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Hazell CM, Hasapopoulos S, McGowan J, Hamza R, Ahmed Z, Gaughan B, Malillos MH, Gill A, Nomani A, Hickson E, Koruni A, Islam F, Souray J, Raune D. The Role of Verbal Auditory Hallucinations in Influencing and Retrospectively Predicting Physical Harm Prevalence in Early Psychosis. Clin Pract Epidemiol Ment Health 2024; 20:e17450179286452. [PMID: 39130189 PMCID: PMC11311800 DOI: 10.2174/0117450179286452240520070533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 03/11/2024] [Accepted: 03/18/2024] [Indexed: 08/13/2024]
Abstract
Background Research has established a relationship between psychosis and physical harm in the early course of psychosis. However, little is known about the relationship between specific psychosis symptoms, such as hearing voices, and physical harm. Objective This study aimed to determine the prevalence and typology of physical harm related to hearing voices, as well as what aspects of the voice-hearing experience retrospectively predicted incidents of harm within an Early Intervention in Psychosis Service (EIPS). Methods We conducted a quality improvement project in a single EIPS. We reviewed case notes of patients and extracted information on the cognitive-phenomenological features of the voices patients heard, as well as any incidents of physical harm that were causally linked to these voices. Results It was found that 32.2% of EI patients had an actual incident of physical harm in their case notes that was causally linked to hearing voices. The most common type of physical harm was neglect. In terms of cognitive phenomenological binary correlations that retrospectively predicted physical harm in the case notes, patients were 20 and 7 times more likely to have harmed themselves if they heard self-harm commands (i.e., directions to harm themselves physically) and perceived the voice as omnipotent, respectively. Patients were 6 times more likely to have harmed someone else if they heard violent commands. Conclusion Verbal auditory hallucinations commonly influence physical harm in the early course of psychosis. Hearing commands and/or believing the voice to be omnipotent are strong retrospective-correlative predictors that may aid in the assessment and therapeutic intervention.
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Affiliation(s)
- Cassie M. Hazell
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, GU2 7XH, UK
| | - Sophia Hasapopoulos
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Jennifer McGowan
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Roman Hamza
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Zareena Ahmed
- Division of Psychology and Language Sciences, University College London, London, UK
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Ben Gaughan
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | | | - Amber Gill
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Amber Nomani
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Emily Hickson
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Anjeza Koruni
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Faaisa Islam
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - Jonathan Souray
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
| | - David Raune
- Harrow and Hillingdon Early Intervention in Psychosis (EIP) Service, London, UK
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Berendsen S, Berendse S, van der Torren J, Vermeulen J, de Haan L. Cognitive behavioural therapy for the treatment of schizophrenia spectrum disorders: an umbrella review of meta-analyses of randomised controlled trials. EClinicalMedicine 2024; 67:102392. [PMID: 38274116 PMCID: PMC10809079 DOI: 10.1016/j.eclinm.2023.102392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 01/27/2024] Open
Abstract
Background Cognitive behavioural therapy (CBT) forms the standard psychotherapy for schizophrenia spectrum disorders (SSD). We aimed to summarize and evaluate the evidence on the effectiveness of CBT for SSD. Methods In this umbrella review, we searched PubMed, Embase, Cochrane Database, and PsychInfo, for meta-analyses of randomised controlled trials (RCTs) of CBT in SSD published between database inception up to Aug 18, 2023. Inclusion criteria were RCTs investigating individually provided CBT in a population of patients with SSD, compared to either standard care, treatment as usually, or any other psychosocial therapies. No restrictions concerning follow-up or language were applied. We used the "assessment of multiple systematic reviews" (AMSTAR-2) appraisal checklist for the evaluation of methodological quality of meta-analysis. We extracted summary metrics from eligible studies in duplicate. The strength of evidence was classified by the sample size, p-value, excess significance bias, prediction intervals, significance of largest study, and heterogeneity. The strength of evidence was ranked according to established criteria as: convincing, highly suggestive, suggestive, weak, or not significant. Primary outcomes were general psychopathology, positive and negative symptoms. This study is registered in PROSPERO, CRD42022334671. Findings We found 26 eligible meta-analyses, of which 16 meta-analyses provided sufficient data. Using the AMSTAR-2, we found limitations in details concerning the selection of study design, quality of the search and reporting of funding in included meta-analyses. A minority of 42.9% of the comparisons showed a significant result in favor of CBT; 57.1% were non-significant with no convincing or highly suggestive evidence. Suggestive evidence was found in favor of CBT for general psychopathology (6.2%, N = 34 RCTs, effect size (ES) = -0.33 (-0.47; -0.19), I2 = 67.93), delusions (16.7%, N = 27, ES = 0.36 (0.22; 0.51), I2 = 50.47), and hallucinations (33.3%, N = 28, ES = 0.32 (0.19; 0.46), I2 = 45.14) at the end of treatment (EoT). Weak (N = 34 RCTs, ES = -0.13 (-0.24; -0.02), I2 = 51.28), or non-significant evidence (N = 28 RCTs, ES = 0.12 (-0.03; 0.27) I2 = 64.63) was found for negative symptoms at EoT. At longer follow-up, evidence became weak or non-significant. Interpretation Findings suggest that the effectiveness of CBT on general and positive symptoms in SSD at EoT was small to medium, while we found inconsistent evidence for a sustainable effect. CBT has no convincing impact on other relevant outcomes. Guidelines may use these results to specify their recommendations. Funding None.
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Affiliation(s)
- Steven Berendsen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
- Dimence Mental Health Care, Deventer, the Netherlands
| | - Silke Berendse
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Jeanne van der Torren
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Jentien Vermeulen
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
| | - Lieuwe de Haan
- Department of Psychiatry, Amsterdam University Medical Center, Location Academic Medical Center, the Netherlands
- Arkin Mental Health Care, Amsterdam, the Netherlands
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Morrison AP, Gonçalves CC, Peel H, Larkin A, Bowe SE. Identifying types of problems and relative priorities in the problem lists of participants in CBT for psychosis trials. Behav Cogn Psychother 2023; 51:633-644. [PMID: 37170808 DOI: 10.1017/s1352465822000583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND There is wide variation in the problems prioritised by people with psychosis in cognitive behavioural therapy for psychosis (CBTp). While research trials and mental health services have often prioritised reduction in psychiatric symptoms, service users may prioritise issues not directly related to psychosis. This discrepancy suggests potential challenges in treatment outcome research. AIMS The present study aimed to examine the types of problems that were recorded on problem lists generated in CBTp trials. METHOD Problem and goals lists for 110 participants were extracted from CBTp therapy notes. Subsequently, problems were coded into 23 distinct categories by pooling together items that appeared thematically related. RESULTS More than half of participants (59.62%) listed a non-psychosis-related priority problem, and 22.12% did not list any psychosis related problems. Chi-square tests indicated there was no difference between participants from early intervention (EI) and other services in terms of priority problem (χ2 = 0.06, p = .804), but that those from EI were more likely to include any psychosis-related problems in their lists (χ2 = 6.66, p = .010). CONCLUSIONS The findings of this study suggest that psychiatric symptom reduction is not the primary goal of CBTp for most service users, particularly those who are not under the care of EI services. The implications for future research and clinical practice are discussed.
