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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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Raffard S, de Connor A, Freeman D, Bortolon C. [Recent developments in the modeling and psychological management of persecutory ideation]. L'ENCEPHALE 2024; 50:99-107. [PMID: 37748987 DOI: 10.1016/j.encep.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/05/2023] [Accepted: 08/05/2023] [Indexed: 09/27/2023]
Abstract
Persecutory ideas are a major clinical problem and are associated with impaired functioning, reduced compliance with medication and increased risk of hospitalization. Persecutory ideation is defined as the false conviction that others are threatening or conspiring against one. Although persecutory delusions are mainly described and experienced in schizophrenia spectrum disorders, they also occur in other neurological and psychiatric diagnoses including Alzheimer disease, epilepsy, depression, mania, dementia and post-traumatic stress disorder. Moreover, epidemiological data from general and clinical populations indicated that paranoid beliefs occur on a hierarchy of severity and are present to a lesser degree in the general population, with paranoid delusions representing the severe end of a continuum. In this review we focus on the important advances following a decade of research from psychological sciences, and more particularly the work of Daniel Freeman and Philippa Garety in England. Their work has demonstrated that a range of causal factors are involved in the development and maintenance of delusions beyond the traditional cognitive and behavioural models. Indeed, there is now well-validated evidence that sleep disturbances, worry proneness, reasoning biases, such as failure to consider alternative explanations or belief confirmation bias, abnormal experiences such as hallucinations, negative self-beliefs, and safety behaviours, are central factors that contribute to the paranoid phenomenon. In this review, we describe each of these causal factors in detail as well as the clinical interventions developed by Freeman and his collaborators, including the integrative and modular "Feeling Safe" intervention. Broadly speaking, the aim of this psychological intervention is for patients to relearn safety by exposing them to situations they consider as potentially dangerous after reduction of the influence of the maintenance factors described above. A recent publication showed that the Feeling Safe program led to recovery in persecutory delusions for 50% of patients having poor response to antipsychotic medication, making the intervention as the most effective psychological treatment for persecutory delusions. Finally, we will critically discuss the efficacy data from the numerous clinical studies validating its effectiveness. Prospects for the implementation of the Feeling Safe program in France also is discussed.
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Affiliation(s)
- Stéphane Raffard
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France; Laboratoire Epsylon, EA 4556, université Paul-Valéry-Montpellier, 3, route de Mende, 34199 Montpellier cedex 5, France.
| | - Alexandre de Connor
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, Royaume-Uni; Oxford Health NHS Foundation Trust, Oxford, Royaume-Uni; NIHR Oxford Health Biomedical Research Centre, Oxford, Royaume-Uni
| | - Catherine Bortolon
- Départment de psychologie, université de Grenoble-Alpes, université Savoie-Mont-Blanc, LIP/PC2S, Grenoble, France; Département de psychologie, institut universitaire de France, Paris, France
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Clemmensen L, Lund CN, Andresen BS, Midtgaard J, Glenthøj LB. Study protocol for RUFUS-A randomized mixed methods pilot clinical trial investigating the relevance and feasibility of rumination-focused cognitive behavioral therapy in the treatment of patients with emergent psychosis spectrum disorders. PLoS One 2024; 19:e0297118. [PMID: 38271383 PMCID: PMC10810475 DOI: 10.1371/journal.pone.0297118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 12/17/2023] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION Psychosis spectrum disorders are characterized by both positive and negative symptoms, but whereas there is good effect of treatment on positive symptoms, there is still a scarcity of effective interventions aimed at reducing negative symptoms. Rumination has been proposed as an important and fundamental factor in the development and maintenance of symptoms across psychiatric diagnoses, and there is a need to develop effective interventions targeting rumination behaviors and negative symptoms in patients with psychotic disorders. The aim of the current study is to investigate the feasibility and acceptability of group rumination-focused cognitive behavioral therapy (RFCBT) in the treatment of young people with psychosis spectrum disorders as well as investigating potential indications of treatment efficacy. METHODS AND ANALYSIS The study is a mixed-method clinical randomized controlled pilot trial with a target sample of 60 patients, who are randomized to either receive 13 weeks of group RFCBT or 13 weeks of treatment as usual (TAU). All patients are examined at the start of the project and at the 13-week follow-up. We will compare changes in outcomes from baseline to posttreatment between group RFCBT and TAU. In addition, qualitative analyzes are carried out to explore feasibility and acceptability and to uncover the patients' experience of receiving the intervention.
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Affiliation(s)
- Lars Clemmensen
- VIRTU Research Group, Copenhagen Research Center on Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Julie Midtgaard
- Center for Applied Research in Mental Health Care (CARMEN), Mental Health Center Glostrup, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Louise Birkedal Glenthøj
- VIRTU Research Group, Copenhagen Research Center on Mental Health (CORE), Copenhagen University Hospital, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
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Dewa LH, Thibaut B, Pattison N, Campbell SJ, Woodcock T, Aylin P, Archer S. Treating insomnia in people who are incarcerated: a feasibility study of a multicomponent treatment pathway. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2024; 5:zpae003. [PMID: 38370440 PMCID: PMC10873789 DOI: 10.1093/sleepadvances/zpae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/11/2023] [Indexed: 02/20/2024]
Abstract
Around 60% of people who are incarcerated have insomnia; 6-10 times more prevalent than the general population. Yet, there is no standardized, evidence-based approach to insomnia treatment in prison. We assessed the feasibility of a treatment pathway for insomnia in a high-secure prison to inform a future randomized controlled trial (RCT) and initial efficacy data for sleep and mental health outcomes. We used a within-participants pre-post design. The stepped-care pathway included: self-management with peer support, environmental aids, and cognitive behavioral therapy for insomnia (CBTi). Assessment measures for insomnia, well-being, mood, anxiety, suicidality, overall health, sleepiness, fatigue, and cognitive functioning were administered at baseline and pathway exit. Feasibility criteria included eligibility to participate, CBTi uptake, and assessment completion. Forty-two adult males who are incarcerated were approached of which 95.2% were eligible. Of those deemed eligible, most participated (36/40, 90.0%). Most who completed baseline completed post-assessments (28/36, 77.8%) and of these, most showed improvements in their subjective sleep (27/28, 96.4%). Large reductions were found from pre- to posttreatment in insomnia severity (d = -1.81, 95% CI: 8.3 to 12.9) and 57.0% reported no clinically significant insomnia symptoms at post-assessment. There was no overall change in actigraphy-measured sleep. Large treatment benefits were found for depression, anxiety, well-being, and cognitive functioning, with a medium benefit on suicidal ideation. The treatment pathway for insomnia in prison was feasible and may be an effective treatment for insomnia in people who are incarcerated, with additional promising benefits for mental health. A pragmatic RCT across different prison populations is warranted. This paper is part of the Sleep and Circadian Health in the Justice System Collection.
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Affiliation(s)
- Lindsay H Dewa
- Imperial College London, School of Public Health, London, UK
| | - Bethan Thibaut
- Imperial College London, School of Public Health, London, UK
| | | | | | - Thomas Woodcock
- Imperial College London, School of Public Health, London, UK
| | - Paul Aylin
- Imperial College London, School of Public Health, London, UK
| | - Stephanie Archer
- University of Cambridge, Department of Public Health and Primary Care, UK
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Moffa G, Kuipers J, Kuipers E, McManus S, Bebbington P. Sexual abuse and psychotic phenomena: a directed acyclic graph analysis of affective symptoms using English national psychiatric survey data. Psychol Med 2023; 53:7817-7826. [PMID: 37485689 PMCID: PMC10755243 DOI: 10.1017/s003329172300185x] [Citation(s) in RCA: 1] [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] [Received: 11/23/2022] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Sexual abuse and bullying are associated with poor mental health in adulthood. We previously established a clear relationship between bullying and symptoms of psychosis. Similarly, we would expect sexual abuse to be linked to the emergence of psychotic symptoms, through effects on negative affect. METHOD We analysed English data from the Adult Psychiatric Morbidity Surveys, carried out in 2007 (N = 5954) and 2014 (N = 5946), based on representative national samples living in private households. We used probabilistic graphical models represented by directed acyclic graphs (DAGs). We obtained measures of persecutory ideation and auditory hallucinosis from the Psychosis Screening Questionnaire, and identified affective symptoms using the Clinical Interview Schedule. We included cannabis consumption and sex as they may determine the relationship between symptoms. We constrained incoming edges to sexual abuse and bullying to respect temporality. RESULTS In the DAG analyses, contrary to our expectations, paranoia appeared early in the cascade of relationships, close to the abuse variables, and generally lying upstream of affective symptoms. Paranoia was consistently directly antecedent to hallucinations, but also indirectly so, via non-psychotic symptoms. Hallucinosis was also the endpoint of pathways involving non-psychotic symptoms. CONCLUSIONS Via worry, sexual abuse and bullying appear to drive a range of affective symptoms, and in some people, these may encourage the emergence of hallucinations. The link between adverse experiences and paranoia is much more direct. These findings have implications for managing distressing outcomes. In particular, worry may be a salient target for intervention in psychosis.
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Affiliation(s)
- Giusi Moffa
- University of Basel, Basel, Switzerland
- University College London, London, UK
| | - Jack Kuipers
- Department of Biosystems Science and Engineering, Eidgenossische Technische Hochschule Zurich, Basel, Switzerland
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Lüdtke T, Hedelt KS, Westermann S. Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies. J Behav Ther Exp Psychiatry 2023; 81:101885. [PMID: 37354896 DOI: 10.1016/j.jbtep.2023.101885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d). METHODS We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994. RESULTS Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data. LIMITATIONS The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations. CONCLUSIONS Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany.
| | | | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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Tolmeijer E, Waite F, Isham L, Bringmann L, Timmers R, van den Berg A, Schuurmans H, Staring ABP, de Bont P, van Grunsven R, Stulp G, Wijnen B, van der Gaag M, Freeman D, van den Berg D. Testing the combination of Feeling Safe and peer counselling against formulation-based cognitive behaviour therapy to promote psychological wellbeing in people with persecutory delusions: study protocol for a randomized controlled trial (the Feeling Safe-NL Trial). Trials 2023; 24:644. [PMID: 37798792 PMCID: PMC10557156 DOI: 10.1186/s13063-023-07661-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Persecutory delusions are strong threat beliefs about others' negative intentions. They can have a major impact on patients' day-to-day life. The Feeling Safe Programme is a new translational cognitive-behaviour therapy that helps patients modify threat beliefs and relearn safety by targeting key psychological causal factors. A different intervention approach, with growing international interest, is peer counselling to facilitate personal recovery. Combining these two approaches is a potential avenue to maximize patient outcomes. This combination of two different treatments will be tested as the Feeling Safe-NL Programme, which aims to promote psychological wellbeing. We will test whether Feeling Safe-NL is more effective and more cost-effective in improving mental wellbeing and reducing persecutory delusions than the current guideline intervention of formulation-based CBT for psychosis (CBTp). METHODS A single-blind parallel-group randomized controlled trial for 190 out-patients who experience persecutory delusions and low mental wellbeing. Patients will be randomized (1:1) to Feeling Safe-NL (Feeling Safe and peer counselling) or to formulation-based CBTp, both provided over a period of 6 months. Participants in both conditions are offered the possibility to self-monitor their recovery process. Blinded assessments will be conducted at 0, 6 (post-treatment), 12, and 18 months. The primary outcome is mental wellbeing. The overall effect over time (baseline to 18-month follow-up) and the effects at each timepoint will be determined. Secondary outcomes include the severity of the persecutory delusion, general paranoid ideation, patient-chosen therapy outcomes, and activity. Service use data and quality of life data will be collected for the health-economic evaluation. DISCUSSION The Feeling Safe-NL Trial is the first to evaluate a treatment for people with persecutory delusions, while using mental wellbeing as the primary outcome. It will also provide the first evaluation of the combination of a peer counselling intervention and a CBT-based program for recovery from persecutory delusions. TRIAL REGISTRATION Current Controlled Trials ISRCTN25766661 (retrospectively registered 7 July 2022).
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Affiliation(s)
- Eva Tolmeijer
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands.
