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Radez J, Johns L, Waite F. Understanding unusual sensory experiences: a randomised experimental study of a school-based intervention for adolescents. Child Adolesc Ment Health 2024; 29:14-21. [PMID: 36959519 PMCID: PMC10877969 DOI: 10.1111/camh.12651] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND One in ten young people experience unusual sensory experiences (USE), such as hallucinations. From a cognitive perspective, the appraisal of USE determines the impact of these experiences. Negative appraisal, as well as other psychological processes (e.g. thinking flexibility, maladaptive schemas, anxiety/depression), is associated with more distress. Our aim was to (a) develop a universal single-session school-based intervention on USE for adolescents and (b) evaluate the effect of the intervention on appraisals of and help seeking intentions for USE. METHODS A randomised controlled experimental design with a one-month follow-up was used to test the effectiveness of the intervention in one school. Students (n = 223) aged 12-13 were randomised by class to a single-session intervention on USE or a control intervention (generic mental wellbeing). Participants completed measures of appraisals of and help-seeking intentions for USE at pre- and postintervention and at one-month follow-up. They also completed measures of schemas, thinking flexibility and anxiety/depression at preintervention. RESULTS Overall, 190 adolescents completed the main outcome measures at all three points. The intervention on USE led to a significant (p < .05) increase of positive appraisals of USE compared with the control, with effects sustained at one-month follow-up. The intervention on USE did not lead to significantly greater help-seeking intentions for USE (p = .26). Adolescents' schemas were associated with appraisals and slow thinking and anxiety/depressive symptoms with help-seeking behaviour for USE. CONCLUSIONS A single-session universal school-based intervention shows promise by improving appraisals of USE. Further research is required across different school populations.
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Affiliation(s)
- Jerica Radez
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences DivisionUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
| | - Louise Johns
- Oxford Institute of Clinical Psychology Training and Research, Medical Sciences DivisionUniversity of OxfordOxfordUK
- Oxford Health NHS Foundation TrustOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
| | - Felicity Waite
- Oxford Health NHS Foundation TrustOxfordUK
- Department of PsychiatryUniversity of OxfordOxfordUK
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Tolmeijer E, Waite F, Isham L, Bringmann L, Timmers R, van den Berg A, Schuurmans H, Staring ABP, de Bont P, van Grunsven R, Stulp G, Wijnen B, van der Gaag M, Freeman D, van den Berg D. Testing the combination of Feeling Safe and peer counselling against formulation-based cognitive behaviour therapy to promote psychological wellbeing in people with persecutory delusions: study protocol for a randomized controlled trial (the Feeling Safe-NL Trial). Trials 2023; 24:644. [PMID: 37798792 PMCID: PMC10557156 DOI: 10.1186/s13063-023-07661-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Persecutory delusions are strong threat beliefs about others' negative intentions. They can have a major impact on patients' day-to-day life. The Feeling Safe Programme is a new translational cognitive-behaviour therapy that helps patients modify threat beliefs and relearn safety by targeting key psychological causal factors. A different intervention approach, with growing international interest, is peer counselling to facilitate personal recovery. Combining these two approaches is a potential avenue to maximize patient outcomes. This combination of two different treatments will be tested as the Feeling Safe-NL Programme, which aims to promote psychological wellbeing. We will test whether Feeling Safe-NL is more effective and more cost-effective in improving mental wellbeing and reducing persecutory delusions than the current guideline intervention of formulation-based CBT for psychosis (CBTp). METHODS A single-blind parallel-group randomized controlled trial for 190 out-patients who experience persecutory delusions and low mental wellbeing. Patients will be randomized (1:1) to Feeling Safe-NL (Feeling Safe and peer counselling) or to formulation-based CBTp, both provided over a period of 6 months. Participants in both conditions are offered the possibility to self-monitor their recovery process. Blinded assessments will be conducted at 0, 6 (post-treatment), 12, and 18 months. The primary outcome is mental wellbeing. The overall effect over time (baseline to 18-month follow-up) and the effects at each timepoint will be determined. Secondary outcomes include the severity of the persecutory delusion, general paranoid ideation, patient-chosen therapy outcomes, and activity. Service use data and quality of life data will be collected for the health-economic evaluation. DISCUSSION The Feeling Safe-NL Trial is the first to evaluate a treatment for people with persecutory delusions, while using mental wellbeing as the primary outcome. It will also provide the first evaluation of the combination of a peer counselling intervention and a CBT-based program for recovery from persecutory delusions. TRIAL REGISTRATION Current Controlled Trials ISRCTN25766661 (retrospectively registered 7 July 2022).
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Affiliation(s)
- Eva Tolmeijer
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands.
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands.
| | - Felicity Waite
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Louise Isham
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Laura Bringmann
- Department of Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Robin Timmers
- Voice-Hearing Support and Recovery-Team, RIBW Nijmegen and Rivierenland, Nijmegen, The Netherlands
- University of Applied Sciences Nijmegen, Nijmegen, The Netherlands
| | - Arjan van den Berg
- Department of Health, Wellbeing and Sport, Zadkine College Rotterdam, Rotterdam, The Netherlands
| | | | - Anton B P Staring
- ABC Department for First Episode Psychosis, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - Paul de Bont
- Mental Health Organizations Oost Brabant, Boekel, The Netherlands
| | - Rob van Grunsven
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Gert Stulp
- Department of Sociology, University of Groningen, Groningen, The Netherlands
| | - Ben Wijnen
- Centre of Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - David van den Berg
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research, Amsterdam, The Netherlands
- Department of Psychosis, Parnassia Psychiatric Institute, The Hague, The Netherlands
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Zhu C, Kwok NTK, Chan TCW, Chan GHK, So SHW. Inflexibility in Reasoning: Comparisons of Cognitive Flexibility, Explanatory Flexibility, and Belief Flexibility Between Schizophrenia and Major Depressive Disorder. Front Psychiatry 2021; 11:609569. [PMID: 33584376 PMCID: PMC7874185 DOI: 10.3389/fpsyt.2020.609569] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 12/18/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Inflexibility in reasoning has been suggested to contribute to psychiatric disorders, such as explanatory flexibility in depression and belief flexibility in schizophrenia. However, studies tended to examine only one of the flexibility constructs, which could be related to each other, within a single group of patients. As enhancing flexibility in thinking has become one of the psychological treatment goals across disorders, this study aimed to examine three constructs of flexibility (cognitive flexibility, explanatory flexibility, and belief flexibility) in two psychiatric groups. Methods: We compared three groups of participants: (i) 56 outpatients with a schizophrenia-spectrum disorder and active delusions, (ii) 57 outpatients with major depressive disorder and at least a moderate level of depression, and (iii) 30 healthy controls. Participants were assessed on symptom severity and flexibility, using the Trail-Making Task, the Attributional Style Questionnaire, the Maudsley Assessment of Delusions Scale (MADS) and the Bias Against Disconfirmatory Evidence (BADE) Task. Results: Cognitive flexibility was reduced in the two clinical groups compared to controls. Explanatory flexibility was comparable across groups. The three groups differed in belief flexibility measured by MADS but not by the BADE task. Response to hypothetical contradiction was reduced in the delusion group than the other two groups, and the ability to generate alternative explanations was reduced in the delusion group than healthy controls. Discussion: We found an effect of diagnosis on cognitive flexibility, which might be confounded by differences in intellectual functioning. Reduced belief flexibility tended to be specific to delusions.
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Affiliation(s)
- Chen Zhu
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Tracey Chi-wan Chan
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Suzanne Ho-wai So
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
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