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Puckett J, Sood M, Newman-Taylor K. Does insecure attachment lead to psychosis via dissociation? A systematic review of the literature. Psychol Psychother 2024; 97:372-392. [PMID: 38358073 DOI: 10.1111/papt.12521] [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: 04/11/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024]
Abstract
PURPOSE Insecure attachment may constitute a vulnerability factor for psychosis, and dissociation may be a key mechanism in the development of auditory hallucinations specifically. While there is good evidence for the role of these processes in isolation, it is unclear whether dissociation accounts for the association between insecure attachment and psychosis. This systematic review takes a theory-driven approach to examine proposed causal relationships across the clinical and nonclinical literature. METHODS We searched five databases (PubMeD, Web of Science, PsycINFO, CINAHL and ETHOS) for published and unpublished research examining attachment, dissociation and psychosis. Two independent reviewers extracted the data and assessed the quality of all included studies. RESULTS We identified 242 potential articles and included 13 in the final review (2096 participants). We found that (1) disorganised attachment was consistently associated with dissociation and inconsistently associated with voices and paranoia, (2) dissociation was associated with voices and paranoia, and these links were stronger in clinical samples, and (3) dissociation played a role in the impact of insecure attachment on voice hearing and paranoia in clinical groups. CONCLUSIONS This is the first review to synthesise the research examining attachment, dissociation, and psychosis. The evidence is consistent with proposed causal hypotheses and raises conceptual and measurement issues, for example, the need to clarify the relative contributions of different insecure attachment styles, and utilise behavioural/observational measures to strengthen study designs. Most importantly, we need experimental and longitudinal studies to confirm causal links and targets for treatment.
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Affiliation(s)
- Joseph Puckett
- Psychology Department, University of Southampton, Southampton, UK
| | - Monica Sood
- Psychology Department, University of Southampton, Southampton, UK
| | - Katherine Newman-Taylor
- Psychology Department, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
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2
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Hardy A, Keen N, van den Berg D, Varese F, Longden E, Ward T, Brand RM. Trauma therapies for psychosis: A state-of-the-art review. Psychol Psychother 2024; 97:74-90. [PMID: 37795877 DOI: 10.1111/papt.12499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 08/11/2023] [Accepted: 09/10/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Traumatic events, particularly childhood interpersonal victimisation, have been found to play a causal role in the occurrence of psychosis and shape the phenomenology of psychotic experiences. Higher rates of post-traumatic stress disorder (PTSD) and other trauma-related mental health problems are also found in people with psychosis diagnoses compared to the general population. It is, therefore, imperative that therapists are willing and able to address trauma and its consequences when supporting recovery from distressing psychosis. METHOD This paper will support this need by providing a state-of-the-art overview of the safety, acceptability and effects of trauma therapies for psychosis. RESULTS We will first introduce how seminal cognitive-behavioural models of psychosis shed light on the mechanisms by which trauma may give rise to psychotic experiences, including a putative role for trauma-related emotions, beliefs and episodic memories. The initial application of prolonged exposure and eye movement and desensitation and reprocessing therapy (EMDR) for treating PTSD in psychosis will be described, followed by consideration of integrative approaches. These integrative approaches aim to address the impact of trauma on both post-traumatic stress symptoms and trauma-related psychosis. Integrative approaches include EMDR for psychosis (EMDRp) and trauma-focused Cognitive-Behavioural Therapy for psychosis (tf-CBTp). Finally, emerging dialogic approaches for targeting trauma-related voice-hearing will be considered, demonstrating the potential value of adopting co-produced (Talking with Voices) and digitally augmented (AVATAR) therapies. CONCLUSION We will conclude by reflecting on current issues in the area, and implications for research and clinical practice.
