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Wright AC, Palmer-Cooper E, Cella M, McGuire N, Montagnese M, Dlugunovych V, Liu CWJ, Wykes T, Cather C. Experiencing hallucinations in daily life: The role of metacognition. Schizophr Res 2024; 265:74-82. [PMID: 36623979 DOI: 10.1016/j.schres.2022.12.023] [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: 08/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND Hallucinations have been linked to failures in metacognitive reflection suggesting an association between hallucinations and overestimation of performance, although the cross-sectional findings are inconsistent. This inconsistency may relate to the fluctuating hallucinatory experiences that are not captured in cross-sectional studies. Ecological Momentary Assessment (EMA) captures in-the-moment experiences over time so can identify causal relationships between variables such as the associations between metacognition and hallucinatory experience in daily life and overcome problems in cross-sectional designs. METHODS Participants (N = 41) experiencing daily hallucinations completed baseline questionnaires and smartphone surveys 7 times per day for 14 days. They were prompted to identify a task they would complete in the next 4 h and to make metacognitive predictions around the likelihood of completing the task, the difficulty of the task, and how well they would complete it (standard of completion). RESULTS 76 % finished the 14-days of assessment with an average of 42.2 % survey completion. Less accurate metacognition was associated with more hallucinations, but less accurate likelihood and standard of completion was associated with fewer hallucinations. Using a cross-lagged analysis, metacognitive predictions around the likelihood of completion (p < .001) and standard of completion (p = .01) predicted hallucination intensity at the following timepoint, and metacognitive predictions regarding likelihood of completion (p = .02) predicted hallucination control at the following timepoint. DISCUSSION Interventions that aim to improve metacognitive ability in-the-moment may serve to reduce the intensity and increase the control of hallucinations.
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Affiliation(s)
- Abigail C Wright
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
| | - Emma Palmer-Cooper
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, UK
| | - Matteo Cella
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Nicola McGuire
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marcella Montagnese
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Chih-Wei Joshua Liu
- Physics of Living Systems Group, Department of Physics, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Til Wykes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; South London & Maudsley NHS Foundation Trust, Maudsley Hospital, London, UK
| | - Corinne Cather
- Center of Excellence for Psychosocial and Systemic Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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Maraldi EO, Taves A, Moll J, Hartle L, Moreira-de-Oliveira ME, Bortolini T, Fischer R. Nonordinary Experiences, Well-being and Mental Health: A Systematic Review of the Evidence and Recommendations for Future Research. JOURNAL OF RELIGION AND HEALTH 2024; 63:410-444. [PMID: 37507577 DOI: 10.1007/s10943-023-01875-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/07/2023] [Indexed: 07/30/2023]
Abstract
Throughout history, people have reported nonordinary experiences (NOEs) such as feelings of oneness with the universe and hearing voices. Although these experiences form the basis of several spiritual and religious traditions, experiencing NOEs may create stress and uncertainty among those who experience such events. To provide a more systematic overview of the research linking NOEs with mental health, we present a systematic review of studies focusing on NOEs, well-being and mental health indicators. In a search of ProQuest and PsycInfo, we identified 725 references, of which 157 reported empirical data and were included in our review. Overall, the studies reviewed suggest that the relationship between NOEs and mental health is complex, varying according to a series of psychological and social factors. In particular, they suggest that appraisal processes play a fundamental role in the mental health outcomes of these experiences. However, we also highlight important methodological challenges such as the conceptual overlap between NOEs and well-being or psychopathological constructs, the conflation between experiences and appraisal processes in the assessment procedure, and the need for clearer assessment of the duration, controllability, impact on daily functioning and general context of the experiences. We provide a qualitative summary of empirical evidence and main themes of research and make recommendations for future investigation.
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Affiliation(s)
- Everton O Maraldi
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil.
- Department of Religious Studies, Pontifical Catholic University of São Paulo, São Paulo, Brazil.
| | - Ann Taves
- Department of Religious Studies, University of California, Santa Barbara, Santa Barbara, CA, USA
| | - Jorge Moll
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil
| | - Larissa Hartle
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil
| | - Maria E Moreira-de-Oliveira
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil
| | - Tiago Bortolini
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil
| | - Ronald Fischer
- Cognitive Neuroscience and Neuroinformatics Unit, D'Or Institute for Research and Education (IDOR), Rua Diniz Cordeiro, 30, Botafogo, Rio de Janeiro, 22281-100, Brazil
- School of Psychology, Victoria University of Wellington, Wellington, New Zealand
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Yu X, Zhou HY. Bodily self-disturbances and schizophrenia: the role of emotional responses to anomalous experiences. Asian J Psychiatr 2023; 83:103483. [PMID: 36758454 DOI: 10.1016/j.ajp.2023.103483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Xue Yu
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
| | - Han-Yu Zhou
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Affiliated Mental Health Center (ECNU), School of Psychology and Cognitive Science, East China Normal University, Shanghai, China; Shanghai Changning Mental Health Center, Shanghai, China.
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4
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Webster L, Norman C, Jones G, Marriott M. Mediating role for metacognitive processes in the relationship between schizotypy and anxiety and depression symptoms. Cogn Neuropsychiatry 2022; 27:393-410. [PMID: 35975632 DOI: 10.1080/13546805.2022.2108388] [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] [Indexed: 01/31/2023]
Abstract
Introduction: Depression and anxiety symptoms are highly prevalent in schizophrenia-spectrum disorders and are commonly associated with schizotypy in non-clinical samples. However, it remains unclear what factors could be contributing to the relationships between schizotypy and anxiety and depression symptoms. Using path analysis, we explored the complex interplay between schizotypy, metacognitive beliefs, cognitive insight, and symptoms of emotional distress.Methods: Self-report data of schizotypy, metacognitive beliefs, cognitive insight, depression, and anxiety symptoms were collected from 344 participants from a predominantly student sample.Results: Path analysis confirmed unique associations between schizotypy dimensions, metacognitive beliefs, and cognitive insight. Furthermore, negative beliefs about worry mediated the link between the schizotypy dimensions, unusual experiences, cognitive disorganisation, and introvertive anhedonia and both depression and anxiety symptoms. Lack of cognitive confidence also mediated the relationship between cognitive disorganisation and depression symptoms. Finally, the cognitive insight subcomponent self-reflectiveness mediated the relationship between unusual experiences and cognitive disorganisation and anxiety.Conclusions: This study significantly furthers our understanding of the complex relationship between schizotypy, metacognitive processes, and emotional distress. Our findings also provide support for interventions which modify metacognitive beliefs and self-reflectiveness, which may prove beneficial for treatment in clinical settings.
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Affiliation(s)
- Lucy Webster
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Christine Norman
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Gary Jones
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Mike Marriott
- Department of Psychology, School of Social Sciences, Nottingham Trent University, Nottingham, UK
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Giugliano M, Contrada C, Foglia L, Francese F, Romano R, Dello Iacono M, Di Fausto E, Esposito M, Azzara C, Bilotta E, Carcione A, Nicolò G. Metacognitive Abilities as a Protective Factor for the Occurrence of Psychotic-Like Experiences in a Non-clinical Population. Front Psychol 2022; 13:805435. [PMID: 35282208 PMCID: PMC8910609 DOI: 10.3389/fpsyg.2022.805435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Psychotic-like experiences (PLEs) are a phenomenon that occurs in the general population experiencing delusional thoughts and hallucinations without being in a clinical condition. PLEs involve erroneous attributions of inner cognitive events to the external environment and the presence of intrusive thoughts influenced by dysfunctional beliefs; for these reasons, the role played by metacognition has been largely studied. This study investigates PLEs in a non-clinical population and discriminating factors involved in this kind of experience, among which metacognition, as well as psychopathological features, seems to have a crucial role. The aim of this study was to extend the knowledge about the relationship between metacognition, psychopathology, and PLEs, orienting the focus on metacognitive functioning. The sample consisted of 207 Italian participants (men = 32% and women = 68%) voluntarily recruited online, who gave consent to participate in the study. The average age of the sample was 32.69 years (SD: 9.63; range: 18-71). Subjects affected by psychosis, neurological disease, and drug addiction were excluded from the analyses. The following scales were used to investigate PLEs: Peters et al. Delusions Inventory (PDI), Launay-Slade Hallucinations Scale-Extended Revised (LSHSE), Prodromal Questionnaire-Brief (PQ-B), and Revised Hallucination Scale (RHS). To assess general psychopathological features, the Behavior and Symptom Identification Scale (BASIS-32) was administrated. The Metacognition Self-Assessment Scale (MSAS) was chosen to evaluate metacognitive functioning. From hierarchical regression analyses, it emerged that the presence of anxiety, depression, and impulsive/addictive symptoms constitute a remarkable vulnerability factor for PLEs, in line with previous evidence regarding the relationship between general psychopathology and PLEs. Metacognition negatively predicts PLEs, and its presence does not affect the significance of psychopathological variables, suggesting that metacognitive abilities seem to play a protective role for the occurrence of PLEs among non-clinical individuals, and such ability operates as an independent predictor along with other variables. These results are explained by the role of metacognitive functions, which allow individuals to operate many mental processes such as interpreting sensorial events as real or illusory, understanding behaviors, thoughts, and drives of others, and questioning the subjective interpretation of facts.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Carla Azzara
- Società Italiana di Cognitivismo Clinico, Rome, Italy
| | - Elena Bilotta
- Società Italiana di Cognitivismo Clinico, Rome, Italy.,Terzo Centro di Psicoterapia, Rome, Italy
| | - Antonino Carcione
- Società Italiana di Cognitivismo Clinico, Rome, Italy.,Terzo Centro di Psicoterapia, Rome, Italy
| | - Giuseppe Nicolò
- Società Italiana di Cognitivismo Clinico, Rome, Italy.,Terzo Centro di Psicoterapia, Rome, Italy
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Coleman EP, Croft RJ, Barkus E. The profile of unusual beliefs associated with metacognitive thinking and attributional styles. Psych J 2022; 11:296-309. [PMID: 35168296 PMCID: PMC9305741 DOI: 10.1002/pchj.528] [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: 09/10/2021] [Revised: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022]
Abstract
Cognitive interpretations of daily events may differ in people from the general population who hold unusual beliefs. It is also important to understand whether different belief profiles exist to appreciate which patterns of beliefs are less psychologically healthy. Cluster analysis was used to form unusual belief profiles in a general population sample (n = 578; Mage = 22 years, SD = 6.98; 80% female) across paranoid, paranormal, and magical ideation beliefs, and we assessed whether they differed in attribution style and metacognitive beliefs about worry. Four clusters were formed: low on all measures (low all); high on all measures (high all); comparably higher on paranormal beliefs (paranormal group); and comparably higher on paranoid beliefs (paranoid group). For total Metacognitions Questionnaire‐30, the high all and high paranoid clusters did not differ, and both clusters scored higher than the high paranormal group, who all scored higher than the low all cluster. For attributional styles (Attributional Styles Questionnaire), lower scores on internal positive attribution were found for the high all and high paranoid clusters compared to the low all and high paranormal clusters. The high paranormal cluster had higher scores than the high paranoid cluster on self‐serving bias. Differences in attributional style appeared to be driven by mental health diagnosis. Our results suggest different profiles of unusual beliefs are detectable in the general population that differ in their metacognitive beliefs and perceived causation of events in their environment. Future studies investigating delusional proneness need to consider multiple unusual beliefs as well as assessing mood state and distress.
