known marker of addiction-associated aberrant neuroplasticity, as well as liability to relapse into maladaptive stress coping strategies. Moreover, they offer strong support to a causal relationship between reduction of D2 receptors in the left Dorsolateral Striatum and impaired consolidation of newly acquired adaptive coping.
Collapse
Affiliation(s)
- Paolo Campus
- Department of Psychology, Center 'Daniel Bovet', Sapienza Università di RomaRome, Italy.,Department of Psychiatry, University of Michigan, Ann ArborMI, United States
| | - Sonia Canterini
- Department of Psychology, Center 'Daniel Bovet', Sapienza Università di RomaRome, Italy
| | - Cristina Orsini
- Department of Psychology, Center 'Daniel Bovet', Sapienza Università di RomaRome, Italy.,Fondazione Santa Lucia (IRCCS)Rome, Italy
| | - Maria Teresa Fiorenza
- Department of Psychology, Center 'Daniel Bovet', Sapienza Università di RomaRome, Italy.,Fondazione Santa Lucia (IRCCS)Rome, Italy
| | - Stefano Puglisi-Allegra
- Department of Psychology, Center 'Daniel Bovet', Sapienza Università di RomaRome, Italy.,Fondazione Santa Lucia (IRCCS)Rome, Italy
| | - Simona Cabib
- Department of Psychology, Center 'Daniel Bovet', Sapienza Università di RomaRome, Italy.,Fondazione Santa Lucia (IRCCS)Rome, Italy
| |
Collapse
|