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Affiliation(s)
- Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Cláudia C Gonçalves
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Heather Peel
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Amanda Larkin
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Samantha E Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Smith LM, Yolland C, Rossell SL, Toh WL. The phenomenology of auditory verbal hallucinations in bipolar disorder. Psychol Psychother 2023; 96:399-409. [PMID: 36748805 PMCID: PMC10952547 DOI: 10.1111/papt.12446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/29/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVES At least one in four persons with bipolar disorder (BD) are estimated to have experienced auditory verbal hallucinations (AVH) or heard voices at some point. Yet few studies have investigated AVH in detail in this population. This preliminary study examined the phenomenology of AVH in BD to identify commonalities and differences relative to other psychiatric disorders where AVH are commonly reported. METHOD Twenty-one participants diagnosed with BD were recruited across two international sites in the UK and Australia. All participants underwent a structured clinical interview to verify psychiatric diagnosis and completed standardised measures of symptomatology, including mood states. Phenomenological information of AVH was gathered using select questions from the comprehensive Mental Health Research Institute Unusual Perceptual Schedule (MUPS). RESULTS AVH experienced by this BD sample were broadly similar in form and content to characterisations reported in the schizophrenia spectrum disorders (SSD) in prior literature, with some exceptions including frequency, duration and the changeability of tone and content. CONCLUSIONS The study highlights possibly subtle differences in the experience of AVH in BD, including the potential influence of mood congruence as a pertinent clinical feature. Further research into these differences might inform adaptations to existing AVH interventions to ensure they are relevant for BD.
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Affiliation(s)
- Lindsay M Smith
- National and Specialist CAMHS, At‐Risk and Forensic Service, South London and Maudsley NHS Foundation Trust, Michael Rutter CentreMaudsley HospitalLondonUK
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Caitlin Yolland
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
| | - Susan L. Rossell
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- Department of PsychiatrySt Vincent's HospitalMelbourneVictoriaAustralia
| | - Wei Lin Toh
- Centre for Mental HealthSwinburne University of TechnologyMelbourneVictoriaAustralia
- Department of PsychiatrySt Vincent's HospitalMelbourneVictoriaAustralia
- Department of PsychologyAlfred HospitalMelbourneVictoriaAustralia
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Loizou S, Fowler D, Hayward M. Measuring the longitudinal course of voice hearing under psychological interventions: A systematic review. Clin Psychol Rev 2022; 97:102191. [PMID: 35995024 DOI: 10.1016/j.cpr.2022.102191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 06/10/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
Abstract
Trials of psychological interventions targeting distressing voices have used a range of variables to measure outcomes. This has complicated attempts to compare outcomes across trials and to evaluate the effectiveness of these interventions. Therefore, this review aimed to identify the variables that have been used to measure the longitudinal course and impact of voice hearing under these interventions and to evaluate how these variables change over time. Inclusion and exclusion criteria were applied, resulting in a total of 66 articles. Of these, 60 studies (28 RCTs, 23 uncontrolled, 9 non-randomised) were published in peer-reviewed journals, whilst 6 were recently completed or currently ongoing. The findings of this review suggest that a range of variables that are not directly relevant to psychological interventions have been used (e.g., depression, characteristics of voice hearing experience), whilst those directly impacted by psychological interventions (e.g., voice-related distress), broader concepts of outcome (e.g., functioning) and specific associated processes (e.g., self-schema) have received less attention. Findings also showed that the majority of variables demonstrated improvements, but effect sizes varied considerably across trials. This may be attributed to methodological differences such as statistical power, blinding, control groups and different methods of measurement. Our review highlights the importance of determining a set of outcomes that are directly targeted and should change under psychological interventions. Recommendations include the use of voice-related distress as a primary outcome. This can ultimately facilitate comparisons across studies and inform the development of psychological interventions.
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Affiliation(s)
- Sofia Loizou
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK.
| | - David Fowler
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK
| | - Mark Hayward
- School of Psychology, University of Sussex, Falmer BN1 9QH, UK; Research & Development Department, Sussex Partnership NHS Foundation Trust, Nevill Avenue, Hove BN7 3HZ, UK
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Feasibility and Benefit of Cognitive Behavioural Therapy for Psychosis via Teleconsultation in Indonesia: A Case Study of a 40-Year-Old Schizoaffective Disorder Patient. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Whilst Cognitive Behavioural Therapy for Psychosis (CBTp) has been found to reduce psychotic symptoms, most evidence supporting its implementation originates from studies in Western and high-income countries. Furthermore, questions remain regarding the efficacy of CBTp conducted via teleconsultation. Herein we report an ongoing case in Indonesia involving an individual with schizoaffective disorder, who received 60 sessions of CBTp over seven months. Sessions were delivered via a combination of voice and video calls. The patient, a 40-year-old male, was diagnosed with schizoaffective disorder at the age of 26. He exhibited symptoms of paranoid and religious delusions, hallucinations (auditory, visual, and somatic) and disorganised speech during our intake interview. Negative symptoms were not apparent. In the 14 years prior to our initial consultation, the patient was prescribed antipsychotics and demonstrated good adherence. He had no history of psychotherapy independent of our clinic. Treatment involved CBTp techniques, including psychoeducation, a symptom diary, relaxation, and behavioural experiments. Study outcome was assessed with Psychotic Symptom Rating Scales. Both hallucination and delusion subscale scores improved 53% from 53 at intake to 25 during an assessment administered 6 months later. Results from this study demonstrate that the CBTp is both feasible, and beneficial, when conducted via teleconsultation in Indonesia.