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Affiliation(s)
- Elle P Coleman
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Rodney J Croft
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Emma Barkus
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Escolà-Gascón Á. Impact of conspiracist ideation and psychotic-like experiences in patients with schizophrenia during the COVID-19 crisis. J Psychiatr Res 2022; 146:135-148. [PMID: 34979358 PMCID: PMC9749884 DOI: 10.1016/j.jpsychires.2021.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 11/29/2021] [Accepted: 12/10/2021] [Indexed: 10/19/2022]
Abstract
Conspiratorial belief is a type of argument that accepts implausible explanations in situations of great uncertainty or mystery. Claiming that the coronavirus is an artificial fabrication of laboratories is an example of conspiracist belief. The aim of this research was to analyze the impact of conspiracist ideation and psychotic-like experiences in patients with schizophrenia, patients with other mental disorders, and participants with no psychiatric history with a 132-day follow-up during the COVID-19 crisis. Analysis of variance (ANOVA) was applied and Bayesian inferences were carried out. The results conclude that conspiracist ideation and psychotic-like experiences increased significantly after 132 days of social-health restrictions in the general population. However, psychotic-like experiences did not increase in patients with schizophrenia. Conspiracist ideation has a quantitative degradation similar to the continuum model of psychosis; it is present both in patients with schizophrenia and in those participants with no clinical history. The psychopathological value of conspiracist ideation within the spectrum of psychosis is discussed.
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Affiliation(s)
- Álex Escolà-Gascón
- School of Communication and International Relations, Blanquerna, Ramon Llull University, Barcelona, Spain; School of Psychology, Education and Sport Sciences, Blanquerna, Ramon Llull University, Barcelona, Spain.
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8
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Baumgartner J, Litvan Z, Koch M, Hinterbuchinger B, Friedrich F, Baumann L, Mossaheb N. Metacognitive beliefs in individuals at risk for psychosis: a systematic review and meta-analysis of sex differences. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2020; 34:108-115. [PMID: 32338344 PMCID: PMC7467958 DOI: 10.1007/s40211-020-00348-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/30/2020] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sex differences were found in several domains in individuals at ultra-high risk for psychosis, but no previous work has systematically reviewed and analysed possible sex differences in metacognition in this population. However, alterations in metacognitive beliefs have been shown in the at-risk mental state for psychosis population. Our aim was to qualitatively review and quantitatively analyse the existing literature for data on sex differences in metacognitive beliefs-mainly depicted by the Metacognitions Questionnaire (MCQ) and its short form (MCQ-30)-in individuals with at-risk mental states. METHODS We performed a systematic review of the literature on metacognition in help-seeking adolescents and young adults at ultra-high risk for psychosis. We included peer-reviewed articles that included a high-risk for psychosis group assessed with operationalised criteria and instruments. For the quantitative meta-analysis, only studies comparing MCQ data in high-risk individuals were included. A fixed-effect meta-model was used and forest plots drawn for each subscale and overall score. The studies were weighted according to the inverse variance method in order to calculate pooled confidence intervals and p values. RESULTS No article on metacognitive beliefs in individuals at increased risk for psychosis explicitly reported possible sex differences. Our meta-analysis of 234 (57% male) individuals' scores in the MCQ yielded no significant sex difference. CONCLUSIONS Currently, no sex differences in metacognition can be described in the at-risk population; however, data are insufficient and heterogeneous with regard to thoroughly answering the question whether sex differences in clinical high-risk populations are mirrored in the metacognitive domain.
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Affiliation(s)
- Josef Baumgartner
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Zsuzsa Litvan
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Marlene Koch
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Barbara Hinterbuchinger
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Fabian Friedrich
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Lukas Baumann
- Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Institute for Medical Statistics, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria
| | - Nilufar Mossaheb
- Department of Psychiatry and Psychotherapy, Clinical Division for Social Psychiatry, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Kuranova A, Booij SH, de Jonge P, Jeronimus B, Lin A, Wardenaar KJ, Wichers M, Wigman JTW. Don't worry, be happy: Protective factors to buffer against distress associated with psychotic experiences. Schizophr Res 2020; 223:79-86. [PMID: 32473933 DOI: 10.1016/j.schres.2020.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 03/12/2020] [Accepted: 05/06/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Around 6-7% of the general population report psychotic experiences (PEs). Positive PEs (e.g. hearing voices) may increase the risk of development of psychotic disorder. An important predictor of the transition to a psychotic disorder is secondary distress associated with PEs. We examined the moderating effect of potential protective factors on this secondary distress. METHODS Data come from 2870 individuals of the HowNutsAreTheDutch study. PEs were assessed with the Community Assessment of Psychic Experience (CAPE) questionnaire and were divided into three subdomains ("Bizarre experiences", "Delusional ideations", and "Perceptual anomalies"). Protective factors explored were having a partner, having a pet, benevolent types of humor, optimism and the high levels of personality traits emotional stability (reversed neuroticism), extraversion, openness to experience, conscientiousness, and agreeableness. We examined whether these protective factors moderated (lowered) the association between frequency of PEs and PE-associated distress. RESULTS Due to low prevalence of perceptual anomalies in the sample, this domain was excluded from analysis. No moderating effects were observed of protective factors on the association between bizarre experiences and distress. Having a partner and high levels of optimism, self-enhancing humor, openness, extraversion and emotional stability moderated the association between delusional ideations and secondary distress, leading to lower levels of distress. CONCLUSIONS Several protective factors were found to moderate the association between frequency and secondary distress of delusional ideations, with high levels of the protective factors being associated with lower levels of distress. A focus on protective factors could be relevant for interventions and prevention strategies regarding psychotic phenomena.
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Affiliation(s)
- Anna Kuranova
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands.
| | - Sanne H Booij
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; Department of Research and Education, Friesland Mental Health Care Services, Leeuwarden, the Netherlands; Center for Integrative Psychiatry, Lentis, Groningen, the Netherlands
| | - Peter de Jonge
- University of Groningen, Department of Developmental Psychology, Groningen, the Netherlands
| | - Bertus Jeronimus
- University of Groningen, Department of Developmental Psychology, Groningen, the Netherlands
| | - Ashleigh Lin
- Telethon Kids Institute, The University of Western Australia, Australia
| | - Klaas J Wardenaar
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Marieke Wichers
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands
| | - Johanna T W Wigman
- University of Groningen, University Medical Center Groningen, University Center Psychiatry (UCP) Interdisciplinary Center Psychopathology and Emotion Regulation (ICPE), Groningen, the Netherlands; Department of Research and Education, Friesland Mental Health Care Services, Leeuwarden, the Netherlands
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10
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Swyer A, Powers AR. Voluntary control of auditory hallucinations: phenomenology to therapeutic implications. NPJ SCHIZOPHRENIA 2020; 6:19. [PMID: 32753641 PMCID: PMC7403299 DOI: 10.1038/s41537-020-0106-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/04/2020] [Indexed: 12/11/2022]
Abstract
Auditory verbal hallucinations (AVH) have traditionally been thought to be outside the influence of conscious control. However, recent work with voice hearers makes clear that both treatment-seeking and non-treatment-seeking voice hearers may exert varying degrees of control over their voices. Evidence suggests that this ability may be a key factor in determining health status, but little systematic examination of control in AVH has been carried out. This review provides an overview of the research examining control over AVH in both treatment-seeking and non-treatment-seeking populations. We first examine the relationship between control over AVH and health status as well as the psychosocial factors that may influence control and functioning. We then link control to various cognitive constructs that appear to be important for voice hearing. Finally, we reconcile the possibility of control with the field’s current understanding of the proposed cognitive, computational, and neural underpinnings of hallucinations and perception more broadly. Established relationships between control, health status, and functioning suggest that the development of control over AVH could increase functioning and reduce distress. A more detailed understanding of the discrete types of control, their development, and their neural underpinnings is essential for translating this knowledge into new therapeutic approaches.
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Affiliation(s)
- Ariel Swyer
- Department of Behavioral Sciences, York College/CUNY, Jamaica, NY, USA
| | - Albert R Powers
- Department of Psychiatry and the Connecticut Mental Health Center, Yale University, New Haven, CT, USA.
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Parker SK, Mulligan LD, Milner P, Bowe S, Palmier-Claus JE. Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study. Front Psychol 2020; 10:2741. [PMID: 32010004 PMCID: PMC6978773 DOI: 10.3389/fpsyg.2019.02741] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 11/20/2019] [Indexed: 11/13/2022] Open
Abstract
Developing effective interventions for preventing first episode psychosis have been an important research focus in the last decade. Cognitive behavioral therapy is a currently indicated treatment for people at ultra-high risk of psychosis, however, access and resource issues limit its delivery within the NHS. Treatments which partial out potential active ingredients and are aimed at a range of psychological difficulties seen within this population have the potential to be more efficacious and efficient. We conducted a single-arm exploratory pilot trial, designed to investigate the feasibility and acceptability of Metacognitive therapy for individuals at ultra-high risk (UHR) of developing psychosis. Trial uptake was good, with 11 out of 12 referred individuals meeting for an eligibility assessment (one individual was excluded prior to the assessment). Of these, 10 individuals were eligible and included in the trial. Retention to treatment was high with 80% treatment adherence gained and an overall average of 8 sessions completed. All participants were offered follow-up assessments immediately post-treatment and at 6 months, which comprised measures of psychotic like experiences, anxiety and depression, and metacognitive processes implicated in the model. Retention to the post-treatment (12-week) follow-up was good, with 80% completion; however retention to the 6-month follow-up was lower at 60%. Clinically significant results were observed in psychotic like experiences, anxiety, depression and functioning with medium to large effect sizes. Measures related to beliefs and processes targeted within MCT showed clinically significant change with medium to large effect sizes. Our results suggest that MCT based upon a specific metacognitive model for individuals meeting ARMS criteria may be an important treatment target and warrants further attention. Limitations and possible focuses for future research are discussed. Registration: ISRCTN53190465 http://www.isrctn.com/ISRCTN53190465.