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.
| | - Felicity Waite
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Isham
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Laura Bringmann
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Robin Timmers
- Voice-Hearing Support and Recovery-Team, RIBW Nijmegen and Rivierenland, Nijmegen, The Netherlands
- University of Applied Sciences Nijmegen, Nijmegen, The Netherlands
| | - Arjan van den Berg
- Department of Health, Wellbeing and Sport, Zadkine College Rotterdam, Rotterdam, The Netherlands
| | | | - Anton B P Staring
- ABC Department for First Episode Psychosis, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Paul de Bont
- Mental Health Organizations Oost Brabant, Boekel, The Netherlands
| | - Rob van Grunsven
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Gert Stulp
- Department of Sociology, University of Groningen, Groningen, The Netherlands
| | - Ben Wijnen
- Centre of Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Isham L, Loe BS, Hicks A, Wilson N, Bentall RP, Freeman D. The Difficulties of Grandiose Delusions: Harms, Challenges, and Implications for Treatment Engagement. Schizophr Bull 2023; 49:1194-1204. [PMID: 36916279 PMCID: PMC10483449 DOI: 10.1093/schbul/sbad016] [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] [Indexed: 03/16/2023]
Abstract
BACKGROUND AND HYPOTHESIS Grandiose delusions may entail difficult responsibilities and detrimental actions for patients. Recognition of these consequences by patients may provide an avenue for engagement in treatment. Furthermore, when patients carry out actions within the delusional system ("immersion behaviors") or spend considerable time thinking about their grandiose beliefs this may contribute to the persistence of the grandiosity and further harmful consequences. We, therefore, investigated grandiose-related subjective harm, immersion behaviors, and perseverative thinking. STUDY DESIGN A cross-sectional study with 798 patients with psychosis (375 of whom had grandiose delusions) and 4518 nonclinical adults. Factor analyses using data from participants scoring highly on grandiosity were used to form 3 scales: subjective harm from exceptional experiences questionnaire; immersion behaviors questionnaire; and thinking about exceptional experiences questionnaire. Associations with grandiosity were tested using structural equation modeling. STUDY RESULTS A total of 268 (77.9%) patients with grandiose delusions identified grandiose-related harms in the past 6 months and 199 (55.1%) wanted help. Immersion behaviors and perseverative thinking were highly prevalent, and explained 39.5% and 20.4% of the variance in grandiosity, respectively. Immersion behaviors and perseverative thinking were significantly associated with subjective harm, even when severity of grandiosity was controlled. Requests for help were associated with higher levels of subjective harm, use of immersion behaviors, and perseverative thinking but not severity of grandiosity. CONCLUSIONS Acting on grandiose delusions, including harmful behaviors and excessive thinking about grandiose delusions, may be routes for clinicians to engage patients in treatment. This could be a starting point for targeted psychological interventions for grandiose delusions.
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Affiliation(s)
- Louise Isham
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Bao Sheng Loe
- The Psychometrics Centre, Cambridge Judge Business School, University of Cambridge, Cambridge, UK
| | - Alice Hicks
- Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Psychiatry, University of Oxford, UK
- The McPin Foundation, London, UK
| | - Natalie Wilson
- Patient Advisory Group, Oxford Cognitive Approaches to Psychosis (O-CAP), Department of Psychiatry, University of Oxford, UK
- The McPin Foundation, London, UK
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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Brown P, Crabtree A. Worry Intervention in an Older Adult With a Persecutory Delusion: A Single Case Experimental Design. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e11173. [PMID: 38356897 PMCID: PMC10863639 DOI: 10.32872/cpe.11173] [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: 01/21/2023] [Accepted: 07/01/2023] [Indexed: 02/16/2024] Open
Abstract
Background This report presents the single case of Jack, a 67-year-old referred to our Older Adult Community Mental Health Team (OA CMHT) for his distressing persecutory delusion and high levels of worry. Jack also reported learning difficulties and autistic traits, although neither were formally diagnosed. Method Ten sessions of worry intervention taken from The Feeling Safe Programme worry module were used to reduce Jack's time spent worrying and increase his engagement in meaningful activity. Weekly face-to-face sessions were held, with Jack's brother acting as a co-therapist. Adaptations to the intervention were made based on Jack's learning preferences. An AB single case experimental design was adopted to compare Jack's scores on measures of worry, paranoia and delusional conviction, and wellbeing and daily functioning before and after intervention. Results Results demonstrate the worry intervention improved Jack's scores on all measures to a clinically significant degree. Conclusions This is the first known report of applying the worry intervention to an older adult. The results show the intervention can be of considerable benefit in terms of reducing worry and paranoia, in the context of both older age and suspected neurodiversity.
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Affiliation(s)
- Poppy Brown
- Oxford Institute for Clinical Psychology Training and Research, Oxford Health NHS Foundation trust and University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Anna Crabtree
- Royal Holloway University of London, Egham Hill, Egham, United Kingdom
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Foley JA, Chen C, Paget A, Cipolotti L. A Bayesian predictive processing account of Othello syndrome in Parkinson's disease. Cogn Neuropsychiatry 2023; 28:269-284. [PMID: 37366042 DOI: 10.1080/13546805.2023.2229080] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 03/24/2023] [Indexed: 06/28/2023]
Abstract
Introduction: Although delusions in Parkinson's disease (PD) are rare, when they occur they frequently take the form of "Othello syndrome": the irrational belief that a spouse or partner is being unfaithful. Hitherto dismissed as either a by-product of dopamine therapy or cognitive impairment, there are still no convincing theoretical accounts to explain why only some patients fall prey to this delusion, or why it persists despite clear disconfirmatory evidence.Methods: We discuss the limitations of existing explanations of this delusion, namely hyperdopaminergia-induced anomalous perceptual experiences and cognitive impairment, before describing how Bayesian predictive processing accounts can provide a more comprehensive explanation by foregrounding the importance of prior experience and its impact upon computation of probability. We illustrate this new conceptualisation with three case vignettes.Results: We suggest that in those with prior experience of romantic betrayal, hyperdominergic-induced aberrant prediction errors enable anomalous perceptual experiences to accrue greater prominence, which is then maintained through Bayes-optimal inferencing to confirm cognitive distortions, eliciting and shaping this dangerous delusion.Conclusions: We propose the first comprehensive mechanistic account of Othello syndrome in PD and discuss implications for clinical interventions.
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Affiliation(s)
- Jennifer A Foley
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Cliff Chen
- Department of Clinical Neuropsychology, Salford Royal NHS Foundation Trust, Salford, UK
| | - Andrew Paget
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Lisa Cipolotti
- Department of Neuropsychology, National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
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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.
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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, 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
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Strakeljahn F, Lincoln TM, Hennig T, Schlier B. The use of adaptive emotion regulation strategies in people with attenuated psychotic symptoms - Results from a two-week diary study. Schizophr Res 2023; 255:233-238. [PMID: 37028204 DOI: 10.1016/j.schres.2023.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 02/17/2023] [Accepted: 03/18/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Prior research has shown that negative emotion constitutes a trigger for psychosis. This effect is further amplified by using maladaptive emotion regulation strategies. In contrast, the role of adaptive emotion regulation strategies is less clear despite its potential for informing interventions and prevention efforts. In this study, we investigated whether the decreased use of adaptive emotion regulation strategies in daily life is associated with an elevated risk of psychosis. METHODS Participants reporting a lifetime prevalence of attenuated psychotic symptoms (AS; n = 43) and comparison participants without attenuated psychotic symptoms (n = 40) completed a 14-day diary study with one daily assessment of adaptive emotion regulation (ER) strategies ranging from tolerance-based ER-strategies (e.g., understanding, constructively directing attention) to change-focused ER-strategies (e.g., modification, effective self-support). We tested for group differences in adaptive ER-strategies use with multilevel models. RESULTS AS used multiple tolerance-based adaptive ER-strategies (acceptance, understanding, clarity, directing attention) less frequently in daily life. However, only a single change-focused adaptive ER-strategy (modification) showed consistently lower utilization rates in AS. CONCLUSION People with an elevated risk of psychosis use various adaptive ER-strategies focusing on comprehending and accepting negative emotions less frequently. Fostering these strategies with targeted interventions could promote resilience against transitioning into psychosis.
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Affiliation(s)
- Felix Strakeljahn
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany.
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
| | - Timo Hennig
- Inclusive Education, Faculty of Human Sciences, Universität Potsdam, Karl-Liebknecht-Straße 24-25, 14476 Potsdam, Germany
| | - Björn Schlier
- Clinical Psychology and Psychotherapy, Institute of Psychology, Faculty of Psychology and Movement Sciences, Universität Hamburg, Von-Melle-Park 5, 20146 Hamburg, Germany
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13
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Kingston JL, Schlier B, Ellett L, So SH, Gaudiano BA, Morris EMJ, Lincoln TM. The Pandemic Paranoia Scale (PPS): factor structure and measurement invariance across languages. Psychol Med 2023; 53:2652-2661. [PMID: 34879896 PMCID: PMC8712962 DOI: 10.1017/s0033291721004633] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 10/21/2021] [Accepted: 10/25/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Globally, the corona virus disease 2019 (COVID-19) pandemic has created an interpersonally threatening context within which other people have become a source of possible threat. This study reports on the development and validation of a self-report measure of pandemic paranoia; that is, heightened levels of suspicion and mistrust towards others due to the COVID-19 pandemic. METHODS An international consortium developed an initial set of 28 items for the Pandemic Paranoia Scale (PPS), which were completed by participants from the UK (n = 512), USA (n = 535), Germany (n = 516), Hong Kong (n = 454) and Australia (n = 502) using stratified quota sampling (for age, sex and educational attainment) through Qualtrics and translated for Germany and Hong Kong. RESULTS Exploratory factor analysis in the UK sample suggested a 25-item, three-factor solution (persecutory threat; paranoid conspiracy and interpersonal mistrust). Confirmatory factor analysis (CFA) on the remaining combined sample showed sufficient model fit in this independent set of data. Measurement invariance analyses suggested configural and metric invariance, but no scalar invariance across cultures/languages. A second-order factor CFA on the whole sample indicated that the three factors showed large loadings on a common second-order pandemic paranoia factor. Analyses also supported the test-retest reliability and internal and convergent validity. CONCLUSION The PPS offers an internationally validated and reliable method for assessing paranoia in the context of a pandemic. The PPS has the potential to enhance our understanding of the impact of the pandemic, the nature of paranoia and to assist in identifying and supporting people affected by pandemic-specific paranoia.
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Affiliation(s)
| | - B. Schlier
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
| | - L. Ellett
- Royal Holloway, University of London, London, UK
| | - S. H. So
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - B. A. Gaudiano
- Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA
| | - E. M. J. Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - T. M. Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Hamburg, Germany
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14
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Vallath S, Narasimhan L, Priyanka M, Varadarajan V, Ravikanth L. Prevalence, service use and clinical correlates of hallucinations and delusions in an out-patient population from India. J Ment Health 2023; 32:87-95. [PMID: 34152249 DOI: 10.1080/09638237.2021.1922627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Despite the persistent public health problem of positive psychotic symptoms, understanding of symptom specific prevalence rates, clinical correlates and service utilisation are sparse. AIMS The current study aimed to establish prevalence, clinical and service utilisation correlates of hallucinations and delusions in people accessing outpatient clinics in Tamil Nadu, India. METHODS Secondary patient data from outpatient clinics, over a 12-month period, in 2016, was used for analysis (N = 917). Based on the presence of positive psychotic symptoms (PPSx), the sample was divided into four groups for analysis- hallucinations-only (H), delusions-only (D), both hallucinations and delusions (HD) and neither PPSx (N-PPSx). RESULTS Findings indicate that the most prevalent PPSx were hallucinations (10.7%) however, barriers to service utilisation and clinical correlates were associated predominantly with the D and the HD group; as was severe work impairment. Yet, this group was most likely to remain with psychiatric services. Lastly, diagnostic challenges were apparent within the sample. CONCLUSIONS The study revealed that despite more barriers to service utilisation, persons with PPSx remain in contact with services. Yet prognosis remains only moderate at best, indicating other mediating and underlying factors impeding recovery may be interplaying and, therefore, a need for enhanced biopsychosocial approaches.
