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Brouwer A, Carhart‐Harris RL, Raison CL. Psychotomimetic compensation versus sensitization. Pharmacol Res Perspect 2024; 12:e1217. [PMID: 38923845 PMCID: PMC11194300 DOI: 10.1002/prp2.1217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Accepted: 05/08/2024] [Indexed: 06/28/2024] Open
Abstract
It is a paradox that psychotomimetic drugs can relieve symptoms that increase risk of and cooccur with psychosis, such as attention and motivational deficits (e.g., amphetamines), pain (e.g., cannabis) and symptoms of depression (e.g., psychedelics, dissociatives). We introduce the ideas of psychotomimetic compensation and psychotomimetic sensitization to explain this paradox. Psychotomimetic compensation refers to a short-term stressor or drug-induced compensation against stress that is facilitated by engagement of neurotransmitter/modulator systems (endocannabinoid, serotonergic, glutamatergic and dopaminergic) that mediate the effects of common psychotomimetic drugs. Psychotomimetic sensitization occurs after repeated exposure to stress and/or drugs and is evidenced by the gradual intensification and increase of psychotic-like experiences over time. Theoretical and practical implications of this model are discussed.
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Affiliation(s)
- Ari Brouwer
- Department of Human Development and Family Studies, School of Human EcologyUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
| | - Robin L. Carhart‐Harris
- Department of Neurology and PsychiatryUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Charles L. Raison
- Department of Psychiatry, School of Medicine and Public HealthUniversity of Wisconsin‐MadisonMadisonWisconsinUSA
- Vail Health Behavioral Health Innovation CenterVailColoradoUSA
- Center for the Study of Human HealthEmory UniversityAtlantaGeorgiaUSA
- Department of Spiritual HealthEmory University Woodruff Health Sciences CenterAtlantaGeorgiaUSA
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2
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Heriot-Maitland C, Wykes T, Peters E. Social influences on the relationship between dissociation and psychotic-like experiences. Psychol Med 2024:1-9. [PMID: 38825863 DOI: 10.1017/s0033291724001405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/04/2024]
Abstract
BACKGROUND Shame is experienced as a threat to social self, and so activates threat-protective responses. There is evidence that shame has trauma-like characteristics, suggesting it can be understood within the same conceptual framework as trauma and dissociation. Evidence for causal links among trauma, dissociation, and psychosis thus warrant the investigation of how shame may influence causal mechanisms for psychosis symptoms. METHODS This study tested the interaction between dissociation and shame, specifically external shame (feeling shamed by others), in predicting psychotic-like experiences (PLEs) six months later in a general population sample (N = 314). It also tested if social safeness moderates these effects. A longitudinal, online questionnaire design tested a moderation model (dissociation-shame) and a moderated moderation model (adding social safeness), using multiple regressions with bootstrap procedures. RESULTS Although there was no direct effect of dissociation on PLEs six months later, there was a significant interaction effect with shame, controlling for PLEs at baseline. There were complex patterns in the directions of effects: For high-shame-scorers, higher dissociation predicted higher PLE scores, but for low-shame-scorers, higher dissociation predicted lower PLE scores. Social safeness was found to significantly moderate these interaction effects, which were unexpectedly more pronounced in the context of higher social safeness. CONCLUSIONS The results demonstrate evidence for an interaction between dissociation and shame on its impact on PLEs, which manifests particularly for those experiencing higher social safeness. This suggests a potential role of social mechanisms in both the etiology and treatment of psychosis, which warrants further testing in clinical populations.
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Affiliation(s)
- Charles Heriot-Maitland
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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3
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Hall H. Dissociation and misdiagnosis of schizophrenia in populations experiencing chronic discrimination and social defeat. J Trauma Dissociation 2024; 25:334-348. [PMID: 36065490 DOI: 10.1080/15299732.2022.2120154] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/12/2022] [Indexed: 10/14/2022]
Abstract
As recently as the late 20th century, Schizophrenia, a category of mental illness with widely varying phenotypic symptoms, was believed by psychobiologists to be a genetically based disorder in which the environment played a limited etiological role. Yet a growing body of evidence indicates a strong correlation between schizophrenia and environmental factors. This theoretical paper explores the relationship between highly elevated rates of schizophrenia in some low-income minority communities worldwide and trauma-related dissociative symptoms that often mimic schizophrenia. Elevated rates of schizophrenia in racially and ethnically isolated, inner-city Black populations are well documented. This paper contains evidence proposing that this amplification in the rate of schizophrenia is mediated by childhood trauma, disorganized attachment, and social defeat. Further, evidence demonstrating how these three variables combine in early childhood to incubate dissociative disorders will also be conveyed. The misdiagnosis of dissociative disorders as schizophrenia is theorized to partially mediate the increased rate of schizophrenia in communities that experience high levels of racial/ethnic discrimination. It is argued that this misdiagnosis is often attributable to cultural misunderstanding and/or a lack of knowledge about dissociative disorders.