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Affiliation(s)
- Sophie Kate Parker
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Lee D. Mulligan
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Philip Milner
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Jasper E. Palmier-Claus
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, United Kingdom
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
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12
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Perceptual biases and metacognition and their association with anomalous self experiences in first episode psychosis. Conscious Cogn 2020; 77:102847. [DOI: 10.1016/j.concog.2019.102847] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 10/25/2019] [Accepted: 10/25/2019] [Indexed: 01/19/2023]
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Koren D, Scheyer R, Stern Y, Adres M, Reznik N, Apter A, Seidman LJ. Metacognition strengthens the association between neurocognition and attenuated psychosis syndrome: Preliminary evidence from a pilot study among treatment-seeking versus healthy adolescents. Schizophr Res 2019; 210:207-214. [PMID: 30630704 DOI: 10.1016/j.schres.2018.12.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 12/11/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In a pilot study, we assessed the potential value of deficits at the metacognitive versus the neurocognitive level of functioning for identifying adolescents with attenuated psychotic syndrome (APS). METHOD Twenty-two treatment-seeking adolescents with APS, 42 treatment-seeking comparisons, and 34 age-matched healthy comparisons were evaluated using the Prodromal Questionnaire, the Structured Interview for Prodromal Syndromes, and the Mood and Anxiety Symptom Questionnaire. Neurocognitive and metacognitive functioning were assessed in two non-social (verbal memory and executive functioning) and two social (facial emotion perception and theory of mind) cognitive domains. In addition to the standard neurocognitive administration of the tasks, subjects were asked to rate their confidence level on each answer and to choose whether they wanted it "counted" toward their overall task performance score on the task. Choices were rewarded. RESULTS As hypothesized, APS among treatment-seeking adolescents was more strongly associated with impaired neurocognition than with impaired metacognition. Likewise, as hypothesized, impaired metacognition was shown to significantly improve the APS prediction beyond the contribution of impaired neurocognition alone, even after controlling for general intellectual ability, negative symptoms, social functioning, and depression. CONCLUSIONS These results suggest that metacognitive monitoring and control play a strengthening role in the association between neurocognition and APS. One possible explanation is that metacognition serves as an indicator of insight into the condition, accounting for differences in insight not explained by neurocognition alone. However, further research with larger samples that include non-treatment seeking individuals, established measures of insight, and follow-up data is required to assess this possibility.
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Affiliation(s)
- Danny Koren
- Psychology Department, University of Haifa, Haifa, Israel; Psychiatry Division, Rambam Medical Center, Haifa, Israel.
| | - Ravit Scheyer
- Psychology Department, University of Haifa, Haifa, Israel
| | - Yonatan Stern
- Psychology Department, University of Haifa, Haifa, Israel
| | - Merav Adres
- Psychology Department, University of Haifa, Haifa, Israel
| | - Noa Reznik
- Psychology Department, University of Haifa, Haifa, Israel
| | - Alan Apter
- Psychological Medicine Clinic, Schneider Children's Medical Center, Petach Tiqva, Israel
| | - Larry J Seidman
- The Massachusetts Mental Health Center Public Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, United States of America
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Koren D, Scheyer R, Reznik N, Adres M, Apter A, Parnas J, Seidman LJ. Basic self-disturbance, neurocognition and metacognition: A pilot study among help-seeking adolescents with and without attenuated psychosis syndrome. Early Interv Psychiatry 2019; 13:434-442. [PMID: 29052951 DOI: 10.1111/eip.12500] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 07/19/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
AIM The goal of this pilot study was to assess the association between basic self-disturbance (SD) and deficits in neurocognitive and metacognitive functioning among help-seeking adolescents with and without attenuated psychosis syndrome (APS). METHODS Sixty-one non-psychotic, help-seeking adolescents (age 13-18) were assessed with the examination of anomalous self-experience, the structured interview for prodromal syndromes and a new metacognitive approach to neurocognitive assessment applied to two non-social (executive functions and verbal memory) and two social (theory of mind and emotion recognition) domains. After each answer, subjects were also requested to indicate their level of confidence in the answer and to decide whether they desired it to be "counted" toward their total score on the task. Each volunteered answer earned a 5-cent gain if correct, but an equal fine if wrong. RESULTS As hypothesized, metacognitive monitoring and control had a significant contribution to the prediction of SD over and above neurocognitive functioning and attenuated psychotic symptoms. However, the direction of this association was positive rather than negative. Also, inconsistent with or hypothesis, it was not moderated by the presence of APS. CONCLUSIONS These pilot results provide preliminary support a modest association between SD and metacognition, which is not reducible to neurocognition and APS. In addition, they raise an intriguing possibility regarding metacognitive monitoring and control being indicators of hyper-reflectivity that characterizes individuals with SD. However, further research with larger samples and high-stress assessment conditions are needed to assess this possibility.
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Affiliation(s)
- Dan Koren
- Psychology Department, University of Haifa, Haifa, Israel
| | - Ravit Scheyer
- Psychology Department, University of Haifa, Haifa, Israel
| | - Noa Reznik
- Psychology Department, University of Haifa, Haifa, Israel
| | - Merav Adres
- Psychology Department, University of Haifa, Haifa, Israel
| | - Alan Apter
- Psychological Medicine Clinic, Schneider Children Medical Center, Petach Tikva, Israel
| | - Josef Parnas
- Psychiatric Center, Glostrup-Hvidovre, Faculty of Health and Medical Sciences, University of Copenhagen, Brøndby, Denmark.,Center for Subjectivity Research, Faculty of Humanities, University of Copenhagen, Copenhagen, Denmark
| | - Larry J Seidman
- The Massachusetts Mental Health Center, Psychiatry Division of the Beth Israel Deaconess Medical Center, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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15
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Brüne M, Drommelschmidt KA, Krüger-Özgürdal S, Juckel G. Relationship between metacognitive beliefs and psychosocial performance in at-risk states of psychosis and patients with first psychotic episodes. Early Interv Psychiatry 2019; 13:604-612. [PMID: 29314591 DOI: 10.1111/eip.12536] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 09/13/2017] [Accepted: 11/08/2017] [Indexed: 01/06/2023]
Abstract
AIMS Improving diagnostic batteries to identify individuals at-risk for developing psychotic disorders as early as possible is an ongoing challenge in schizophrenia research. Here, we sought to explore whether metacognition in at-risk of developing psychosis would differ from that of first episode psychosis and unaffected controls and whether dysfunctional metacognitive beliefs would be associated with psychosocial functioning in the clinical groups. METHODS Twenty-three subjects at-risk of psychosis were compared with a group of 15 first psychotic episode patients and 21 healthy controls with regard to their metacognitive beliefs and psychosocial functioning. Metacognition was assessed using the Metacognition Questionnaire (MCQ), psychosocial functioning was rated using the Personal and Social Performance Scale (PSP). Depression and anxiety were also evaluated. RESULTS The clinical groups differed significantly from controls in several MCQ scores, particularly the subscales "negative beliefs" and "need for control," as well as on all PSP scales. Furthermore, significant correlations emerged between the metacognition and psychosocial functioning. A mediation analysis revealed that dysfunctional metacognitive beliefs had no direct effect on psychosocial functioning, but was mediated by depressive symptoms. CONCLUSIONS These results corroborate findings assigning depressive symptoms an important role in early recognition of psychosis.
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Affiliation(s)
- Martin Brüne
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Kim-Alisha Drommelschmidt
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Seza Krüger-Özgürdal
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Georg Juckel
- LWL University Hospital Bochum, Department of Psychiatry, Division of Cognitive Neuropsychiatry and Psychiatric Preventive Medicine, Ruhr-University Bochum, Bochum, Germany
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16
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Prevalence of Religious and Spiritual Experiences and the Perceived Influence Thereof in Patients With Bipolar Disorder in a Dutch Specialist Outpatient Center. J Nerv Ment Dis 2019; 207:291-299. [PMID: 30865073 DOI: 10.1097/nmd.0000000000000965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The aim of the current cross-sectional study was to estimate the prevalence of religious and spiritual (R/S) experiences and their perceived lasting influence in outpatients with bipolar disorder (BD; n = 196). A questionnaire with a range of R/S was constructed, building on the results of an earlier qualitative study. Experiences of horizontal transcendence (not necessarily referring to the divine) such as the experience of "intense happiness, love, peace, beauty, freedom" (77%) or "meaningful synchronicity" (66%) were the most prevalent. The experience of "divine presence" (vertical transcendence, referring to the divine) had a prevalence of 44%. Perceived lasting influence of the experiences was 20% to 67% of the total frequency, depending on the type. Most positive R/S experiences were significantly more related to BD I and mania, and on average, persons with BD I had more R/S experiences (mean = 4.5, SD = 2.6) than those with BD II (mean = 2.8, SD = 2.4, p = 0.000). Patient-reported R/S experiences in BD can have both R/S and pathological features.
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17
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Wright AC, Fowler D, Greenwood KE. Developing a dynamic model of anomalous experiences and function in young people with or without psychosis: a cross-sectional and longitudinal study protocol. BMJ Open 2018; 8:e022546. [PMID: 30391913 PMCID: PMC6231554 DOI: 10.1136/bmjopen-2018-022546] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 07/06/2018] [Accepted: 09/21/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Anomalous experiences are common within the general population, but the frequency and intensity is increased in young people with psychosis. Studies have demonstrated that perceptual biases towards noticing these phenomena plays a role, but the way one thinks about one's experience (metacognition) may also be relevant. While poor metacognitive function has been theoretically associated with anomalous experiences, this relationship is currently unclear. However, metacognition may work along a continuum with various metacognitive levels, many of which have been demonstrated as impaired in psychosis. These metacognitive components may interact via processes that maintain poor metacognition across levels, and that potentially impact both what people do in their everyday lives (functional outcome) and how people feel about their everyday lives (subjective recovery outcome) in young people with psychosis compared with healthy control participants. METHODS AND ANALYSIS This study will investigate the association and contribution of metacognition to anomalous experiences and outcome measures cross-sectionally and longitudinally in a 36-month follow-up. First, young people with psychosis will be compared with healthy control participants on selected measures of anomalous experience, metacognition, and function, using analysis of covariance to identify group differences. Next, the relationship between metacognitive components and processes will be explored, including processes connecting the different components, using regression analyses. Finally, mediation analyses will be used to assess the predictive value of metacognitive measures on outcome measures, both cross-sectionally and longitudinally at 36 months, while controlling for symptoms and cognition. ETHICS AND DISSEMINATION Ethical and Health Research Authority approval has been obtained through Camberwell St. Giles Research Ethics Committee (reference number: 17/LO/0055). This research project will be reported within a PhD thesis and submitted for journal publication. Once key predictive components of poor outcome in psychosis are identified, this study will develop a series of dynamic models to understand influences on outcome for young people with psychosis.
