1
|
Lloyd A, Roiser JP, Skeen S, Freeman Z, Badalova A, Agunbiade A, Busakhwe C, DeFlorio C, Marcu A, Pirie H, Saleh R, Snyder T, Fearon P, Viding E. Reviewing explore/exploit decision-making as a transdiagnostic target for psychosis, depression, and anxiety. COGNITIVE, AFFECTIVE & BEHAVIORAL NEUROSCIENCE 2024; 24:793-815. [PMID: 38653937 PMCID: PMC11390819 DOI: 10.3758/s13415-024-01186-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 04/25/2024]
Abstract
In many everyday decisions, individuals choose between trialling something novel or something they know well. Deciding when to try a new option or stick with an option that is already known to you, known as the "explore/exploit" dilemma, is an important feature of cognition that characterises a range of decision-making contexts encountered by humans. Recent evidence has suggested preferences in explore/exploit biases are associated with psychopathology, although this has typically been examined within individual disorders. The current review examined whether explore/exploit decision-making represents a promising transdiagnostic target for psychosis, depression, and anxiety. A systematic search of academic databases was conducted, yielding a total of 29 studies. Studies examining psychosis were mostly consistent in showing that individuals with psychosis explored more compared with individuals without psychosis. The literature on anxiety and depression was more heterogenous; some studies found that anxiety and depression were associated with more exploration, whereas other studies demonstrated reduced exploration in anxiety and depression. However, examining a subset of studies that employed case-control methods, there was some evidence that both anxiety and depression also were associated with increased exploration. Due to the heterogeneity across the literature, we suggest that there is insufficient evidence to conclude whether explore/exploit decision-making is a transdiagnostic target for psychosis, depression, and anxiety. However, alongside our advisory groups of lived experience advisors, we suggest that this context of decision-making is a promising candidate that merits further investigation using well-powered, longitudinal designs. Such work also should examine whether biases in explore/exploit choices are amenable to intervention.
Collapse
Affiliation(s)
- Alex Lloyd
- Clinical, Educational and Health Psychology, Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK.
| | - Jonathan P Roiser
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - Sarah Skeen
- Institute for Life Course Health Research, Stellenbosch University, Stellenbosch, South Africa
| | - Ze Freeman
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Aygun Badalova
- Institute of Neurology, University College London, London, UK
| | | | | | | | - Anna Marcu
- Young People's Advisor Group, London, UK
| | | | | | | | - Pasco Fearon
- Clinical, Educational and Health Psychology, Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
- Centre for Family Research, Department of Psychology, University of Cambridge, Cambridge, UK
| | - Essi Viding
- Clinical, Educational and Health Psychology, Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, UK
| |
Collapse
|
2
|
Constantino MJ, Coyne AE, Gaines AN, Goodwin BJ, Muir HJ, Critchfield KL, Westra HA, Antony MM. Therapist verification of patient self-concepts as a responsive precondition for early alliance development and subsequent introject change. Psychother Res 2023:1-15. [PMID: 38158827 DOI: 10.1080/10503307.2023.2297995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE Social psychological research has indicated that people strive for self-consistent feedback and interactions, even if negative, to preserve the epistemic security of knowing themselves. Without such self-verification, any interpersonal exchange may become frustrated, anxiety-riddled, and at risk for deterioration. Thus, it may be important for therapists to meet patients' self-verification needs as a responsive precondition for early alliance establishment and development. We tested this hypothesis with patients receiving cognitive behavioral therapy for generalized anxiety disorder-a condition that may render one's self-verification needs especially strong. We also tested the hypothesis that better early alliance quality would relate to subsequent adaptive changes in and posttreatment level of patients' self-concepts. METHOD Eighty-four patients rated their self-concepts at baseline and across treatment and follow-up, their postsession recollection of their therapist's interpersonal behavior toward them during session 2, and their experience of alliance quality rated after sessions 3-6. RESULTS As predicted, the more therapists verified at session 2 a patient's baseline self-concepts (which trended toward disaffiliative and overcontrolling, on average), the more positively that patient perceived their next-session alliance. Moreover, better session 3 alliance related to more adaptive affiliative and autonomy-granting self-concepts at posttreatment. CONCLUSION Results are discussed within a therapist responsiveness framework.