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Affiliation(s)
- Smriti Vallath
- Vrije Universiteit, Amsterdam, The Netherlands.,The Banyan, Chennai, India.,The Banyan Academy of Leadership in Mental Health (BALM), Kanchipuram, India
| | - Lakshmi Narasimhan
- The Banyan, Chennai, India.,The Banyan Academy of Leadership in Mental Health (BALM), Kanchipuram, India
| | - M Priyanka
- The Banyan Academy of Leadership in Mental Health (BALM), Kanchipuram, India
| | | | - Lakshmi Ravikanth
- The Banyan Academy of Leadership in Mental Health (BALM), Kanchipuram, India
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15
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Vanek J, Prasko J, Genzor S, Mizera J. The Management of Sleep Disturbances in Patients with Schizophrenia: A Case Series. Psychol Res Behav Manag 2022; 15:3673-3681. [PMID: 36544913 PMCID: PMC9762406 DOI: 10.2147/prbm.s388702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Patients with schizophrenia commonly encounter a variety of sleep disorders. Disturbed sleep can be found in 30-80% of patients, depending on the degree of psychotic symptomatology. Difficulty falling asleep, maintaining, or achieving restful sleep is associated with symptom severity and has been reported as a prodromal symptom of psychotic relapse. Although some sleep disorders improve with antipsychotic treatment, in many cases, even during disease remission, sleep continues to be fragmented, or even different pathophysiological mechanism is causing sleep disruption. Moreover, it may be complicated if the patient needs specific treatment, such as positive airway pressure (PAP) therapy, due to sleep-disordered breathing. The article presents case reports of patients with schizophrenia with sleep disturbances. As presented in our case reports, cognitive behavioral therapy seems effective in treating comorbid insomnia, even in patients with schizophrenia. The second and third case reports emphasise the need for broader clinical considerations, a cross-diagnostic approach, and cooperation in care for patients with severe mental disorders.
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Affiliation(s)
- Jakub Vanek
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic
| | - Jan Prasko
- Department of Psychiatry, University Hospital Olomouc, Faculty of Medicine, Palacky University in Olomouc, Olomouc, The Czech Republic,Department of Psychological Sciences, Faculty of Social Science and Health Care, Constantine the Philosopher University in Nitra, Nitra, The Slovak Republic,Department of Psychotherapy, Institute for Postgraduate Training in Health Care, Prague, The Czech Republic,Rehabilitation Hospital Beroun, Jessenia Inc, Akeso Holding, Závodí, The Czech Republic,Correspondence: Jan Prasko, Department of Psychiatry, Faculty of Medicine and Dentistry, University Hospital Olomouc, I. P. Pavlova 6, Olomouc, 77900, The Czech Republic, Email
| | - Samuel Genzor
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, The Czech Republic
| | - Jan Mizera
- Department of Respiratory Medicine, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Olomouc, The Czech Republic
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16
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Blodgett JM, Birch JM, Musella M, Harkness F, Kaushal A. What Works to Improve Wellbeing? A Rapid Systematic Review of 223 Interventions Evaluated with the Warwick-Edinburgh Mental Well-Being Scales. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15845. [PMID: 36497919 PMCID: PMC9737992 DOI: 10.3390/ijerph192315845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/23/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION The Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) is a commonly used scale of mental wellbeing focusing entirely on the positive aspect of mental health. It has been widely used in a broad range of clinical and research settings, including to evaluate if interventions, programmes or pilots improve wellbeing. We aimed to systematically review all interventions that used WEMWBS and evaluate which interventions are the most effective at improving wellbeing. METHODS Eligible populations included children and adults, with no health or age restrictions. Any intervention study was eligible if the wellbeing outcome was measured using the 7 or 14-item WEMWBS scale assessed both pre- and post-intervention. We identified eligible intervention studies using three approaches: a database search (Medline, EMBASE, CINAHL, PyschInfo and Web of Science from January 2007 to present), grey literature search, and by issuing a call for evidence. Narrative synthesis and random-effects meta-analysis of standardised mean differences in the intervention group were used to summarise intervention effects on WEMWBS score. RESULTS We identified 223 interventions across 209 studies, with a total of 53,834 participants across all studies. Five main themes of interventions were synthesised: psychological (n = 80); social (n = 54); arts, culture and environment (n = 29); physical health promotion (n = 18); and other (n = 28). Psychological interventions based on resilience, wellbeing or self-management techniques had the strongest effect on wellbeing. A broad range of other interventions were effective at improving mental wellbeing, including other psychological interventions such as cognitive behavioural therapy, psychoeducation and mindfulness. Medium to strong effects were also seen for person-centred support/advice (social), arts-based, parenting (social) and social prescribing interventions. However, a major limitation of the evidence was that only 75 (36%) of studies included a control group. CONCLUSIONS WEMWBS has been widely used to assess wellbeing across a diverse range of interventions, settings and samples. Despite substantial heterogeneity in individual intervention design, delivery and groups targeted, results indicate that a broad range of intervention types can successfully improve wellbeing. Methodological changes, such as greater use of control groups in intervention evaluation, can help future researchers and policy makers further understand what works for mental wellbeing.
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Affiliation(s)
- Joanna M. Blodgett
- Kohlrabi Consulting, Manchester SK4 3HJ, UK
- Institute of Sport Exercise & Health, Division of Surgery & Interventional Science, University College London, London W1T 7HA, UK
| | - Jack M. Birch
- Kohlrabi Consulting, Manchester SK4 3HJ, UK
- Homerton College, University of Cambridge, Cambridge CB2 8PH, UK
| | | | | | - Aradhna Kaushal
- Kohlrabi Consulting, Manchester SK4 3HJ, UK
- Institute of Epidemiology and Health Care, University College London, London WC1E 7HB, UK
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17
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Sheffield JM, Suthaharan P, Leptourgos P, Corlett PR. Belief Updating and Paranoia in Individuals With Schizophrenia. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1149-1157. [PMID: 35430406 PMCID: PMC9827723 DOI: 10.1016/j.bpsc.2022.03.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/10/2022] [Accepted: 03/31/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Persecutory delusions are among the most common delusions in schizophrenia and represent the extreme end of the paranoia continuum. Paranoia is accompanied by significant worry and distress. Identifying cognitive mechanisms underlying paranoia is critical for advancing treatment. We hypothesized that aberrant belief updating, which is related to paranoia in human and animal models, would also contribute to persecutory beliefs in individuals with schizophrenia. METHODS Belief updating was assessed in 42 participants with schizophrenia and 44 healthy control participants using a 3-option probabilistic reversal learning task. Hierarchical Gaussian Filter was used to estimate computational parameters of belief updating. Paranoia was measured using the Positive and Negative Syndrome Scale and the revised Green et al. Paranoid Thoughts Scale. Unusual thought content was measured with the Psychosis Symptom Rating Scale and the Peters et al. Delusions Inventory. Worry was measured using the Dunn Worry Questionnaire. RESULTS Paranoia was significantly associated with elevated win-switch rate and prior beliefs about volatility both in schizophrenia and across the whole sample. These relationships were specific to paranoia and did not extend to unusual thought content or measures of anxiety. We observed a significant indirect effect of paranoia on the relationship between prior beliefs about volatility and worry. CONCLUSIONS This work provides evidence that relationships between belief updating parameters and paranoia extend to schizophrenia, may be specific to persecutory beliefs, and contribute to theoretical models implicating worry in the maintenance of persecutory delusions.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry & Behavioral Sciences, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Praveen Suthaharan
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, Connecticut
| | - Pantelis Leptourgos
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, Connecticut
| | - Philip R Corlett
- Department of Psychiatry, Connecticut Mental Health Center, Yale University, New Haven, Connecticut
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18
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Wood L, Williams C, Pinfold V, Nolan F, Morrison AP, Morant N, Lloyd-Evans B, Lewis G, Lay B, Jones R, Greenwood K, Johnson S. Crisis-focused Cognitive Behavioural Therapy for psychosis (CBTp) in acute mental health inpatient settings (the CRISIS study): protocol for a pilot randomised controlled trial. Pilot Feasibility Stud 2022; 8:205. [PMID: 36088373 PMCID: PMC9463503 DOI: 10.1186/s40814-022-01160-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Cognitive Behavioural Therapy for psychosis (CBTp) has an established evidence base and is recommended by clinical guidelines to be offered during the acute phases of psychosis. However, few research studies have examined the efficacy of CBTp interventions specifically adapted for the acute mental health inpatient context with most research trials being conducted with white European community populations.
Aims
The aim of this study is to conduct a pilot randomised controlled trial (RCT), which incorporates the examination of feasibility markers, of a crisis-focused CBTp intervention adapted for an ethnically diverse acute mental health inpatient population, in preparation for a large-scale randomised controlled trial. The study will examine the feasibility of undertaking the trial, the acceptability and safety of the intervention and the suitability of chosen outcome measures. This will inform the planning of a future, fully powered RCT.
Methods
A single-site, parallel-group, pilot RCT will be conducted examining the intervention. Drawing on principles of coproduction, the intervention has been adapted in partnership with key stakeholders: service users with lived experience of psychosis and of inpatient care (including those from ethnic minority backgrounds), carers, multi-disciplinary inpatient clinicians and researchers. Sixty participants with experience of psychosis and in current receipt of acute mental health inpatient care will be recruited. Participants will be randomly allocated to either the crisis-focused CBTp intervention or treatment as usual (TAU).
Discussion
Findings of this pilot RCT will indicate whether a larger multi-site RCT is needed to investigate the efficacy of the intervention. If the initial results demonstrate that this trial is feasible and the intervention is acceptable, it will provide evidence that a full-scale effectiveness trial may be warranted.
Trial registration
This trial has been prospectively registered on the ISRCTN registry (ISRCTN59055607) on the 18th of February 2021.
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19
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Kowalski J, Styła R. Visual worry in patients with schizophrenia. J Psychiatr Res 2022; 153:116-124. [PMID: 35810601 DOI: 10.1016/j.jpsychires.2022.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 06/22/2022] [Accepted: 07/01/2022] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Worrying is a pervasive transdiagnostic symptom in schizophrenia. It is most often associated in the literature with verbal modality due to many studies of its presence in generalised anxiety disorder. The current study aimed to elucidate worry in different sensory modalities, visual and verbal, in individuals with schizophrenia. METHOD We tested persons with schizophrenia (n = 92) and healthy controls (n = 138) in a cross-sectional design. We used questionnaires of visual and verbal worry (original Worry Modality Questionnaire), trait worry (Penn State Worry Questionnaire) and general psychopathology symptoms (General Functioning Questionnaire-58 and Brief Psychiatric Rating Scale). RESULTS Both visual and verbal worry were associated with psychotic, anxiety and general symptoms of psychopathology in both groups with medium to large effect sizes. Regression analyses indicated that visual worry was a single significant predictor of positive psychotic symptoms in a model with verbal and trait worry, both in clinical and control groups (β's of 0.49 and 0.38, respectively). Visual worry was also a superior predictor of anxiety and general psychopathology severity (β's of 0.34 and 0.37, respectively) than verbal worry (β's of 0.03 and -0.02, respectively), under control of trait worry, in the schizophrenia group. We also proposed two indices of worry modality dominance and analysed profiles of dominating worry modality in both groups. CONCLUSIONS Our study is the first to demonstrate that visual worry might be of specific importance for understanding psychotic and general psychopathology symptoms in persons with schizophrenia.
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Affiliation(s)
- Joachim Kowalski
- Experimental Psychopathology Laboratory, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
| | - Rafał Styła
- Faculty of Psychology, University of Warsaw, Warsaw, Poland
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20
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Ward T, Hardy A, Holm R, Collett N, Rus‐Calafell M, Sacadura C, McGourty A, Vella C, East A, Rea M, Harding H, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Garety P. SlowMo therapy, a new digital blended therapy for fear of harm from others: An account of therapy personalisation within a targeted intervention. Psychol Psychother 2022; 95:423-446. [PMID: 35019210 PMCID: PMC9306634 DOI: 10.1111/papt.12377] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 12/06/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES SlowMo therapy is a pioneering blended digital therapy for paranoia, augmenting face-to-face therapy with an interactive 'webapp' and a mobile app. A recent large-scale trial demonstrated small-moderate effects on paranoia alongside improvements in self-esteem, worry, well-being and quality of life. This paper provides a comprehensive account of therapy personalisation within this targeted approach. DESIGN Case examples illustrate therapy delivery and descriptive data are presented on personalised thought content. METHOD Thought content was extracted from the webapp (n = 140 participants) and coded using newly devised categories: Worries: (1) Persecutory, (2) Negative social evaluation, (3) Negative self-concept, (4) Loss/life stresses, (5) Sensory-perceptual experiences and (6) Health anxieties. Safer thoughts: (1) Safer alternative (specific alternatives to worries), (2) Second-wave (generalised) coping, (3) Positive self-concept, (4) Positive activities and (5) Third-wave (mindfulness-based) coping. Data on therapy fidelity are also presented. RESULTS Worries: 'Persecutory' (92.9% of people) and 'Negative social evaluation' (74.3%) were most common. 'General worries/ life stresses' (31.4%) and 'Negative self-concept' (22.1%) were present in a significant minority; 'Health anxieties' (10%) and 'Sensory-perceptual' (10%) were less common. Safer thoughts: 'Second-wave (general) coping' (85%), 'Safer alternatives' (76.4%), 'Positive self-concept' (65.7%) and 'Positive activities' (64.3%) were common with 'Third-wave' (mindfulness) coping observed for 30%. Fidelity: Only three therapy withdrawals were therapy related. Session adherence was excellent (mean = 15.2/16; SD = 0.9). Behavioural work was conducted with 71% of people (119/168). CONCLUSION SlowMo therapy delivers a targeted yet personalised approach. Potential mechanisms of action extend beyond reasoning. Implications for cognitive models of paranoia and causal interventionist approaches are discussed.