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Affiliation(s)
- Abigail C Wright
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - David Fowler
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
| | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research & Development, Sussex Partnership NHS Foundation Trust, Worthing, UK
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18
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Bright M, Parker S, French P, Morrison AP, Tully S, Stewart SLK, Wells A. Assessment of metacognitive beliefs in an at risk mental state for psychosis: A validation study of the Metacognitions Questionnaire-30. Clin Psychol Psychother 2018; 25:710-720. [PMID: 29882228 PMCID: PMC6221013 DOI: 10.1002/cpp.2301] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 04/17/2018] [Accepted: 05/07/2018] [Indexed: 11/10/2022]
Abstract
AIM The Metacognitions Questionnaire-30 (MCQ-30) has been used to assess metacognitive beliefs in a range of mental health problems. The aim of this study is to assess the validity of the MCQ-30 in people at risk for psychosis. METHODS One hundred eighty-five participants meeting criteria for an at risk mental state completed the MCQ-30 as part of their involvement in a randomized controlled trial. Confirmatory and exploratory factor analyses were conducted to assess factor structure and construct validity. RESULTS Confirmatory factor analyses confirmed the original five-factor structure of the MCQ-30. Examination of principal component analysis and parallel analysis outputs also suggested a five-factor structure. Correlation analyses including measures of depression, social anxiety, and beliefs about paranoia showed evidence of convergent validity. Discriminant validity was supported using the normalizing subscale of the beliefs about paranoia tool. CONCLUSIONS The MCQ-30 demonstrated good fit using the original five-factor model, acceptable to very good internal consistency of items was evident and clinical usefulness in those at risk for psychosis was demonstrated.
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Affiliation(s)
- Measha Bright
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sophie Parker
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Paul French
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anthony P Morrison
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sarah Tully
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
| | | | - Adrian Wells
- School of Health Sciences, Division of Psychology & Mental Health, The University of Manchester, Manchester, UK
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19
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Varese F, Mansell W, Tai SJ. What is distressing about auditory verbal hallucinations? The contribution of goal interference and goal facilitation. Psychol Psychother 2017; 90:720-734. [PMID: 28726350 DOI: 10.1111/papt.12135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 03/22/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Distressing and pleasant/positive voices (auditory verbal hallucinations) are common in both clinical and non-clinical voice-hearers. Identifying factors that contribute to emotional reactions to voices is essential for developing effective psychological interventions. Several theories propose that facilitation and interference with personal goals are important predictors of distress and well-being. This study examined whether voice-related distress is related to the degree to which voices interfere with personal goals, and whether pleasantness of voices is influenced by the extent to which they facilitate goals. DESIGN Cross-sectional with clinical and non-clinical voice-hearers. METHOD Twenty-two clinical and 18 non-clinical voice-hearers completed interviews and self-report measures assessing (1) personal goals, (2) content, characteristics, and affective reactions to voices, and (3) ratings of the extent to which voices facilitated and/or interfered with achievement of important personal goals. RESULTS Affective reactions were strongly correlated with measures of goal interference and goal facilitation. Regression analyses revealed that these associations remained significant when controlling for important covariates (e.g., participant grouping; content, frequency and duration of voices). Goal interference was specifically associated with distress, whereas goal facilitation specifically predicted perceived pleasantness of voices. CONCLUSIONS This study provides a novel perspective on the factors that might contribute to distress in people who hear voices. The findings suggest that perceived impact of voices on valued personal goals may be an important contributor of voice-related distress. We propose that clinical assessments, formulations, and interventions could benefit from the careful analysis of the perceived impact of voices on goals. PRACTITIONER POINTS These findings suggest that variability in voice-related distress is closely linked to the perceived impact of voices on personal goals. These strong effects observed highlight the importance of considering the role of personal goals in future research on the psychological mechanisms leading to distress associated with voice hearing. Psychological assessments may benefit from the careful exploration of the impact of voice hearing on valued goals, and interventions promoting control over personal goals may be explored as treatment options for clients with distressing voices.
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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Warren Mansell
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Sara J Tai
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
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20
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Tully S, Wells A, Morrison AP. Attentional avoidance increases voice hearing in an analogue task in people with psychosis: An experimental study. Psychiatry Res 2017; 257:186-192. [PMID: 28763737 DOI: 10.1016/j.psychres.2017.07.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
Cognitive models of psychosis suggest that unhelpful ways of responding to experiences can maintain such experiences and the associated distress. The response styles of attentional avoidance and attentional focusing were manipulated in an analogue voice-hearing task. Predictions were that both would increase detection of words in response to an ambiguous audio-recording but that attentional avoidance would lead to a greater increase than focusing. We also predicted that there would be a greater increase in anxiety and distress in the avoidance group. Predictions were tested in a sample of 44 participants with a diagnosis of schizophrenia. Participants were randomly assigned to either attentional avoidance or focusing while listening to an ambiguous auditory task. Number of words identified and anxiety and distress were recorded. As predicted, there was an increase in the number of words identified in both groups; however, this increase was greater in the avoidance group. The prediction that there would also be an increase in distress that would be greater in the avoidance group was not supported. It is possible that emotional reactions relate more closely to appraisals of the voice. The results suggest that avoidance of experiences is particularly counterproductive and can result in greater detection of experiences.
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Affiliation(s)
- Sarah Tully
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK; The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK.
| | - Adrian Wells
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Anthony P Morrison
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK; The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
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21
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Hagen K, Solem S, Opstad HB, Hansen B, Hagen R. The role of metacognition and obsessive-compulsive symptoms in psychosis: an analogue study. BMC Psychiatry 2017; 17:233. [PMID: 28662637 PMCID: PMC5492129 DOI: 10.1186/s12888-017-1392-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/21/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several studies have indicated that obsessive-compulsive disorder (OCD) is a common comorbidity in patients with psychotic disorders, but there is sparse knowledge about the relationship between symptoms of OCD and psychotic symptoms. Metacognitions which guides thinking and coping is theorized to be a transdiagnostic component central for development and maintenance of psychological disorders, OCD and psychosis included. The aim of the study was therefore to explore how symptoms of OCD and metacognitions relate to symptoms of psychosis. Our main hypotheses were that metacognitions would be significantly related to all symptoms of psychological distress, and that there is considerable overlap between symptoms of psychosis and OCD. METHODS Community controls (N = 194) completed an internet survey measuring levels of paranoid ideation, predisposition to hallucinations, symptoms of OCD, depression, anxiety, and metacognitions. Correlations and hierarchical multiple linear regression analyses were used to unveil the relationship between symptoms and beliefs. RESULTS Symptoms of OCD showed a strong positive correlation with symptoms of psychosis, and the relationships were still significant after controlling for symptoms of anxiety and depression. Metacognitions also showed strong positive correlations with all symptom measures. Metacognition and OCD-symptoms accounted for 53.8% of the variance in paranoid ideation and 43.8% of predisposition to hallucinations. There was a large overlap between symptoms of psychosis, OCD-symptoms, and metacognitions (30.2-37.3%). CONCLUSIONS In general, the results suggest considerable overlap between paranoid ideation, predisposition to hallucinations, and OCD and metacognitive beliefs in a non-clinical sample. Further experimental- and clinical studies are needed in order to explore metacognitive models of OCD and psychosis.
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Affiliation(s)
- Kristen Hagen
- Hospital of Molde, OCD-team, Molde, Norway. .,Haukeland University Hospital, OCD-team, Bergen, Norway.
| | - Stian Solem
- 0000 0001 1516 2393grid.5947.fDepartment of Psychology, Norwegian University of Science and Technology, Trondheim, Norway ,0000 0004 0627 3560grid.52522.32St. Olavs University Hospital, Trondheim, Norway
| | | | - Bjarne Hansen
- 0000 0000 9753 1393grid.412008.fHaukeland University Hospital, OCD-team, Bergen, Norway ,0000 0004 1936 7443grid.7914.bFaculty of Psychology, University of Bergen, Bergen, Norway
| | - Roger Hagen
- 0000 0001 1516 2393grid.5947.fDepartment of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Sun X, Zhu C, So SHW. Dysfunctional metacognition across psychopathologies: A meta-analytic review. Eur Psychiatry 2017; 45:139-153. [PMID: 28763680 DOI: 10.1016/j.eurpsy.2017.05.029] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dysfunctions in metacognition have been reported in individuals with anxiety disorders. Although recent studies have examined metacognition in other disorders, how dysfunctional metacognition compares across disorders is not clear. This review aimed to ascertain the importance of dysfunctional metacognition in various psychopathologies, and to identify similarities and differences in metacognitive profiles across disorders. METHODS Forty-seven studies were selected from 586 articles published between 1990 and August 2015, including a total sample of 3772 patients and 3376 healthy individuals. Studies that measured metacognition using the Meta-Cognitions Questionnaire (MCQ) and its variants were included. We conducted five meta-analyses including 49 to 55 effect sizes, comparing psychiatric patients to healthy individuals on respective metacognitive dimensions of the MCQ. RESULTS We found elevated metacognitive dysfunctions in patients, as a group, on all MCQ dimensions. Group effects were large and robust for the two negative beliefs (i.e., beliefs about the uncontrollability and danger of thoughts, and beliefs about the need to control thoughts), and moderate and unstable for the positive beliefs. Patients showed decreased cognitive confidence and heightened cognitive self-consciousness on moderate to large levels. Moderator analyses revealed that negative beliefs about uncontrollability and danger of thoughts were most prevalent in generalized anxiety disorder, whereas heightened cognitive self-consciousness was more characteristic in obsessive-compulsive disorder. Generalized anxiety disorder, obsessive-compulsive disorder and eating disorders manifested more similar metacognitive profiles than other disorders. CONCLUSIONS Our findings supported dysfunctional metacognition as common processes across psychopathologies, with certain dimensions being more prevalent in particular disorders.