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7
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Goulder J. Role of psychotherapeutic models in rehabilitation and recovery. Int J Soc Psychiatry 2022; 68:3-5. [PMID: 33100097 DOI: 10.1177/0020764020968590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Arul B, Lee D, Marzen S. A Proposed Probabilistic Method for Distinguishing Between Delusions and Other Environmental Judgements, With Applications to Psychotherapy. Front Psychol 2021; 12:674108. [PMID: 34434137 PMCID: PMC8380927 DOI: 10.3389/fpsyg.2021.674108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Accepted: 07/12/2021] [Indexed: 11/16/2022] Open
Abstract
How can individuals with schizophrenia best be equipped to distinguish delusions from accurate judgements about their environment? This study presents an approach based on the principles of Bayesian probability and presents the results of a series of tests in which a simulated observer classifies randomly generated data characteristic of a simulated environment. The complexity of the data ranges from scalars to vectors of variable lengths, and the simulated observer makes its decisions based on either perfect or imperfect models of its environment. We find that when a low-dimensional observation is considered characteristic of both real observations and delusions, the prior probabilities of any observation being real or fake are of greater importance to the final decision than the attributes of the observation. However, when an observation is high-dimensional (complex), classification accuracy tends to improve toward 100% with increasing complexity of observations, as long as the patient's model of the world isn't drastically inaccurate. On the contrary, when the observer's model is sufficiently inaccurate, the accuracy rate decreases with increasing observational complexity. Overall, the results suggest applicability of the Bayesian model to the use of interventional therapy for those who suffer from psychosis.
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Affiliation(s)
- Boopala Arul
- Division of Biological Sciences, University of California, San Diego, San Diego, CA, United States
| | - Daniel Lee
- W. M. Keck Science Department, Pitzer, Scripps, and Claremont McKenna College, Claremont, CA, United States
| | - Sarah Marzen
- W. M. Keck Science Department, Pitzer, Scripps, and Claremont McKenna College, Claremont, CA, United States
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Parry G, Bennett D, Roth AD, Kellett S. Developing a competence framework for cognitive analytic therapy. Psychol Psychother 2021; 94 Suppl 1:151-170. [PMID: 32930457 DOI: 10.1111/papt.12306] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 08/14/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This paper describes the development and summarizes the content of a competence framework for delivery of cognitive analytic therapy (CAT). DESIGN The framework was developed using the evidence-based method developed by Roth and Pilling (2008, Behavioural and Cognitive Psychotherapy, 36, 129). METHODS A review of the CAT outcome literature identified where CAT interventions had evidence of efficacy. Standard texts on CAT were primary sources for details of theory and practice. This process was supported by an expert reference group (ERG). The role of the ERG was to provide professional advice on areas where the evidence base was lacking, but where CAT interventions were commonly used by therapists trained in the model. RESULTS A framework was produced and structured in terms of core knowledge, core skills, and meta-competences (which require therapeutic judgement rather than simple adherence to a treatment protocol). CONCLUSIONS The framework enables trainees, service users, service managers, and commissioners to better understand a) the core features of CAT and b) what competences need to be in place for CAT to be skilfully delivered in practice. PRACTITIONER POINTS It is possible to define the core competences of CAT. Whilst generic competences are important, there are five CAT-specific domains of competence. The CAT-specific competences reflect the three-phase structure of the therapy: reformulation, recognition, and revision.
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Tailoring cognitive behavioural therapy to subtypes of voice-hearing using a novel tabletised manual: a feasibility study. Behav Cogn Psychother 2020; 49:287-301. [PMID: 32972483 DOI: 10.1017/s1352465820000661] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive behavioural therapy for psychosis (CBTp) is a recommended treatment for psychotic experiences, but its effectiveness has been questioned. One way of addressing this may be to tailor therapy materials to the phenomenology of specific psychotic experiences. AIM In this study, we investigated the acceptability of a novel treatment manual for subtypes of 'voice-hearing' experiences (i.e. auditory verbal hallucinations). An uncontrolled, single-arm design was used to assess feasibility and acceptability of using the manual in routine care for people with frequent voice-hearing experiences. METHOD The manual was delivered on a smart tablet and incorporated recent research evidence and theory into its psychoeducation materials. In total, 24 participants completed a baseline assessment; 19 started treatment, 15 completed treatment and 12 participants completed a follow-up assessment (after 10 sessions of using the manual). RESULTS Satisfaction with therapy scores and acceptability ratings were high, while completion rates suggested that the manual may be more appropriate for help with participants from Early Intervention in Psychosis services rather than Community Mental Health Teams. CONCLUSION Within-group changes in symptom scores suggested that overall symptom severity of hallucinations - but not other psychosis features, or beliefs about voices - are likely to be the most appropriate primary outcome for further evaluation in a full randomised controlled trial.
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Longden E, Branitsky A, Moskowitz A, Berry K, Bucci S, Varese F. The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis. Schizophr Bull 2020; 46:1104-1113. [PMID: 32251520 PMCID: PMC7505175 DOI: 10.1093/schbul/sbaa037] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI: .386 -.486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI: .386 -.531), delusions (r = .418; 95%CI: .370 -.464), paranoia (r = .447; 95%CI: .393 -.499), and disorganization (r = .346; 95%CI: .249 -.436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.
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Affiliation(s)
- Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Alison Branitsky
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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Jolley S, Johns LC, O'Donoghue E, Oliver J, Khondoker M, Byrne M, Butler L, De Rosa C, Leal D, McGovern J, Rasiukeviciute B, Sim F, Morris E. Group acceptance and commitment therapy for patients and caregivers in psychosis services: Feasibility of training and a preliminary randomized controlled evaluation. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:524-551. [PMID: 32944971 DOI: 10.1111/bjc.12265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 08/16/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Psychological interventions reduce the impact of psychosis, but widescale implementation is problematic. We tested the feasibility of group acceptance and commitment therapy for Psychosis (G-ACTp), delivered by frontline staff, and co-facilitated by service-user experts-by-experience (SU-EbyE), for service-users and informal caregivers (ISRCTN: 68540929). We estimated recruitment/retention rates and outcome variability for future evaluation. METHODS Staff and SU-EbyE facilitators completed 1-day workshops, then delivered closely supervised G-ACTp, comprising four sessions (weeks 1-4) and two boosters (10 and 12 weeks). Participants recruited from adult community psychosis services were randomized to receive G-ACTp immediately or after 12 weeks, completing outcome assessments at 0, 4, and 12 weeks. Service-use/month was calculated for 1-year pre-randomization, weeks 0-12, and 5-year uncontrolled follow-up. RESULTS Of 41 facilitators trained (29 staff, 12 SU-EbyE), 29 (71%; 17 staff, 12 SU-EbyE) delivered 18 G-ACTp courses. Participant refusal rates were low (9% of service-users [10/112]; 5% of caregivers [4/79]); 60% of those invited to participate attended ≥1 G-ACTp session (64% of service-users [39/61]; 56% of caregivers [35/63]). Randomization of facilitators and participants proved problematic and participant follow-up was incomplete (78% [66/85]; 82% of service-users [36/44]; 73% of caregivers [30/41]). Effect sizes ranged from very small to large mostly favouring treatment. Service-use reductions require cautious interpretation, as very few participants incurred costs. CONCLUSIONS Implementation appears feasible for service-users; for caregivers, retention needs improving. Outcome variability indicated n = 100-300/arm followed up (α = 0.05, 90% power). Methodological limitations' mean replication is needed: identified sources of potential bias may be reduced in a cluster randomized design with sessional outcome completion. PRACTITIONER POINTS Group acceptance and commitment therapy can be successfully adapted for people with psychosis and their caregivers. Implementation (training and delivery) is possible in routine community mental health care settings. Clinical and economic outcomes are promising, but replication is needed. Recommendations are made for future studies.