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Abstract
PURPOSE This paper outlines the theoretical and empirical basis for compassion focused therapy (CFT) for psychosis, the gaps in the current knowledge and research, as well as some of the challenges for addressing gaps. It will guide the direction of future work and the steps needed to develop and advance this approach. METHOD This paper reviews evidence of how evolutionary models such as social rank theory and attachment theory have greatly contributed to our understanding of psychosis and provide a clear rationale and evidence base for the mechanisms of change in CFT for psychosis. It reviews the evidence for outcomes of compassion training more generally, and early feasibility evaluations of CFT for psychosis. RESULTS The process evidence shows that people with psychosis have highly active social rank and threat systems, and the benefits of switching into attachment and care systems, which can support emotion regulation and integrative mind states. The outcomes evidence shows that compassion training impacts not only psychological outcomes, but also physiological outcomes such as neural circuits, immune system, and the autonomic nervous system. Within the psychosis field, outcomes research is still in the early days, but there are good indications of feasibility and a clear path forward for the next steps. CONCLUSIONS CFT for psychosis is an approach that integrates biopsychosocial processes, an integration that's evidenced across each aspect of the model, from theoretical foundations (evolution-informed) to interventions (e.g., body/breath training and relational techniques), to evaluation. Future RCTs are required to understand the effects on biopsychosocial outcomes for people with psychosis.
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Affiliation(s)
- Charles Heriot-Maitland
- Balanced Minds, London, UK
- King's College London, London, UK
- University of Glasgow, Glasgow, UK
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Grady S, Twomey C, Cullen C, Gaynor K. Does affect mediate the relationship between interpersonal trauma and psychosis? A systematic review and meta-analysis. Schizophr Res 2024; 264:435-447. [PMID: 38245930 DOI: 10.1016/j.schres.2024.01.008] [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: 08/04/2023] [Revised: 12/24/2023] [Accepted: 01/01/2024] [Indexed: 01/23/2024]
Abstract
INTRODUCTION The relationship between interpersonal trauma and psychosis is well established, and research is now focused on identifying mechanisms that may explain this relationship. Models of trauma and psychosis increasingly emphasize a broad range of affective processes, yet the overall effect of these affective processes is not well understood. AIM This review systematically examined the effect of any form of long-term affective dysfunction on the relationship between interpersonal trauma and psychosis. Where possible, it used meta-analytic techniques to quantify the overall magnitude of this effect. METHOD Searches were conducted using PsychINFO, MEDLINE and CINAHL databases, and eligible studies were appraised for methodological quality. Narrative synthesis and meta-analytic methods were used to evaluate evidence. RESULTS Twenty-nine studies met criteria for inclusion. Five affective mediators were found; depression, anxiety, affective dysregulation, loneliness and attachment. Findings from both the narrative synthesis (n = 29) and meta-analysis (n = 8) indicated that, overall, affect is a small but significant mediator of the relationship between interpersonal trauma and psychosis (pooled Cohen's d = 0.178; pooled 95 % CI: 0.022-0.334). CONCLUSIONS Overall, findings support affective pathways to psychosis, though highlight the need for further research on broader affective mediators (loneliness, shame). The small effect size found in the meta-analysis also points to the potential importance of non-affective mediators. Clinically, these findings highlight the value of treatment modalities that attend to multiple mechanisms in the relationship between interpersonal trauma and psychosis. Future research should focus on the interplay and causal sequence between these mechanisms to further understand pathways between interpersonal trauma and psychosis.