Collapse
Affiliation(s)
- Michael J Constantino
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Alice E Coyne
- Department of Psychology, American University, Washington, DC, USA
| | - Averi N Gaines
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Brien J Goodwin
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Heather J Muir
- Department of Psychological and Brain Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | | | - Henny A Westra
- Department of Psychology, York University, Toronto, Canada
| | - Martin M Antony
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| |
Collapse
|
3
|
A model of self-criticism as a transdiagnostic mechanism of eating disorder comorbidity: A review. NEW IDEAS IN PSYCHOLOGY 2022. [DOI: 10.1016/j.newideapsych.2022.100949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
4
|
Muziki JD, Uwera T, Niyonsenga J, Nshimiyimana A, Sebatukura SG, Mutabaruka J. A qualitative analysis of negative feelings among incarcerated filicide mothers in Rwanda. BMC Psychiatry 2022; 22:432. [PMID: 35761308 PMCID: PMC9235198 DOI: 10.1186/s12888-022-04081-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Most of the research on filicide mothers suggests that they experience negative feelings before they kill their child. However, little is known about whether these negative feelings can be expressed after one-year post-offense among incarcerated filicide mothers with no history of psychiatric problems. In this study, we aimed to conduct a qualitative analysis to (a) understand negative feelings evolving from negative emotions such as anger, guilt, shame, depression, and anxiety among filicide mothers incarcerated in Nyarugenge Prison in Rwanda, (b) identify the impact of experienced negative feelings on their personal wellbeing, and (c) explore their coping strategies. METHODS This study adopted a phenomenology research design and face-to-face in-depth interviews to explore the problem among twenty filicide mothers selected from Nyarugenge prison. Data were audio recorded, transcribed verbatim, organized, and analysed by using ATLAS.ti 8 Windows. RESULTS Anxious and depressed participants experienced both physical and emotional negative feelings. Social withdrawal and cognitive problems were expressed by anxious participants, while avoidance behaviours were particularly experienced by depressed participants. Intolerance created anger, while self-blame, regret, and acute stress created guilt. In addition, avoidance behaviours and poor self-judgment emerged from shame. Participants felt disconnected from their community and worried about a variety of issues because of their negative feelings. To cope with negative feelings, participants reported that they used abnormal defense, surrender and support from community resources. DISCUSSION Our findings highlight the overall negative feelings of incarcerated filicide mothers, which can guide mental health professionals and different stakeholders to respond with appropriate interventions.
Collapse
Affiliation(s)
- Jean d’Amour Muziki
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Thaoussi Uwera
- grid.10818.300000 0004 0620 2260Department of Health Informatics, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Japhet Niyonsenga
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda ,grid.10818.300000 0004 0620 2260Mental Health & Behavior Research Group, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Augustin Nshimiyimana
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Siméon Gitimbwa Sebatukura
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Mutabaruka
- grid.10818.300000 0004 0620 2260Department of Clinical Psychology, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| |
Collapse
|
5
|
Stephen S, Bell L, Khan M, Love R, Macintosh H, Martin M, Moran R, Price E, Whitehead B, Elliott R. Comparing helpful and hindering processes in good and poor outcome cases: A qualitative metasynthesis of eight Hermeneutic Single Case Efficacy Design studies. Psychother Res 2021; 32:389-403. [PMID: 34088254 DOI: 10.1080/10503307.2021.1934746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Objective: We tested qualitative metasynthesis of a series of Hermeneutic Single Case Efficacy Design (HSCED) studies as a method for comparing within-session processes that may explain good and poor therapeutic outcome. Method: We selected eight HSCED studies according to change in clients' scores on the Strathclyde Inventory (SI), a brief self-report instrument used to measure outcome in person-centered psychotherapy. Four of the case studies investigated the experience of clients whose pre-post change in SI scores showed improvement by the end of therapy, and the other four focused on clients whose change in SI scores indicated deterioration. We conducted a qualitative metasynthesis, adopting a generic descriptive-interpretive approach to analyze and compare the data generated by the HSCED studies. Results: In contrast to improvers, deteriorators appeared to be less ready to engage in therapeutic work at the beginning of therapy, and found the process more difficult; their therapists were less able to respond to these difficulties in a responsive, empathic manner; deteriorators were less able to cope successfully with changes of therapist and, eventually, gave up on therapy. Conclusion: We found that our qualitative metasynthesis of a series of HSCED studies produced a plausible explanation for the contrasting outcomes that occurred.