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Affiliation(s)
- Suzanne Jolley
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Louise C Johns
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,Department of Psychiatry, University of Oxford, UK
| | - Emma O'Donoghue
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | | | | | - Majella Byrne
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Lucy Butler
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Daniela Leal
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Jessica McGovern
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Brigita Rasiukeviciute
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Faye Sim
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Eric Morris
- School of Psychology and Public Health, La Trobe University, Melbourne, Victoria, Australia
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Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest that the therapy is both acceptable and beneficial. The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. We interviewed nine trial participants using the Change Interview and a mixed methods approach. Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE.
Key learning aims
(1)
To explore participants’ experience of accessing GiVE as part of a trial.
(2)
To identify what (if any) changes participants noticed over the course of the GiVE trial.
(3)
To identify what participants attribute these changes to.
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14
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Pinto KC, Pinto S. Converging through difference: A case of empathic incongruence in treatment of an elderly woman with psychosis. J Aging Stud 2019; 51:100797. [PMID: 31761096 DOI: 10.1016/j.jaging.2019.100797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 07/01/2019] [Indexed: 11/26/2022]
Abstract
Contemporary person-centered psychotherapy often references empathy as a basic component of the therapeutic alliance and, thus, effective treatment, such that nascent clinicians study this basic skill early in training. However, the psychotherapy literature often presumes a collective agreement about how empathy manifests as a clinical tool, in the process institutionalizing the ideal of omnipresent alignment with a client, applied across populations of patients, regardless of their conditions, ages, and personal and cultural characteristics. Misalignments between clinicians and clients have the potential to bely broadly imagined ethics of empathy (and the notion of collective agreement about what it is) by demonstrating the ways tension, difference, and incongruence promote treatment. Through an autoethnography of a 12-month psychotherapy dyad with an elderly woman committed for treatment at a U.S. psychiatric hospital, we discuss how moments of incongruence between clinician and client expand conceptualizations of empathy in treatment of psychosis. Specifically, in this context, deployment of empathy-as-alignment becomes a fallacy of care, risking the effectiveness of treatment through impossible epistemological assumptions of and counterproductive joining with the client. As such, this transtheoretical discussion presents two types of incongruence in the dyad-developmental and subjective-as a backdrop for expressing empathy. This paper makes space for a theory of empathy as the practice of working in genuine and careful service of the client's psychology through acts of incongruence as much as alignment.
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Affiliation(s)
- Kristina C Pinto
- Department of Clinical Psychology, Suffolk University, Boston, MA, USA.
| | - Sarah Pinto
- Department of Anthropology, Tufts University, Medford, MA, USA
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15
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Ridenour JM, Hamm JA, Czaja M. A review of psychotherapeutic models and treatments for psychosis. PSYCHOSIS 2019. [DOI: 10.1080/17522439.2019.1615111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
| | - Jay A. Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN, USA
| | - Meg Czaja
- Center for Motivation and Change, New Marlborough, MA, USA
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16
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Bjornestad J, Lavik KO, Davidson L, Hjeltnes A, Moltu C, Veseth M. Antipsychotic treatment – a systematic literature review and meta-analysis of qualitative studies. J Ment Health 2019; 29:513-523. [DOI: 10.1080/09638237.2019.1581352] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Jone Bjornestad
- Department of Social Studies, Faculty of Social Sciences, University of Stavanger, Stavanger, Norway
| | - Kristina O. Lavik
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | | | - Aslak Hjeltnes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Christian Moltu
- Department of Psychiatry, District General Hospital of F⊘rde, F⊘rde, Norway
| | - Marius Veseth
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
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17
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Thomas N, Bless JJ, Alderson-Day B, Bell IH, Cella M, Craig T, Delespaul P, Hugdahl K, Laloyaux J, Larøi F, Lincoln TM, Schlier B, Urwyler P, van den Berg D, Jardri R. Potential Applications of Digital Technology in Assessment, Treatment, and Self-help for Hallucinations. Schizophr Bull 2019; 45:S32-S42. [PMID: 30715539 PMCID: PMC6357981 DOI: 10.1093/schbul/sby103] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The field of digital mental health is rapidly expanding with digital tools being used in assessment, intervention, and supporting self-help. The application of digital mental health to hallucinations is, however, at a very early stage. This report from a working group of the International Consortium on Hallucinations Research considers particular synergies between the phenomenon of hallucinations and digital tools that are being developed. Highlighted uses include monitoring and managing intermittently occurring hallucinations in daily life; therapeutic applications of audio and video media including virtual and augmented reality; targeting verbal aspects of hallucinations; and using avatars to represent hallucinatory voices. Although there is a well-established Internet-based peer support network, digital resources for hallucinations have yet to be implemented in routine practice. Implementation may benefit from identifying how to market resources to the broad range of populations who experience hallucinations and identifying sustainable funding models. It is envisaged that digital tools will contribute to improved self-management and service provision for people experiencing hallucinations.