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Affiliation(s)
- Thomas Ward
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Amy Hardy
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Rebecca Holm
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Nicola Collett
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,Oxford Institute of Clinical Psychology Training and ResearchOxford UniversityOxfordUK
| | - Mar Rus‐Calafell
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK,Mental Health Research and Treatment CenterFaculty of PsychologyRuhr‐Universität BochumBochumGermany
| | | | | | - Claire Vella
- Sussex Partnership NHS Foundation TrustWorthingUK,School of PsychologyUniversity of SussexBrightonUK
| | - Anna East
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - Michaela Rea
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Helen Harding
- South London and Maudsley NHS Foundation TrustLondonUK
| | - Richard Emsley
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | | | - Daniel Freeman
- Department of PsychiatryOxford UniversityOxfordUK,Oxford Health NHS Foundation TrustOxfordUK
| | - David Fowler
- Sussex Partnership NHS Foundation TrustWorthingUK,School of PsychologyUniversity of SussexBrightonUK
| | - Elizabeth Kuipers
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | | | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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21
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McDonagh MS, Dana T, Kopelovich SL, Monroe-DeVita M, Blazina I, Bougatsos C, Grusing S, Selph SS. Psychosocial Interventions for Adults With Schizophrenia: An Overview and Update of Systematic Reviews. Psychiatr Serv 2022; 73:299-312. [PMID: 34384230 DOI: 10.1176/appi.ps.202000649] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The authors of this systematic review (SR) sought to provide evidence for effects of commonly used psychosocial interventions on several outcomes among adults with schizophrenia. METHODS MEDLINE, the Cochrane Library, and PsycINFO databases were searched through July 2020. Eligible studies were SRs and trials of at least 12 weeks duration and with ≥50 participants that compared psychosocial interventions with treatment as usual among adults with schizophrenia. Study design, year, setting, country, sample size, eligibility criteria, population, clinical and intervention characteristics, results, and funding source were extracted, along with quality criteria. The evidence was evaluated on quality and strength of evidence stratified by intervention area and outcome, according to the Evidence-Based Practice Centers Methods Guide of the Agency for Healthcare Research and Quality. RESULTS Nine SRs and 30 trials (N=23,921 patients) in 11 intervention areas were included. Trials were mostly of fair quality and had low-to-moderate strength of evidence. Compared with treatment as usual, most psychosocial interventions were more effective in improving intervention-targeted outcomes, including core illness symptoms. Compared with treatment as usual, assertive community treatment, cognitive-behavioral therapy (CBT), family interventions, psychoeducation, social skills training, supported employment, and early interventions for first-episode psychosis (FEP) improved various functional outcomes. CBT and early interventions for FEP improved quality of life. Family interventions, psychoeducation, illness self-management, and early interventions for FEP reduced relapse. CONCLUSIONS Compared with treatment as usual, most psychosocial interventions improved functional outcomes, quality of life, and core illness symptoms, and several reduced relapse frequency among adults with schizophrenia.
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Affiliation(s)
- Marian S McDonagh
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Tracy Dana
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sarah L Kopelovich
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Maria Monroe-DeVita
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Ian Blazina
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Christina Bougatsos
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Sara Grusing
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
| | - Shelley S Selph
- Pacific Northwest Evidence-Based Practice Center, Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland (McDonagh, Dana, Blazina, Bougatsos, Grusing, Selph); University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle (Kopelovich, Monroe-DeVita)
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So SHW, Zhu C, Lincoln TM, Gaudiano BA, Kingston JL, Ellett L, Morris EMJ. Pandemic paranoia, general paranoia, and their relationships with worry and beliefs about self/others - A multi-site latent class analysis. Schizophr Res 2022; 241:122-129. [PMID: 35121437 DOI: 10.1016/j.schres.2022.01.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, an increase in paranoid thinking has been reported internationally. The development of the Pandemic Paranoia Scale (PPS) has provided a reliable assessment of various facets of pandemic paranoia. This study aimed to (i) identify classes of individuals with varying levels of general paranoia and pandemic paranoia, and (ii) examine associations between classification and worry, core beliefs, and pro-health behaviours. METHODS An international sample of adults (N = 2510) across five sites completed the Revised-Green Paranoid Thoughts Scale and the PPS. Latent class analysis (LCA) was conducted using these two paranoia variables. Classes were compared on trait worry (Penn State Worry Questionnaire), beliefs about self/others (Brief Core Schema Scales), and pro-health behaviour. RESULTS Three latent classes emerged: Class 1 with low R-GPTS and PPS scores, Class 2 with a high R-GPTS score and a moderate PPS score, and Class 3 with high R-GPTS and PPS scores. Compared to Class 1, Classes 2-3 were associated with more worry and negative self- and other-beliefs. Class 3 was further characterised by greater positive-self beliefs and less engagement in pro-health behaviours. Engagement in pro-health behaviours was positively correlated with interpersonal mistrust and negatively correlated with paranoid conspiracy and persecutory threat. CONCLUSIONS Individuals with a general paranoia tendency were more likely to respond to the global health threats in a suspicious and distrusting way. Our findings suggested that worry and negative self/other beliefs may contribute to not just general paranoia but also pandemic paranoia. The preliminary finding of a link between pro-health behaviours and interpersonal mistrust warrants further examination.
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Affiliation(s)
| | - Chen Zhu
- The Chinese University of Hong Kong, Hong Kong, China
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23
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Pathways from insecure attachment to paranoia: the mediating role of emotion regulation. Behav Cogn Psychother 2022; 50:404-417. [DOI: 10.1017/s1352465822000029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Background:
Paranoia is common across the clinical and non-clinical spectrum. Cognitive behavioural therapy for psychosis currently yields modest results, warranting research into symptom-specific maintenance factors to improve outcomes. There is strong evidence of a relationship between insecure attachment and increased paranoia, but little is known about the mediating mechanisms. Emotion dysregulation is associated with both insecure attachment and paranoia, and a candidate causal mechanism.
Aims:
This study aimed to determine if emotion dysregulation mediates the association between attachment and paranoia.
Method:
Sixty-two individuals with elevated paranoia were recruited from NHS services and community settings across the South of England. Mediation analyses were conducted on trait attachment, emotion regulation and paranoia variables, which were collected at one time point.
Results:
As predicted, emotion dysregulation mediated the relationship between attachment avoidance and paranoia, and between attachment anxiety and paranoia. Emotion suppression did not mediate the relationship between attachment avoidance and paranoia, possibly due to power. Attachment avoidance correlated with deactivating emotion regulation strategies (e.g. lack of emotional awareness) and attachment anxiety correlated with hyperactivating emotion regulation strategies (e.g. impulse control difficulties). Both deactivating and hyperactivating strategies correlated with paranoia.
Conclusion:
Emotion dysregulation is not routinely targeted in cognitive behavioural therapy for psychosis. This study suggests that incorporating emotion regulation strategies in therapy may improve clinical outcomes. Experimental studies are now required to support a causal argument, and pilot intervention studies should investigate if emotion regulation skills development (aligned with attachment style) is effective in reducing non-clinical and clinical paranoia.
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Salvador A, Arnal LH, Vinckier F, Domenech P, Gaillard R, Wyart V. Premature commitment to uncertain decisions during human NMDA receptor hypofunction. Nat Commun 2022; 13:338. [PMID: 35039498 PMCID: PMC8763907 DOI: 10.1038/s41467-021-27876-3] [Citation(s) in RCA: 4] [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: 09/10/2020] [Accepted: 12/21/2021] [Indexed: 11/15/2022] Open
Abstract
Making accurate decisions based on unreliable sensory evidence requires cognitive inference. Dysfunction of n-methyl-d-aspartate (NMDA) receptors impairs the integration of noisy input in theoretical models of neural circuits, but whether and how this synaptic alteration impairs human inference and confidence during uncertain decisions remains unknown. Here we use placebo-controlled infusions of ketamine to characterize the causal effect of human NMDA receptor hypofunction on cognitive inference and its neural correlates. At the behavioral level, ketamine triggers inference errors and elevated decision uncertainty. At the neural level, ketamine is associated with imbalanced coding of evidence and premature response preparation in electroencephalographic (EEG) activity. Through computational modeling of inference and confidence, we propose that this specific pattern of behavioral and neural impairments reflects an early commitment to inaccurate decisions, which aims at resolving the abnormal uncertainty generated by NMDA receptor hypofunction.
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Affiliation(s)
- Alexandre Salvador
- Laboratoire de Neurosciences Cognitives et Computationnelles, Institut National de la Santé et de la Recherche Médicale, Paris, France
- Département d'Études Cognitives, École Normale Supérieure, Université PSL, Paris, France
- Université de Paris, Paris, France
- Département de Psychiatrie, Service Hospitalo-Universitaire, GHU Paris Psychiatrie et Neurosciences, Paris, France
| | - Luc H Arnal
- Institut de l'Audition, Inserm unit 1120, Institut Pasteur, Paris, France
| | - Fabien Vinckier
- Université de Paris, Paris, France
- Département de Psychiatrie, Service Hospitalo-Universitaire, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Équipe Motivation, Cerveau et Comportement, Institut du Cerveau, Sorbonne Université, Paris, France
| | - Philippe Domenech
- Équipe Neurophysiologie des Comportements Répétitifs, Institut du Cerveau, Sorbonne Université, Paris, France
- Département Médico-Universitaire de Psychiatrie et d'Addictologie, CHU AP-HP Henri Mondor, Université Paris-Est Créteil, Créteil, France
| | - Raphaël Gaillard
- Université de Paris, Paris, France
- Département de Psychiatrie, Service Hospitalo-Universitaire, GHU Paris Psychiatrie et Neurosciences, Paris, France
- Unité de Neuropathologie Expérimentale, Département de Santé Globale, Institut Pasteur, Paris, France
| | - Valentin Wyart
- Laboratoire de Neurosciences Cognitives et Computationnelles, Institut National de la Santé et de la Recherche Médicale, Paris, France.
- Département d'Études Cognitives, École Normale Supérieure, Université PSL, Paris, France.
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25
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von Hardenberg L, Leopold K, Stenzel N, Kallenbach M, Aliakbari N, Bechdolf A, Mehl S. Feasibility and efficacy of an acceptance and mindfulness-based group intervention for young people with early psychosis (Feel-Good group). Front Psychiatry 2022; 13:943488. [PMID: 36186856 PMCID: PMC9522968 DOI: 10.3389/fpsyt.2022.943488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over the last decade, researchers have sought for alternative interventions that have better treatment effects than Cognitive Behavioral Therapy (CBT) when treating psychotic symptoms. Mindfulness-based interventions have been a proposed alternative to CBT, yet research regarding its feasibility, acceptance and effectiveness is lacking when treating individuals with early psychosis in inpatient settings. OBJECTIVE Before conducting a large-scale randomized-controlled trial (RCT), this pilot study evaluated the feasibility and the potential efficacy of a mindfulness-based inpatient group intervention that targets emotion regulation in patients with early psychosis, and thus indirectly improving psychotic symptoms. METHODS A pre-post study was performed. Thirty-six patients with early psychosis treated at the specialized inpatient treatment "Frühinterventions- und Therapiezentrum; FRITZ" (early intervention and therapy center) received eight group therapy sessions. Assessments were performed at baseline, after 8 weeks post treatment and at follow-up after 16 weeks. RESULTS Rates of patients who participated in the study suggests that a mindfulness-based group therapy is highly accepted and feasible for patients with early psychosis being treated in an inpatient ward. Friedman analyses revealed significant changes in the primary outcomes of emotional goal attainment (Goal 1: W = 0.79; Goal 2: W = 0.71) and psychotic symptoms (PANSS-T: W = 0.74). Significant, albeit small, effect sizes were found in patients' self-perception of emotion regulation skills (ERSQ: W = 0.23). DISCUSSION We found favorable findings regarding the feasibility and acceptance of the Feel-Good mindfulness-based intervention. Results of the study provide a basis for an estimation of an adequate sample size for a fully powered RCT that needs to be conducted to test whether Feel-Good is effective in the inpatient treatment of psychotic symptoms for individuals with early psychosis. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/ct2/show/NCT04592042], identifier [NCT04592042].