Collapse
Affiliation(s)
- Susan Stephen
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Laura Bell
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Maha Khan
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Ruth Love
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Hannah Macintosh
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Melanie Martin
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Rebecca Moran
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Emily Price
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Brigid Whitehead
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| | - Robert Elliott
- School of Psychological Sciences & Health, University of Strathclyde, Glasgow, UK
| |
Collapse
|
6
|
Toledo-Chávarri A, Ramos-García V, Torres-Castaño A, Trujillo-Martín MM, Peñate Castro W, Del Cura-Castro I, Serrano-Aguilar P, Perestelo-Pérez L. Framing the process in the implementation of care for people with generalized anxiety disorder in primary care: a qualitative evidence synthesis. BMC FAMILY PRACTICE 2020; 21:237. [PMID: 33218311 PMCID: PMC7678131 DOI: 10.1186/s12875-020-01307-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 11/09/2020] [Indexed: 11/27/2022]
Abstract
Background Generalized anxiety disorder (GAD) is one of the most common mental disorders in primary care (PC). GAD has low remission and high relapse rates over long follow-up periods. Qualitative evidence was synthesized to understand the implementation of care and treatment options for people with GAD in PC. Methods Research published from 2008 to September 2020 was searched in five databases (MEDLINE, EMBASE, CINAHL, WOS and PsycArticles). Studies that used qualitative methods for data collection and analysis to investigate the implementation of care and treatment options for people with GAD in PC and outpatient settings were included. Non-qualitative studies, mixed methods studies that did not separately report qualitative findings and studies in languages other than English or Spanish were excluded. We used the Confidence in the Evidence from Reviews of Qualitative Research (CERQual) framework to assess the overall confidence in the findings. Results The results with a moderate level of confidence showed that the trajectory of care for people with GAD in PC and outpatient settings is long and fluctuates over time, involving multiple difficulties in accessing and maintaining initial treatment or successive treatment options. In addition, there are wide variations in the preferences for and acceptability of different treatment options. The results with a high level of confidence indicated that more information on GAD and its treatment options is needed for PC practitioners, GAD patients and their carers. The results with a low level of confidence suggested that patients use antidepressants for longer than recommended and that the interruption of treatment is not usually planned. Conclusions Initial resistance to new treatments among people with GAD can make access and adherence to treatment difficult. Improving care may require patients to be informed of possible trajectories in stepped care pathways before the initiation of treatment so they are aware that they may need to try a number of options until the most effective treatment for them is found. Increased awareness of and information materials on GAD may facilitate both appropriate diagnosis and long-term care. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-020-01307-6.