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Affiliation(s)
- Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Josef J Bless
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
| | | | - Imogen H Bell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
- Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
- Psychosis Early Intervention, South London and Maudsley NHS Trust, London, UK
| | - Tom Craig
- Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neurosciences, University of Maastricht, Maastricht, The Netherlands
- Mondriaan Mental Health Trust, Heerlen, The Netherlands
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Julien Laloyaux
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- NORMENT—Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Björn Schlier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Universität Hamburg, Hamburg, Germany
| | - Prabitha Urwyler
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering, University of Bern, Bern, Switzerland
- Institute of Neuroscience, Newcastle University, Newcastle-Upon-Tyne, UK
| | - David van den Berg
- Research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Renaud Jardri
- PsyCHIC Team, SCALab CNRS UMR-9193, Lille University, Lille, France
- CURE Platform, CHU Lille, Fontan Hospital, Lille, France
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18
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Lincoln TM, Peters E. A systematic review and discussion of symptom specific cognitive behavioural approaches to delusions and hallucinations. Schizophr Res 2019; 203:66-79. [PMID: 29352708 DOI: 10.1016/j.schres.2017.12.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 12/29/2022]
Abstract
Studies on cognitive behavioural therapy for psychosis (CBTp) have developed from evaluating generic approaches to focusing on specific symptoms. The evidence for targeted studies on delusions and hallucinations was reviewed. We included randomized controlled trials (RCTs) examining the effect of individualized CBT-based interventions focusing either on delusions or on hallucinations. Twelve suitable RCTs were identified. Four RCTs focused on delusions, of which three took a focused approach targeting mechanisms assumed causal to persecutory delusions. Eight RCTs focused on hallucinations, a common component of these studies being a focus on the perceived power imbalance between the voice(s) and the voice-hearer, to reduce distress and dysfunction. Only three RCTS were powered adequately; the remainder were pilot trials. All trials reported effect sizes against treatment-as-usual above d=0.4 on at least one primary outcome at post-therapy, with several effects in the large range. Effects on the primary outcome were maintained for five of the seven studies that had significant outcomes and reported a follow-up comparison, but most of the follow-up periods were brief. Although targeted studies are still in their infancy, the results are promising with a tendency towards higher effects compared to the small-to-moderate range found for generic CBTp. In clinical practice, CBTp will need to continue including a range of approaches that can be adapted to patients in a flexible manner according to the primary goals and prevalent combination of symptoms. However, symptom-focused and causal-interventionist approaches are informative research strategies to evaluate the efficacy of separate components or mechanisms of generic CBTp.
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Affiliation(s)
- Tania M Lincoln
- Department of Clinical Psychology and Psychotherapy, University of Hamburg, Germany.
| | - Emmanuelle Peters
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, Psychological Interventions Clinic for outpatients with Psychosis (PICuP), London, UK
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19
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Gianfrancesco O, Bubb VJ, Quinn JP. Treating the "E" in "G × E": Trauma-Informed Approaches and Psychological Therapy Interventions in Psychosis. Front Psychiatry 2019; 10:9. [PMID: 30761022 PMCID: PMC6363686 DOI: 10.3389/fpsyt.2019.00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 01/08/2019] [Indexed: 12/31/2022] Open
Abstract
Despite advances in genetic research, causal variants affecting risk for schizophrenia remain poorly characterized, and the top 108 loci identified through genome-wide association studies (GWAS) explain only 3.4% of variance in risk profiles. Such work is defining the highly complex nature of this condition, with omnigenic models of schizophrenia suggesting that gene regulatory networks are sufficiently interconnected such that altered expression of any "peripheral" gene in a relevant cell type has the capacity to indirectly modulate the expression of "core" schizophrenia-associated genes. This wealth of associated genes with small effect sizes makes identifying new druggable targets difficult, and current pharmacological treatments for schizophrenia can involve serious side effects. However, the fact that the majority of schizophrenia genome-wide associated variants fall within non-coding DNA is suggestive of their potential to modulate gene regulation. This would be consistent with risks that can be mediated in a "gene × environment" (G × E) manner. Stress and trauma can alter the regulation of key brain-related pathways over the lifetime of an individual, including modulation of brain development, and neurochemistry in the adult. Recent studies demonstrate a significant overlap between psychotic symptoms and trauma, ranging from prior trauma contributing to psychosis, as well as trauma in response to the experience of psychosis itself or in response to treatment. Given the known effects of trauma on both CNS gene expression and severity of psychosis symptoms, it may be that pharmacological treatment alone risks leaving individuals with a highly stressful and unresolved environmental component that continues to act in a "G × E" manner, with the likelihood that this would negatively impact recovery and relapse risk. This review aims to cover the recent advances elucidating the complex genetic architecture of schizophrenia, as well as the long-term effects of early life trauma on brain function and future mental health risk. Further, the evidence demonstrating the role of ongoing responses to trauma or heightened stress sensitivity, and their impact on the course of illness and recovery, is presented. Finally, the need for trauma-informed approaches and psychological therapy-based interventions is discussed, and a brief overview of the evidence to determine their utility is presented.
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Affiliation(s)
- Olympia Gianfrancesco
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.,MRC Human Genetics Unit, Institute of Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Vivien J Bubb
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
| | - John P Quinn
- Department of Molecular and Clinical Pharmacology, Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom
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20
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Hardy A, Wojdecka A, West J, Matthews E, Golby C, Ward T, Lopez ND, Freeman D, Waller H, Kuipers E, Bebbington P, Fowler D, Emsley R, Dunn G, Garety P. How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo. JMIR Ment Health 2018; 5:e11222. [PMID: 30518514 PMCID: PMC6300708 DOI: 10.2196/11222] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. OBJECTIVE This study aimed to optimize the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface. METHODS We conducted inclusive, user-centered design research characterized by purposive sampling of extreme users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's double diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping, and a mood board; define, consisting of workshops to synthesize findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded. RESULTS Consistent with our previous work, the Thinking Well case series showed medium to large effects on paranoia and well-being and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia, and provide tailored interpersonal support from therapists and peers, although they reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalization and normalization, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with 2 key concepts of thoughts visualized as bubbles and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A Web app supports the delivery of 8 face-to-face sessions, which are synchronized to a native mobile app. CONCLUSIONS SlowMo makes use of personalization, ambient information, and visual metaphors to tailor the appeal, engagement, and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multicentered randomized controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface to optimize its impact in daily life.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Wojdecka
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Jonathan West
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Ed Matthews
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | | | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Natalie D Lopez
- Department of Psychology, Royal Holloway, Egham, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Helen Waller
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Graham Dunn
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
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21
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Schnackenberg J, Fleming M, Walker H, Martin CR. Experience Focussed Counselling with Voice Hearers: Towards a Trans-diagnostic Key to Understanding Past and Current Distress-A Thematic Enquiry. Community Ment Health J 2018; 54:1071-1081. [PMID: 29713850 DOI: 10.1007/s10597-018-0280-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 04/23/2018] [Indexed: 10/17/2022]
Abstract
As it is increasingly evident that distressing voices can be linked to traumatic events across diagnoses, there is a need for new transdiagnostic interventions for persons with voice hearing related distress. Twenty-five interviews with voice hearers and mental health professionals explored the trans-diagnostic suitability of Experience Focussed Counselling (EFC) compared to Treatment As Usual. An Applied Thematic Analysis was used. Themes identified were: intervention applicability; impact of regular treatment before study; impact of EFC process; process of working with voices; impact of regular treatment during study; views on treatment or approach. The EFC focus was considered helpful across diagnoses. The findings support EFC as a transdiagnostic intervention.