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Affiliation(s)
- Shelley Grady
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland.
| | - Conal Twomey
- Dept. of Psychology, St Patrick's University Hospital, Dublin, Ireland
| | - Clare Cullen
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland
| | - Keith Gaynor
- School of Psychology, University College Dublin, Belfield, Dublin, Ireland; DETECT, Early Intervention in Psychosis Service, Blackrock, Dublin, Ireland
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Yates K, Lång U, Peters EM, Wigman JTW, Boyda D, McNicholas F, Cannon M, Alderson-Day B, Bloomfield M, Ramsay H, Kelleher I. Hallucinations as a risk marker for suicidal behaviour in individuals with a history of sexual assault: a general population study with instant replication. Psychol Med 2023; 53:4627-4633. [PMID: 35698850 PMCID: PMC10388314 DOI: 10.1017/s0033291722001532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/04/2022] [Accepted: 05/09/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Research has shown a strong relationship between hallucinations and suicidal behaviour in general population samples. Whether hallucinations also index suicidal behaviour risk in groups at elevated risk of suicidal behaviour, namely in individuals with a sexual assault history, remains to be seen. AIMS We assessed whether hallucinations were markers of risk for suicidal behaviour among individuals with a sexual assault history. METHODS Using the cross-sectional 2007 (N = 7403) and 2014 (N = 7546) Adult Psychiatric Morbidity Surveys, we assessed for an interaction between sexual assault and hallucinations in terms of the odds of suicide attempt, as well as directly comparing the prevalence of suicide attempt in individuals with a sexual assault history with v. without hallucinations. RESULTS Individuals with a sexual assault history had increased odds of hallucinations and suicide attempt compared to individuals without a sexual assault history in both samples. There was a significant interaction between sexual assault and hallucinations in terms of the odds of suicide attempt. In total, 14-19% of individuals with a sexual assault history who did not report hallucinations had one or more suicide attempt. This increased to 33-52% of individuals with a sexual assault history who did report hallucinations (2007, aOR = 2.85, 1.71-4.75; 2014, aOR = 4.52, 2.78-7.35). CONCLUSIONS Hallucinations are a risk marker for suicide attempt even among individuals with an elevated risk of suicidal behaviour, specifically individuals with a sexual assault history. This finding highlights the clinical significance of hallucinations with regard to suicidal behaviour risk, even among high-risk populations.
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Affiliation(s)
- Kathryn Yates
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ulla Lång
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Evyn M. Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon SK, Canada
| | - Johanna T. W. Wigman
- Department of Psychiatry, Interdisciplinary Center Psychopathology and Emotion regulation (ICPE), University of Groningen, Groningen, The Netherlands
| | - David Boyda
- School of Psychology, University of Wolverhampton, Wolverhampton, UK
| | - Fiona McNicholas
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Lucena Clinic, St John of God Hospitaller Services, Dublin, Ireland
- Department of Child Psychiatry, Our Lady's Hospital for Sick Children, Dublin, Ireland
| | - Mary Cannon
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
| | - Ben Alderson-Day
- Department of Psychology, Science Laboratories, Durham University, South Road, Durham, UK
| | - Michael Bloomfield
- Division of Psychiatry, University College London, London, UK
- Traumatic Stress Clinic, Camden & Islington NHS Foundation Trust, London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, London, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Hugh Ramsay
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Department of Psychiatry, Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland
| | - Ian Kelleher
- Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin 2, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Lucena Clinic, St John of God Hospitaller Services, Dublin, Ireland
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Echoes of shame: a comparison of the characteristics and psychological sequelae of recalled shame experiences across the voice hearing continuum. Behav Cogn Psychother 2023; 51:61-73. [PMID: 36285429 DOI: 10.1017/s1352465822000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Voice hearing occurs across a number of psychiatric diagnoses and appears to be present on a continuum within the general population. Previous research has highlighted the potential role of past experiences of shame in proneness to voice hearing in the general population. AIMS This study aimed to extend this past research and compare people with distressing voices, people with voices but no distress, and a non-voice hearing control group, on various dimensions of shame and shame memory characteristics. METHOD In a cross-sectional, online study 39 distressed voice hearers, 31 non-distressed voice hearers and 50 non-voice hearers undertook a shame memory priming task in which they were prompted to recall a memory of a shaming experience from their past. They then completed questionnaires assessing the characteristics of the recalled shame event and the psychological sequalae of this event (i.e. intrusions, hyperarousal, avoidance, the centrality of shame memories, external shame, and self-criticism). RESULTS The majority of recalled shame memories involved experiences such as interpersonal criticism or experiences of being devalued. Univariate analyses found no significant differences between the three groups with regard to the shame events that were recalled, but the distressed voice hearer group reported significantly more hyperarousal, intrusions, self-criticism, and external shame in relation to their experience. CONCLUSIONS The findings suggest that voice hearers recall similar types of shame experiences to non-voice hearers, but that problematic psychological sequelae of these shame experiences (in the form of intrusive memories, hyperarousal, external shame, and self-criticism) may specifically contribute to distressing voice hearing.
