Cognitive behavioural therapy for psychosis: The end of the line or time for a new approach?

The role of the behavioural inhibition and activation system in the association between attachment style and positive or negative symptoms in patients with psychosis and unaffected siblings

BACKGROUND

The association between attachment style and psychotic symptomatology is well established. However, little is known about the mechanisms underlying this relationship. In the present study, we aimed to investigate whether the sensitivity of the behavioural inhibition and activation system mediates the association between attachment style and positive or negative symptoms, in patients with psychotic disorders and unaffected siblings.

METHODS

In a subsample of the Genetic Risk and Outcome of Psychosis (GROUP) study (87 patients and 94 siblings), attachment style was assessed using the Psychotic Attachment Measure, behavioural inhibition or activation with the Behavioral Inhibition System (BIS) and Behavioral Activation System (BAS) Scale and positive and negative symptomatology with the Community Assessment of Psychic Experiences. Linear regression models and mediation models were used, while correcting for age and gender and adjusting for multiple testing.

RESULTS

We found that anxious and avoidant attachment were associated with negative symptoms across both groups. Additionally, in siblings, anxious and avoidant attachment were associated with positive symptoms. In the patient group, BIS sensitivity mediated the association between anxious attachment and negative symptoms. In the sibling group, BIS sensitivity mediated the association between avoidant attachment and both positive and negative symptoms, and between anxious attachment and positive symptoms.

CONCLUSIONS

Findings indicate that BIS sensitivity, but not BAS sensitivity, is a possible mediating mechanism contributing to the association between insecure attachment and psychotic symptoms. Longitudinal studies are required to confirm the associations between attachment style, BIS and BAS sensitivity, and psychotic symptoms, and explore causality.

Co-designing a low-intensity psychological therapy for fear of recurrence in psychosis using translational learning from fear of recurrence in oncology: protocol for intervention development for future testing in a feasibility study

INTRODUCTION

Fear of recurrence is a transdiagnostic problem experienced by people with psychosis, which is associated with anxiety, depression and risk of future relapse events. Despite this, there is a lack of available psychological interventions for fear of recurrence, and psychological therapies for schizophrenia are often poorly implemented in general. However, low-intensity psychological therapy is available for people who experience fear of recurrence in the context of cancer, which means there is an opportunity to learn what has worked in a well-implemented psychological therapy to see if any learning can be adapted for schizophrenia care. This article describes the design, methods and expected data collection of development, acceptab i lity, feasibility, a n d preliminary outcome signals for a copro d uced low-intensity psycholo g ical intervention targeting fear o f relapse in people with schizophrenia (INDIGO), which aims to develop an acceptable psychological intervention for fear of recurrence.

METHODS AND ANALYSIS

INDIGO will use a mixed-methods approach to co-design and deliver a model and treatment pathway for a psychological intervention for people diagnosed with schizophrenia who experience fear of recurrence. The study will consist of four stages. First, in-depth interviews with mental health staff and people diagnosed with schizophrenia (with a further social network mapping task for patient participants only) to develop the intervention. Second, in-depth interviews with people who have accessed the Glasgow Fear of Recurrence service and oncology staff will be conducted to inform further development of the intervention. Third, co-design workshops will be held with people diagnosed with schizophrenia and mental health staff to co-design intervention content and the treatment pathway. Finally, people diagnosed with schizophrenia will be presented with an intervention prototype and invited to complete 'think-aloud' interviews to gather further feedback so adaptations can be implemented.

ETHICS AND DISSEMINATION

The INDIGO study received ethical approval from East Midlands-Nottingham 2 Research Ethics Committee (24/EM/0124). The study received independent peer review prior to funding. This co-design study is expected to lead to a future feasibility study and, if indicated, a randomised controlled trial.

Trauma and social pathways to psychosis: Examining the role of attachment, social rank and dissociation in a clinical sample

OBJECTIVES

The trauma and social pathways model of psychosis proposes interactions between trauma, attachment, social rank and dissociation in pathways to psychosis, though this model has yet to be empirically investigated. The primary aim of this study was to examine the overall predictive value of the trauma and social pathways model using regression analysis. A secondary aim was to delineate hypothesized pathways between trauma and positive symptoms of psychosis using serial mediation analysis.

METHOD

This was a cross-sectional study of people attending mental health services for a psychosis-related diagnosis (N = 71). Measures of trauma, positive symptoms of psychosis, attachment, social comparison and dissociation were completed.

RESULTS

A model of recurrent trauma, insecure attachment, social rank and dissociation predicted 23.2% of the variance in positive symptoms of psychosis. Recurrent trauma, attachment and dissociation contributed significantly to the model, while social rank did not. Further, serial mediation analysis indicated that the sequence of disorganized attachment and dissociation fully mediated the relationship between recurrent trauma and positive symptoms.

CONCLUSIONS

Results provide preliminary support for the trauma and social pathways model of psychosis, specifically as it relates to recurrent trauma, insecure attachment and dissociation. Results did not support the social rank component of this model, however. These findings provide clear targets for the development of next-wave psychological interventions that focus on trauma-related variables in psychosis. Future studies should replicate these findings with a larger clinical sample, and consider a measure of shame to further elucidate social processes in pathways to psychosis.