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Affiliation(s)
- Joachim Schnackenberg
- EFC Institute, Hohn, Germany. .,Stiftung Diakoniewerk Kropp & St Ansgar gGmbH, Kropp, Germany.
| | - Mick Fleming
- DHSC Education and Training Centre/Cabinet Office, Keyll Darree, Strang, Isle of Man
| | - Helen Walker
- University of the West of Scotland, Hamilton, South Lanarkshire, Scotland, UK
| | - Colin R Martin
- Faculty of Health Sciences, Institute for Clinical and Applied Health Research (ICAHR), University of Hull, Hull, UK
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22
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The Acceptability, Feasibility and Potential Outcomes of an Individual Mindfulness-Based Intervention for Hearing Voices. Behav Cogn Psychother 2018; 47:200-216. [PMID: 29983128 DOI: 10.1017/s1352465818000425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND A prominent area of advancement in the psychological treatment for people with persisting psychosis has been the application of mindfulness-based therapies. Recent literature has recommended the investigation of focused mindfulness interventions for voices (auditory hallucinations) as a specific experience. To date, only mindfulness programs in group format have been examined. AIMS This non-randomized pilot study aimed to assess the acceptability, feasibility and potential outcomes of an individual mindfulness program for persistent voices on the negative impact of voices on the subjective experience of mental health and wellbeing, depression and voice-related distress and disruption. Also, it aimed to identify potential psychological and neurocognitive mechanisms of change. METHOD A new 4-week individual Mindfulness Program for Voices (iMPV) was developed, and piloted with a group of 14 participants with a schizophrenia-spectrum disorder and persisting voices. Participants completed clinical and neurocognitive measures pre- and post-intervention and at 2-month follow-up. RESULTS Results revealed low attrition rates, high formal practice engagement levels and positive participant feedback. Pre-post outcomes suggested small to moderate effects for a reduction in the negative impact of voices on experience, depression and disruption. Large effects for changes in mindful responding and attentional switching were also identified. CONCLUSIONS Our findings suggest that this novel treatment protocol is appropriate, engaging and safe for persistent voice hearers. Findings for mindful responding and attentional switching suggest these to be potential mechanisms of change for further investigation. Further RCTs are warranted to ascertain the feasibility and efficacy for focused mindfulness interventions for voices of individual format.
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23
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Cognitive behavioural therapy for visual hallucinations: an investigation using a single-case experimental design. COGNITIVE BEHAVIOUR THERAPIST 2017. [DOI: 10.1017/s1754470x17000174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractThere has been limited application of cognitive behavioural therapy (CBT) to the treatment of distressing visual hallucinations (VH) in people with psychosis. Preliminary research applying interventions to a novel presenting issue are enhanced by utilizing designs that allow strong inferences to be made about the effect of the intervention. Hence, this study aimed to measure change in appraisal, affect, and behaviour as a consequence of CBT VH, to improve understanding of the process of change. A multiple-baseline experimental single-case design methodology was used with five participants who received a CBT VH treatment package. Participants used daily diary measures to record appraisals, affect, and behaviours related to the distressing VH. Standardized measures were completed at each phase change. Four individuals completed therapy. Formal visual analysis of the data supported by statistical analysis indicated significant changes for appraisal and affect, with replication across three participants. Changes in frequency of VH were reported in two cases. Change was not evident on the standardized measures. This study replicates and extends the findings in showing potential value of CBT VH. Further research should consider alternative methods of capturing behavioural change. Attempts should also be made to replicate across therapists and centres.
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Chan V. Schizophrenia and Psychosis: Diagnosis, Current Research Trends, and Model Treatment Approaches with Implications for Transitional Age Youth. Child Adolesc Psychiatr Clin N Am 2017; 26:341-366. [PMID: 28314460 DOI: 10.1016/j.chc.2016.12.014] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This article reviews the current state of diagnosis and treatment of schizophrenia, describing the recent proliferation of research in high-risk psychosis spectrum conditions, which are different from childhood-onset and early onset schizophrenia, and findings of psychotic-like experiences in the normal population. Taken from adult and childhood literature, clinical quandaries in accurate diagnosis, and treatment gaps in co-occurring, or sometimes confounding, conditions are discussed. Thoughts on the impact of schizophrenia on an emerging adulthood trajectory are offered. Recent best practices in the treatment of schizophrenia are consistent with a recovery-oriented model of mental health services for transitional age youth.
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Affiliation(s)
- Vivien Chan
- 501 Student Health, Student Health Center, University of California Irvine, Irvine, CA 92697-5200, USA; Behavioral Health Services, Children, Youth & Prevention Division, Center for Resiliency Wellness & Education (First Episode Psychosis), Orange County Health Care Agency, 729 W Town & Country Road, Building E, Orange, CA 92868, USA; Department of Psychiatry & Human Behavior, UCI Health, Orange, CA 92868, USA.
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25
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Morrison AP. A manualised treatment protocol to guide delivery of evidence-based cognitive therapy for people with distressing psychosis: learning from clinical trials. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2017. [DOI: 10.1080/17522439.2017.1295098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Anthony P. Morrison
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
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26
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Shawyer F, Farhall J, Thomas N, Hayes SC, Gallop R, Copolov D, Castle DJ. Acceptance and commitment therapy for psychosis: randomised controlled trial. Br J Psychiatry 2017; 210:140-148. [PMID: 27979820 DOI: 10.1192/bjp.bp.116.182865] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND The efficacy of acceptance and commitment therapy (ACT) in psychosis has been reported but not for medication-resistant psychosis. AIMS To test the efficacy of ACT in a sample of community-residing patients with persisting psychotic symptoms. (Australian New Zealand Clinical Trials Registry: ACTRN12608000210370.) METHOD: The primary outcome was overall mental state at post-therapy (Positive and Negative Syndrome Scale - total); secondary outcomes were psychotic symptom dimensions and functioning. In total, 96 patients were randomised to ACT (n = 49) or befriending (n = 47). Symptom, functioning and process measures were administered at baseline, post-therapy and 6 months later. RESULTS There was no group difference on overall mental state. In secondary analyses the ACT group showed greater improvement in positive symptoms and hallucination distress at follow-up: Cohen's d = 0.52 (95% CI 0.07-0.98) and 0.65 (95% CI 0.24-1.06), respectively. CONCLUSIONS Improvements reflected the treatment focus on positive symptoms; however, absence of process-measure changes suggests that the ACT intervention used did not manipulate targeted processes beyond befriending. Symptom-specific therapy refinements, improved investigation of process and attention to cognitive functioning and dose are warranted in future research.