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A Psychotherapy Oriented by Compassion and Metacognition for Schizoid Personality Disorder: A Two Cases Series. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09566-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Oh H, Nagendra A, Besecker M, Smith L, Koyanagi A, Wang JSH. Economic strain, parental education and psychotic experiences among college students in the United States: Findings from the Healthy Minds Study 2020. Early Interv Psychiatry 2022; 16:770-781. [PMID: 34469041 DOI: 10.1111/eip.13221] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/28/2021] [Accepted: 08/15/2021] [Indexed: 01/14/2023]
Abstract
AIM Socioeconomic status (SES) is linked to psychosis, and much can be learned by examining how various indicators of SES-specifically economic strain and intergenerational transfer of resources-are related to sub-threshold psychotic experiences among college students. METHODS Using data from the Healthy Minds Survey (September 2020-December 2020), we used multivariable logistic regression models to examine the associations between five SES indicators and 12-month psychotic experiences, adjusting for age, gender and race/ethnicity. We also examined the count of predictors and psychotic experiences. RESULTS Each indicator of economic strain was associated with greater odds of psychotic experiences. In particular, increasing levels of financial stress (current, childhood and pandemic-related) were associated with greater odds of psychotic experiences in a dose-response fashion. Food insecurity was associated with double the odds of psychotic experiences. In terms of intergenerational transfer of resources, having either one or no parents who attended college was associated with significantly greater odds of having psychotic experiences, when compared with having both parents who attended college. Examining all predictors in the same model, only childhood and current financial stress and food insecurity were significantly associated with psychotic experiences. The count of predictors was significantly associated with greater odds of having psychotic experiences in a dose-dependent fashion. CONCLUSIONS Among college students, economic strain and intergenerational transfer of resources were associated with recent psychotic experiences, highlighting the importance of economic interventions targeting young adults to influence risk for psychosis.
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Affiliation(s)
- Hans Oh
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Arundati Nagendra
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts, USA
| | - Megan Besecker
- Suzanne Dworak Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Julia Shu-Huah Wang
- Department of Social Work and Social Administration, The University of Hong Kong, Pok Fu Lam Road, Hong Kong
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10
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Volpato E, Cavalera C, Castelnuovo G, Molinari E, Pagnini F. The "common" experience of voice-hearing and its relationship with shame and guilt: a systematic review. BMC Psychiatry 2022; 22:281. [PMID: 35443637 PMCID: PMC9022353 DOI: 10.1186/s12888-022-03902-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite Auditory Verbal Hallucinations (AVHs) having been long associated with mental illness, they represent a common experience also in the non-clinical population, yet do not exhibit distress or need for care. Shame and guilt are emotions related to one's perception of oneself and one's responsibility. As such, they direct our attention to aspects of AVHs that are under-researched and elusive, particularly about the status of voices as others, their social implications and the constitution and conceptualisation of the self. OBJECTIVES This paper aims to provide a systematic review of studies that investigated the relationship between auditory hallucinations, shame, and guilt in people without relevant signs of psychiatric issues. METHODS We searched studies reporting information about voices characteristics, the relationship between voices and hearers, hearer's reactions, and beliefs, paying peculiar attention to shame and guilt issues. Included papers were evaluated for risk of bias. RESULTS Eleven studies that explored the relationship between AVHs, shame and guilt, were extracted. Phenomenological, pragmatic, as well as neuropsychological features of hearing voices in non-clinical populations, allowed us to note a dynamic relationship and the constellation of subjective experiences that can occur. The role of guilt was characterized by few studies and mixed results, while shame was mainly common. CONCLUSIONS Due to the high heterogeneity detected and the scarce sources available, further studies should focus on both the aetiology and the bidirectional relationship between hearing voices, shame, and guilt in non-clinical people. This can be helpful in therapies for non-clinical populations who are distressed by their voices (e.g., psychotherapy), and for whom shame, and guilt may contribute to negative consequences such as isolation, anxiety or future depression. Moreover, it might favour the development and implication of different treatments considering emotion regulation, distress tolerance and interpersonal sensitivity on the clinical populations.