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Affiliation(s)
- Laura von Hardenberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Nikola Stenzel
- Department of Psychology, Psychologische Hochschule Berlin (PHB), Berlin, Germany
| | - Michèle Kallenbach
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Navid Aliakbari
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Mehl
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior, Philipps-University Marburg, Marburg, Germany.,Department of Health and Social Work, Frankfurt University of Applied Sciences, Frankfurt, Germany
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26
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Lam AHY, Cheung YTD, Wong KH, Leung SF, Chien WT. Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion. Neuropsychiatr Dis Treat 2022; 18:75-85. [PMID: 35046658 PMCID: PMC8760986 DOI: 10.2147/ndt.s338133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/26/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Studies have shown that rumination plays a significant mediating role between dispositional mindfulness (DM) and psychopathological symptoms in both clinical and non-clinical populations. However, no studies have examined this pathway in people with schizophrenia spectrum disorders (SSDs). METHODS A cross-sectional, clinician-administered survey was conducted among people with SSDs (n = 52) in a community setting. Participants completed the Chinese versions of the Depression Anxiety Stress Scale, Five Facet Mindfulness Questionnaire-Short Form, Psychotic Symptom Rating Scale and Scale for the Assessment of Negative Symptoms. Structural equation modelling was performed to examine the pathways of mindfulness facets, rumination, negative emotions and psychotic symptoms. RESULTS Two facets of mindfulness (nonjudging and acting with awareness) reduced rumination and negative emotional status. Rumination fully mediated the relationship between nonjudging and negative emotions and partially mediated the relationship between acting with awareness and negative emotions. Furthermore, rumination and negative emotions sequentially mediated the relationship between acting with awareness and hallucination (B = -0.44, 95% confidence interval [CI] = -0.338 to -0.045, p = 0.01) and between nonjudging and hallucination (B = -0.356, 95% CI = -0.255 to -0.008, p = 0.034). The model fit the data well (χ2(2) = 1.318, p = 0.517, Tucker-Lewis index = 1.075, comparative fit index = 1, standardised root mean residual = 0.0251, root mean square error of approximation = 0.0001). CONCLUSION Rumination and negative emotions serially mediated the relationship between DM and hallucination. The findings support the contribution of changes across transdiagnostic mediators underlying the therapeutic effects of mindfulness training. Further research examining the transdiagnostic processes of DM in influencing clinical outcomes in SSDs is warranted.
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Affiliation(s)
- Angie Ho Yan Lam
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Yee Tak Derek Cheung
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region
| | - Kwan Ho Wong
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Sau Fong Leung
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong Special Administrative Region
| | - Wai Tong Chien
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
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27
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Livet A, Estingoy P. [The value of cognitive restructuring of reference ideas in schizophrenia]. Soins Psychiatr 2022; 43:35-41. [PMID: 35598913 DOI: 10.1016/j.spsy.2022.01.009] [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] [Indexed: 06/15/2023]
Abstract
The process and results of cognitive restructuring of disabling reference ideas are presented through the study of a case of schizophrenia. The clinical evolution is measured according to an applied behavior analysis protocol that targets psychotic symptomatology and illness awareness. The results are encouraging since we observe a clinically significant decrease in the severity of reference ideas, anxiety and an improvement in illness awareness in only ten sessions.
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Affiliation(s)
- Audrey Livet
- Institut universitaire en santé mentale de Montréal. Centre intégré de santé et de services sociaux de l'Est-de-l'Île-de Montréal. 7401 rue Hochelaga, Montréal, QC H1N 3M5, Canada; Pôle intersectoriel de soins et de réhabilitation, CH Saint-Jean-de-Dieu, BP 8252, 69355 Lyon cedex 08, France.
| | - Pierrette Estingoy
- Pôle intersectoriel de soins et de réhabilitation, CH Saint-Jean-de-Dieu, BP 8252, 69355 Lyon cedex 08, France
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28
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Lüdtke T, Rüegg N, Moritz S, Berger T, Westermann S. Insight and the number of completed modules predict a reduction of positive symptoms in an Internet-based intervention for people with psychosis. Psychiatry Res 2021; 306:114223. [PMID: 34826711 DOI: 10.1016/j.psychres.2021.114223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 09/20/2021] [Accepted: 09/21/2021] [Indexed: 11/17/2022]
Abstract
Emerging evidence suggests that Internet-based interventions for people with psychosis (ICBTp) are feasible and efficacious. However, predictors of adherence and treatment outcomes are largely unknown. To narrow this research gap, we conducted secondary analyses on data from a randomized controlled trial, which evaluated an eight-week ICBTp intervention targeting topics, such as voice hearing, mindfulness, and others. In n = 100 participants with psychosis, we aimed at identifying sociodemographic, psychopathological, and treatment-related predictor variables of post-treatment symptoms and adherence (i.e., at least four completed modules). We followed a two-stage approach. First, we conducted regression analyses to examine the effect of single candidate predictors on post-treatment symptoms as well as adherence. Subsequently, we selected variables that met a significance threshold of p < .1 and entered them into linear and logistic multiple regression models. Whereas no variable was able to predict adherence, the number of completed modules was negatively associated with self-reported delusion severity at post-treatment. Additionally, higher pre-treatment insight predicted fewer hallucinations after treatment. Because this was one of the first studies to investigate predictors in ICBTp, more research is needed to customize future interventions to the needs of users.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany; Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.
| | - Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland.
| | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany.
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29
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Holthoff-Detto V, Seifert K. [Importance of psychotherapeutically oriented treatment procedures in geriatric psychiatry and psychotherapy]. Z Gerontol Geriatr 2021; 54:747-752. [PMID: 34825955 DOI: 10.1007/s00391-021-01992-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/13/2021] [Indexed: 10/19/2022]
Abstract
There is an increasing body of evidence for occupational and art therapies for treatment of severe mental illness in old age, such as geriatric depression, dementia and delirium. The individualized intervention strategies activate the patients' skills and activities in various ways and enhance psychological processes such as awareness of thoughts and activities, experiences and feelings of self-determination and autonomy. They may also encourage the patients' willingness to participate in multimodal treatment and to agree to pharmacotherapy and psychotherapy.
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Affiliation(s)
- Vjera Holthoff-Detto
- Medizinische Fakultät, Technische Universität Dresden, Dresden, Deutschland. .,Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Alexianer Krankenhaus Hedwigshöhe, Höhensteig 1, 12526, Berlin, Deutschland.
| | - Kathrin Seifert
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn, Sigmund-Freud-Str. 25, 53127, Bonn, Deutschland. .,Hochschule für Künste im Sozialen, Ottersberg, Deutschland.
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30
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Ravari A, Mirzaei T, Hosieni F, Hassanshahi E. Comparison of The Effects of Cognitive Therapy and Logotherapy on Iranian Elderly People's General Health. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2021; 9:289-299. [PMID: 34604398 PMCID: PMC8479288 DOI: 10.30476/ijcbnm.2021.88217.1497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 06/02/2021] [Accepted: 06/12/2021] [Indexed: 11/19/2022]
Abstract
Background: Mental health promotion programs in the elderly are important. The main objective of the present study was to compare the effects of cognitive therapy and
logotherapy on the general health of elderly people who referred to health centers. Methods: This is a quasi-experimental study with pretest-posttest design using a control group. A sample of 90 elderly people was recruited from health centers located in Rafsanjan,
between April 2017 and June 2017. 30 participants were considered in each group, separately (cognitive therapy (N=30), logotherapy (N=30), and control (N=30)).
Cognitive therapy and logotherapy programs were implemented in eight 90-minute sessions, while people in the control group received neither cognitive therapy nor logotherapy.
The demographic questionnaire was used at baseline. The 28-item General Health Questionnaire (GHQ-28) was used in two steps of pre-test and post-test. The study data were analyzed
through independent t-test, Chi-square, one-way ANOVA, and the Tukey’s post hoc tests; SPSS 18 was used to analyze the data, and P<0.05 was considered as significant. Results: The mean GHQ-28 total scores before the intervention in the cognitive therapy and logotherapy groups and control group were 52.53±2.55,
52.63±5.64, and 52.26±4.09, respectively, which were not significantly different (P=0.94). However, after the intervention these scores were 41.60±3.31,
40.46±3.97 and 51.93±4.22, respectively, and the difference between the two intervention groups and control group was statistically significant (P<0.001).
There was no significant difference between the two intervention groups (P=0.49). Conclusions: Group cognitive therapy is as effective as logotherapy in improving the elderly people’s general health.
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Affiliation(s)
- Ali Ravari
- Deptartment of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tayebeh Mirzaei
- Deptartment of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Fatemeh Hosieni
- Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Elham Hassanshahi
- Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
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31
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Andersson E, Ljótsson B, Hedman-Lagerlöf M, Nygren L, Persson M, Rosengren K, Gezelius A, Andersson L, Sundquist T, Ivanov VZ, Bjureberg J, Hedman-Lagerlöf E. Targeting excessive worry with internet-based extinction therapy: a randomised controlled trial with mediation analysis and economical evaluation. Psychol Med 2021; 51:2023-2033. [PMID: 32340638 PMCID: PMC8426147 DOI: 10.1017/s0033291720000781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/19/2019] [Accepted: 03/17/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Excessive worry is a common phenomenon. Our research group has previously developed an online intervention for excessive worry based on operant principles of extinction (IbET; internet-based extinction therapy) and tested it against a waiting-list. The aim of this study was to evaluate IbET against an active control comparator (CTRL). METHODS A 10-week parallel participant blind randomised controlled trial with health-economical evaluation and mediation analyses. Participants (N = 311) were randomised (ratio 4.5:4.5:1) to IbET, to CTRL (an internet-based stress-management training program) or to waiting-list. The nation-wide trial included self-referred adults with excessive worry. The primary outcome was change in worry assessed with the Penn State Worry Questionnaire from baseline to 10 weeks. RESULTS IbET had greater reductions in worry compared to CTRL [-3.6 point difference, (95% CI -2.4 to -4.9)] and also a significantly larger degree of treatment responders [63% v. 51%; risk ratio = 1.24 (95% CI 1.01-1.53)]. Both IbET and CTRL made large reductions in worry compared to waiting-list and effects were sustained up to 1 year. Treatment credibility, therapist attention, compliance and working alliance were equal between IbET and CTRL. Data attrition was 4% at the primary endpoint. The effects of IbET were mediated by the hypothesized causal mechanism (reduced thought suppression) but not by competing mediators. Health-economical evaluation indicated that IbET had a 99% chance of being cost-effective compared to CTRL given societal willingness to pay of 1000€. CONCLUSIONS IbET is more effective than active comparator to treat excessive worry. Replication and extensions to real-world setting are warranted.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Maria Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Linn Nygren
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Malin Persson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Karin Rosengren
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Anton Gezelius
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Louise Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Tove Sundquist
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Volen Z. Ivanov
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Johan Bjureberg
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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32
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Arul B, Lee D, Marzen S. A Proposed Probabilistic Method for Distinguishing Between Delusions and Other Environmental Judgements, With Applications to Psychotherapy. Front Psychol 2021; 12:674108. [PMID: 34434137 PMCID: PMC8380927 DOI: 10.3389/fpsyg.2021.674108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
How can individuals with schizophrenia best be equipped to distinguish delusions from accurate judgements about their environment? This study presents an approach based on the principles of Bayesian probability and presents the results of a series of tests in which a simulated observer classifies randomly generated data characteristic of a simulated environment. The complexity of the data ranges from scalars to vectors of variable lengths, and the simulated observer makes its decisions based on either perfect or imperfect models of its environment. We find that when a low-dimensional observation is considered characteristic of both real observations and delusions, the prior probabilities of any observation being real or fake are of greater importance to the final decision than the attributes of the observation. However, when an observation is high-dimensional (complex), classification accuracy tends to improve toward 100% with increasing complexity of observations, as long as the patient's model of the world isn't drastically inaccurate. On the contrary, when the observer's model is sufficiently inaccurate, the accuracy rate decreases with increasing observational complexity. Overall, the results suggest applicability of the Bayesian model to the use of interventional therapy for those who suffer from psychosis.