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Affiliation(s)
- Frances Shawyer
- Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
| | - John Farhall
- Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
| | - Neil Thomas
- Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
| | - Steven C Hayes
- Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
| | - Robert Gallop
- Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
| | - David Copolov
- Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
| | - David J Castle
- Frances Shawyer, PhD, MAPS, MCCLP, School of Psychology and Public Health, La Trobe University, Victoria and Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia; John Farhall, PhD, FAPS, School of Psychology and Public Health, La Trobe University, Victoria and NorthWestern Mental Health, Royal Melbourne Hospital, Victoria, Australia; Neil Thomas, DClinPsy, School of Psychology and Public Health, La Trobe University, Victoria, School of Health Sciences, Swinburne University, Hawthorn, Victoria and Monash Alfred Psychiatry Research Centre, Melbourne, Victoria, Australia; Steven C. Hayes, PhD, Department of Psychology, University of Nevada, Reno, Nevada, USA; Robert Gallop, PhD, Department of Mathematics, Applied Statistics Program, West Chester University, West Chester, Pennsylvania, USA; David Copolov, PhD, MBBS, Office of the Vice-Chancellor and Discipline of Psychiatry, Monash University, Clayton, Victoria, Department of Psychiatry, University of Melbourne, Parkville, Victoria and Florey Institute of Neuroscience and Mental Health, Parkville, Victoria, Australia; David J. Castle, MD, FRCPsych, FRANZCP, Department of Psychiatry, University of Melbourne, Parkville, Victoria and St Vincent's Hospital Mental Health, Fitzroy, Victoria, Australia
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Brabban A, Byrne R, Longden E, Morrison AP. The importance of human relationships, ethics and recovery-orientated values in the delivery of CBT for people with psychosis. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2016. [DOI: 10.1080/17522439.2016.1259648] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Alison Brabban
- TEWV NHS Trust, EIP, Chester le Street HC, Chester le Street, UK
- Mental Health Research Centre, Durham University, Durham, UK
| | - Rory Byrne
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Eleanor Longden
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Anthony P. Morrison
- Psychosis Research Unit, Greater Manchester West NHS Trust, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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28
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Thomas N, Farhall J, Foley F, Rossell SL, Castle D, Ladd E, Meyer D, Mihalopoulos C, Leitan N, Nunan C, Frankish R, Smark T, Farnan S, McLeod B, Sterling L, Murray G, Fossey E, Brophy L, Kyrios M. Randomised controlled trial of a digitally assisted low intensity intervention to promote personal recovery in persisting psychosis: SMART-Therapy study protocol. BMC Psychiatry 2016; 16:312. [PMID: 27604363 PMCID: PMC5015321 DOI: 10.1186/s12888-016-1024-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Psychosocial interventions have an important role in promoting recovery in people with persisting psychotic disorders such as schizophrenia. Readily available, digital technology provides a means of developing therapeutic resources for use together by practitioners and mental health service users. As part of the Self-Management and Recovery Technology (SMART) research program, we have developed an online resource providing materials on illness self-management and personal recovery based on the Connectedness-Hope-Identity-Meaning-Empowerment (CHIME) framework. Content is communicated using videos featuring persons with lived experience of psychosis discussing how they have navigated issues in their own recovery. This was developed to be suitable for use on a tablet computer during sessions with a mental health worker to promote discussion about recovery. METHODS/DESIGN This is a rater-blinded randomised controlled trial comparing a low intensity recovery intervention of eight one-to-one face-to-face sessions with a mental health worker using the SMART website alongside routine care, versus an eight-session comparison condition, befriending. The recruitment target is 148 participants with a schizophrenia-related disorder or mood disorder with a history of psychosis, recruited from mental health services in Victoria, Australia. Following baseline assessment, participants are randomised to intervention, and complete follow up assessments at 3, 6 and 9 months post-baseline. The primary outcome is personal recovery measured using the Process of Recovery Questionnaire (QPR). Secondary outcomes include positive and negative symptoms assessed with the Positive and Negative Syndrome Scale, subjective experiences of psychosis, emotional symptoms, quality of life and resource use. Mechanisms of change via effects on self-stigma and self-efficacy will be examined. DISCUSSION This protocol describes a novel intervention which tests new therapeutic methods including in-session tablet computer use and video-based peer modelling. It also informs a possible low intensity intervention model potentially viable for delivery across the mental health workforce. TRIAL REGISTRATION NCT02474524 , 24 May 2015, retrospectively registered during the recruitment phase.
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Affiliation(s)
- Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC, 3122, Australia. .,Monash Alfred Psychiatry Research Centre, Monash University and The Alfred, Melbourne, VIC, 3004, Australia.
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC 3086 Australia ,NorthWestern Mental Health, Royal Melbourne Hospital, Melbourne, VIC 3050 Australia
| | - Fiona Foley
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia ,Monash Alfred Psychiatry Research Centre, Monash University and The Alfred, Melbourne, VIC 3004 Australia ,Department of Psychiatry, St Vincent’s Hospital, Fitzroy, VIC 3065 Australia
| | - David Castle
- Department of Psychiatry, St Vincent’s Hospital, Fitzroy, VIC 3065 Australia ,Department of Psychiatry, University of Melbourne, Parkville, VIC 3052 Australia
| | - Emma Ladd
- Wellways Australia, Fairfield, VIC 3068 Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Cathrine Mihalopoulos
- Centre for Population Health Research, Deakin University, Burwood, VIC 3125 Australia
| | - Nuwan Leitan
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Cassy Nunan
- Wellways Australia, Fairfield, VIC 3068 Australia
| | | | - Tara Smark
- Wellways Australia, Fairfield, VIC 3068 Australia
| | - Sue Farnan
- Wellways Australia, Fairfield, VIC 3068 Australia
| | - Bronte McLeod
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Leon Sterling
- Centre for Design Innovation, Swinburne University of Technology, Hawthorn, VIC 3122 Australia ,Department of Computing and Information Systems, University of Melbourne, Parkville, VIC 3052 Australia
| | - Greg Murray
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia
| | - Ellie Fossey
- Department of Occupational Therapy, Monash University - Peninsula Campus, Frankston, VIC 3199 Australia ,Living with Disability Research Centre, La Trobe University, Melbourne, VIC 3086 Australia
| | - Lisa Brophy
- Mind Australia, Heidelberg, VIC 3084 Australia ,Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC 3052 Australia
| | - Michael Kyrios
- Centre for Mental Health, Swinburne University of Technology, PO Box 218, Hawthorn, VIC 3122 Australia ,Australian National University, Canberra, ACT 2601 Australia
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29
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Farrelly S, Peters E, Azis M, David A, Hunter EC. A brief CBT intervention for depersonalisation/derealisation in psychosis: study protocol for a feasibility randomised controlled trial. Pilot Feasibility Stud 2016; 2:47. [PMID: 27965864 PMCID: PMC5154060 DOI: 10.1186/s40814-016-0086-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 07/26/2016] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Depersonalisation is the experience of being detached or disconnected from one's experience. Studies suggest that clinically significant levels of depersonalisation are common in individuals who have psychotic symptoms and are associated with increased impairment. However, to date, there have been no studies that have investigated an intervention designed to target clinically significant depersonalisation in such patient groups. This study aims to determine the feasibility and acceptability of a brief intervention targeting clinically significant depersonalisation in those who also have current psychotic symptoms. METHODS/DESIGN The feasibility of delivering six sessions of cognitive behavioural therapy for depersonalisation in psychosis patients will be evaluated using a single-blinded randomised controlled trial with a treatment as usual control condition. Participants will be assessed at baseline and then randomised to either the treatment or control arm. Participants randomised to the treatment arm will be offered six sessions of individual cognitive behavioural therapy delivered over a maximum of 10 weeks. Therapy will focus on an individualised shared formulation of depersonalisation experiences and behavioural, cognitive, emotional regulation and thinking process strategies to decrease distress associated with depersonalisation. Participants will be assessed again at a 10-week (post-randomisation) follow-up assessment. The primary outcomes of interest will be those assessing the feasibility and acceptability of the intervention including rates of referral, eligibility and acceptance to participate; attendance at therapy sessions and completion of homework tasks; satisfaction with the intervention; maintenance of blinding; and therapist competence. Secondary outcomes will be data on clinical outcome measures of depersonalisation and positive symptoms of psychosis, anxiety, depression and post-traumatic stress. DISCUSSION This study will determine the feasibility of delivering six sessions of cognitive behavioural therapy for individuals with current psychotic symptoms who also experience clinically significant levels of depersonalisation. The results will provide information to inform a larger randomised trial to assess intervention efficacy. TRIAL REGISTRATION ClinicalTrials.gov NCT02427542.