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Affiliation(s)
- E. Volpato
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.418563.d0000 0001 1090 9021IRCCS Fondazione Don Carlo Gnocchi, Milan, Italy
| | - C. Cavalera
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy
| | - G. Castelnuovo
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.418224.90000 0004 1757 9530Istituto Auxologico Italiano IRCCS, Psychology Research Laboratory , Verbania , Italy
| | - E. Molinari
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.418224.90000 0004 1757 9530Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
| | - F. Pagnini
- grid.8142.f0000 0001 0941 3192Present Address: Department of Psychology, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 1, 20123 Milan, Italy ,grid.38142.3c000000041936754XDepartment of Psychology, Harvard University, Cambridge, MA USA
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Bortolon C, Dorahy MJ, Brand R, Dondé C, Slovak S, Raffard S. The effect of voice content and social context on shame: a simulation and vignette paradigm to evaluate auditory verbal hallucinations. Cogn Neuropsychiatry 2022; 27:122-138. [PMID: 34353237 DOI: 10.1080/13546805.2021.1962265] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Recent theoretical models and preliminary data suggest that shame is a central emotion in the context of auditory verbal hallucinations (AVH or voice-hearing). Nevertheless, all previous studies were correlational. Thus, the present study sought to explore whether simulated AVH experiences can trigger shame using an experimental design. METHODS 346 participants from the general population were randomised to one of 6 conditions. They had to read a vignette describing a character who was either in a situation alone or with a close friend. While reading the vignettes, participants also heard either negative or neutral simulated voices or non-voice neutral sounds. Subsequently, participants completed different measures, including shame. RESULTS Our results showed that both the negative and neutral simulated voice-hearing triggered higher levels of shame, but also other negative emotions when compared to ambient sound, regardless of the social context. Participants in the simulated voice-hearing conditions reported higher levels of maladaptive coping strategies and negative beliefs about voices than in the ambient sound condition. CONCLUSIONS The simulation of neutral and negative voices trigger similar levels of subjective shame, indicating the effect is not specific to negative voices but rather associated with the experience per se. Nevertheless, it can also trigger other negative emotions.
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Affiliation(s)
- Catherine Bortolon
- LIP PC2S Lab, Department of Psychology, University Grenoble Alpes, Grenoble, France.,Centre référent de réhabilitation psychosociale et de remédiation cognitive, Centre Hospitalière Alpes Isère, Grenoble, France
| | - Martin J Dorahy
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Rachel Brand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sippy Downs, Australia
| | - Clément Dondé
- Inserm U1216, Grenoble Institut des Neurosciences, CHU Grenoble-Alpes, Université Grenoble Alpes, Grenoble, France
| | | | - Stéphane Raffard
- University Department of Adult Psychiatry, La Colombière Hospital, CHU Montpellier, Montpellier, France.,Univ Paul Valéry Montpellier 3, Univ. Montpellier, Montpellier, France
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12
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Melvin K, Rollins CPE, Cromby J, Crossley J, Garrison JR, Murray GK, Suckling J. Arts-based methods for hallucination research. Cogn Neuropsychiatry 2022; 27:199-218. [PMID: 34708671 DOI: 10.1080/13546805.2021.1993807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Neurocognitive models of hallucinations posit theories of misattribution and deficits in the monitoring of mental or perceptual phenomena but cannot yet account for the subjective experience of hallucinations across individuals and diagnostic categories. Arts-based research methods (ABRM) have potential for advancing research, as art depicts experiences which cognitive neuropsychiatry seeks to explain. METHODS To examine how incorporating ABRM may advance hallucination research and theories, we explore data on the lived experiences of hallucinations in psychiatric and neurological populations. We present a multiple case study of two empirical ABRM studies, which used participant-generated artwork and artist collaborations alongside interviews. RESULTS ABRM combined with interviews illustrated that hallucinations were infused with sensory features, characterised by embodiment, and situated within lived circumstances. These findings advance neurocognitive models of hallucinations by nuancing their multimodal nature, illustrating their embodied feelings, and exploring their content and themes. The process of generating artworks aided in disclosing difficult to discuss hallucinations, promoted participant self-reflection, and clarified multimodal details that may have been misconstrued through interview alone. ABRM were relevant and acceptable for participants and researchers. CONCLUSION ABRM may contribute to the development of neurocognitive models of hallucinations by making hallucination experiences more visible, tangible, and accessible.