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Affiliation(s)
- Boopala Arul
- Division of Biological Sciences, University of California, San Diego, San Diego, CA, United States
| | - Daniel Lee
- W. M. Keck Science Department, Pitzer, Scripps, and Claremont McKenna College, Claremont, CA, United States
| | - Sarah Marzen
- W. M. Keck Science Department, Pitzer, Scripps, and Claremont McKenna College, Claremont, CA, United States
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Freeman D, Emsley R, Diamond R, Collett N, Bold E, Chadwick E, Isham L, Bird JC, Edwards D, Kingdon D, Fitzpatrick R, Kabir T, Waite F. Comparison of a theoretically driven cognitive therapy (the Feeling Safe Programme) with befriending for the treatment of persistent persecutory delusions: a parallel, single-blind, randomised controlled trial. Lancet Psychiatry 2021; 8:696-707. [PMID: 34246324 PMCID: PMC8311296 DOI: 10.1016/s2215-0366(21)00158-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/03/2021] [Accepted: 04/12/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND There is a large clinical need for improved treatments for patients with persecutory delusions. We aimed to test whether a new theoretically driven cognitive therapy (the Feeling Safe Programme) would lead to large reductions in persecutory delusions, above non-specific effects of therapy. We also aimed to test treatment effect mechanisms. METHODS We did a parallel, single-blind, randomised controlled trial to test the Feeling Safe Programme against befriending with the same therapists for patients with persistent persecutory delusions in the context of non-affective psychosis diagnoses. Usual care continued throughout the duration of the trial. The trial took place in community mental health services in three UK National Health Service trusts. Participants were included if they were 16 years or older, had persecutory delusions (as defined by Freeman and Garety) for at least 3 months and held with at least 60% conviction, and had a primary diagnosis of non-affective psychosis from the referring clinical team. Patients were randomly assigned to either the Feeling Safe Programme or the befriending programme, using a permuted blocks algorithm with randomly varying block size, stratified by therapist. Trial assessors were masked to group allocation. If an allocation was unmasked then the unmasked assessor was replaced with a new masked assessor. Outcomes were assessed at 0 months, 6 months (primary endpoint), and 12 months. The primary outcome was persecutory delusion conviction, assessed within the Psychotic Symptoms Rating Scale (PSYRATS; rated 0-100%). Outcome analyses were done in the intention-to-treat population. Each intervention was provided individually over 6 months. This trial is registered with the ISRCTN registry, ISRCTN18705064. FINDINGS From Feb 8, 2016, to July 26, 2019, 130 patients with persecutory delusions (78 [60%] men; 52 [40%] women, mean age 42 years [SD 12·1, range 17-71]; 86% White, 9% Black, 2% Indian; 2·3% Pakistani; 2% other) were recruited. 64 patients were randomly allocated to the Feeling Safe Programme and 66 patients to befriending. Compared with befriending, the Feeling Safe Programme led to significant end of treatment reductions in delusional conviction (-10·69 [95% CI -19·75 to -1·63], p=0·021, Cohen's d=-0·86) and delusion severity (PSYRATS, -2·94 [-4·58 to -1·31], p<0·0001, Cohen's d=-1·20). More adverse events occurred in the befriending group (68 unrelated adverse events reported in 20 [30%] participants) compared with the Feeling Safe group (53 unrelated adverse events reported in 16 [25%] participants). INTERPRETATION The Feeling Safe Programme led to a significant reduction in persistent persecutory delusions compared with befriending. To our knowledge, these are the largest treatment effects seen for patients with persistent delusions. The principal limitation of our trial was the relatively small sample size when comparing two active treatments, meaning less precision in effect size estimates and lower power to detect moderate treatment differences in secondary outcomes. Further research could be done to determine whether greater effects could be possible by reducing the hypothesised delusion maintenance mechanisms further. The Feeling Safe Programme could become the recommended psychological treatment in clinical services for persecutory delusions. FUNDING NIHR Research Professorship and NIHR Oxford Health Biomedical Research Centre.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK.
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Rowan Diamond
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Nicola Collett
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Emily Bold
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Eleanor Chadwick
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Isham
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
| | - Danielle Edwards
- Department of Biostatistics and Health Informatics, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - David Kingdon
- Department of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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Wahlund T, Hesser H, Perrin S, Johansson S, Huhn V, Sörhus S, Lindskog S, Serlachius E, Hedman-Lagerlöf E, Ljótsson B, Andersson E. Therapist-guided online metacognitive intervention for excessive worry: a randomized controlled trial with mediation analysis. Cogn Behav Ther 2021; 51:21-41. [PMID: 34283004 DOI: 10.1080/16506073.2021.1937695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Previous studies have found an association between excessive worrying and negative beliefs about worry. It is unclear if change in these beliefs mediate worry reduction. This study aimed to examine (1) if a simplified online metacognitive intervention can reduce worry, (2) whether changes in negative beliefs about worry mediate changes in worry severity, and (3) moderated mediation, i.e., if the mediating effect is more pronounced in individuals with a high degree of negative beliefs about worry at baseline. Adult excessive worriers (N = 108) were randomized to 10-weeks of the online metacognitive intervention (MCI) aimed at reducing negative beliefs about worry, or to wait-list (WL). Outcomes, mediation, and moderated mediation were examined via growth curve modelling. Results indicated a significant reduction in the MCI group (d = 1.6). Reductions in negative beliefs about worry and depressive symptoms separately mediated changes in worry severity during the intervention, but in a multivariate test only the former remained significant. Sensitivity analysis indicated that the hypothesized mediation was robust to possible violations of mediator-outcome confounding. The moderated mediation hypothesis was not supported. The results from this randomized trial add to the growing literature suggesting that negative beliefs about worry play a key role in worry-related problems. ClinicalTrials.gov Identifier: NCT03393156.
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Affiliation(s)
- Tove Wahlund
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,School of Law, Psychology and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Sanna Johansson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Vilgot Huhn
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Sara Sörhus
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Severin Lindskog
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Erik Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
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35
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Garety P, Ward T, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Rus-Calafell M, McGourty A, Sacadura C, Collett N, James K, Hardy A. Effects of SlowMo, a Blended Digital Therapy Targeting Reasoning, on Paranoia Among People With Psychosis: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:714-725. [PMID: 33825827 PMCID: PMC8027943 DOI: 10.1001/jamapsychiatry.2021.0326] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Persistent paranoia is common among patients with psychosis. Cognitive-behavioral therapy for psychosis can be effective. However, challenges in engagement and effectiveness remain. OBJECTIVE To investigate the effects on paranoia and mechanisms of action of SlowMo, a digitally supported reasoning intervention, plus usual care compared with usual care only. DESIGN, SETTING, AND PARTICIPANTS This parallel-arm, assessor-blinded, randomized clinical trial recruited participants at UK community health services from May 1, 2017, to May 14, 2019. Eligible participants consisted of a referral sample with schizophrenia-spectrum psychosis and distressing, persistent (≥3 months) paranoia. INTERVENTIONS Individuals were randomized 1:1 to SlowMo, consisting of 8 digitally supported face-to-face sessions and a mobile app, plus usual care (n = 181) and usual care only (n = 181). MAIN OUTCOMES AND MEASURES The primary outcome was paranoia, measured by the Green et al Paranoid Thoughts Scale (GPTS) total score at 24 weeks. Secondary outcomes included GPTS total score at 12 weeks and GPTS Part A (reference) and Part B (persecutory) scores, the Psychotic Symptom Rating Scales (PSYRATS Delusion subscale), reasoning (belief flexibility, possibility of being mistaken [Maudsley Assessment of Delusions, rated 0%-100%]), and jumping to conclusions (Beads Task). RESULTS A total of 361 participants were included in intention-to-treat analysis, of whom 252 (69.8%) were male and 249 (69.0%) were White; the mean (SD) age was 42.6 (11.6) years. At 24 weeks, 332 participants (92.0%) provided primary outcome data. Of 181 participants in the SlowMo group, 145 (80.1%) completed therapy. SlowMo plus usual care was not associated with greater reductions than usual care in GPTS total score at 24 weeks (Cohen d, 0.20; 95% CI, -0.02 to 0.40; P = .06). There were significant effects on secondary paranoia outcomes at 12 weeks, including GPTS total score (Cohen d, 0.30; 95% CI, 0.09-0.51; P = .005), Part A score (Cohen d, 0.22; 95% CI, 0.06-0.39; P = .009), and Part B score (Cohen d, 0.32; 95% CI, 0.08-0.56; P = .009), and at 24 weeks, including Part B score (Cohen d, 0.25; 95% CI, 0.01-0.49; P = .04) but not Part A score (Cohen d, 0.12; 95% CI, -0.05 to 0.28; P = .18). Improvements were observed in an observer-rated measure of persecutory delusions (PSYRATS delusion) at 12 weeks (Cohen d, 0.47; 95% CI, 0.17-0.78; P = .002) and 24 weeks (Cohen d, 0.50; 95% CI, 0.20-0.80; P = .001) and belief flexibility at 12 weeks (Cohen d, 0.29; 95% CI, 0.09-0.49; P = .004) and 24 weeks (Cohen d, 0.28; 95% CI, 0.08-0.49; P = .005). There were no significant effects on jumping to conclusions. Improved belief flexibility and worry mediated paranoia change (range mediated, 36%-56%). CONCLUSIONS AND RELEVANCE SlowMo did not demonstrate significant improvements in the primary measure of paranoia at 24 weeks; however, a beneficial effect of SlowMo on paranoia was indicated by the results on the primary measure at an earlier point and on observer-rated paranoia and self-reported persecution at 12 and 24 weeks. Further work to optimize SlowMo's effects is warranted. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN 32448671.
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Affiliation(s)
- Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kathryn Greenwood
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - David Fowler
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Alison McGourty
- Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | | | - Nicola Collett
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, United Kingdom
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
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Increasing access to brief Coping Strategy Enhancement for distressing voices: a service valuation exploring a possible role for briefly-trained therapists. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract
Hearing voices is a distressing and trans-diagnostic experience. Cognitive behavioural therapy (CBT) is an effective psychological treatment for distressing voices, but is offered to only a minority of patients. Limited resources are a barrier to accessing CBT. Evaluations of brief forms of CBT for voices have offered encouraging findings, but the ability of briefly-trained therapists to deliver these brief therapies has yet to be explored. We evaluated the outcomes of a brief form of CBT (Coping Strategy Enhancement, CSE) for voices when delivered by highly-trained and briefly-trained therapists. This was a service evaluation comparing pre–post outcomes in patients who had completed brief CSE over four sessions, within NHS Mental Health Services, delivered by highly-trained and briefly-trained therapists. The primary outcome was the negative impact scale of the Hamilton Program for Schizophrenia Voices Questionnaire. Data were available from 92 patients who completed a course of brief CSE – nearly half of whom received therapy from a briefly-trained therapist. Modest benefits across the sample were consistent with previous evaluations and did not seem to be influenced by the training of the therapist. This service evaluation offers further evidence that brief CSE can begin a therapeutic conversation about distressing voices within routine clinical practice. The usefulness of this initial conversation does not seem to be reliant upon the extent of therapist training, suggesting that briefly-trained therapists may play a role in increasing access to these conversations for patients distressed by hearing voices.
Key learning aims
(1)
How can access to CBT be increased for patients distressed by hearing voices?
(2)
Can a wider workforce of briefly-trained therapists start a CBT-informed conversation about distressing voices?
(3)
How do the outcomes of these conversations compare with the same conversations facilitated by highly trained therapists?
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37
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Sired R, Griffith E, Jamalamadaka T, Salkovskis P. Negative interpretations of ambiguous 'psychosis-like' and 'anxiety-like' experiences in recovery from psychosis or anxiety. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:463-485. [PMID: 33982800 DOI: 10.1111/bjc.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 04/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Fear of relapse (FOR) after experiencing psychosis has been found to predict actual relapse; however, potential mechanisms underlying this relationship have not been investigated. Negative appraisals of 'prodromal symptoms' are believed to play an important role in both psychosis and mental health anxiety (MHA). This study aimed to explore whether people in recovery from psychosis or anxiety disorders show an enduring tendency to negatively interpret ambiguous experiences both related and less related to their previous mental health difficulty relative to controls. DESIGN Cross-sectional between-groups questionnaire design. METHODS Participants self-reported as in recovery from psychosis (n = 33) or anxiety (n = 77) or without previous experience of mental health problems (n = 61) were recruited online or via NHS services. Interpretations of psychosis-like, anxiety-like, and external-control experiences were measured using the newly developed Experiences Interpretation Questionnaire (EIQ). MHA and FOR were measured using self-report questionnaires. RESULTS People in recovery from psychosis interpreted psychosis-like experiences significantly more negatively than the other groups. Negative interpretations of anxiety-like experiences were greater than controls but comparable between mental health groups. Contrary to predictions, FOR was not significantly different between the mental health groups. MHA and FOR did not significantly predict negative interpretations of psychosis-like items in the psychosis group, however, MHA predicted negative interpretations of anxiety-like items in the anxiety group. The EIQ subscales demonstrated good test-retest reliability. CONCLUSIONS People in self-defined recovery from psychosis or anxiety are more likely to negatively interpret ambiguous experiences relating to their previous mental health difficulties. Clinical and future research implications are outlined. PRACTITIONER POINTS People in recovery from psychosis or anxiety appraise possible symptoms of their previous difficulties negatively/catastrophically (as indicating relapse) relative to those without prior MH problems. Clinicians should consider attending to how people in recovery appraise possible symptoms when encouraging early signs monitoring as part of relapse prevention. This may be important to ensure that self-monitoring leads to helpful responses rather than being counterproductive, with catastrophic interpretations leading to anxiety and thus increasing the risk of relapse. Interventions drawing on CBT principles to address catastrophic interpretations of possible symptoms may potentially be a useful addition to relapse prevention work; in psychosis this may also include symptoms of anxiety.
