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MacDougall AG, Wiener JC, Puka K, Price E, Oyewole-Eletu O, Gardizi E, Anderson KK, Norman RMG. Effectiveness of a mindfulness-based intervention for persons with early psychosis: A multi-site randomized controlled trial. Schizophr Res 2024; 264:502-510. [PMID: 38290375 DOI: 10.1016/j.schres.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/17/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND The Mindfulness Ambassador Program (MAP) is a group-based, facilitated mindfulness-based intervention (MBI). We sought to determine the effectiveness of MAP on reducing negative psychotic symptoms and enhancing mindfulness skills among persons experiencing early psychosis. METHODS We conducted a pragmatic randomized controlled trial (RCT) at three early psychosis intervention (EPI) programs in Ontario, Canada. Participants (N = 59) were randomly assigned to receive MAP (n = 29) for 1-hour weekly sessions over 3 months, or to treatment as usual (TAU, n = 30). Assessments were conducted at baseline, 3 months, and 6 months using the Self-Evaluation of Negative Symptoms (SNS) and Kentucky Inventory of Mindfulness Skills (KIMS). Linear mixed methods were used to assess the joint effects of group and time. RESULTS At 3 months, participants who received MAP (n = 17) demonstrated greater reductions on the SNS relative to TAU (n = 15), which were clinically and statistically significant (-4.1; 95%CI -7.5, -0.7; p = 0.019). At 6 months, the difference between MAP (n = 10) and TAU (n = 13) was no longer statistically significant (-1.2; 95%CI -5.2,2.7; p = 0.54). On the KIMS, no significant effects were found at 3 months (+0.3; 95%CI -2.0,2.5; p = 0.82) or 6 months (+0.4; 95%CI -2.2,2.9; p = 0.79). CONCLUSIONS We conducted one of the first multi-site RCTs of a MBI for early psychosis. Our findings indicated that MAP was more effective in reducing negative symptoms compared to TAU in the short term. Earlier reductions in negative psychotic symptoms may help facilitate recovery in the long term.
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Affiliation(s)
- Arlene G MacDougall
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada.
| | - Joshua C Wiener
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Klajdi Puka
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | | | | | - Elmar Gardizi
- Department of Psychiatry and Behavioural Neurosciences, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Kelly K Anderson
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Ross M G Norman
- Department of Psychiatry, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
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Aliche CJ, Ifeagwazi CM, Nwamarah JU, Okechukwu FO, Ngwu EC. Mediating roles of positive reappraisal and stigma resistance in the relationship between mindfulness and quality of life among stable schizophrenia patients. CURRENT PSYCHOLOGY 2023. [DOI: 10.1007/s12144-023-04563-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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Silver JH, Lewton M, Lewis HW. Mediators of negative content and voice-related distress in a diverse sample of clinical and non-clinical voice-hearers. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:96-111. [PMID: 36205115 PMCID: PMC10092889 DOI: 10.1111/bjc.12396] [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: 11/09/2021] [Revised: 07/29/2022] [Accepted: 09/08/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Negative content in hearing voices (i.e., auditory verbal hallucinations) has been associated with adverse clinical outcomes including voice-related distress. Voice appraisals and responding mindfully to voices are theorized to reduce voice-related distress. This study aimed in examine mediators of the negative content voice-related distress relationship in clinical (those who recently received input from mental health services) and non-clinical voice-hearers. METHODS One hundred and twenty-one adults (71.9% female; 35.5% mixed or non-white ethnic background) who hear voices were recruited online and completed self-report measures of negative content of voices, voice-related distress, mindfulness of voices, interpretation of loss of control, thought suppression and intrusion. RESULTS Clinical voice-hearers had significantly higher levels of negative content, voice-related distress and interpretation of loss of control than non-clinical voice-hearers. A mindful approach to voices and interpretation of loss of control mediated the relationship between negative content and voice-related distress across the whole sample. Thought suppression and intrusion did not mediate the relationship. CONCLUSIONS The results support the use of mindfulness-based psychological intervention to reduce voice-related distress. Further development of valid and reliable measures specifically relating to constructs of voice content, voice-related distress and voice suppression will support further research in this area.
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Affiliation(s)
- Jessica Helen Silver
- Older Persons Mental Health Psychology Service, Cwm Taf Morgannwg University Health Board, Pontypridd, UK
| | - Marcus Lewton
- Child and Adolescent Mental Health Service, Cwm Taf Morgannwg University Health Board, Pontypridd, UK
| | - Heledd Wyn Lewis
- South Wales Doctoral Programme in Clinical Psychology, Cardiff University, Cardiff, UK
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4
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Török E, Kéri S. The Relationship Among Mentalization, Mindfulness, Working Memory, and Schizotypal Personality Traits in the General Population. Front Psychol 2022; 13:682889. [PMID: 35586232 PMCID: PMC9108540 DOI: 10.3389/fpsyg.2022.682889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/12/2022] [Indexed: 11/24/2022] Open
Abstract
Individuals with high schizotypal traits are less able to observe, describe, and monitor inner feelings, thoughts, and experiences, commonly referred to as mindfulness and mentalization. High schizotypy is also associated with impaired working memory (WM). However, the relationship among mindfulness, mentalization, WM, and schizotypal traits is unknown. Three hundred individuals from the community (mean age: 38.0 years, SD = 10.5; 49.3% women) completed questionnaires examining schizotypal traits, mindfulness, and mentalization and performed working memory tasks. Results revealed that mentalization was a general predictor of schizotypal traits, including unusual experiences, cognitive disorganization, introverted anhedonia, and impulsive nonconformity, when the effect of mindfulness and working memory was controlled. We also found a positive correlation between mindfulness and mentalization. Low mindfulness and mentalization performances were associated with high schizotypy. However, poor working memory was only weakly linked to cognitive disorganization and introverted anhedonia. These findings suggest that weak mentalization is a core feature of schizotypy independent of mindfulness and working memory.
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Affiliation(s)
- Edina Török
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
| | - Szabolcs Kéri
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
- Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary
- Department of Physiology, University of Szeged, Szeged, Hungary
- *Correspondence: Szabolcs Kéri, ;
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5
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von Hardenberg L, Leopold K, Stenzel N, Kallenbach M, Aliakbari N, Bechdolf A, Mehl S. Feasibility and efficacy of an acceptance and mindfulness-based group intervention for young people with early psychosis (Feel-Good group). Front Psychiatry 2022; 13:943488. [PMID: 36186856 PMCID: PMC9522968 DOI: 10.3389/fpsyt.2022.943488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/22/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over the last decade, researchers have sought for alternative interventions that have better treatment effects than Cognitive Behavioral Therapy (CBT) when treating psychotic symptoms. Mindfulness-based interventions have been a proposed alternative to CBT, yet research regarding its feasibility, acceptance and effectiveness is lacking when treating individuals with early psychosis in inpatient settings. OBJECTIVE Before conducting a large-scale randomized-controlled trial (RCT), this pilot study evaluated the feasibility and the potential efficacy of a mindfulness-based inpatient group intervention that targets emotion regulation in patients with early psychosis, and thus indirectly improving psychotic symptoms. METHODS A pre-post study was performed. Thirty-six patients with early psychosis treated at the specialized inpatient treatment "Frühinterventions- und Therapiezentrum; FRITZ" (early intervention and therapy center) received eight group therapy sessions. Assessments were performed at baseline, after 8 weeks post treatment and at follow-up after 16 weeks. RESULTS Rates of patients who participated in the study suggests that a mindfulness-based group therapy is highly accepted and feasible for patients with early psychosis being treated in an inpatient ward. Friedman analyses revealed significant changes in the primary outcomes of emotional goal attainment (Goal 1: W = 0.79; Goal 2: W = 0.71) and psychotic symptoms (PANSS-T: W = 0.74). Significant, albeit small, effect sizes were found in patients' self-perception of emotion regulation skills (ERSQ: W = 0.23). DISCUSSION We found favorable findings regarding the feasibility and acceptance of the Feel-Good mindfulness-based intervention. Results of the study provide a basis for an estimation of an adequate sample size for a fully powered RCT that needs to be conducted to test whether Feel-Good is effective in the inpatient treatment of psychotic symptoms for individuals with early psychosis. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/ct2/show/NCT04592042], identifier [NCT04592042].