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Affiliation(s)
- Katie Melvin
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK.,Innovation, Technology and Operations Division, School of Business, University of Leicester, Leicester, UK
| | | | - John Cromby
- Innovation, Technology and Operations Division, School of Business, University of Leicester, Leicester, UK
| | - Jon Crossley
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, UK.,Leicestershire Partnership NHS Trust, Leicester, UK
| | - Jane R Garrison
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - John Suckling
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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13
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Heriot-Maitland C, Levey V. A case report of compassion-focused therapy for distressing voice-hearing experiences. J Clin Psychol 2021; 77:1821-1835. [PMID: 34252979 DOI: 10.1002/jclp.23211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/07/2021] [Accepted: 06/22/2021] [Indexed: 11/07/2022]
Abstract
This paper describes a 6-month period of compassion-focused therapy (CFT) for a client who has a 35-year history of hearing voices that are threatening, derogatory, and abusive. In this intervention, the client is encouraged to develop compassionate motives toward herself and to her voices, recognizing that her voices may have been functional in the context of difficult early experiences. The client develops a compassionate self-identity, which becomes the vehicle through which she approaches therapeutic tasks, such as listening and talking to voices, engaging with traumatic childhood pain, and resolving emotional conflicts. The client is an author on this study, so is able to provide valuable first-hand insights into the experience of working compassionately with her voices, and of experiencing CFT techniques for the first time.
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14
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Bortolon C, Brand RM, Altman R, Matos M. Beyond trauma: the contribution of characteristics of shame memories, shame, and self-criticism to voice-hearing proneness. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01438-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Heriot-Maitland C, Wykes T, Peters E. Trauma and Social Pathways to Psychosis, and Where the Two Paths Meet. Front Psychiatry 2021; 12:804971. [PMID: 35082703 PMCID: PMC8785245 DOI: 10.3389/fpsyt.2021.804971] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/17/2021] [Indexed: 12/17/2022] Open
Abstract
The pathways from trauma-via dissociation-to psychosis have been thoroughly tested and evidenced, but what has received less attention has been the social pathways-via dissociation-to psychosis. Often social factors are more commonly linked to other influences, e.g., to appraisals and the creation of negative schema in cognitive models, or to unsupportive caregiving experiences where there is high "expressed emotion." However, evidence is now emerging that negative social rank experiences, such as being excluded or shamed, may themselves have dissociative properties, which poses intriguing questions as to how trauma pathways and social pathways might interact. This article reviews the state of knowledge in trauma and social pathways to psychosis and then considers the potential mechanisms and the relationships between them, specifically (i) dissociation, (ii) attachment, and (iii) social rank. Recommendations are suggested for future modeling and testing of three-way interactions (dissociation × attachment × social rank) in the pathway from trauma to psychosis.
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Affiliation(s)
- Charles Heriot-Maitland
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,Institute of Health and Wellbeing, Mental Health Research Facility, University of Glasgow, Glasgow, United Kingdom
| | - Til Wykes
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Emmanuelle Peters
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom.,South London and Maudsley NHS Foundation Trust, London, United Kingdom
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16
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Hallucinations: diagnosis, neurobiology and clinical management. Int Clin Psychopharmacol 2020; 35:293-299. [PMID: 32324611 DOI: 10.1097/yic.0000000000000313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Hallucinations are important diagnostic symptoms in schizophrenia, but also occur in other medical and neuropsychiatric conditions. Not all patients with hallucinations are psychotic. There has been a surge of interest in the topic of hallucinations, as new research data have begun to reveal their neurobiology. Hallucinogenic molecules may also serve as new scaffolds for the development of new psychotropic drugs. We searched and reviewed recent literature, focusing on the refinement of clinical management, which was inspired by new data regarding the neurobiology of hallucination subtypes. We concluded that the successful management of hallucinations depends on accurate differential diagnosis to identify subtypes, which would then determine the most appropriate treatment.
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Carden LJ, Saini P, Seddon C, Evans E, Taylor PJ. Shame, social deprivation, and the quality of the voice-hearing relationship. Psychol Psychother 2020; 93:292-308. [PMID: 30729646 DOI: 10.1111/papt.12216] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 12/05/2018] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Many individuals hold different beliefs about the voices that they hear and have distinct relationships with them, the nature of which may determine the distress experienced. Understanding what factors contribute to these beliefs and relationships and consequently the resulting distress is important. The current research examined whether shame and social deprivation, in a sample of adult voice-hearers, were related to the relationships that individuals had with their voices or the beliefs that they held about them. DESIGN The study utilized a cross-sectional, Internet-based design. METHODS Eighty-seven adult voice-hearers from England were recruited to the online survey. Participants completed measures regarding shame, beliefs about voices, and relationships with voices and provided demographic information and postcodes that were used to refer to Index of Multiple Deprivation data. RESULTS Social deprivation and shame were not associated. Shame was positively associated with variables describing negative voice-hearing beliefs/relationships but not positive voice-hearing beliefs/relationships. Principal component analysis on the eight voice-hearing variables yielded two components related to positive and negative voice-hearing qualities. A multiple regression conducted on the two components identified that shame was only associated with negative voice-hearing qualities. CONCLUSIONS The results suggest that therapies that target shame may be helpful when working with negative voice-hearing beliefs and relationships. Future research should utilize experimental or longitudinal designs to examine the direction of the relationship. PRACTITIONER POINTS The results contribute to the limited research evidence available regarding the relationship between shame and voice-hearing. The results suggest the utility of psychological therapies that focus on shame such as compassion-focused therapy and that conceptualize voices interpersonally such as cognitive analytic therapy. No conclusions can be made regarding causation. The sample size was relatively small, and results cannot be generalized to other areas of the United Kingdom. Future research should utilize experimental and longitudinal designs to examine the impact of shame on voice-hearing experiences and to examine other factors that may predict shame.