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Affiliation(s)
- X Sun
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan
| | - C Zhu
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan
| | - S H W So
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan.
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23
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Cotter J, Yung AR, Carney R, Drake RJ. Metacognitive beliefs in the at-risk mental state: A systematic review and meta-analysis. Behav Res Ther 2017; 90:25-31. [DOI: 10.1016/j.brat.2016.12.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 10/28/2016] [Accepted: 12/05/2016] [Indexed: 10/20/2022]
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Abstract
BACKGROUND Voice hearing experiences, or auditory verbal hallucinations, occur in healthy individuals as well as in individuals who need clinical care, but news media depict voice hearing primarily as a symptom of mental illness, particularly schizophrenia. AIMS This article explores whether, and how, public perception of an exaggerated association between voice hearing and mental illness might influence individuals' need for clinical care. METHOD A narrative literature review was conducted, using relevant peer-reviewed research published in the English language. RESULTS Stigma may prevent disclosure of voice hearing experiences. Non-disclosure can prevent access to sources of normalizing information and lead to isolation, loss of social support and distress. Internalization of stigma and concomitantly decreased self-esteem could potentially affect features of voices such as perceived voice power, controllability, negativity and frequency, as well as distress. Increased distress may result in a decrease in functioning and increased need for clinical care. CONCLUSION The literature reviewed suggests that stigma has the potential to increase need for care through many interrelated pathways. However, the ability to draw definitive conclusions was constrained by the designs of the studies reviewed. Further research is needed to confirm the findings of this review.
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25
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Sellers R, Varese F, Wells A, Morrison AP. A meta-analysis of metacognitive beliefs as implicated in the self-regulatory executive function model in clinical psychosis. Schizophr Res 2017; 179:75-84. [PMID: 27670237 DOI: 10.1016/j.schres.2016.09.032] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/17/2022]
Abstract
This meta-analysis investigated whether the five metacognitive beliefs implicated in the Self-Regulatory Executive Function (S-REF) model (Wells and Matthews, 1994; Wells and Matthews, 1996) are elevated in people with clinical psychosis compared to people with emotional disorder and non-psychiatric controls. The review followed guidance set-out in the PRISMA statement. Primary analyses compared summary effect sizes on each sub-scale of the Metacognitions Questionnaire (MCQ) for people with psychosis and non-psychiatric controls; and people with psychosis and people with emotional disorder. Eleven eligible studies were identified comprised of 568 psychosis participants, 212 emotional disorder participants and 776 non-psychiatric controls. Findings indicated that people with psychosis had higher scores on all sub-scales of the MCQ compared to non-psychiatric controls; and higher scores on the positive beliefs about worry sub-scale compared to people with emotional disorder. This suggests metacognitive beliefs may be associated with the presence of psychological disorder and distress in general, rather than specific diagnoses. Implications for models of psychosis and treatment are discussed.
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Affiliation(s)
- Rachel Sellers
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester, M25 3BL, United Kingdom.
| | - Filippo Varese
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester, M25 3BL, United Kingdom
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26
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Sellers R, Gawęda Ł, Wells A, Morrison AP. The role of unhelpful metacognitive beliefs in psychosis: Relationships with positive symptoms and negative affect. Psychiatry Res 2016; 246:401-406. [PMID: 27788460 DOI: 10.1016/j.psychres.2016.10.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 01/13/2023]
Abstract
The Self-Regulatory Executive Function (s-REF) model assumes that a common set of unhelpful metacognitive beliefs have a central role in predisposition to psychological disorder and the maintenance of symptoms and distress. This research aims to test whether the five unhelpful metacognitive beliefs implicated in the model are associated with positive symptoms of psychosis and whether they are a better predictor of negative affect than topological characteristics of positive symptoms. A sample of people with psychosis completed a semi-structured interview about psychotic symptoms and self-report measures of metacognitive beliefs (MCQ-30), anxiety and depression. Hierarchical multiple regression analyses suggested that unhelpful metacognitive beliefs predict negative affect in people with psychosis over and above symptom frequency and other topological characteristics of symptoms captured by the Psychotic Symptoms Rating Scale (PSYRATS). The findings support the application of the metacognitive model to emotional distress in people with psychosis.
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Affiliation(s)
- Rachel Sellers
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom.
| | - Łukasz Gawęda
- II Department of Psychiatry, Medical University of Warsaw, Poland; Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom; Psychosis Research Unit, Greater Manchester West Mental Health Foundation NHS Trust, Bury New Road, Prestwich, Manchester M25 3BL, United Kingdom
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Varese F, Morrison AP, Beck R, Heffernan S, Law H, Bentall RP. Experiential avoidance and appraisals of voices as predictors of voice-related distress. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2016; 55:320-31. [PMID: 26752336 DOI: 10.1111/bjc.12102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 11/11/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Research has suggested that the extent to which voices (i.e., auditory verbal hallucinations) are experienced as distressing might be influenced by negative beliefs about voices as well as maladaptive metacognitive styles involving the negative appraisal and maladaptive control of mental experiences. This cross-sectional study examined the contribution of both specific appraisals of voices and a metacognitive factor (i.e., experiential avoidance) to voice-related distress. METHODS Self-report measurers of voice characteristics (voice frequency, duration as well as amount and intensity of voice-related distress), experiential avoidance, and appraisals of voices were collected in a sample of 101 voice-hearers. RESULTS Experiential avoidance and negative beliefs about voices were associated with higher levels of voice-related distress, but not to measures of voice frequency and duration. Experiential avoidance and negative 'metaphysical' beliefs about voices were significant predictors of voice-related distress even after accounting for the effect of frequency and duration of voices, and explained similar proportions of unique variance in distress. CONCLUSIONS These findings suggest that the appraisals of voices and experiential avoidance are predictive of voice-related distress and that cognitive-behavioural interventions targeting both voice-specific appraisals and general maladaptive metacognitive processes could prove useful treatment approaches for clients with distressing voices. PRACTITIONER POINTS Experiential avoidance (EA) and negative appraisals predict voice-related distress caused by voices, but not their frequency and duration. Interventions for voices should consider targeting EA and negative appraisals (e.g., cognitive-behavioural therapy, Acceptance and Commitment Therapy) to ameliorate distress.
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Affiliation(s)
- Filippo Varese
- Division of Health Research, Lancaster University, UK.,School of Psychological Sciences, University of Manchester, UK
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, UK.,Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Rosie Beck
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Heather Law
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard P Bentall
- Institute of Psychology Health and Society, University of Liverpool, UK
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Østefjells T, Melle I, Hagen R, Romm KL, Sönmez N, Andreassen OA, Røssberg JI. Unhelpful metacognitive beliefs in early psychosis are associated with affective symptoms and childhood social adjustment. Schizophr Res 2015; 169:280-285. [PMID: 26519990 DOI: 10.1016/j.schres.2015.10.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous studies have shown that individuals with schizophrenia exhibit higher levels of unhelpful metacognitive beliefs than healthy controls, but no studies have explored metacognitive beliefs in early psychosis. AIMS We examined i) differences in levels of unhelpful metacognitive beliefs between psychosis spectrum disorders, and healthy controls, and ii) to what extent demographic and clinical characteristics predicted levels of metacognitive beliefs in the early treated phases of psychotic disorders. METHOD Patients were included within two years of first treatment for a psychotic disorder (N=92). They were assessed on premorbid adjustment, psychotic symptoms, anxiety/depression, and self-reported metacognitive beliefs (MCQ-30). Ninety-seven controls also completed MCQ-30. Predictors of metacognitive beliefs were explored with multiple linear regression analyses. RESULTS Patients scored significantly higher than controls on all metacognitive subscales except positive beliefs about worry. The regression model explained 14-38% of the variance on each metacognitive subscale. Current affective symptoms explained a significant amount of variance on all subscales, except positive beliefs about worry. Childhood (premorbid) social adjustment predicted a significant amount of the variance on all subscales, except cognitive confidence. Duration of untreated psychosis contributed significantly to more unhelpful beliefs about cognitive confidence. Negative symptoms predicted lower scores on cognitive self-consciousness. CONCLUSION Affective symptoms and childhood social adjustment could be important predictors of unhelpful metacognitive beliefs in the early treated phases of psychosis, indicating potential psychopathological relationships that warrant further investigation for clinical relevance.
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Affiliation(s)
- Tiril Østefjells
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway; Department for Specialised Inpatient Treatment, Division of Mental Health and Addiction, Akershus University Hospital, 1478 Lørenskog, Norway.
| | - Ingrid Melle
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway.
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway.
| | - Kristin L Romm
- Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway.
| | - Nasrettin Sönmez
- Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway.
| | - Ole A Andreassen
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway.
| | - Jan Ivar Røssberg
- NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, 0424, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, 0424, Oslo, Norway.
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Buchy L, Stowkowy J, MacMaster FP, Nyman K, Addington J. Meta-cognition is associated with cortical thickness in youth at clinical high risk of psychosis. Psychiatry Res 2015. [PMID: 26210694 DOI: 10.1016/j.pscychresns.2015.07.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Meta-cognition is compromised in people with schizophrenia and people at clinical high risk (CHR) of psychosis. In the current work in a CHR sample, we hypothesized that meta-cognitive functions would correlate with cortical thickness in five brain regions implicated in the pathogenesis of psychosis: inferior and middle frontal cortices, anterior cingulate cortex, superior temporal cortex and insula. Secondly, we hypothesized that similar neural systems would underlie different meta-cognitive functions. Narratives were gathered for 29 youth at CHR of psychosis using a semi-structured interview. Four meta-cognitive functions within the narratives were measured with the Meta-cognition Assessment Scale and regressed on cortical thickness from our a priori regions of interest using FreeSurfer. Mapping statistics from our a priori regions of interest revealed that meta-cognition functions were associated with cortical thickness in inferior and middle frontal gyri, superior temporal cortex and insula. The distribution of cortical thickness was partially similar across the four MAS items. Results confirm our hypothesis that cortical thickness is significantly associated with meta-cognition in brain regions that consistently show gray matter reductions across the schizophrenia spectrum. Evidence for thickness covariation in a variety of regions suggests partial dependence in the neural architecture underlying various meta-cognitive functions in CHR.