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Affiliation(s)
- Laura von Hardenberg
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Karolina Leopold
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Carl Gustav Carus University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Nikola Stenzel
- Department of Psychology, Psychologische Hochschule Berlin (PHB), Berlin, Germany
| | - Michèle Kallenbach
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Navid Aliakbari
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Bechdolf
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine Incorporating Frühinterventions- und Therapiezentrum (FRITZ) and Soulspace, Vivantes Hospital am Urban and Vivantes Hospital im Friedrichshain, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Orygen, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Stephanie Mehl
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Center for Mind, Brain and Behavior, Philipps-University Marburg, Marburg, Germany.,Department of Health and Social Work, Frankfurt University of Applied Sciences, Frankfurt, Germany
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Schlechta Portella CF, Espósito Sorpreso IC, da Silva Menezes de Assis A, de Abreu LC, Soares JM, Baracat EC, de Araujo Moraes SDT, D’Andretta Tanaka AC. Meditation as an approach to lessen menopausal symptoms and insomnia in working women undergoing the menopausal transition period: A randomized controlled trial. ADVANCES IN INTEGRATIVE MEDICINE 2021. [DOI: 10.1016/j.aimed.2020.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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7
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Tao TJ, Hui CLM, Lam BST, Ho ECN, Hui PWM, Suen YN, Lin JJ, Tong ACY, Lee EHM, Chan SKW, Chang WC, Chen EYH. Mindfulness meditation for Chinese patients with psychosis: A systematic review and meta-analysis. Schizophr Res 2021; 237:103-114. [PMID: 34509897 DOI: 10.1016/j.schres.2021.08.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/29/2022]
Abstract
Mindfulness meditation (MM) and its alignment with the mind-body perspective of health in Chinese cultures indicate its potential to benefit Chinese patients with psychosis. This is the first systematic review and meta-analysis to address the following questions: (1) Does MM improve clinical, well-being, and third-wave outcomes (i.e., mindfulness, acceptance, and compassion levels) among Chinese patients with psychosis? (2) What are the patient- and/or intervention-specific factors that moderate the efficacy of MM? (3) Are improvements on third-wave outcomes associated with improvements on clinical and well-being outcomes? (4) What are the mechanisms underlying the effects of MM? Evidence synthesized from 23 relevant articles (20 studies) involving 1749 patients showed that (1) MM improved a wide range of patients' outcomes, most consistently and sustainably for insight, rehospitalization duration, recovery rate, and social functioning; (2) age and duration of illness, but not the cumulated intervention hours, moderated the overall efficacy of MM; (3) post-MM improvements on mindfulness and on clinical and well-being outcomes were related, and (4) the effects of MM on patients' outcomes may be driven by its ability to promote positive changes in personal growth and enhance one's coping with the illness and its symptoms. Our data showed preliminary support for the benefits of MM in Chinese patients with psychosis. However, results should be considered in light of the varying quality of included studies and their heterogeneity in multiple aspects. Further research is needed to deduce the sustainability of MM's effects, its active ingredients, underlying mechanisms, and additional moderators of its efficacy.
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Affiliation(s)
| | | | | | | | | | - Yi Nam Suen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Jessie Jingxia Lin
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Alan Chun Yat Tong
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, China
| | - Edwin Ho Ming Lee
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China
| | - Sherry Kit Wa Chan
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Wing Chung Chang
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
| | - Eric Yu Hai Chen
- Department of Psychiatry, The University of Hong Kong, Hong Kong, China; State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong, China
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8
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El Ashry AMN, Abd El Dayem SM, Ramadan FH. EFFECT OF APPLYING "ACCEPTANCE AND COMMITMENT THERAPY" ON AUDITORY HALLUCINATIONS AMONG PATIENTS WITH SCHIZOPHRENIA. Arch Psychiatr Nurs 2021; 35:141-152. [PMID: 33781392 DOI: 10.1016/j.apnu.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/02/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
UNLABELLED Experiencing persistent auditory hallucinations may contribute to unproductive struggle and interference with valued living among patients with schizophrenia. Acceptance and commitment therapy (ACT) represents a new generation of behavior therapies that proposes active acceptance and achievement of worthwhile goals despite experiencing auditory hallucinations. Utilization of acceptance commitment therapy may assist in reducing auditory hallucinations and may increase patient's feeling of control. AIM Determine the effect of applying acceptance and commitment therapy on auditory hallucinations among patients with schizophrenia. SETTING The study was conducted at El-Maamoura Hospital for Psychiatric Medicine in Alexandria, Egypt. SUBJECTS A random sample of 70 male inpatients with schizophrenia was selected and divided equally into a study and a control groups (35 patients in each group). Both groups were matched as much as possible in relation to socio- demographic and clinical data. Tools: Psychotic Symptom Rating Scales (PSYRATS-AHs) and Voices Acceptance and Action Scale (VAAS). A quasi-experimental research design was utilized in this study. RESULTS Significant differences were found between the study and control groups immediately post and after 3 months of ACT on baseline PSYRATS& VAAS scores. CONCLUSION ACT offers a promising new treatment for auditory hallucination among patients with schizophrenia. A significant improvement in auditory hallucination was found in the study group immediately after implementing ACT and after 3 months. As well as a decrement in re hospitalization rate and improvement in drug compliance for the study group compares to control one. RECOMMENDATIONS ACT should be integrated in psychiatric treatment and nursing interventions of inpatients with schizophrenia who experiencing auditory hallucination.
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Affiliation(s)
| | | | - Fatma Hussien Ramadan
- Psychiatric Nursing and Mental Health Department, Faculty of Nursing, Alexandria University, Egypt.
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9
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Li Y, Coster S, Norman I, Chien WT, Qin J, Ling Tse M, Bressington D. Feasibility, acceptability, and preliminary effectiveness of mindfulness-based interventions for people with recent-onset psychosis: A systematic review. Early Interv Psychiatry 2021; 15:3-15. [PMID: 32037721 DOI: 10.1111/eip.12929] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/16/2019] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Early intervention for psychosis is recommended because the first 5 years beyond the first episode is considered the critical period within which individuals have the most potential to maximize their response to treatment and recovery. Mindfulness-based interventions (MBIs) have been studied extensively in diverse disease groups, but research in people with recent-onset psychosis is still immature. AIM This review aims to explore the feasibility, acceptability and summarize any effectiveness data on of the MBIs for people with recent-onset psychosis reported by the study authors. METHODS A systematic search of original intervention research studies relevant to the topic published between January 2000 and August 2019 was conducted with 10 databases. Articles published in English with accessible full text were included. RESULTS A total of eight studies were included, which reported recruitment rates of between 62.5% and 100%, withdrawal rates between 0% and 37.5% and attendance rates of between 56% and 100%. Participants' qualitative feedback indicated high levels of satisfaction with the MBIs. The intervention approaches adopted in the reviewed studies include mindfulness-based interventions, acceptance and commitment therapy and compassion-based interventions. MBIs have produced promising positive effects on participants' psychiatric and psychosocial outcomes. CONCLUSION This review confirms that MBIs are generally feasible and acceptable for people with recent-onset psychosis. The preliminary results suggested the potential effects of MBIs in this area. Fully powered randomized controlled trials are suggested to confirm the effectiveness and exploratory studies to gain greater insight into the active components and mechanism of actions of MBIs for recent-onset psychosis.
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Affiliation(s)
- Yan Li
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, King's College London, London, UK.,The Hong Kong Polytechnic University, School of Nursing, Hung Hom, Hong Kong
| | - Samantha Coster
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, King's College London, London, UK
| | - Ian Norman
- Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, King's College London, London, UK
| | - Wai Tong Chien
- The Chinese University of Hong Kong, The Nethersole School of Nursing, Ma Liu Shui, Hong Kong
| | - Jing Qin
- The Hong Kong Polytechnic University, School of Nursing, Hung Hom, Hong Kong
| | - Mei Ling Tse
- The Hong Kong Polytechnic University, School of Nursing, Hung Hom, Hong Kong
| | - Dan Bressington
- The Hong Kong Polytechnic University, School of Nursing, Hung Hom, Hong Kong
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10
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Schlier B, Sitara X, Strauss C, Rammou A, Lincoln TM, Hayward M. Can Gender Differences in Distress Due to Difficult Voices Be Explained by Differences in Relating? COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10190-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Abstract
Background
Research on gender differences has found that women relate to negative voice hearing experiences with more negative emotions and report more distress due to voices, which may be rooted in differences in relating to voices. This study used a robust methodology and a large sample to explore gender differences in relating to voices and voice distress.