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Affiliation(s)
- Rebecca Sired
- Avon and Wiltshire Partnership NHS Mental Health Trust, UK.,Department of Psychology, University of Bath, UK
| | - Emma Griffith
- Avon and Wiltshire Partnership NHS Mental Health Trust, UK.,Department of Psychology, University of Bath, UK
| | | | - Paul Salkovskis
- Department of Experimental Psychology, The Oxford Centre for Psychological Health, The Oxford Institute of Clinical Psychology, University of Oxford, Salisbury, UK
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38
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Treise C, Perez J. The Role of Dissociative Compartmentalization in Difficult-to-Treat Psychotic Phenomena. Front Psychol 2021; 12:533884. [PMID: 33897507 PMCID: PMC8062699 DOI: 10.3389/fpsyg.2021.533884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/12/2021] [Indexed: 12/03/2022] Open
Affiliation(s)
- Cate Treise
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Jesus Perez
- CAMEO Early Intervention Services, Cambridgeshire and Peterborough National Health Service Foundation Trust, Cambridge, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,Norwich Medical School, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, United Kingdom
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39
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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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40
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Mei C, van der Gaag M, Nelson B, Smit F, Yuen HP, Berger M, Krcmar M, French P, Amminger GP, Bechdolf A, Cuijpers P, Yung AR, McGorry PD. Preventive interventions for individuals at ultra high risk for psychosis: An updated and extended meta-analysis. Clin Psychol Rev 2021; 86:102005. [PMID: 33810885 DOI: 10.1016/j.cpr.2021.102005] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 01/14/2021] [Accepted: 03/01/2021] [Indexed: 02/06/2023]
Abstract
Intervention at the earliest illness stage, in ultra or clinical high-risk individuals, or indicated prevention, currently represents the most promising strategy to ameliorate, delay or prevent psychosis. We review the current state of evidence and conduct a broad-spectrum meta-analysis of various outcomes: transition to psychosis, attenuated positive and negative psychotic symptoms, mania, depression, anxiety, general psychopathology, symptom-related distress, functioning, quality of life, and treatment acceptability. 26 randomized controlled trials were included. Meta-analytically pooled interventions reduced transition rate (risk ratio [RR] = 0.57, 95%CI 0.41-0.81) and attenuated positive psychotic symptoms at 12-months (standardized mean difference = -0.15, 95%CI = -0.28--0.01). When stratified by intervention type (pharmacological, psychological), only the pooled effect of psychological interventions on transition rate was significant. Cognitive behavioral therapy (CBT) was associated with a reduction in incidence at 12-months (RR = 0.52, 95%CI = 0.33-0.82) and 18-48-months (RR = 0.60, 95%CI = 0.42-0.84), but not 6-months. Findings at 12-months and 18-48-months were robust in sensitivity and subgroup analyses. All other outcomes were non-significant. To date, effects of trialed treatments are specific to transition and, a lesser extent, attenuated positive symptoms, highlighting the future need to target other symptom domains and functional outcomes. Sound evidence supports CBT in reducing transition and the value of intervening at this illness stage. STUDY REGISTRATION: Research Registry ID: reviewregistry907.
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Affiliation(s)
- Cristina Mei
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Mark van der Gaag
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, The Hague, the Netherlands.
| | - Barnaby Nelson
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Filip Smit
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Centre of Mental Health and Prevention, Utrecht, the Netherlands; Department of Epidemiology and Biostatistics, Amsterdam University Medical Centres, Amsterdam, the Netherlands
| | - Hok Pan Yuen
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Maximus Berger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Marija Krcmar
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Paul French
- School of Health Sciences, University of Manchester, Manchester, UK
| | - G Paul Amminger
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Klinikum am Urban, Charite-Universitätsmedizin, Berlin, Germany; Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Pim Cuijpers
- Department of Clinical, Neuro and Developmental Psychology, Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Alison R Yung
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia; School of Health Sciences, University of Manchester, Manchester, UK
| | - Patrick D McGorry
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.
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41
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Isham L, Griffith L, Boylan A, Hicks A, Wilson N, Byrne R, Sheaves B, Bentall RP, Freeman D. Understanding, treating, and renaming grandiose delusions: A qualitative study. Psychol Psychother 2021; 94:119-140. [PMID: 31785077 PMCID: PMC7984144 DOI: 10.1111/papt.12260] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/23/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND Grandiose delusions are arguably the most neglected psychotic experience in research. OBJECTIVES We aimed to discover from patients: whether grandiose delusions have harmful consequences; the psychological mechanisms that maintain them; and what help patients may want from clinical services. DESIGN A qualitative interview design was used to explore patients' experiences of grandiose delusions. METHOD Fifteen patients with past or present experiences of grandiose delusions who were attending psychiatric services were interviewed. Thematic analysis and grounded theory were used to analyse the data. RESULTS Participants reported physical, sexual, social, occupational, and emotional harms from grandiose delusions. All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self-identity, or it made sense of unusual or difficult events. The meaning from the belief was not synonymous with extreme superiority or arrogance. The meaning obtained appeared to be a key driver of the persistence of the beliefs. Other maintenance factors were subjectively anomalous experiences (e.g., voices), symptoms of mania, fantasy elaboration, reasoning biases, and immersive behaviours. Participants described insufficient opportunities to talk about their grandiose beliefs and related experiences and were generally positive about the possibility of a psychological therapy. CONCLUSIONS We conclude that grandiosity is a psychologically rich experience, with a number of maintenance factors that may be amenable to a targeted psychological intervention. Importantly, the term 'grandiose delusion' is an imprecise description of the experience; we suggest 'delusions of exceptionality' may be a credible alternative. PRACTITIONER POINTS Harm from grandiose delusions can occur across multiple domains (including physical, sexual, social, occupational, and emotional) and practitioners should assess accordingly. However, grandiose delusions are experienced by patients as highly meaningful: they provide a sense of purpose, belonging, or self-identity, or make sense of unusual or difficult events. Possible psychological maintenance mechanisms that could be a target for intervention include the meaning of the belief, anomalous experiences, mania, fantasy elaboration, reasoning biases, and immersive behaviours. Patients are keen to have the opportunity to access talking therapies for this experience. Taking extra time to talk at times of distress, 'going the extra mile', and listening carefully can help to facilitate trust.
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Affiliation(s)
- Louise Isham
- Oxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
| | - Laura Griffith
- Health Services Management CentreUniversity of BirminghamUK
| | - Anne‐Marie Boylan
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordUK
| | - Alice Hicks
- Patient Advisory GroupOxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,The McPin FoundationLondonUK
| | - Natalie Wilson
- Patient Advisory GroupOxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,The McPin FoundationLondonUK
| | - Rory Byrne
- Psychosis Research UnitGreater Manchester Mental Health NHS Foundation TrustUK
| | - Bryony Sheaves
- Oxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
| | | | - Daniel Freeman
- Oxford Cognitive Approaches to Psychosis (O‐CAP)Department of PsychiatryUniversity of OxfordUK,Oxford Health NHS Foundation TrustUK
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Pondering on how great I am: Does rumination play a role in grandiose ideas? J Behav Ther Exp Psychiatry 2021; 70:101596. [PMID: 32841922 DOI: 10.1016/j.jbtep.2020.101596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 06/17/2020] [Accepted: 06/30/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND & OBJECTIVES A recent psychological model proposed that rumination might be involved in grandiose delusions (GD) by amplifying positive mood triggered by the occurrence of a positive event or the recall of positive autobiographical memories. This is the first study whose aim is to explore the role of rumination in the development and maintenance of grandiose ideas in a nonclinical sample. METHODS Following a grandiose ideas induction task, 109 nonclinical participants completed a rumination and distraction condition. Participants also completed a questionnaire designed to measure GD. RESULTS Rumination induction was associated with maintained levels of grandiose ideas and positive affect, while distraction led to reduced levels of grandiose ideas. Our findings showed that grandiose ideas after the rumination condition, but not after the distraction condition, was associated with trait grandiosity. LIMITATIONS This study needs to be replicated in clinical samples. CONCLUSIONS Our findings suggest that ruminative thinking style might play a role in the maintenance of grandiose ideas. Consequently, interventions targeting rumination might be useful when targeting grandiose delusions in clinical samples.
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Pipkin A, Hogg L, Armitage S. 'Someone on my level': A Meta-Ethnographic Review of Therapeutic Relationships in Cognitive Behavioural Therapy for Psychosis. Clin Psychol Psychother 2021; 28:1297-1313. [PMID: 33605515 DOI: 10.1002/cpp.2578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cognitive Behavioural Therapy for Psychosis (CBTp) demonstrates variable and at times mild to moderate effect sizes; thus, its therapeutic processes are important to explore. Establishing a secure therapeutic relationship is one such key process where barriers may exist, including those related to psychotic symptoms and associated stigma. This review synthesizes the available qualitative research pertaining to the experience of the therapeutic relationship from the perspective of those experiencing psychosis. METHODS A systematic review was undertaken using PRISMA guidelines. Search terms included variants of 'psychosis', 'therapy' and 'qualitative'. PsycInfo, CINAHL, EmBase, MedLine and Web of Science were searched, and reference lists were hand-scanned. Yardley's quality appraisal tool was utilized and Noblit and Hare's seven-stage process for conducting a meta-ethnographic review. A line-of-argument synthesis is presented. RESULTS Fourteen papers were identified using inclusion and exclusion criteria. Twelve papers were deemed to have satisfactory quality. The line-of-argument synthesis used attachment theory to propose four semi-distinct stages to establishing a therapeutic relationship: beginning; safety, hope and trust; the practicalities of therapy; and branching out. Findings suggest that the therapist's persona and use of CBTp techniques such as collaboration and shared agency over the process were important in establishing for the patient a sense of self as normal, equal and worthwhile. CONCLUSIONS Attachment security may be an important strand of CBTp and warrants further research and clinical investigation as a process and an outcome. Future research can benefit from increased transparency regarding researcher positionality as a potential source of bias.
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Affiliation(s)
- Alastair Pipkin
- Senior Clinical Psychologist, Northamptonshire Gender Service, Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK
| | - Lorna Hogg
- Deputy Director and Consultant Clinical Psychologist, Oxford Institute of Clinical Psychology Training, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Armitage
- Clinical Psychologist, Berkshire Early Intervention in Psychosis Service, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
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Beale S, Vitoratou S, Liness S. An investigation into the factor structure of the Cognitive Therapy Scale - Revised (CTS-R) in a CBT training sample. Behav Cogn Psychother 2021; 49:1-11. [PMID: 33455609 DOI: 10.1017/s1352465820000983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Effective monitoring of cognitive behaviour therapy (CBT) competence depends on psychometrically robust assessment methods. While the UK Cognitive Therapy Scale - Revised (CTS-R; Blackburn et al., 2001) has become a widely used competence measure in CBT training, practice and research, its underlying factor structure has never been investigated. AIMS This study aimed to present the first investigation into the factor structure of the CTS-R based on a large sample of postgraduate CBT trainee recordings. METHOD Trainees (n = 382) provided 746 mid-treatment audio recordings for depression (n = 373) and anxiety (n = 373) cases scored on the CTS-R by expert markers. Tapes were split into two equal samples counterbalanced by diagnosis and with one tape per trainee. Exploratory factor analysis was conducted. The suggested factor structure and a widely used theoretical two-factor model were tested with confirmatory factor analysis. Measurement invariance was assessed by diagnostic group (depression versus anxiety). RESULTS Exploratory factor analysis suggested a single-factor solution (98.68% explained variance), which was supported by confirmatory factor analysis. All 12 CTS-R items were found to contribute to this single factor. The univariate model demonstrated full metric invariance and partial scalar invariance by diagnosis, with one item (item 10 - Conceptual Integration) demonstrating scalar non-invariance. CONCLUSIONS Findings indicate that the CTS-R is a robust homogenous measure and do not support division into the widely used theoretical generic versus CBT-specific competency subscales. Investigation into the CTS-R factor structure in other populations is warranted.