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Affiliation(s)
- Lisa Buchy
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada.
| | - Jacque Stowkowy
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Frank P MacMaster
- Department of Psychiatry and Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Karissa Nyman
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
| | - Jean Addington
- Department of Psychiatry, University of Calgary, Calgary, Alberta, Canada
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Rausch F, Mier D, Eifler S, Fenske S, Schirmbeck F, Englisch S, Schilling C, Meyer-Lindenberg A, Kirsch P, Zink M. Reduced activation in the ventral striatum during probabilistic decision-making in patients in an at-risk mental state. J Psychiatry Neurosci 2015; 40:163-73. [PMID: 25622039 PMCID: PMC4409434 DOI: 10.1503/jpn.140191] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Patients with schizophrenia display metacognitive impairments, such as hasty decision-making during probabilistic reasoning - the "jumping to conclusion" bias (JTC). Our recent fMRI study revealed reduced activations in the right ventral striatum (VS) and the ventral tegmental area (VTA) to be associated with decision-making in patients with schizophrenia. It is unclear whether these functional alterations occur in the at-risk mental state (ARMS). METHODS We administered the classical beads task and fMRI among ARMS patients and healthy controls matched for age, sex, education and premorbid verbal intelligence. None of the ARMS patients was treated with antipsychotics. Both tasks request probabilistic decisions after a variable amount of stimuli. We evaluated activation during decision-making under certainty versus uncertainty and the process of final decision-making. RESULTS We included 24 AMRS patients and 24 controls in our study. Compared with controls, ARMS patients tended to draw fewer beads and showed significantly more JTC bias in the classical beads task, mirroring findings in patients with schizophrenia. During fMRI, ARMS patients did not demonstrate JTC bias on the behavioural level, but showed a significant hypoactivation in the right VS during the decision stage. LIMITATIONS Owing to the cross-sectional design of the study, results are constrained to a better insight into the neurobiology of risk constellations, but not prepsychotic stages. Nine of the ARMS patients were treated with antidepressants and/or lorazepam. CONCLUSION As in patients with schizophrenia, a striatal hypoactivation was found in ARMS patients. Confounding effects of antipsychotic medication can be excluded. Our findings indicate that error prediction signalling and reward anticipation may be linked to striatal dysfunction during prodromal stages and should be examined for their utility in predicting transition risk.
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Affiliation(s)
- Franziska Rausch
- Correspondence to: F. Rausch, Central Institute of Mental Health, Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim/Heidelberg University J5D-68159, Mannheim, Germany;
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Abstract
Cognitive therapy for psychosis has developed over the past 30 years from initial case studies, treatment manuals, pilot randomized controlled studies to fully powered and methodologically rigorous efficacy and, subsequently, effectiveness trials. Reviews and meta-analyses have confirmed the benefits of the interventions. Considered appraisal by government and professional organizations has now led to its inclusion in international treatment guidelines for schizophrenia. Patients consistently ask for access to psychotherapeutic interventions, and it is slowly becoming available in many European countries and other parts of the world, eg, US and the People’s Republic of China. However, it remains unacceptably difficult to access for the vast majority of people with psychosis who could benefit from it. Psychosis affects people in the prime of their lives and leads to major effects on their levels of distress, well-being, and functioning, and also results in major costs to society. Providing effective interventions at an early stage has the potential to reduce the high relapse rates that occur after recovery from first episode and the ensuing morbidity and premature mortality associated with psychosis.
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Affiliation(s)
- Helen Mander
- Mental Health Group, University of Southampton, Southampton, Hampshire, England, UK
| | - David Kingdon
- Mental Health Group, University of Southampton, Southampton, Hampshire, England, UK
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Relationships of perceived public stigma of mental illness and psychosis-like experiences in a non-clinical population sample. Soc Psychiatry Psychiatr Epidemiol 2015; 50:289-98. [PMID: 25053149 DOI: 10.1007/s00127-014-0929-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 07/16/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Studies on the association between psychopathology, perceived public stigma, and labeling in mental illness have focused primarily on severe but rare mental disorders, especially schizophrenia, or other clinically defined psychotic disorders. Although evidence is mounting that psychosis-like experiences show high prevalence in the general population and lead to an increased risk of psychotic disorders, little is known about how psychosis-like experiences independently affect perceived public stigma in the non-clinical population. The aim of the present study was to examine the relationship between psychosis-like experiences and perceived public stigma in a non-clinical sample. METHODS For this cross-sectional study, we recruited 524 individuals (239 male, 285 female) who had no lifetime history of psychiatric disorder. Participants completed questionnaires that asked for sociodemographic and clinical information, a measure of perceived public stigma (Perceived Psychiatric Stigma Scale [PPSS]), and two measures of psychosis-like experiences (Peters et al. Delusions Inventory [PDI]; Cardiff Anomalous Perceptions Scale [CAPS]). RESULTS Of the sociodemographic characteristics analyzed in this study-gender, age, education level, marital status, and religion-only age simultaneously influenced PPSS, PDI, and CAPS scores. As hypothesized, perceived public stigma was positively correlated with measures of psychosis-like experiences, even after controlling for age. Furthermore, the perceived stigma was more strongly associated with delusion proneness than with anomalous perceptual experiences. CONCLUSION The association between psychopathology and perceived public stigma appears to extend beyond clinically defined psychosis to more common psychosis-like experiences in a sample drawn from the general Han Chinese population.
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Brett CMC, Peters ER, McGuire PK. Which psychotic experiences are associated with a need for clinical care? Eur Psychiatry 2015; 30:648-54. [PMID: 25614438 DOI: 10.1016/j.eurpsy.2014.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 12/11/2014] [Accepted: 12/12/2014] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The aims of this study were to identify (1) the factor structure of anomalous experiences across the psychosis continuum; (2) qualitative and quantitative differences in psychotic experiences (PEs) between "non need-for-care" and two clinical groups: psychosis patients and individuals at ultra high risk (UHR) of psychosis. We aimed to distinguish which types of experiences would be related to malign (need-for-care and/or help-seeking) versus benign outcomes. METHODS Component scores obtained from a Principal Components Analysis of PEs from lifetime scores on the Appraisals of Anomalous Experience Inventory (Brett et al., 2007) were compared across 96 participants: patients diagnosed with a psychotic disorder (n=37), help-seeking UHR people (n=21), and non-clinical individuals presenting with enduring PEs (n=38). RESULTS A five-component structure provided the best solution, comprising dissociative-type experiences, subjective cognitive deficits, and three separate components relating to "positive" symptoms. All groups reported "positive" experiences, such as ideas of reference and hallucinations, with the non-clinical group displaying more PEs in the Paranormal/Hallucinatory component than both clinical groups. "Cognitive/Attentional anomalies" was the only component where the clinical groups reported significantly more anomalies than the non-clinical group. However psychosis patients reported more frequent first-rank type symptoms and "hypomanic" type PEs than the other groups. DISCUSSION "Positive" PEs were common across the psychosis spectrum, although first-rank type symptoms were particularly marked in participants diagnosed with a psychotic disorder. Help-seeking and need-for-care were associated with the presence of subjective cognitive disturbances. These findings suggest that anomalies of cognition and attention may be more relevant to poorer outcomes than the presence of anomalous experiences.
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Affiliation(s)
- C M C Brett
- King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Department of Psychosis Studies, London, United Kingdom; Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - E R Peters
- King's College London, IoPPN, Department of Psychology, PO77, HWB, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London SE5 8AF, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, London, United Kingdom.
| | - P K McGuire
- King's College London, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Department of Psychosis Studies, London, United Kingdom; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, London, United Kingdom; OASIS, Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Bortolon C, Larøi F, Stephan Y, Capdevielle D, Yazbek H, Boulenger JP, Gely-Nargeot MC, Raffard S. Further insight into the role of metacognitive beliefs in schizophrenia and OCD patients: testing a mediation model. Psychiatry Res 2014; 220:698-701. [PMID: 25150921 DOI: 10.1016/j.psychres.2014.07.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 07/26/2014] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
This study explored the mediation effect of metacognitive beliefs on the relationship between intrusive thoughts and emotional distress in schizophrenia (N=49) and obsessive-compulsive disorder (OCD) (N=35). Intrusive thoughts impact on anxiety and depression through beliefs about uncontrollability and danger of thoughts in schizophrenia. Negative beliefs in general mediated the effect of intrusive thoughts on anxiety in obsessive-compulsive disorder. The results suggest that metacognitive beliefs may be a vulnerability factor for emotional and psychological disorder.
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Affiliation(s)
- Catherine Bortolon
- Epsylon Laboratory, EA 4556, Montpellier, France; University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France.
| | - Frank Larøi
- Department of Psychology, FAPSE, University of Liège, 4000 Liège, Belgium
| | | | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France; French National Institute of Health and Medical Research (INSERM), U1061Pathologies of the Nervous System: Epidemiological and Clinical Research, La Colombiere Hospital, 34093 Montpellier Cedex 5, France
| | - Hanan Yazbek
- University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France
| | - Jean-Philippe Boulenger
- University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France; French National Institute of Health and Medical Research (INSERM), U1061Pathologies of the Nervous System: Epidemiological and Clinical Research, La Colombiere Hospital, 34093 Montpellier Cedex 5, France
| | | | - Stéphane Raffard
- Epsylon Laboratory, EA 4556, Montpellier, France; University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France
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Spanish version of the Meta-Cognitions Questionnaire 30 (MCQ-30). SPANISH JOURNAL OF PSYCHOLOGY 2014; 16:E95. [PMID: 24230958 DOI: 10.1017/sjp.2013.95] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The Meta-cognitions Questionnaire 30 (MCQ-30; Wells & Cartwright-Hatton, 2004) has been used to assess individual differences in metacognitive beliefs considered to be central in the metacognitive theory of generalized anxiety disorder (Wells, 2005). In the present study, the psychometric properties, reliability, and validity of a Spanish adaptation of the MCQ-30 were tested in a broad sample of participants (N = 768) of Spanish nationality aged 16-81 years (31.1% males, 68.9% females). Confirmatory factor analysis showed the expected five-factor structure, which was found to be invariant across gender. Internal consistency and test-retest reliability of the subscales were adequate, and the expected relationships to theoretically related variables such as pathological worry, meta-worry, thought suppression and trait anxiety were obtained. Convergent validity with other measures of beliefs about worry was also found. Taken together, these findings suggest that the Spanish version of the MCQ-30 is a valid instrument for evaluating metacognitive beliefs in the Spanish-speaking population.