Methods
Matched samples of male (n = 124) and female (n = 124) voice hearers were drawn from a survey for secondary analysis. Voice severity (e.g., frequency or loudness), voice distress, and different types of dysfunctional (i.e., passive or aggressive) and functional (assertive) relating were measured. Group comparisons, mediation models, and network analyses were calculated.
Results
Female voice hearers reported more severe voices, more voice distress, more passive, and less assertive relating. Mediation and network analyses yielded evidence for pathways from gender to voice distress via relating and via differences in voice severity.
Conclusion
Gender differences in the emotional impact of voices can be partially explained by relating behavior. Psychological interventions for voice hearing could be optimized by exploring the influence of gender in the emergence of distressing voices. Nevertheless, gender differences need to be treated as one of several different possible mechanisms when working with individual patients.
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11
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Liu YC, Li IL, Hsiao FH. Effectiveness of mindfulness-based intervention on psychotic symptoms for patients with schizophrenia: A meta-analysis of randomized controlled trials. J Adv Nurs 2021; 77:2565-2580. [PMID: 33450107 DOI: 10.1111/jan.14750] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/16/2020] [Accepted: 12/10/2020] [Indexed: 12/23/2022]
Abstract
AIMS To evaluate the effects of mindfulness-based intervention on psychotic symptoms, positive symptoms, negative symptoms, depressive symptoms, anxiety, and rehospitalization. DESIGN A meta-analysis of randomized controlled trials. DATA SOURCES Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, CINAHL, National Digital Library of Theses and Dissertations in Taiwan, and Airiti Library were searched from their earliest available date up to April 2019. REVIEW METHODS The guidelines of the Cochrane Collaboration were followed to report this systematic review. Two authors conducted this meta-analysis independently. RESULTS Nine randomized controlled trials were included. Meta-analysis showed that mindfulness-based intervention significantly decreased psychotic symptoms, positive symptoms, negative symptoms, depressive symptoms, and duration of rehospitalization among patients with schizophrenia, and that the reduction in negative symptoms lasted through short-term follow-up. The moderation analysis showed that significantly decreased positive symptoms occurred in the nurse-led intervention group, while no significant impact was found in the psychologist-led intervention group. CONCLUSION The psychotic symptoms of the patients with schizophrenia are improved after mindfulness-based intervention and the effects on the negative symptoms can be maintained for at least 3 to 6 months. Mindfulness-based intervention provided by nurses produces more improvements in positive symptoms than intervention provided by psychologists. IMPACT A growing number of mindfulness-based interventions have been implemented for patients with schizophrenia, although the effectiveness had not previously been established by meta-analysis. Mindfulness-based interventions appear to reduce the symptom severity of schizophrenia patients. Further suggestions for healthcare providers and researchers are provided and discussed.
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Affiliation(s)
- Yu-Chen Liu
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-Ling Li
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fei-Hsiu Hsiao
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,National Taiwan University Hospital, Taipei, Taiwan
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12
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Ting KT, Tam W, Jacobsen P. Mindfulness for psychosis groups; description and preliminary evaluation of a novel routine care pathway in Hong Kong. Int J Ment Health Syst 2020; 14:81. [PMID: 33292380 PMCID: PMC7653858 DOI: 10.1186/s13033-020-00415-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/29/2020] [Indexed: 11/18/2022] Open
Abstract
Background There is no current guidance on where Mindfulness for Psychosis groups should best be situated within care pathways. The objectives of this paper are to (1) describe a novel care pathway tested out in a psychiatric outpatient service in Hong Kong, and (2) to present feasibility outcomes on attendance and drop-out, and routine clinical outcomes. Methods A new mindfulness pathway was set up, for service users with psychosis who had first completed a course of Cognitive Behavioural Therapy for psychosis (CBTp). After attending an orientation ‘taster’ session, service users could then attended a 4-session weekly Mindfulness for Psychosis group, followed by optional monthly follow-up sessions. Results A high proportion of service users referred into the pathway (19/22; 86%) went on to attend a Mindfulness for Psychosis group after attending an orientation ‘taster’ session. Attendance at group sessions was high, with all participants attending at least 2/4 group sessions, and no drop-outs. Attendance at monthly follow-up groups was also high, with 84% (16/19) attending at least one monthly follow-up. Routine clinical outcome data showed a reduction in negative symptoms of psychosis, and an increase in mindfulness and mindful responding in daily life, from pre- to post group. Conclusions Offering service users with psychosis the opportunity to attend a mindfulness for psychosis group after completing a course of CBTp was highly acceptable, as evidenced by high attendance, and low drop-out. Possible benefits in terms of improving negative symptoms may be particularly important in promoting recovery through improved everyday functioning.
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Affiliation(s)
- K T Ting
- Department of Clinical Psychology, Kowloon Hospital, Kowloon, Hong Kong
| | - Wendy Tam
- Department of Clinical Psychology, Kowloon Hospital, Kowloon, Hong Kong
| | - Pamela Jacobsen
- Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
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13
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Evidence map on the contributions of traditional, complementary and integrative medicines for health care in times of COVID-19. Integr Med Res 2020; 9:100473. [PMID: 32766112 PMCID: PMC7362868 DOI: 10.1016/j.imr.2020.100473] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/20/2022] Open
Abstract
Background Due to the pandemic, there is a significant interest in the therapeutic resources linked to TCIM to support potentially therapeutic research and intervention in the management of Coronavirus - 19 (COVID-19). At the date of this evidence map´s publication, there is no evidence of specific treatments for COVID-19. This map organizes information about symptoms management (especially on dimensions related to mental health and mild viral respiratory infections, as well as immune system strengthening and antiviral activity). Method This evidence map applies methodology developed by Latin American and Caribbean Center on Health Sciences Information based on the 3iE evidence gap map. A search was performed in the Traditional, Complementary and Integrative Medicine Virtual Health Library and PubMed, using the MeSH and DeCS terms for respiratory viral diseases associated with epidemics, COVID-19 symptoms, relevant mental health topics, pharmacological and non-pharmacological interventions related to TCIM. Results For the map, 126 systematic reviews and controlled clinical studies were characterized, distributed in a matrix with 62 interventions (18 phytotherapy, 9 mind-body therapies, 11 traditional Chinese medicine, 7 homeopathic and anthroposophic dynamized medicines and 17 supplements), and 67 outcomes (14 immunological response, 23 mental health, 25 complementary clinical management of the infection and 5 other). Conclusion The map presents an overview of possible TCIM contributions to various dimensions of the COVID-19 pandemic, especially in the field of mental health, and it is directed to researchers and health professionals specialized in TCIM. Most of the antiviral activity outcomes described in this map refers to respiratory viruses in general, and not specifically to SARS-CoV-2 (Severe Acute Respiratory Syndrome CoronaVirus 2). This information may be useful to guide new research, but not necessarily to support a therapeutic recommendation. Finally, any suspicion of COVID-19 infection should follow the protocols recommended by the health authorities of each country/region.
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14
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Lawlor C, Hepworth C, Smallwood J, Carter B, Jolley S. Self-reported emotion regulation difficulties in people with psychosis compared with non-clinical controls: A systematic literature review. Clin Psychol Psychother 2020; 27:107-135. [PMID: 31661593 DOI: 10.1002/cpp.2408] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 01/10/2023]
Abstract
Emotions play a key role in the development and experience of psychosis, yet there are important gaps in our understanding of how individuals with psychosis understand and respond to their emotions. This systematic review investigated self-reported emotion regulation difficulties in individuals with psychosis compared with non-clinical controls. An electronic database search was conducted in Medline, PsychINFO, and Embase and supplemented by searches of reference lists and citations. Seventeen studies were included. A narrative synthesis was conducted because contextual diversity was present across the studies and outcomes. Individuals with psychosis reported greater difficulties in (i) emotional clarity (specifically with identifying, describing, and understanding their emotions), (ii) emotional acceptance, (iii) engaging in goal-directed behaviours when experiencing negative emotions, and (iv) willingness to experience emotional distress in the pursuit of meaningful activities in life. Evidence pertaining to other self-reported emotion regulation difficulties was less clear. Effect sizes were generally large in magnitude but there were few studies on some self-reported emotion regulation difficulties, and all studies were at moderate to high risk of bias. Further research is needed to clarify the nature of emotion regulation difficulties in individuals with psychosis to inform the provision of targeted clinical interventions.