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Affiliation(s)
- Louise J Carden
- Single Point of Access, Mersey Care NHS Trust, Liverpool, UK
| | - Pooja Saini
- Institute of Psychology, Health and Society, NIHR CLAHRC NWC, University of Liverpool, UK.,Natural Sciences and Psychology, Liverpool John Moores University, UK
| | - Claire Seddon
- Liverpool Early Intervention Service, Mersey Care NHS Trust, UK
| | - Emma Evans
- Bootle Community Mental Health Team, Mersey Care NHS Trust, UK
| | - Peter James Taylor
- Division of Psychology and Mental Health, Manchester Academic Health Sciences Centre, University of Manchester, UK
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Bortolon C, Raffard S. Affective and cognitive factors associated with hallucination proneness in the general population: the role of shame and trauma-related intrusions. Cogn Neuropsychiatry 2019; 24:406-420. [PMID: 31549568 DOI: 10.1080/13546805.2019.1670152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Feelings of shame may be an important factor implicated in the onset and maintenance of hallucination (or hearing voices). Shame has been shown to increase trauma-related intrusions and avoidance and may reinforce negative beliefs about the self, which in turn may contribute to hallucinations in clinical and non-clinical populations. To our knowledge, no study has so far explored the role of shame in hallucination-proneness. Therefore, the main goal of the present study is to explore the mediation role of shame, trauma-related intrusions and avoidance in the association between childhood trauma and hallucination-proneness.Methods: Self-report questionnaires were used to assess past traumatic experiences, trauma-related symptoms, shame, and hallucination proneness in 175 participants from the general population.Results: Mediation analyses (joint-significance test and Monte Carlo test) showed that both shame and intrusions mediated the association between childhood trauma and hallucination-proneness.Conclusions: Our results reinforce the importance of considering previous experiences of trauma and trauma-related symptoms, including feelings of shame in individuals experiencing hallucinations. Moreover, this study reinforces previous studies showing some preliminary evidence that compassion-focused therapy, whose primary goal is to reduce shame by increasing self-compassion, could have a significant effect on voices whose content is hostile.
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Affiliation(s)
- Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Saint Martin d'Hères, France
| | - Stéphane Raffard
- Service Universitaire de Psychiatrie Adulte, Hôpital La Colombière, Centre Hospitaliere Universitaire de Montpellier, Montpellier, France.,Laboratoire Epsylon, Montpellier, France
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Maladaptive Rumination as a Transdiagnostic Mediator of Vulnerability and Outcome in Psychopathology. J Clin Med 2019; 8:jcm8030314. [PMID: 30841644 PMCID: PMC6463018 DOI: 10.3390/jcm8030314] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/27/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Maladaptive rumination is a form of negative repetitive thinking which has attracted the interest of researchers, as it is considered a cognitive vulnerability to depression. Some of the original beliefs regarding rumination, in particular its exclusive link with depression, have been questioned in the light of research findings. At present, the very concept of rumination is still unclear, so research has been investigating this topic from different, and somewhat inconsistent, perspectives. Methods: A literature review was performed in order to outline some core characteristics of rumination, explain its determinants, and discuss its possible role as a transdiagnostic mediator of vulnerability and outcome in psychopathology. Results: Maladaptive rumination could be interpreted as a dysfunctional coping strategy strictly linked to emotion regulation and metacognition that may occur in several psychopathological conditions, such as psychosis, eating disorders, and alcohol dependence. Conclusion: Evidence allows the interpretation of maladaptive rumination as a transdiagnostic mediator of vulnerability and outcome in psychopathology. Therefore, investigating it from a dimensional perspective may represent a valid research strategy.