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Affiliation(s)
- Sarah Beale
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, LondonSE5 8AF, UK
| | - Silia Vitoratou
- Psychometrics & Measurement Lab, Department of Biostatistics and Health Informatics, King's College London, London, UK
| | - Sheena Liness
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, LondonSE5 8AF, UK
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45
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Sheffield JM, Brinen AP, Freeman D. Paranoia and Grandiosity in the General Population: Differential Associations With Putative Causal Factors. Front Psychiatry 2021; 12:668152. [PMID: 33995151 PMCID: PMC8119764 DOI: 10.3389/fpsyt.2021.668152] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 03/30/2021] [Indexed: 11/25/2022] Open
Abstract
Worry, negative self-beliefs, and sleep disturbance have been identified as contributory factors to the onset, maintenance, and severity of paranoia. We tested the specificity of these contributory factors to paranoia compared to grandiosity, a different type of delusional ideation. Data were used from 814 adults from the Nathan Kline Institute-Rockland (NKI-Rockland) study, a general population dataset. Paranoid and grandiose delusional ideation was assessed using the Peters Delusions Inventory (PDI-21) and correlated with self-reported worry (n = 228), negative self-beliefs (n = 485), and sleep quality (n = 655). Correlations were compared using Fisher's r-to-z transform to examine whether the magnitude of relationships differed by delusion type. Paranoia was significantly associated with worry, negative self-belief, and sleep quality. Grandiosity demonstrated significantly weaker relationships with worry and negative self-beliefs. Relationships with sleep quality were similar. We replicate previous reports that worry, negative self-beliefs and sleep quality are associated with paranoid ideation in the general population. We extend these findings by demonstrating that these contributory factors, particularly worry and negative self-beliefs, are associated with paranoid ideation to a greater extent than grandiosity. This suggests a degree of specificity of contributory factors to different types of delusional thinking, supporting the pursuit of specific psychological models and treatments for each delusion type.
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Affiliation(s)
- Julia M Sheffield
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Aaron P Brinen
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
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Freeman D, Loe BS, Kingdon D, Startup H, Molodynski A, Rosebrock L, Brown P, Sheaves B, Waite F, Bird JC. The revised Green et al., Paranoid Thoughts Scale (R-GPTS): psychometric properties, severity ranges, and clinical cut-offs. Psychol Med 2021; 51:244-253. [PMID: 31744588 PMCID: PMC7893506 DOI: 10.1017/s0033291719003155] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND The Green et al., Paranoid Thoughts Scale (GPTS) - comprising two 16-item scales assessing ideas of reference (Part A) and ideas of persecution (Part B) - was developed over a decade ago. Our aim was to conduct the first large-scale psychometric evaluation. METHODS In total, 10 551 individuals provided GPTS data. Four hundred and twenty-two patients with psychosis and 805 non-clinical individuals completed GPTS Parts A and B. An additional 1743 patients with psychosis and 7581 non-clinical individuals completed GPTS Part B. Factor analysis, item response theory, and receiver operating characteristic analyses were conducted. RESULTS The original two-factor structure of the GPTS had an inadequate model fit: Part A did not form a unidimensional scale and multiple items were locally dependant. A Revised-GPTS (R-GPTS) was formed, comprising eight-item ideas of reference and 10-item ideas of persecution subscales, which had an excellent model fit. All items in the new Reference (a = 2.09-3.67) and Persecution (a = 2.37-4.38) scales were strongly discriminative of shifts in paranoia and had high reliability across the spectrum of severity (a > 0.90). The R-GPTS score ranges are: average (Reference: 0-9; Persecution: 0-4); elevated (Reference: 10-15; Persecution: 5-10); moderately severe (Reference: 16-20; Persecution:11-17); severe (Reference: 21-24; Persecution: 18-27); and very severe (Reference: 25+; Persecution: 28+). Recommended cut-offs on the persecution scale are 11 to discriminate clinical levels of persecutory ideation and 18 for a likely persecutory delusion. CONCLUSIONS The psychometric evaluation indicated a need to improve the GPTS. The R-GPTS is a more precise measure, has excellent psychometric properties, and is recommended for future studies of paranoia.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Bao S. Loe
- The Psychometrics Centre, University of Cambridge, Cambridge, UK
| | - David Kingdon
- Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | | | - Laina Rosebrock
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Poppy Brown
- Department of Psychiatry, University of Oxford
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jessica C. Bird
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
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47
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Lüdtke T, Pfuhl G, Moritz S, Rüegg NL, Berger T, Westermann S. Sleep problems and worrying precede psychotic symptoms during an online intervention for psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 60:48-67. [PMID: 33305386 DOI: 10.1111/bjc.12270] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Experience sampling assessments (multiple assessments per day for approximately one week) indicate that positive symptoms fluctuate over time in psychosis. Precursors, such as sleep problems or worrying, predict these fluctuations. To date, it remains unclear whether the same precursors predict symptom variability also during treatment in an online intervention for psychosis, using assessments lying temporally further apart. METHODS Participants completed brief intermediate online self-report assessments on their computers (up to every 7 days during a 2-month waiting period and up to twice every 6 days during a 2-month intervention period) within a randomized controlled trial. We monitored the course of paranoia, auditory verbal hallucinations, and their theory-driven precursors worrying, negative affect, self-esteem, self-reported cognitive biases, and quality of sleep in n = 124 participants (M = 10.32 assessments per participant; SD = 6.07). We tested group differences regarding the course of the composite of precursors, group differences regarding the effect of the composite on subsequent momentary psychotic symptoms, and the effect of each individual precursor on subsequent psychotic symptoms, using (lagged) linear mixed models. RESULTS The course composite precursors over time and their lagged effect on subsequent momentary psychotic symptoms did not differ between groups. During the intervention, increased worrying and decreased quality of sleep preceded heightened momentary psychotic symptoms. CONCLUSION The regression-based design does not allow drawing causal conclusions. However, worrying and sleep problems likely represent underlying mechanisms of psychotic symptom variability during online psychosis treatment, indicating that experience sampling findings from everyday life generalize to interventions with assessments lying several days apart. PRACTITIONER POINTS Worrying and sleep problems represent important mechanisms of symptom fluctuations during an online intervention for people with psychosis. Our findings further support the notion that worrying and sleep problems are important treatment targets in psychological interventions for people with psychosis. Momentary levels of worrying and quality of sleep can signal subsequent fluctuations of psychotic symptom severity so practitioners should monitor these variables during treatment. Worrying seems to predict subsequent paranoia specifically during treatment whereas quality of sleep predicts both paranoia and auditory verbal hallucinations.
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Affiliation(s)
- Thies Lüdtke
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Gerit Pfuhl
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Nina Lee Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Switzerland
| | - Stefan Westermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.,Department of Clinical Psychology and Psychotherapy, MSH Medical School Hamburg, Germany
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Steel C, Korrelboom K, Fazil Baksh M, Kingdon D, Simon J, Wykes T, Phiri P, van der Gaag M. Positive memory training for the treatment of depression in schizophrenia: A randomised controlled trial. Behav Res Ther 2020; 135:103734. [PMID: 33002684 DOI: 10.1016/j.brat.2020.103734] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 09/07/2020] [Accepted: 09/21/2020] [Indexed: 02/05/2023]
Affiliation(s)
- Craig Steel
- Oxford Health NHS Foundation Trust, Oxford, UK; School of Psychology, University of Reading, UK.
| | - Kees Korrelboom
- Department of Anxiety Disorders, PsyQ Parnassia Group, Psychiatric Center, The Hague, the Netherlands; Department of Medical and Clinical Psychiatry, Tilburg University, Tilburg, the Netherlands
| | - M Fazil Baksh
- Department of Mathematics and Statistics, University of Reading, Whiteknights, Reading, RG6 6AL, UK
| | - David Kingdon
- University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Judit Simon
- Department of Health Economics, Center for Public Health, Medical University of Vienna, 1090, Wien, Kinderspitalgasse 15, Austria; Department of Psychiatry, University of Oxford and Oxford Health NHS Trust, Warneford Hospital, Oxford OX3 7JX, UK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, UK
| | - Peter Phiri
- Southern Health NHS Foundation Trust, Research & Development Department, Tom Rudd Unit, Moorgreen Hospital, Botley Rd, West End Southampton, SO30 3JB, UK
| | - Mark van der Gaag
- VU University and Amsterdam Public Mental Health Research Institute, Department of Clinical Psychology Van der Boechorststraat 1, 1081, BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512, HN, The Hague, the Netherlands
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Webb R, Bartl G, James B, Skan R, Peters E, Jones AM, Garety P, Kuipers E, Hayward M, Greenwood K. Exploring the Development, Validity, and Utility of the Short-Form Version of the CHoice of Outcome In Cbt for PsychosEs: A Patient-Reported Outcome Measure of Psychological Recovery. Schizophr Bull 2020; 47:653-661. [PMID: 33215190 PMCID: PMC8084424 DOI: 10.1093/schbul/sbaa173] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The original CHoice of Outcome In Cbt for psychosEs (CHOICE) measure was designed in collaboration with experts by experience as a patient-reported "Psychological Recovery" outcome measure for cognitive-behavioral therapy for psychosis (CBTp). A short version (CHOICE-SF) was developed to use as a brief outcome measure, with a focus on sensitivity to change, for use in future research and practice. CHOICE-SF was developed and validated using 3 separate samples, comprising 640 service users attending 1 of 2 transdiagnostic clinics for (1) CBTp or (2) therapies for voice hearing or (3) who took part in the treatment as usual arm of a trial. In the initial subsample of 69 participants, items from the original CHOICE measure with medium to large effect sizes for change pre- to post-CBTp were retained to form the CHOICE-SF. Internal consistency, construct validity, and sensitivity to change were confirmed, and the factor structure was examined in 242 participants. Specificity was confirmed by comparison with 44 participants who completed CHOICE at 2 time points but did not receive therapy. Validation of CHOICE-SF was carried out by confirming factor structure and sensitivity to change in a new sample of 354 and a subsample of 51 participants, respectively. The CHOICE-SF comprised 11 items and 1 additional personal goal item. A single-factor structure was confirmed, with high internal consistency, construct validity, and sensitivity to change. The CHOICE-SF is a brief, psychometrically robust measure to assess change following psychological therapies in research and clinical practice for people with psychosis and severe mental illness.
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Affiliation(s)
- Rebecca Webb
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Gergely Bartl
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Bryony James
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Rosie Skan
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Anna-Marie Jones
- R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Philippa Garety
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Elizabeth Kuipers
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK,Psychological Interventions Clinic for Outpatients With Psychosis, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK,National Institute for Health Research Biomedical Research Centre, South London and Maudsley NHS Foundation Trust and King’s College London, London, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Pevensey, Falmer, Brighton, UK,R&D Department, Sussex Partnership NHS Foundation Trust, Brighton, UK,To whom correspondence should be addressed; tel: +44 1273 678409, fax: +44 1273 678058, e-mail:
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50
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Bidirectional pathways between psychosocial risk factors and paranoid ideation in a general nonclinical population. Dev Psychopathol 2020; 34:421-430. [PMID: 33084551 DOI: 10.1017/s0954579420001030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We investigated (a) whether psychosocial factors (experienced stress, anticipatory worry, social detachment, sleeping disturbances, alcohol use) predict the course of paranoid ideation between the ages of 24 to 50 years and (b) whether the predictive relationships are more likely to proceed from the psychosocial factors to paranoid ideation, or vice versa. The participants (N = 1534-1553) came from the population-based Young Finns study. Paranoid ideation and psychosocial factors were assessed by reliable self-report questionnaires in 2001, 2007, and 2011/2012. The data were analyzed using growth curve and structural equation models. High experienced stress, anticipatory worry, social detachment, frequent sleeping disturbances, and frequent alcohol use predicted more paranoid ideation. More risk factors predicted increasing paranoid ideation. There were bidirectional predictive relationships of paranoid ideation with experienced stress, anticipatory worry, social detachment, and sleeping disturbances. The link between alcohol use and paranoid ideation was only correlative. In conclusion, paranoid ideation increases by reciprocal interactions with stress, worry, social detachment, and sleeping disturbances. The findings support the threat-anticipation model of paranoid ideation, providing important implications for treatment of paranoia.
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