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Affiliation(s)
- Caroline Lawlor
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Claire Hepworth
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jane Smallwood
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Carter
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Suzanne Jolley
- North Lambeth Focused Support Team, South London and Maudsley NHS Foundation Trust, London, UK.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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15
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Lüdtke T, Platow-Kohlschein H, Rüegg N, Berger T, Moritz S, Westermann S. Mindfulness Mediates the Effect of a Psychological Online Intervention for Psychosis on Self-Reported Hallucinations: A Secondary Analysis of Voice Hearers From the EviBaS Trial. Front Psychiatry 2020; 11:228. [PMID: 32308631 PMCID: PMC7145894 DOI: 10.3389/fpsyt.2020.00228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 03/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Psychological online interventions (POIs) could represent a promising approach to narrow the treatment gap in psychosis but it remains unclear whether improving mindfulness functions as a mechanism of change in POIs. For the present study, we examined if mindfulness mediates the effect of a comprehensive POI on distressing (auditory) hallucinations. METHODS We conducted a secondary analysis on voice hearers (n = 55) from a randomized controlled trial evaluating a POI for psychosis (EviBaS; trial registration NCT02974400, clinicaltrials.gov). The POI includes a module on mindfulness and we only considered POI participants in our analyses who completed the mindfulness module (n = 16). RESULTS Participants who completed the mindfulness module reported higher mindfulness (p = 0.015) and lower hallucinations (p = 0.001) at post assessment, compared to controls, but there was no effect on distress by voices (p = 0.598). Mindfulness mediated the POI's effect on hallucinations (b = -1.618, LLCI = -3.747, ULCI = -0.054) but not on distress by voices (b = -0.057, LLCI = -0.640, ULCI = 0.915). LIMITATIONS AND DISCUSSION Completion of the mindfulness module was not randomized. Hence, we cannot draw causal inferences. Even if we assumed causality, it remains unclear which contents of the POI could have resulted in increased mindfulness and reduced hallucinations, as participants completed other modules as well. In addition, confounding variables could explain the mediation and the sample size was small. Nonetheless, the overall pattern of results indicates that the POI is likely to improve mindfulness, and that increased mindfulness could partially explain the POI's efficacy.
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Affiliation(s)
- Thies Lüdtke
- Department of Psychology, UiT - The Arctic University of Norway, Tromsø, Norway.,Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Heike Platow-Kohlschein
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nina Rüegg
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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16
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Chien WT, Cheng HY, McMaster TW, Yip ALK, Wong JCL. Effectiveness of a mindfulness-based psychoeducation group programme for early-stage schizophrenia: An 18-month randomised controlled trial. Schizophr Res 2019; 212:140-149. [PMID: 31416744 DOI: 10.1016/j.schres.2019.07.053] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 04/17/2019] [Accepted: 07/28/2019] [Indexed: 10/26/2022]
Abstract
Current psychosocial interventions in schizophrenia are evidenced to improve patients' illness-related knowledge, mental status and relapse rate, but substantive benefits to patients, such as their functioning and insight into the illness, remain uncertain. This multi-centre randomised clinical trial aimed to examine the effects of mindfulness-based psycho-education group intervention for adult patients with early-stage schizophrenia over an 18-month follow-up. The controlled trial was conducted with a repeated-measure, three-arm design at two psychiatric outpatient clinics in Jilin (China) and Hong Kong. A stratified random sample of 180 outpatients with schizophrenia spectrum disorders (60/group) was randomly assigned to a mindfulness-based psycho-education group programme, psycho-education group and treatment-as-usual group. The primary outcomes on patients' psychosocial functioning and other patient outcomes, such as psychotic symptoms, in the three groups were compared over the 18-month follow-up (baseline and 1-week, 9-month and 18-month post-intervention). One hundred and sixty (89%) patients completed at least two post-tests. Their mean age and duration of illness were 25-28 years (SD = 6.1-7.8) and 2.1-2.5 years (SD = 1.3-2.0; range 4-54 months), respectively. Compared with the two other groups, the mindfulness-based group exhibited a significantly greater improvement with moderate to large effect sizes (Cohen's d = 0.49-0.98) in functioning (p = 0.005), duration of psychiatric re-hospitalisations (p = 0.007), psychotic symptoms (p = 0.008) and illness insight (p = 0.001) over the 18-month follow-up. Supplementary MRI findings indicated that the mindfulness-based intervention resulted in significant changes in gray matter volume and density in brain regions concerning attention and emotional regulation. Mindfulness-oriented psycho-education group intervention can be an effective intervention for adults with early-stage schizophrenia and exert long-term effects on patients' functioning and mental conditions.
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Affiliation(s)
- Wai Tong Chien
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China.
| | - Ho Yu Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Terry W McMaster
- Department of Psychology, Concordia University, Montreal H4B 1R6, Quebec, Canada
| | - Annie L K Yip
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong, China
| | - JoJo C L Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
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17
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Rosen C, Chase KA, Perona-Garcelán S, Marvin RW, Sharma RP. The psychometric properties of the DAIMON Scale, a translation from Spanish to English: An instrument to measure the relationship with and between voices. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2019; 12:45-56. [PMID: 32983256 DOI: 10.1080/17522439.2019.1652843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Cherise Rosen
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Kayla A Chase
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Salvador Perona-Garcelán
- University Hospital Virgen del Rocío, and University of Seville Personality, Evaluation and Psychological Treatment Department, Spain
| | - Robert W Marvin
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Rajiv P Sharma
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
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18
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MacDougall AG, Price E, Vandermeer MRJ, Lloyd C, Bird R, Sethi R, Shanmugalingam A, Carr J, Anderson KK, Norman RMG. Youth-focused group mindfulness-based intervention in individuals with early psychosis: A randomized pilot feasibility study. Early Interv Psychiatry 2019; 13:993-998. [PMID: 30318868 DOI: 10.1111/eip.12753] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 09/12/2018] [Accepted: 09/22/2018] [Indexed: 01/18/2023]
Abstract
AIM To assess the feasibility of a randomized pilot trial that evaluated the acceptability and potential clinical utility of the Mindfulness Ambassador Program (MAP), a unique, standardized 12-session facilitated group mindfulness-based intervention (MBI) for youth experiencing early psychosis. METHODS Twenty-one patients of an early psychosis intervention program were randomized to receive MAP (n = 11) or treatment as usual (n = 10). Acceptability was measured by group attendance rate and client satisfaction; feasibility of the study design was measured by the recruitment and retention rate. The means, standard deviations, and 95% confidence intervals were described for outcomes of interest. RESULTS MAP is associated with a high degree of acceptability and has beneficial effects for depression and fatigue. The randomized trial design is feasible. CONCLUSIONS This study provides important pilot data supporting a larger randomized trial of effectiveness for MAP as a group MBI for early psychosis. Details of MAP and study limitations are discussed.