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Einboden R, Rudge T, Varcoe C. Beyond and around mandatory reporting in nursing practice: Interrupting a series of deferrals. Nurs Inq 2019; 26:e12285. [PMID: 30801853 DOI: 10.1111/nin.12285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 01/18/2019] [Accepted: 01/19/2019] [Indexed: 12/01/2022]
Abstract
Nurses are well positioned to contribute to child protection efforts but are underutilised. This paper describes a critical discursive analysis of nursing responses to child neglect and abuse (CN&A) in British Columbia, Canada. Legal and practice guidelines were analysed alongside nurse interview texts, offering a glimpse into how nurses prevent CN&A in their everyday practice with families. Results show how the primacy of mandatory reporting to child protection authorities coordinates a series of deferrals and how nurses engage with and interrupt these deferrals in everyday practice. Nurses' relational approaches are essential to gain access to the private sphere of the family to assess, plan, elicit cooperation with interventions and monitor the situation. They considered reporting to be one among many possible responses. This study highlights how nursing contributions to prevention are largely overlooked and points to the potential for a more significant role for nurses in a public health approach to child protection.
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Affiliation(s)
- Rochelle Einboden
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Trudy Rudge
- Faculty of Medicine and Health, The University of Sydney Susan Wakil School of Nursing and Midwifery, Sydney, New South Wales, Australia
| | - Colleen Varcoe
- The University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
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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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Larøi F, Thomas N, Aleman A, Fernyhough C, Wilkinson S, Deamer F, McCarthy-Jones S. The ice in voices: Understanding negative content in auditory-verbal hallucinations. Clin Psychol Rev 2018; 67:1-10. [PMID: 30553563 DOI: 10.1016/j.cpr.2018.11.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 07/23/2018] [Accepted: 11/10/2018] [Indexed: 12/25/2022]
Abstract
Negative voice-content is the best sole predictor of whether the hearer of an auditory-verbal hallucination will experience distress/impairment necessitating contact with mental health services. Yet, what causes negative voice-content and how interventions may reduce it remains poorly understood. This paper offers definitions of negative voice content and considers what may cause negative voice-content. We propose a framework in which adverse life-events may underpin much negative voice-content, a relation which may be mediated by mechanisms including hypervigilance, reduced social rank, shame and self-blame, dissociation, and altered emotional processing. At a neurological level, we note how the involvement of the amygdala and right Broca's area could drive negative voice-content. We observe that negative interactions between hearers and their voices may further drive negative voice-content. Finally, we consider the role of culture in shaping negative voice-content. This framework is intended to deepen and extend cognitive models of voice-hearing and spur further development of psychological interventions for those distressed by such voices. We note that much of the relevant research in this area remains to be performed or replicated. We conclude that more attention needs to be paid to methods for reducing negative voice-content, and urge further research in this important area.
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Affiliation(s)
- Frank Larøi
- Department of Biological and Medical Psychology, University of Bergen, Jones Lies vei 91, Bergen 5009, Norway; Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium; NORMENT - Norwegian Centre of Excellence for Mental Disorders Research, University of Oslo, Oslo, Norway.
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Monash Alfred Psychiatry Research Centre, The Alfred and Monash University Central Clinical School, Melbourne, Australia
| | - André Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sam Wilkinson
- Department of Sociology, Philosophy and Anthropology, University of Exeter, Exeter, UK
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Bowman D. Vulnerability, survival and shame in Nina Raine's Tiger Country. MEDICAL HUMANITIES 2017; 43:264-268. [PMID: 29079608 DOI: 10.1136/medhum-2017-011354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
Shame in healthcare remains relatively underexplored, yet it is commonplace and its impact is significant. This paper explores shame in healthcare using Nina Raine's 2011 play Tiger Country Three manifestations of shame are explored, namely (1) shame in relation to professional identity and survival in the clinical workplace; (2) shame and illness as experienced by both patients and doctors; and (3) the systemic and organisational influences on shame within healthcare systems. I suggest that the theatre is particularly well-placed to elucidate shame, and that Tiger Country demonstrates the prevalence and impact of shame on clinical work. Shame has a fundamental and overlooked relationship with damaging and well-documented phenomena in healthcare, including moral distress, ethical erosion, compassion fatigue, burnout, stress and ill health. Attention to shame is essential for those interested in medicine and healthcare and must, I propose, include the experiences and perceptions of those who provide care, as well as attending to those who receive care.
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