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Austin SF, Mors O, Nordentoft M, Hjorthøj CR, Secher RG, Hesse M, Hagen R, Spada M, Wells A. Schizophrenia and Metacognition: An Investigation of Course of Illness and Metacognitive Beliefs Within a First Episode Psychosis. COGNITIVE THERAPY AND RESEARCH 2014. [DOI: 10.1007/s10608-014-9633-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Welsh P, Cartwright-Hatton S, Wells A, Snow L, Tiffin PA. Metacognitive beliefs in adolescents with an at-risk mental state for psychosis. Early Interv Psychiatry 2014; 8:82-6. [PMID: 23682978 DOI: 10.1111/eip.12052] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 03/23/2013] [Indexed: 11/29/2022]
Abstract
AIM The self-regulatory executive function model suggests that metacognitive beliefs play a role in all forms of psychological disorder, including psychosis. However, our understanding of these beliefs and their relationship with symptoms in adolescents with an at-risk mental state (ARMS) for psychosis is limited. METHODS The Metacognitions Questionnaire short form (MCQ-30) was administered to 31 adolescents with an identified ARMS. Scores were subsequently compared to a control group of 76 adolescents drawn from a community population. RESULTS As predicted, ARMS patients scored significantly higher on metacognition subscales, with negative beliefs (F = 42.97, P = 0.001), cognitive confidence (F = 17.11, P = 0.001) and need for control (F = 22.48, P = 0.001) subscales of the MCQ-30 distinguishing them from the comparison group. CONCLUSIONS The finding that metacognitive beliefs are significantly elevated in comparison to a community sample of adolescents is in keeping with previous adult-orientated research. Possible implications for clinical practice are discussed.
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Affiliation(s)
- Patrick Welsh
- School for Health, The Wolfson Research Institute, Durham University, Stockton-on-Tees, UK; South Durham Early Intervention in Psychosis Service, Tees, Esk and Wear Valleys NHS Foundation Trust, Bishop Auckland, UK
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Gawęda L, Holas P, Kokoszka A. Do depression and anxiety mediate the relationship between meta-cognitive beliefs and psychological dimensions of auditory hallucinations and delusions in schizophrenia? Psychiatry Res 2013; 210:1316-9. [PMID: 23993468 DOI: 10.1016/j.psychres.2013.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 05/12/2013] [Accepted: 08/10/2013] [Indexed: 11/28/2022]
Abstract
We investigated if depression and anxiety mediate the relationship between meta-cognitive beliefs and psychological dimensions of delusions and hallucinations in schizophrenia subjects (n=74). Depression, but not anxiety, mediated the relationship between certain dysfunctional meta-cognitive beliefs and psychological dimensions of delusions. Although direct effects between hallucination dimensions and certain meta-cognitive beliefs were found, anxiety and depression did not serve as mediators in this relationship. The results suggest a significant pathway from meta-cognition to delusions through depression.
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Affiliation(s)
- Lukasz Gawęda
- II Department of Psychiatry, Medical University of Warsaw, ul. Kondratowicza 8, 03-242 Warsaw, Poland.
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Latent profile analysis of healthy schizotypy within the extended psychosis phenotype. Psychiatry Res 2013; 210:1008-13. [PMID: 24001585 PMCID: PMC4026183 DOI: 10.1016/j.psychres.2013.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 06/08/2013] [Accepted: 08/08/2013] [Indexed: 11/22/2022]
Abstract
Converging evidence suggests that psychosis exists on a continuum, and that even mentally "healthy" individuals may experience subclinical psychotic experiences. However, little research has examined the subjective and psychological well-being of individuals in the putatively healthy end of the continuum. This study explored the latent profile structure of schizotypy in a non-clinical sample and compared subjective and psychological well-being across schizotypy profiles. Latent profile analysis was conducted on participants' responses (N=420) to the Oxford-Liverpool Inventory of Feelings and Experiences. Six latent profiles emerged: Low Schizotypy, Average, High Schizotypy, High Unusual Experiences (UE), High Introvertive Anhedonia, and High Introvertive Anhedonia/Cognitive Disorganization. Individuals in the profile characterized by high UE without negative, disorganized or impulsive features tended to endorse similar levels of well-being as the Average and Low Schizotypy profiles. With some exceptions, all three profiles also demonstrated significantly greater subjective and psychological well-being when compared to negative/disorganized schizotypy profiles. The UE profile most closely aligns with previous conceptualizations of "healthy schizotypy." Future research should investigate how individuals in this profile make sense of unusual or ambiguous experiences that may lead to distress in clinical populations.
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Brett C, Heriot-Maitland C, McGuire P, Peters E. Predictors of distress associated with psychotic-like anomalous experiences in clinical and non-clinical populations. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 53:213-27. [PMID: 24261699 DOI: 10.1111/bjc.12036] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 09/30/2013] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Psychotic-like anomalous experiences are not inherently distressing, nor do they inevitably lead to clinical conditions. However, distress is an important predictor of onset and relapse in psychosis, and a primary indicator of problematic mental health. This study aimed to identify factors that predict distress across three groups with anomalous experiences. DESIGN AND METHODS This study used a cross-sectional design. Participants in 'Diagnosed' (n = 35), 'At Risk' (n = 20), and 'Undiagnosed' (n = 36) groups completed the Appraisals of Anomalous Experiences Interview (AANEX; Brett et al., 2007, Br. J. Psychiatry, 191, s23), which taps anomalies experienced, appraisals, and other psychological and contextual variables. A series of ordinal logistic regression analyses was conducted to investigate which variables predicted anomaly-related distress. RESULTS Predictors of higher distress were anomalous states characterized by changes in awareness and cognitive functioning (rather than more typical positive symptoms), appraisals of experiences as caused by 'other people', and greater attempted control over experiences. Predictors of lower distress were 'spiritual' appraisals, greater perceived social support/understanding, greater perceived controllability, and reacting with a 'neutral response'. CONCLUSIONS While psychotic-like experiences themselves are not necessarily distressing, appraisals and responses to anomalies do predict distress, as do factors relating to the social context. This adds support to the cognitive-behavioural models, and continuum models, of positive psychotic symptoms.
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Affiliation(s)
- Caroline Brett
- Sussex Partnership NHS Foundation Trust, Early Intervention in Psychosis Service (EIPS), Brighton & Hove, UK; Department of Psychology (P077), Institute of Psychiatry, King's College London, UK
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Moritz S, Favrod J, Andreou C, Morrison AP, Bohn F, Veckenstedt R, Tonn P, Karow A. Beyond the usual suspects: positive attitudes towards positive symptoms is associated with medication noncompliance in psychosis. Schizophr Bull 2013; 39:917-22. [PMID: 22337789 PMCID: PMC3686441 DOI: 10.1093/schbul/sbs005] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Antipsychotic medication represents the treatment of choice in psychosis according to clinical guidelines. Nevertheless, studies show that half to almost three-quarter of all patients discontinue medication with antipsychotics after some time, a fact which is traditionally ascribed to side-effects, mistrust against the clinician and poor illness insight. The present study investigated whether positive attitudes toward psychotic symptoms (ie, gain from illness) represent a further factor for medication noncompliance. An anonymous online survey was set up in order to prevent conservative response biases that likely emerge in a clinical setting. Following an iterative selection process, data from a total of 113 patients with a likely diagnosis of schizophrenia and a history of antipsychotic treatment were retained for the final analyses (80%). While side-effect profile and mistrust emerged as the most frequent reasons for drug discontinuation, 28% of the sample reported gain from illness (eg, missing voices, feeling of power) as a motive for noncompliance. At least every fourth patient reported the following reasons: stigma (31%), mistrust against the physician/therapist (31%), and rejection of medication in general (28%). Approximately every fifth patient had discontinued antipsychotic treatment because of forgetfulness. On average, patients provided 4 different explanations for noncompliance. Ambivalence toward symptoms and treatment should thoroughly be considered when planning treatment in psychosis. While antipsychotic medication represents the evidence-based cornerstone of the current treatment in schizophrenia, further research is needed on nonpharmacological interventions for noncompliant patients who are willing to undergo intervention but refuse pharmacotherapy.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Hamburg, Germany.
| | - Jerome Favrod
- La Source, Health Campus of the University of Applied Sciences of Western Switzerland, Lausanne, Switzerland,Community Psychiatry Service, Department of Psychiatry, University Hospital Center of Lausanne, Switzerland
| | - Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | | | - Francesca Bohn
- Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Peter Tonn
- Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
| | - Anne Karow
- Department of Psychiatry and Psychotherapy, University Medical Center in Hamburg-Eppendorf, Martinistr. 52, D-20246 Hamburg, Germany
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Kao YC, Wang TS, Lu CW, Liu YP. Assessing anomalous perceptual experiences in nonpsychiatric individuals and outpatients with psychosis in Taiwan: an investigation using the cardiff anomalous perceptions scale (CAPS). Psychiatr Q 2013; 84:137-57. [PMID: 22878835 DOI: 10.1007/s11126-012-9234-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The Cardiff anomalous perceptions scale (CAPS) has been recently designed for the assessment of anomalous perceptual experiences in the general population, and includes dimensions that measure distress, intrusiveness, and frequency. The purpose of this study was to assess the psychometric properties of a Taiwanese version of the CAPS. The English version of the CAPS was translated into Taiwanese (CAPS-T) and the latter was applied to this study. We administered the questionnaire to a consecutive sample of 192 participants with (n = 106; clinical group including schizophrenia and affective psychosis) or without psychotic disorders (n = 86; non-clinical group). In addition to the CAPS-T, the Taiwanese version of the brief psychiatric symptom rating scale (BSRS) measured the severity of the psychopathology. We also tested the psychometric properties of the CAPS-T including construct validity, internal consistency, test-retest reliability, and convergent and discriminative validity. Overall, the CAPS-T showed good construct validity, internal consistency, and stability over time and correlated significantly with the psychoticism subscale of the BSRS. As predicted, the mean differences in CAPS-T scores between participants with or without a psychotic disorder were significant. Convergent and discriminative validity were satisfactory. A score of 5 was found to the best threshold in discriminating between clinical and non-clinical samples. Our findings indicate that the Taiwanese version of the CAPS is a reliable and valid instrument to measure the multidimensionality of perceptual anomalies in general and appears to complement the clinical measures of psychosis proneness in Taiwan.