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Affiliation(s)
- Arlene G MacDougall
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | | | | | - Chantelle Lloyd
- Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada
| | - Richelle Bird
- Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada
| | - Rickinder Sethi
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Aturan Shanmugalingam
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jason Carr
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Kelly K Anderson
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Ross M G Norman
- Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada.,Prevention and Early Intervention Program for Psychoses, London Health Sciences Centre, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
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19
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Heriot-Maitland C, McCarthy-Jones S, Longden E, Gilbert P. Compassion Focused Approaches to Working With Distressing Voices. Front Psychol 2019; 10:152. [PMID: 30774614 PMCID: PMC6367219 DOI: 10.3389/fpsyg.2019.00152] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/16/2019] [Indexed: 12/22/2022] Open
Abstract
This paper presents an outline of voice-hearing phenomenology in the context of evolutionary mechanisms for self- and social- monitoring. Special attention is given to evolved systems for monitoring dominant-subordinate social roles and relationships. These provide information relating to the interpersonal motivation of others, such as neutral, friendly or hostile, and thus the interpersonal threat, versus safe, social location. Individuals who perceive themselves as subordinate and dominants as hostile are highly vigilant to down-rank threat and use submissive displays and social spacing as basic defenses. We suggest these defense mechanisms are especially attuned in some individuals with voices, in which this fearful-subordinate – hostile-dominant relationship is played out. Given the evolved motivational system in which voice-hearers can be trapped, one therapeutic solution is to help them switch into different motivational systems, particularly those linked to social caring and support, rather than hostile competition. Compassion focused therapy (CFT) seeks to produce such motivational shifts. Compassion focused therapy aims to help voice-hearers, (i) notice their threat-based (dominant-subordinate) motivational systems when they arise, (ii) understand their function in the context of their lives, and (iii) shift into different motivational patterns that are orientated around safeness and compassion. Voice-hearers are supported to engage with biopsychosocial components of compassionate mind training, which are briefly summarized, and to cultivate an embodied sense of a compassionate self-identity. They are invited to consider, and practice, how they might wish to relate to themselves, their voices, and other people, from the position of their compassionate self. This paper proposes, in line with the broader science of compassion and CFT, that repeated practice of creating internal patterns of safeness and compassion can provide an optimum biopsychosocial environment for affect-regulation, emotional conflict-resolution, and therapeutic change. Examples of specific therapeutic techniques, such as chair-work and talking with voices, are described to illustrate how these might be incorporated in one-to-one sessions of CFT.
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Affiliation(s)
- Charles Heriot-Maitland
- Glasgow Mental Health Research Facility, Institute of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom.,Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | | | - Eleanor Longden
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Paul Gilbert
- Centre for Compassion Research and Training, University of Derby, Derby, United Kingdom
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20
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Stephanie L, Susan L R, Wei Lin T, Monique S, Neil T. Does mindfulness help people adapt to the experience of hearing voices? Psychiatry Res 2018; 270:329-334. [PMID: 30292085 DOI: 10.1016/j.psychres.2018.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 07/01/2018] [Accepted: 09/10/2018] [Indexed: 11/20/2022]
Abstract
Mindfulness-based interventions show promise in the treatment of psychotic symptoms. From a theoretical perspective, there may be several benefits of mindfulness for individuals who experience hearing voices. Related cross-sectional findings suggest mindfulness may protect against distress, disruption, negative beliefs, dysfunctional relational style and responding, and mood symptoms for individuals who hear voices. To extend on previous findings, this study aimed to identify whether mindful relating to voices predicted voice-related negative impacts (distress, disruption and resistance), when the influence of voice-topography and mood symptoms were controlled for. Overall, 62 participants with a psychotic disorder who had experienced hearing voices in the previous week were given the Southampton Mindfulness of Voices Questionnaire, Psychotic Symptom Rating Scales, Beliefs About Voices Questionnaire, Beck Depression Inventory-II, and Beck Anxiety Inventory. As predicted, greater mindfulness of voices predicted less voice-related distress and lower resistance to voices. Regression analyses revealed that when associated voice topography and mood symptoms were controlled for, mindful relating to voices explained a significant proportion of variance in voice-related distress and resistance. Conversely, mindfulness of voices did not significantly predict voice-related disruption. In the context of existing literature, these findings suggest further mindfulness-based protocols for persistent voices should be developed and trialled.
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Affiliation(s)
- Louise Stephanie
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
| | - Rossell Susan L
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia; Psychiatry, St Vincent's Hospital, Melbourne, VIC Australia.
| | - Toh Wei Lin
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
| | - Scott Monique
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
| | - Thomas Neil
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
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21
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McHale C, Hayward M, Jones FW. Building a Grounded Theory of Engagement in Mindfulness-Based Group Therapy for Distressing Voices. QUALITATIVE HEALTH RESEARCH 2018; 28:2169-2182. [PMID: 30095031 DOI: 10.1177/1049732318789897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Mindfulness-based group therapy shows promise as a treatment for distressing voice hearing. However, fostering engagement in groups can be challenging, and no theory of engagement in group therapy for distressing voices exists to guide practice or research. This study employed Grounded Theory Method to build a theory of engagement in mindfulness-based groups for distressing voices. Ten service-users and three therapists were interviewed about their experiences of such groups. The model that emerged involves a recursive process of investing in change and continually evaluating its usefulness and safety. Barriers to engagement were often overcome, but sometimes compromised perceived safety, leading to dropout. For others, group participation led to rewards, some of which were integrated beyond group termination. Group engagement can be encouraged by establishing universality around voice hearing early, reducing uncertainty, sharing difficulties with mindfulness practices, and mapping group progress to create a cohering sense of collaboration on therapy tasks.
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Affiliation(s)
- Ciaran McHale
- 1 Canterbury Christ Church University, Tunbridge Wells, United Kingdom
| | - Mark Hayward
- 2 Sussex Partnership NHS Foundation Trust, West Sussex, United Kingdom
| | - Fergal W Jones
- 1 Canterbury Christ Church University, Tunbridge Wells, United Kingdom
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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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Zanello A, Badan Bâ M, Sentissi O. Are there clinical differences between inner, outer or dual spatial locations of auditory verbal hallucinations? Psychiatry Res 2018; 264:124-130. [PMID: 29631244 DOI: 10.1016/j.psychres.2018.03.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 02/11/2018] [Accepted: 03/18/2018] [Indexed: 11/28/2022]
Abstract
The aim of the present exploratory study was to examine the clinical differences of Auditory Verbal Hallucinations (AVHs) according to their spatial localization. Sixty-six outpatients were divided into three separate groups: inner, external and dual AVHs. The three groups were compared on sociodemographic variables (age, gender, education, marital status, living situation, employment, social disability), on clinical psychiatric characteristics (diagnosis, medication, comorbidities, illness onset, illness duration and hospitalizations) and on the measure yielded by the clinical assessments (Brief Psychiatric Rating Scale-Expanded, version 4.0; Maastricht Voices Interview for Adults; Belief About Voices Questionnaire Revised, the Clinical Global Impression, the Global Assessment Functioning Self-Esteem Rating Short Form, the World Health Organisation Quality of Life-Bref). Gender, living situation, social quality of life and some items regarding beliefs about AVHs raised significant difference, however most of the other comparisons failed to reach significance. Taken together, our findings suggest that all AVHs subtypes have equal clinical significance in patients presenting a chronic mental illness. However, the power of the study limits the generalization of the findings. Clinical implications of the findings are proposed.
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Affiliation(s)
- Adriano Zanello
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Belle-Idée, ch. Petit Bel-Air 2, 1226 Thônex, Geneva, Switzerland.
| | - Maryse Badan Bâ
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Belle-Idée, ch. Petit Bel-Air 2, 1226 Thônex, Geneva, Switzerland
| | - Othman Sentissi
- Department of Mental Health and Psychiatry, University Hospitals of Geneva, Belle-Idée, ch. Petit Bel-Air 2, 1226 Thônex, Geneva, Switzerland
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24
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Waters F, Blom JD, Jardri R, Hugdahl K, Sommer IEC. Auditory hallucinations, not necessarily a hallmark of psychotic disorder. Psychol Med 2018; 48:529-536. [PMID: 28826411 DOI: 10.1017/s0033291717002203] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Auditory hallucinations (AH) are often considered a sign of a psychotic disorder. This is promoted by the DSM-5 category of Other Specified Schizophrenia Spectrum And Other Psychotic Disorder (OSSSOPD), the diagnostic criteria for which are fulfilled with the sole presence of persistent AH, in the absence of any other psychotic symptoms. And yet, persistent AH are not synonymous with having a psychotic disorder, and should therefore not be uncritically treated as such. Many people who seek treatment for persistent AH have no other psychotic symptoms, have preserved reality-testing capacities, and will never develop a schizophrenia spectrum disorder. Instead, hallucinations may be the result of many different causes, including borderline personality disorder, post-traumatic stress disorder (PTSD), hearing loss, sleep disorders or brain lesions, and they may even occur outside the context of any demonstrable pathology. In such cases, the usage of the DSM-5 diagnosis of OSSSOPD would be incorrect, and it may prompt unwarranted treatment with antipsychotic medication. We therefore argue that a DSM-5 diagnosis of Schizophrenia Spectrum Disorder (or any other type of psychotic disorder) characterized by AH should require at least one more symptom listed under the A-criterion (i.e. delusions, disorganized speech, disorganized or catatonic behavior or negative symptoms). Adhering to these more stringent criteria may help to distinguish between individuals with persistent AH which are part of a psychotic disorder, for whom antipsychotic medication may be helpful, and individuals with AH in the absence of such a disorder who may benefit from other approaches (e.g. different pharmacological interventions, improving coping style, trauma-related therapy).