Collapse
Affiliation(s)
- Ana Toledo-Chávarri
- Canary Islands Health Research Institute Foundation, Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Vanesa Ramos-García
- Canary Islands Health Research Institute Foundation, Tenerife, Spain. .,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.
| | - Alezandra Torres-Castaño
- Canary Islands Health Research Institute Foundation, Tenerife, Spain.,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - María M Trujillo-Martín
- Canary Islands Health Research Institute Foundation, Tenerife, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain
| | - Wenceslao Peñate Castro
- Facultad de Ciencias de la Salud - Sección de Psicología, University of La Laguna, Tenerife, Spain
| | - Isabel Del Cura-Castro
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Unidad de Apoyo a la Investigación, Gerencia Asistencial de Atención Primaria, Madrid, Spain.,Department Preventive Medicine and Public Health, University Rey Juan Carlos, Madrid, Spain
| | - Pedro Serrano-Aguilar
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
| | - Lilisbeth Perestelo-Pérez
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.,Center for Biomedical Research of the Canary Islands (CIBICAN), Tenerife, Spain.,The Spanish Network of Agencies for Health Technology Assessment and Services of the National Health System (RedETS), Tenerife, Spain.,Evaluation Unit (SESCS), Canary Islands Health Service (SCS), Tenerife, Spain
| |
Collapse
|
7
|
Hissa J, Timulak L. Theoretically informed qualitative psychotherapy research: A primer. COUNSELLING & PSYCHOTHERAPY RESEARCH 2020. [DOI: 10.1002/capr.12301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Joana Hissa
- South West London & St George's Mental Health NHS Trust London UK
| | | |
Collapse
|
8
|
Hurtado MM, Villena A, Vega A, Amor G, Gómez C, Morales-Asencio JM. 'I have anxiety, but I have values and preferences' Experiences of users with generalized anxiety disorder: A qualitative study. Int J Ment Health Nurs 2020; 29:521-530. [PMID: 31908140 DOI: 10.1111/inm.12690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2019] [Indexed: 12/12/2022]
Abstract
To understand the experience and perceptions of people diagnosed with generalized anxiety disorder, along the whole process and their role through the decision-making process for their treatment. A qualitative study through focus groups composed of people diagnosed with generalized anxiety disorder was carried out. Content analysis was carried out to explore the most representative issues. Five thematic categories were identified: onset of the disorder, symptoms and course; daily life with the disorder; coping with the disorder; demand of healthcare for anxiety, and treatment options and decision-making. Most of the patients reported physical symptoms of anxiety. The majority of participants perceived little social support from their environment and occupational interferences. Coping seems to differ among participant that have recovered or not recovered. The involvement of users with generalized anxiety disorder was scarce, and pharmacological treatment was always the first option offered. There is scarce orientation to elicit preferences and values of patients across the process of care for people with generalized anxiety disorder. The consequence is a biased predisposition of the healthcare system to provide pharmacological treatment as the first option and ignore the perspective of patients on how to cope with their illness.
Collapse
Affiliation(s)
- María M Hurtado
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Amelia Villena
- Mental Health Unit, Valle de los Pedroches Hospital, Pozoblanco, Spain
| | - Amanda Vega
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | - Gisela Amor
- Mental Health Unit, Regional University Hospital, Málaga, Spain
| | | | | |
Collapse
|
9
|
Emotion-Focused Therapy for Anxiety and Depression in Women with Breast Cancer. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2020. [DOI: 10.1007/s10879-019-09439-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
10
|
Hissa J, Connolly A, Timulak L, Hession N. Emotion-focused perspective on breast cancer patients’ experiences of comorbid anxiety and depression: a qualitative case analysis of three clients’ in-session presentations. PERSON-CENTERED & EXPERIENTIAL PSYCHOTHERAPIES 2020. [DOI: 10.1080/14779757.2020.1717988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Joana Hissa
- School of Psychology, Trinity College, Dublin, Ireland
| | - Allison Connolly
- School of Psychology, Trinity College, Dublin, Ireland
- St. Luke’s Radiation Oncology Network, Dublin, Ireland
| | | | | |
Collapse
|
11
|
|
12
|
Timulak L, Elliott R. Taking stock of descriptive-interpretative qualitative psychotherapy research: Issues and observations from the front line. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018. [DOI: 10.1002/capr.12197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
13
|
Humanistic‐experiential therapies in the treatment of generalised anxiety: A perspective. COUNSELLING & PSYCHOTHERAPY RESEARCH 2018. [DOI: 10.1002/capr.12172] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|