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Affiliation(s)
- Simone Farrelly
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Matilda Azis
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anthony David
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Elaine C Hunter
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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30
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Schnackenberg J, Fleming M, Martin CR. A randomised controlled pilot study of Experience Focused Counselling with voice hearers. PSYCHOSIS 2016. [DOI: 10.1080/17522439.2016.1185452] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Joachim Schnackenberg
- Community Support & Recovery Team (Psychosis Service Line), Barnet, Enfield, & Haringey Mental Health NHS Trust, London, UK
- EFC Institute (independent training and supervision provider in Experience Focussed Counselling), Hanover, Germany
- School of Health, Nursing and Midwifery, University of the West of Scotland, Ayr, Scotland
| | - Mick Fleming
- School of Health, Nursing and Midwifery, University of the West of Scotland, Ayr, Scotland
| | - Colin R. Martin
- Institute of Mental Health, Bucks New University, Uxbridge, UK
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31
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Moseley P, Alderson-Day B, Ellison A, Jardri R, Fernyhough C. Non-invasive Brain Stimulation and Auditory Verbal Hallucinations: New Techniques and Future Directions. Front Neurosci 2016; 9:515. [PMID: 26834541 PMCID: PMC4717303 DOI: 10.3389/fnins.2015.00515] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 12/22/2015] [Indexed: 12/11/2022] Open
Abstract
Auditory verbal hallucinations (AVHs) are the experience of hearing a voice in the absence of any speaker. Results from recent attempts to treat AVHs with neurostimulation (rTMS or tDCS) to the left temporoparietal junction have not been conclusive, but suggest that it may be a promising treatment option for some individuals. Some evidence suggests that the therapeutic effect of neurostimulation on AVHs may result from modulation of cortical areas involved in the ability to monitor the source of self-generated information. Here, we provide a brief overview of cognitive models and neurostimulation paradigms associated with treatment of AVHs, and discuss techniques that could be explored in the future to improve the efficacy of treatment, including alternating current and random noise stimulation. Technical issues surrounding the use of neurostimulation as a treatment option are discussed (including methods to localize the targeted cortical area, and the state-dependent effects of brain stimulation), as are issues surrounding the acceptability of neurostimulation for adolescent populations and individuals who experience qualitatively different types of AVH.
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Affiliation(s)
- Peter Moseley
- School of Psychology, University of Central Lancashire Preston, UK
| | - Ben Alderson-Day
- Science Laboratories, Department of Psychology, Durham University Durham, UK
| | - Amanda Ellison
- Science Laboratories, Department of Psychology, Durham University Durham, UK
| | - Renaud Jardri
- Centre National de la Recherche Scientifique UMR-9193, SCA-Lab & CHU Lille, Fontan Hospital, CURE Platform, Lille University Lille, France
| | - Charles Fernyhough
- Science Laboratories, Department of Psychology, Durham University Durham, UK
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32
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Smailes D, Alderson-Day B, Fernyhough C, McCarthy-Jones S, Dodgson G. Tailoring Cognitive Behavioral Therapy to Subtypes of Voice-Hearing. Front Psychol 2015; 6:1933. [PMID: 26733919 PMCID: PMC4685120 DOI: 10.3389/fpsyg.2015.01933] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 12/01/2015] [Indexed: 01/20/2023] Open
Abstract
Cognitive behavioral therapy (CBT) for voice-hearing (i.e., auditory verbal hallucinations; AVH) has, at best, small to moderate effects. One possible reason for this limited efficacy is that current CBT approaches tend to conceptualize voice-hearing as a homogenous experience in terms of the cognitive processes involved in AVH. However, the highly heterogeneous nature of voice-hearing suggests that many different cognitive processes may be involved in the etiology of AVH. These heterogeneous voice-hearing experiences do, however, appear to cluster into a set of subtypes, opening up the possibility of tailoring treatment to the subtype of AVH that a voice-hearer reports. In this paper, we (a) outline our rationale for tailoring CBT to subtypes of voice-hearing, (b) describe CBT for three putative subtypes of AVH (inner speech-based AVH, memory-based AVH, and hypervigilance AVH), and (c) discuss potential limitations and problems with such an approach. We conclude by arguing that tailoring CBT to subtypes of voice-hearing could prove to be a valuable therapeutic development, which may be especially effective when used in early intervention in psychosis services.
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Affiliation(s)
- David Smailes
- Department of Psychology, Durham UniversityDurham, UK; Department of Psychology, Leeds Trinity UniversityLeeds, UK
| | | | | | - Simon McCarthy-Jones
- Department of Psychology, Durham UniversityDurham, UK; Department of Psychiatry, Trinity College DublinDublin, Ireland
| | - Guy Dodgson
- Early Intervention in Psychosis, Northumberland, Tyne and Wear NHS Foundation Trust Ashington, UK
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