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Affiliation(s)
- F Waters
- Clinical Research Centre,Graylands Health Campus,North Metropolitan Area Health Service Mental Health,Perth,Australia
| | - J D Blom
- Faculty of Social Sciences,Leiden University,Leiden,the Netherlands
| | - R Jardri
- Univ Lille, CNRS UMR-9193,SCALab & CHU Lille,Psychiatry Department,CURE Platform,Fontan Hospital,Lille,France
| | - K Hugdahl
- Division of Psychiatry,Haukeland University Hospital,Bergen,Norway
| | - I E C Sommer
- Department of Neuroscience and Department of Psychiatry,University Medical Center Groningen,Groningen,the Netherlands
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25
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Louise S, Fitzpatrick M, Strauss C, Rossell SL, Thomas N. Mindfulness- and acceptance-based interventions for psychosis: Our current understanding and a meta-analysis. Schizophr Res 2018; 192:57-63. [PMID: 28545945 DOI: 10.1016/j.schres.2017.05.023] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Revised: 05/17/2017] [Accepted: 05/17/2017] [Indexed: 02/07/2023]
Abstract
In promoting optimal recovery in persons with psychosis, psychological interventions have become a key element of treatment, with cognitive behavioural therapy being widely recommended in clinical practice guidelines. One key area of development has been the trialling of "third wave" cognitive behavioural interventions, which promote mindfulness, acceptance and compassion as means of change. Trials to date have demonstrated encouraging findings, with beneficial effects observed on measures of psychotic symptoms. This meta-analysis evaluated the efficacy of third wave interventions for the treatment of psychosis in randomised controlled trials, with psychotic symptoms as the primary outcome. Overall, 10 studies were included. The primary outcome demonstrated a small but significant effect (g=0.29) for third wave interventions compared with control post-treatment. Trials of group format mindfulness-based interventions showed larger effects (g=0.46) than individual acceptance and commitment therapy based interventions (g=0.08), although methodological differences between trials were noted. Among secondary outcomes, a moderate, significant treatment effect (g=0.39) was found for depressive symptoms, but no significant effects were found on specific measures of positive and negative symptoms, hallucination distress, or functioning/disability. A moderate effect on mindfulness (g=0.56) was observed, but not on acceptance. Overall, findings indicate that third wave interventions show beneficial effects on symptoms in persons with psychotic disorders. However, further research is required to determine the efficacy of specific models of treatment.
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Affiliation(s)
- Stephanie Louise
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
| | - Molly Fitzpatrick
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia.
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Hove, UK.
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia; Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia.
| | - Neil Thomas
- Centre for Mental Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, VIC, Australia; Monash Alfred Psychiatry Research Centre (MAPrc), Central Clinical School, Monash University and The Alfred Hospital, Melbourne, VIC, Australia.
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Strauss C, Hugdahl K, Waters F, Hayward M, Bless JJ, Falkenberg LE, Kråkvik B, Asbjørnsen AE, Johnsen E, Sinkeviciute I, Kroken RA, Løberg EM, Thomas N. The Beliefs about Voices Questionnaire - Revised: A factor structure from 450 participants. Psychiatry Res 2018; 259:95-103. [PMID: 29035759 PMCID: PMC5764292 DOI: 10.1016/j.psychres.2017.09.089] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/31/2017] [Accepted: 09/30/2017] [Indexed: 12/30/2022]
Abstract
Hallucinated voices are common across psychiatric and non-clinical groups. The predominant cognitive theory about the impact of voices posits that beliefs about voice power ('Omnipotence') and voice intent ('Malevolence'/'Benevolence') play a key role in determining emotional and behavioral reactions. The revised Beliefs about Voices Questionnaire (BAVQ-R) was designed to assess these constructs, together with two styles of responding (Engagement and Resistance). The BAVQ-R is widely used in clinical and research settings, yet it has not received validation of its constructs and factor structure. This study examined the factor structure of the BAVQ-R by combining datasets from five study centers, comprising 450 participants (belief constructs) and 269 participants (response styles), and using confirmatory and exploratory factor analysis. Findings failed to support a three factor belief model, instead showing a two-factor structure ('Persecutory beliefs' combining Omnipotence and Malevolence constructs, and a Benevolent construct). Emotional and behavioral items did not separate. Overall, results showed that (i) a two-factor model of beliefs (Persecutory and Benevolent beliefs) provides a better fit to the data than a three-factor model, and (ii) emotional and behavioral modes of responding items should not be separated. Theoretical implications of this finding are discussed in relation to the research and therapy.
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Affiliation(s)
- Clara Strauss
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK; Sussex Partnership NHS Foundation Trust, Hove, UK.
| | - Kenneth Hugdahl
- Department of Biological and Medical Psychology, University of Bergen, Norway,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway
| | - Flavie Waters
- Clinical Research Centre, North Metro Health Service, Graylands Hospital, Perth, Australia,School of Psychiatry and Clinical Neurosciences, University of Western Australia, Australia
| | - Mark Hayward
- School of Psychology, University of Sussex, Brighton BN1 9QH, UK,Sussex Partnership NHS Foundation Trust, Hove, UK
| | - Josef J. Bless
- Department of Biological and Medical Psychology, University of Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway
| | - Liv E. Falkenberg
- Department of Biological and Medical Psychology, University of Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway
| | - Bodil Kråkvik
- Nidaros District Psychiatric Center, Department of Research and Development, St. Olavs University Hospital, Trondheim, Norway
| | | | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Department of Clinical Medicine (K1), University of Bergen, Norway
| | - Igne Sinkeviciute
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A. Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Department of Clinical Medicine (K1), University of Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway,NORMENT Center of Excellence, University of Oslo, Norway,Department of Clinical Medicine (K1), University of Bergen, Norway,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway,Department of Clinical Psychology, University of Bergen, Norway
| | - 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
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Tully S, Wells A, Morrison AP. Attentional avoidance increases voice hearing in an analogue task in people with psychosis: An experimental study. Psychiatry Res 2017; 257:186-192. [PMID: 28763737 DOI: 10.1016/j.psychres.2017.07.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 07/21/2017] [Accepted: 07/26/2017] [Indexed: 11/30/2022]
Abstract
Cognitive models of psychosis suggest that unhelpful ways of responding to experiences can maintain such experiences and the associated distress. The response styles of attentional avoidance and attentional focusing were manipulated in an analogue voice-hearing task. Predictions were that both would increase detection of words in response to an ambiguous audio-recording but that attentional avoidance would lead to a greater increase than focusing. We also predicted that there would be a greater increase in anxiety and distress in the avoidance group. Predictions were tested in a sample of 44 participants with a diagnosis of schizophrenia. Participants were randomly assigned to either attentional avoidance or focusing while listening to an ambiguous auditory task. Number of words identified and anxiety and distress were recorded. As predicted, there was an increase in the number of words identified in both groups; however, this increase was greater in the avoidance group. The prediction that there would also be an increase in distress that would be greater in the avoidance group was not supported. It is possible that emotional reactions relate more closely to appraisals of the voice. The results suggest that avoidance of experiences is particularly counterproductive and can result in greater detection of experiences.