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Affiliation(s)
- Yu-Chen Kao
- Department of Psychiatry, Songshan Armed Forces General Hospital, Taipei, Taiwan, ROC.
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Goldstone E, Farhall J, Thomas N, Ong B. The role of metacognitive beliefs in the proneness to hallucinations and delusions: An analysis across clinical and non-clinical populations. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2013; 52:330-46. [DOI: 10.1111/bjc.12020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Revised: 01/31/2013] [Indexed: 01/23/2023]
Affiliation(s)
| | | | | | - Ben Ong
- School of Psychological Science; La Trobe University; Bundoora; Victoria; Australia
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Connor C, Birchwood M. Through the looking glass: self-reassuring meta-cognitive capacity and its relationship with the thematic content of voices. Front Hum Neurosci 2013; 7:213. [PMID: 23734118 PMCID: PMC3659289 DOI: 10.3389/fnhum.2013.00213] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 05/06/2013] [Indexed: 11/24/2022] Open
Abstract
AIMS To examine the self-critical thoughts and self-reassuring meta-cognitive capacity of those who hear voices and explore whether they are associated with the theme of voice content and appraisals of voice power and voice expressed emotion. METHOD A cross-sectional design was used, combining semi-structured interviews and self-report measures. Data on symptomatology, self-critical thoughts and self-reassuring meta-cognitive capacity, thematic voice content, and appraisals of voice power and expressed emotion were collected from 74 voice-hearers in Birmingham, UK. RESULTS Common themes of voice content reflected issues of shame, control, and affiliation. Controlling content was the most prevalent theme, however, no significant predictor of this theme was found; shaming thematic voice content linked with reduced capacity to self-reassure following self-critical thoughts. Voice-hearers with the greatest level of self-critical thoughts appraised their voices as powerful and high in voice expressed emotion. CONCLUSIONS Findings suggest that voice-hearers self-critical thoughts are reflected in the type of relationship they have with their voice. However, access to self-reassuring meta-cognitive capacity may serve as a protective factor for those who hear voices, resulting in more benign voice content. These findings highlight the importance of this specific meta-cognitive capacity and will inform future therapeutic interventions for the management of voices in this vulnerable group.
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Affiliation(s)
- Charlotte Connor
- Birmingham and Solihull Mental Health Foundation Trust, University of BirminghamBirmingham, UK
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Moritz S, Andreou C, Klingberg S, Thoering T, Peters MJV. Assessment of subjective cognitive and emotional effects of antipsychotic drugs. Effect by defect? Neuropharmacology 2013; 72:179-86. [PMID: 23643756 DOI: 10.1016/j.neuropharm.2013.04.039] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Revised: 03/11/2013] [Accepted: 04/23/2013] [Indexed: 11/29/2022]
Abstract
Antipsychotic medication represents the first-line treatment for schizophrenia. While it is undisputed that antipsychotics ameliorate positive symptoms, the exact cognitive and emotional pathways through which the effect is exerted has remained unclear. The present study investigated the subjective effects of antipsychotics across various domains of cognition and emotion in both patients with psychotic symptoms and patients with other psychiatric diagnoses. A total of 69 patients with a probable history of psychosis or psychotic symptoms and 26 patients with psychiatric diagnoses other than psychosis participated in a survey conducted over the Internet. Multiple control measures aimed to secure response validity. All patients were currently or had previously been treated with antipsychotic agents. A questionnaire comprising 49 items and measuring possible effects of antipsychotics on cognition and emotion was administered. For 30 out of 49 items a clear response pattern emerged, which was similar for patients with psychotic disorders and patients with other diagnoses. Factor analysis of these items revealed three main effects of antipsychotic medication related to doubt and self-doubt, cognitive and emotional numbing, and social withdrawal. Antipsychotic treatment appears to be connected to a number of negative subjective effects on cognition and emotion. Further studies are warranted to assess how these effects impact on the patients' subjective well-being and quality of life, as well as their association with antipsychotic efficacy on one hand, and adherence rates on the other. Induction of doubt and dampening of emotion may be one reason why antipsychotics work and at the same time offer an explanation why they are experienced as rather unpleasant and are eventually discontinued by many patients.
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Affiliation(s)
- Steffen Moritz
- University Medical Center Hamburg Eppendorf, Department of Psychiatry and Psychotherapy, Martinistrasse 52, 20246 Hamburg, Germany.
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Abstract
BACKGROUND Metacognition has been described as the knowledge of our own cognitive processes. Metacognitive deficits are common in schizophrenia, but little is known about metacognition before the onset of full-blown psychosis. AIMS This study aimed to longitudinally characterize metacognition in a sample of individuals at clinical high risk (CHR) for psychosis, and to determine if metacognition was related to later conversion to psychosis. METHOD Participants (153 CHR individuals; 68 help seeking controls, HSC) were part of the large multi-site PREDICT study, which sought to determine predictors of conversion to psychosis. They were tested at baseline and 6 months using the Meta-Cognitions Questionnaire (MCQ) that has five sub-scales assessing different domains of metacognition. RESULTS RESULTS of the mixed-effect models demonstrated significantly poorer scores at baseline for the CHR group compared to the HSC group in Negative beliefs about uncontrollability, Negative beliefs and the overall MCQ score. At the 6-month assessment, no difference was observed in metacognition between the two groups, but both groups showed improvement in metacognition over time. Those who later converted to psychosis had poorer performance on metacognitive beliefs at baseline. CONCLUSIONS A poorer performance in metacognition can be seen as a marker of developing a full blown psychotic illness and confirms the potential value of assessing metacognitive beliefs in individuals vulnerable for psychosis.
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Can we trust the internet to measure psychotic symptoms? SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:457010. [PMID: 23936652 PMCID: PMC3725883 DOI: 10.1155/2013/457010] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 05/24/2013] [Accepted: 06/06/2013] [Indexed: 12/02/2022]
Abstract
Online studies are increasingly utilized in applied research. However, lack of external diagnostic verification in many of these investigations is seen as a threat to the reliability of the data. The present study examined the robustness of internet studies on psychosis against simulation. We compared the psychometric properties of the Community Assessment of Psychic Experiences scale (CAPE), a self-report instrument measuring psychotic symptoms, across three independent samples: (1) participants with a confirmed diagnosis of schizophrenia, (2) participants with self-reported schizophrenia who were recruited over the internet, and (3) clinical experts on schizophrenia as well as students who were asked to simulate a person with schizophrenia when completing the CAPE. The CAPE was complemented by a newly developed 4-item psychosis lie scale. Results demonstrate that experts asked to simulate schizophrenia symptoms could be distinguished from real patients: simulators overreported positive symptoms and showed elevated scores on the psychosis lie scale. The present study suggests that simulated answers in online studies on psychosis can be distinguished from authentic responses. Researchers conducting clinical online studies are advised to adopt a number of methodological precautions and to compare the psychometric properties of online studies to established clinical indices to assert the validity of their results.
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van Oosterhout B, Krabbendam L, Smeets G, van der Gaag M. Metacognitive beliefs, beliefs about voices and affective symptoms in patients with severe auditory verbal hallucinations. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2012; 52:235-48. [DOI: 10.1111/bjc.12011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2011] [Accepted: 11/01/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Bas van Oosterhout
- Reinier van Arkel Psychiatric Institute; ‘s-Hertogenbosch; The Netherlands
| | | | - Guus Smeets
- Erasmus University; Rotterdam; The Netherlands
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Valiente C, Prados JM, Gómez D, Fuentenebro F. Metacognitive beliefs and psychological well-being in paranoia and depression. Cogn Neuropsychiatry 2012; 17:527-43. [PMID: 22530974 DOI: 10.1080/13546805.2012.670504] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
INTRODUCTION Despite the growing interest in the effects of metacognitive beliefs and psychological well-being on psychiatric conditions, little is known about how these two variables interact in clinical samples. The central aim of this study was to investigate the role of some metacognitive beliefs in the relationship between psychological well-being dimensions and psychopathology. METHODS Fifty-five participants with persecutory delusions diagnosed with schizophrenia or other psychotic disorders, 38 participants with a major depressive episode, and 44 healthy controls completed the 30-item short form of the Metacognitions Questionnaire (MCQ-30) and the 54-item form of the Ryff Scales of Psychological Well-Being (PWB). RESULTS MANCOVA analyses revealed group differences on four subscales of PWB (self-acceptance, autonomy, personal growth, and environmental mastery), as well as on three subscales of MCQ-30 (uncontrollability of worry, need to control thoughts, and lack of memory confidence). Moderation analyses showed the interaction between persecutory thinking and cognitive self-consciousness to be a predictor of psychological well-being. CONCLUSIONS These findings suggest that psychological well-being is particularly compromised in participants with a high level of persecutory thinking when they have low levels of cognitive self-consciousness.
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Affiliation(s)
- Carmen Valiente
- Department of Clinical Psychology, Complutense University of Madrid, Madrid, Spain.
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Modelling the emergence of hallucinations: early acquired vulnerabilities, proximal life stressors and maladaptive psychological processes. Soc Psychiatry Psychiatr Epidemiol 2012; 47:1367-80. [PMID: 22045103 DOI: 10.1007/s00127-011-0446-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 10/17/2011] [Indexed: 10/16/2022]
Abstract
BACKGROUND The study aimed to expand upon existing findings on the vulnerability to psychosis by examining synergistic models of hallucination emergence. Hypothesised vulnerability factors were separated into three stages of vulnerability; early acquired and enduring vulnerabilities (heredity, childhood trauma, early cannabis use), proximal life stressors (life hassles) and psychological appraisals/coping (metacognitions/experiential avoidance). METHODS Participants were recruited to a non-clinical sample (N = 133) and a clinical sample of psychosis patients (N = 100). RESULTS Path analyses in the non-clinical sample indicated that experiences of childhood emotional trauma, in combination with subsequent experiences of life hassles, best predicted vulnerability to both hallucinations in general and auditory hallucinations specifically. This pathway was partially mediated by negative metacognitions. The models were then replicated in the clinical sample, with two notable differences: (1) childhood sexual trauma replaced childhood emotional trauma as the best enduring predictor in the clinical model. (2) Experiential avoidance replaced metacognitions as the best cognitive predictor of hallucinations. CONCLUSIONS The study's findings highlighted how vulnerability to hallucinations can occur developmentally across time, with early acquired vulnerability factors, combining additively with more proximal day-to-day factors and cognitive style, to propel a person further towards the formation of hallucinations.
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