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Affiliation(s)
- Sarah Tully
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK; The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK.
| | - Adrian Wells
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Anthony P Morrison
- The University of Manchester, Oxford Road, Manchester M13 9PL, UK; The Psychosis Research Unit, Greater Manchester West Mental Health NHS Foundation Trust, Prestwich M25 3BL, UK
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Thurstone C, Hull M, Timmerman J, Emrick C. Development of a motivational interviewing/acceptance and commitment therapy model for adolescent substance use treatment. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2017.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Dudley J, Eames C, Mulligan J, Fisher N. Mindfulness of voices, self-compassion, and secure attachment in relation to the experience of hearing voices. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2017; 57:1-17. [PMID: 28801978 PMCID: PMC5811822 DOI: 10.1111/bjc.12153] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 07/05/2017] [Indexed: 12/04/2022]
Abstract
Objectives Developing compassion towards oneself has been linked to improvement in many areas of psychological well‐being, including psychosis. Furthermore, developing a non‐judgemental, accepting way of relating to voices is associated with lower levels of distress for people who hear voices. These factors have also been associated with secure attachment. This study explores associations between the constructs of mindfulness of voices, self‐compassion, and distress from hearing voices and how secure attachment style related to each of these variables. Design Cross‐sectional online. Method One hundred and twenty‐eight people (73% female; Mage = 37.5; 87.5% Caucasian) who currently hear voices completed the Self‐Compassion Scale, Southampton Mindfulness of Voices Questionnaire, Relationships Questionnaire, and Hamilton Programme for Schizophrenia Voices Questionnaire. Results Results showed that mindfulness of voices mediated the relationship between self‐compassion and severity of voices, and self‐compassion mediated the relationship between mindfulness of voices and severity of voices. Self‐compassion and mindfulness of voices were significantly positively correlated with each other and negatively correlated with distress and severity of voices. Conclusion Mindful relation to voices and self‐compassion are associated with reduced distress and severity of voices, which supports the proposed potential benefits of mindful relating to voices and self‐compassion as therapeutic skills for people experiencing distress by voice hearing. Practitioner points Greater self‐compassion and mindfulness of voices were significantly associated with less distress from voices. These findings support theory underlining compassionate mind training. Mindfulness of voices mediated the relationship between self‐compassion and distress from voices, indicating a synergistic relationship between the constructs. Although the current findings do not give a direction of causation, consideration is given to the potential impact of mindful and compassionate approaches to voices.
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Affiliation(s)
- James Dudley
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | - Catrin Eames
- Institute of Psychology, Health and Society, University of Liverpool, UK
| | | | - Naomi Fisher
- Faculty of Health and Medicine, Lancaster University, Lancashire, UK
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Shore R, Strauss C, Cavanagh K, Hayward M, Ellett L. A Randomised Controlled Trial of a Brief Online Mindfulness-Based Intervention on Paranoia in a Non-Clinical Sample. Mindfulness (N Y) 2017; 9:294-302. [PMID: 29387267 PMCID: PMC5770499 DOI: 10.1007/s12671-017-0774-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Paranoia is common and distressing in the general population and can impact on health, emotional well-being and social functioning, such that effective interventions are needed. Brief online mindfulness-based interventions (MBIs) have been shown to reduce symptoms of anxiety and depression in non-clinical samples; however, at present, there is no research investigating whether they can reduce paranoia. The current study explored whether a brief online MBI increased levels of mindfulness and reduced levels of paranoia in a non-clinical population. The mediating effect of mindfulness on any changes in paranoia was also investigated. One hundred and ten participants were randomly allocated to either a 2-week online MBI including 10 min of daily guided mindfulness practice or to a waitlist control condition. Measures of mindfulness and paranoia were administered at baseline, post-intervention and 1-week follow-up. Participants in the MBI group displayed significantly greater reductions in paranoia compared to the waitlist control group. Mediation analysis demonstrated that change in mindfulness skills (specifically the observe, describe and non-react facets of the FFMQ) mediated the relationship between intervention type and change in levels of paranoia. This study provides evidence that a brief online MBI can significantly reduce levels of paranoia in a non-clinical population. Furthermore, increases in mindfulness skills from this brief online MBI can mediate reductions in non-clinical paranoia. The limitations of the study are discussed.
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Affiliation(s)
- Robert Shore
- 1School of Psychology, University of Surrey, Guildford, Surrey, GU2 7XH UK
| | - Clara Strauss
- 2School of Psychology, University of Sussex, Falmer, East Sussex, BN1 9RH UK.,3Sussex Partnership NHS Foundation Trust, Mill View Hospital, Nevill Avenue, Hove, BN3 7HY UK
| | - Kate Cavanagh
- 2School of Psychology, University of Sussex, Falmer, East Sussex, BN1 9RH UK
| | - Mark Hayward
- 2School of Psychology, University of Sussex, Falmer, East Sussex, BN1 9RH UK.,3Sussex Partnership NHS Foundation Trust, Mill View Hospital, Nevill Avenue, Hove, BN3 7HY UK
| | - Lyn Ellett
- 4Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX UK
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Chiesa A, Fazia T, Bernardinelli L, Morandi G. Citation patterns and trends of systematic reviews about mindfulness. Complement Ther Clin Pract 2017; 28:26-37. [PMID: 28779934 DOI: 10.1016/j.ctcp.2017.04.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 04/22/2017] [Accepted: 04/27/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVES We performed a citation analysis of the literature about mindfulness aimed at describing the most significant topics and the impact of more relevant papers. METHODS We classified 128 systematic reviews about mindfulness-based intervention retrieved in Scopus according to their object, the population included and the type of mindfulness proposed. The citation counting was reported. The cumulative citation numbers per chronological years and article life were analyzed thorough a linear regression model. RESULTS 1) We observed a general increase in the number of reviews published from 2003 to 2016; 2) two reviews collected the 33% of the overall citations; 3) citation counting for clinical and mixed population collected the 90% of total citations; 4) clinical reviews had higher cumulative citation per publication/year growth. CONCLUSIONS As mindfulness research advances, higher attention should be given to the mechanisms by which mindfulness interventions work so as to provide fruitful insights for future research.
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Affiliation(s)
- Alberto Chiesa
- Istituto Mente e Corpo, Bologna, Italy; Associazione di Psicologia Cognitiva - Scuola di Psicoterapia Cognitiva, Roma, Italy
| | - Teresa Fazia
- Department of Brain and Behavioral Science, Medical and Genomic Statistics Unit, University of Pavia, Italy
| | - Luisa Bernardinelli
- Department of Brain and Behavioral Science, Medical and Genomic Statistics Unit, University of Pavia, Italy
| | - Gabriella Morandi
- Department of Brain and Behavioral Science, Medical and Genomic Statistics Unit, University of Pavia, Italy.
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Siddi S, Petretto DR, Burrai C, Scanu R, Baita A, Trincas P, Trogu E, Campus L, Contu A, Preti A. The role of set-shifting in auditory verbal hallucinations. Compr Psychiatry 2017; 74:162-172. [PMID: 28167329 DOI: 10.1016/j.comppsych.2017.01.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 12/05/2016] [Accepted: 01/16/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Auditory verbal hallucinations (AVHs) are a cardinal characteristic of psychosis. Recent research on the neuropsychological mechanism of AVHs has focused on source monitoring failure, but a few studies have suggested the involvement of attention, working memory, processing speed, verbal learning, memory, and executive functions. In this study we examined the neuropsychological profile of patients with AVHs, assuming that the mechanism underlying this symptom could be a dysfunction of specific cognitive domains. METHODS A large neuropsychological battery including set-shifting, working memory, processing speed, attention, fluency, verbal learning and memory, and executive functions was administered to 90 patients with psychotic disorders and 44 healthy controls. The group of patients was divided into two groups: 46 patients with AVHs in the current episode and 44 who denied auditory hallucinations or other modalities in the current episode. AVHs were assessed with the Psychotic Symptom Rating Scales (PSYRATS); the Launay-Slade Hallucination Scale was used to measure long-term propensity to auditory verbal hallucination-like experiences (HLEs) in the sample. RESULTS Patients showed poorer performances on all neuropsychological measures compared to the healthy controls' group. In the original dataset without missing data (n=58), patients with AVHs (n=29) presented poorer set shifting and verbal learning, higher levels of visual attention, and marginally significant poorer semantic fluency compared to patients without AVHs (n=29). In the logistic model on the multiple imputed dataset (n=90, 100 imputed datasets), lower capacity of set shifting and semantic fluency distinguished patients with AVHs from those without them. CONCLUSIONS Patients experiencing persistent AVHs might fail to shift their attention away from the voices; poorer semantic fluency could be a secondary deficit of set-shifting failure.
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Affiliation(s)
- Sara Siddi
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Faculty of Medicine, University of Barcelona, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
| | - Donatella Rita Petretto
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy
| | - Caterina Burrai
- Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Rosanna Scanu
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy
| | - Antonella Baita
- Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Pierfranco Trincas
- Psychiatric Diagnosis and Treatment Service II, Department of Mental Health, ASL Cagliari, Cagliary, Italy
| | - Emanuela Trogu
- Psychiatric Diagnosis and Treatment Service II, Department of Mental Health, ASL Cagliari, Cagliary, Italy
| | - Liliana Campus
- Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Augusto Contu
- Head, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Antonio Preti
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy
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Siddi S, Petretto DR, Scanu R, Burrai C, Baita A, Trincas P, Trogu E, Campus L, Contu A, Preti A. Deficits in metaphor but not in idiomatic processing are related to verbal hallucinations in patients with psychosis. Psychiatry Res 2016; 246:101-112. [PMID: 27690132 DOI: 10.1016/j.psychres.2016.09.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 09/16/2016] [Accepted: 09/18/2016] [Indexed: 10/21/2022]
Abstract
There is scant evidence that the verbal cognitive deficits observed in patients with psychosis are related to auditory verbal hallucinations. The understanding of metaphors and idiomatic expressions was investigated in a cohort of 90 patients with active psychosis, and in 44 healthy controls. The Psychotic Symptom Rating Scales (PSYRATS: verbal hallucinations subscale) was used to measure the current verbal hallucinations episode; a subscore of the Launay-Slade Hallucination Scale was used to measure long-term propensity to auditory verbal hallucination-like experiences (HLEs) in the sample. The concurrent influence of education, IQ, and cognitive functioning in memory, attention, fluency, and processing speed on metaphor and idioms processing was investigated. Patients performed worse than healthy controls on all neuropsychological measures. Metaphor, but not idioms processing was poorer in patients with verbal hallucinations (n=46) when compared to patients without verbal hallucinations in the current episode (n=44). By taking into account confounding variables, the ability to produce explanations of metaphors was related to scores on the verbal HLEs in the whole sample of patients. Metaphor-comprehension deficit was related to the occurrence of auditory verbal hallucinations in patients with psychosis, suggesting that abnormal pragmatic inferential abilities have an impact on the mechanisms that cause hallucinatory experiences.
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Affiliation(s)
- Sara Siddi
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain, CIBERSAM; Faculty of Medicine, University of Barcelona, Spain.
| | - Donatella Rita Petretto
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy
| | - Rosanna Scanu
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy
| | - Caterina Burrai
- Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Antonella Baita
- Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Pierfranco Trincas
- Psychiatric Diagnosis and Treatment Service II, Department of Mental Health, ASL Cagliari, Cagliary, Italy
| | - Emanuela Trogu
- Psychiatric Diagnosis and Treatment Service II, Department of Mental Health, ASL Cagliari, Cagliary, Italy
| | - Liliana Campus
- Psychiatric Diagnosis and Treatment Service I, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Augusto Contu
- Head, Department of Mental Health, ASL Cagliari, Cagliari, Italy
| | - Antonio Preti
- Section of Clinical Psychology, Department of Education, Psychology, and Philosophy, University of Cagliari, Italy; Genneruxi Medical Center, Cagliari, Italy
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Antonova E, Amaratunga K, Wright B, Ettinger U, Kumari V. Schizotypy and mindfulness: Magical thinking without suspiciousness characterizes mindfulness meditators. Schizophr Res Cogn 2016; 5:1-6. [PMID: 28740810 PMCID: PMC5514306 DOI: 10.1016/j.scog.2016.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 10/28/2022]
Abstract
Despite growing evidence for demonstrated efficacy of mindfulness in various disorders, there is a continuous concern about the relationship between mindfulness practice and psychosis. As schizotypy is part of the psychosis spectrum, we examined the relationship between long-term mindfulness practice and schizotypy in two independent studies. Study 1 included 24 experienced mindfulness practitioners (19 males) from the Buddhist tradition (meditators) and 24 meditation-naïve individuals (all males). Study 2 consisted of 28 meditators and 28 meditation-naïve individuals (all males). All participants completed the Schizotypal Personality Questionnaire (Raine, 1991), a self-report scale containing 9 subscales (ideas of reference, excessive social anxiety, magical thinking, unusual perceptual experiences, odd/eccentric behavior, no close friends, odd speech, constricted affect, suspiciousness). Participants of study 2 also completed the Five-Facet Mindfulness Questionnaire which assesses observing (Observe), describing (Describe), acting with awareness (Awareness), non-judging of (Non-judgment) and non-reactivity to inner experience (Non-reactivity) facets of trait mindfulness. In both studies, meditators scored significantly lower on suspiciousness and higher on magical thinking compared to meditation-naïve individuals and showed a trend towards lower scores on excessive social anxiety. Excessive social anxiety correlated negatively with Awareness and Non-judgment; and suspiciousness with Awareness, Non-judgment and Non-reactivity facets across both groups. The two groups did not differ in their total schizotypy score. We conclude that mindfulness practice is not associated with an overall increase in schizotypal traits. Instead, the pattern suggests that mindfulness meditation, particularly with an emphasis on the Awareness, Non-judgment and Non-reactivity aspects, may help to reduce suspiciousness and excessive social anxiety.
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Affiliation(s)
- Elena Antonova
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
| | - Kavitha Amaratunga
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
| | - Bernice Wright
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
| | | | - Veena Kumari
- King's College London, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), Department of Psychology, London, UK
- NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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Preliminary study of a rehabilitation program based on attentional processes to treat auditory hallucinations. Cogn Neuropsychiatry 2016; 21:315-334. [PMID: 27424464 DOI: 10.1080/13546805.2016.1208610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Despite the effectiveness of pharmacological treatment, residual hallucinations do not completely resolve in some medicated patients. The aim of this study was to investigate the efficacy of attention training for reducing hallucinations in individuals with psychosis. METHODS A randomised controlled trial was performed in which 20 individuals suffering auditory hallucinations received auditory stimulation similar to their internal voices, which was integrated into the RehaCom program of attention training. An equal number of individuals suffering auditory hallucinations did not receive this training. Cognitive and symptomatological variables were evaluated before and after the intervention period in both groups. RESULTS Only data of 16 subjects were analysed. Auditory hallucinations no longer occurred by the end of the training program in five of eight individuals, whereas their frequency, intensity and negative content and associated anxiety were significantly reduced in the remaining three. No changes in hallucinations were observed in the control group. Attentional processes and executive functions were significantly better in patients who underwent the training than in those who did not at the end of the intervention period. CONCLUSIONS Attention training can help people with auditory hallucinations develop an ability to ignore them, which can reduce or eliminate them entirely.
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Metacognitive Interpersonal Therapy for Treating Auditory Verbal Hallucinations in First-onset Schizophrenia. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2016. [DOI: 10.1007/s10879-016-9336-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hayward M, Slater L, Berry K, Perona-Garcelán S. Establishing the "Fit" between the Patient and the Therapy: The Role of Patient Gender in Selecting Psychological Therapy for Distressing Voices. Front Psychol 2016; 7:424. [PMID: 27065907 PMCID: PMC4814658 DOI: 10.3389/fpsyg.2016.00424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 03/10/2016] [Indexed: 11/19/2022] Open
Abstract
The experience of hearing distressing voices has recently attracted much attention in the literature on psychological therapies. A new “wave” of therapies is considering voice hearing experiences within a relational framework. However, such therapies may have limited impact if they do not precisely target key psychological variables within the voice hearing experience and/or ensure there is a “fit” between the profile of the hearer and the therapy (the so-called “What works for whom” debate). Gender is one aspect of both the voice and the hearer (and the interaction between the two) that may be influential when selecting an appropriate therapy, and is an issue that has thus far received little attention within the literature. The existing literature suggests that some differences in voice hearing experience are evident between the genders. Furthermore, studies exploring interpersonal relating in men and women more generally suggest differences within intimate relationships in terms of distancing and emotionality. The current study utilized data from four published studies to explore the extent to which these gender differences in social relating may extend to relating within the voice hearing experience. The findings suggest a role for gender as a variable that can be considered when identifying an appropriate psychological therapy for a given hearer.
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Affiliation(s)
- Mark Hayward
- School of Psychology, University of Sussex Brighton, UK
| | - Luke Slater
- Sussex Education Centre, Sussex Partnership NHS Foundation Trust Hove, UK
| | - Katherine Berry
- School of Psychological Sciences, University of Manchester Manchester, UK
| | - Salvador Perona-Garcelán
- Personality, Evaluation and Psychological Treatment Department, University of SevilleSeville, Spain; Virgen del Rocío Outpatient Mental Hospital, University Hospital Virgen del RocíoSeville, Spain
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