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Affiliation(s)
- Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Nadine Keen
- South London and Maudsley NHS Foundation Trust, London, UK
| | - David van den Berg
- Mark van der Gaag Research Centre, Parnassia Psychiatric Institute, The Hague, The Netherlands
- Vrije University, Amsterdam, The Netherlands
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Eleanor Longden
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Thomas Ward
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Rachel M Brand
- School of Health, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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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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Strachan LP, Paulik G, Preece DA, McEvoy PM. Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation. Psychol Psychother 2023; 96:934-951. [PMID: 37493351 DOI: 10.1111/papt.12486] [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: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. AIMS This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. MATERIALS The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. METHODS We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. RESULTS Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). DISCUSSION Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. CONCLUSION Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Preece
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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Strachan LP, Paulik G, Roberts L, McEvoy PM. Voice hearers' explanations of trauma-related voices and processes of change throughout imagery rescripting: A qualitative exploration. Psychol Psychother 2023; 96:982-998. [PMID: 37638740 DOI: 10.1111/papt.12491] [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: 10/31/2022] [Revised: 08/01/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Post-traumatic stress is common among people who hear voices (auditory verbal hallucinations), many of whom hear trauma-related voices, whereby voice content is related to past trauma. Preliminary evidence suggests that imagery rescripting (ImRs) may more effectively reduce post-traumatic stress and voices compared to treatments that are based on existing models of PTSD or positive symptoms. No known studies have explored the potential maintaining factors of trauma-related voices in relation to ImRs. We aimed to uncover insights into the factors that maintain trauma-related voices and how ImRs may influence such factors by exploring voice hearers' explanations of voices and experiences of change throughout ImRs. DESIGN Thematic analytical methodology was used due to the study's critical epistemological framework. METHODS Semi-structured interviews explored relationships between trauma and voices, and experiences of change and stability throughout ImRs in a transdiagnostic sample (N = 10) who underwent 10-18 weekly ImRs sessions. Thematic analysis was used to develop themes. RESULTS Two themes captured explanations of voices, which suggested voices may have counterproductive protective functions. Three themes captured psychological experiences during ImRs, which reflected concepts such as freedom to experience emotions, and experiences of justice, closure and grieving. Three themes described the outcomes of ImRs, reflecting concepts such as increased confidence, coping, perceived safety and voices becoming less powerful. CONCLUSIONS Trauma-related voices may have underlying protective functions and ImRs may support emotional expression, adaptive trauma re-appraisals and improve self-worth and coping self-efficacy. These change processes may have clinical implications in ImRs and other treatments for trauma-affected voice hearers.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Lynne Roberts
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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Piesse E, Paulik G, Mathersul D, Valentine L, Kamitsis I, Bendall S. An exploration of the relationship between voices, dissociation, and post-traumatic stress disorder symptoms. Psychol Psychother 2023; 96:1015-1028. [PMID: 37800445 DOI: 10.1111/papt.12493] [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: 11/30/2022] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Extensive research has shown voice hearing to be associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and dissociation. However, most studies have adopted a quantitative design, using cross-sectional data sampling methods, precluding temporal relationships between variables from being defined. DESIGN Using a qualitative design, this study sought to identify potential symptom relationships by addressing the research question: what is the nature of the temporal relationship between voices, dissociation and PTSD symptoms? METHODS Seven voice hearers (aged 27 to 68 years) participated in a semi-structured interview exploring voice hearing, PTSD symptoms, and dissociation. The interviews were analysed using Interpretative Phenomenological Analysis. RESULTS One superordinate theme was identified in the data. Voices were observed to occur in dynamic interrelationship with PTSD symptoms and dissociation, and were frequently experienced before and after PTSD symptoms and dissociative episodes. CONCLUSIONS Implications for theoretical understandings of voice hearing and future research are discussed.
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Affiliation(s)
- Emily Piesse
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Perth Voices Clinic, Murdoch University, Murdoch, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Nedlands, Western Australia, Australia
| | - Danielle Mathersul
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Lee Valentine
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Ilias Kamitsis
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Puckett J, Sood M, Newman-Taylor K. Does disorganised attachment lead to auditory hallucinations via dissociation? An experimental study with an analogue sample. Psychol Psychother 2023; 96:868-884. [PMID: 37283236 DOI: 10.1111/papt.12477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Auditory hallucinations (such as hearing voices) are common in clinical and non-clinical populations. Many people who hear voices also report early adversity and have an insecure attachment style. Current cognitive models suggest that dissociation mediates an association between disorganised attachment and auditory hallucinations, but this has not been tested experimentally. DESIGN We recruited a non-clinical analogue sample highly predisposed to auditory hallucinations and utilised an experimental design to examine the impact of disorganised attachment imagery on hallucinatory experiences, and whether dissociation mediates an expected association. METHODS Participants completed self-report measures of state auditory hallucinations and dissociation before and after random allocation to secure or disorganised attachment conditions. RESULTS Attachment imagery did not affect auditory hallucinations. Both secure and disorganised attachment conditions increased state dissociation. Secure attachment imagery reduced paranoia, but state dissociation did not mediate this effect. An exploratory analysis found that trait dissociation fully accounted for the association between trait-disorganised attachment and hallucinatory experience while controlling for paranoia. CONCLUSIONS Secure attachment imagery reduces paranoia but not auditory hallucinations and the impact on paranoia is not mediated by dissociation. Secure attachment imagery may be useful in reducing fears and distress associated with voices, rather than the frequency or severity of hallucinations. Disorganised attachment may increase hallucinatory experiences for people vulnerable to dissociation. Trait dissociation should be assessed in clinical settings and addressed where indicated as a means of targeting vulnerability to distressing voices.
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Affiliation(s)
- Joseph Puckett
- Psychology Department, University of Southampton, Southampton, UK
| | - Monica Sood
- Psychology Department, University of Southampton, Southampton, UK
| | - Katherine Newman-Taylor
- Psychology Department, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
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8
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de With J, de Haan L, Schirmbeck F. Attachment Style and Self-Experience: The Association Between Attachment Style and Self-Reported Altered Self-Experience in Patients With Psychotic Disorders, Unaffected Siblings, and Healthy Controls. J Nerv Ment Dis 2023; 211:440-447. [PMID: 36971431 DOI: 10.1097/nmd.0000000000001634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/15/2023]
Abstract
ABSTRACT The present study aimed to examine the cross-sectional association between attachment style and self-reported disturbed self-awareness (disturbed sense of mineness of experiences) and depersonalization (disturbed sense of first-person perspective) in patients with psychotic disorders, unaffected siblings, and healthy controls. Data pertain to a subsample of the GROUP (Genetic Risk and Outcome of Psychosis) study. We found positive associations between anxious attachment and disturbed self-awareness and depersonalization across participants with different psychosis vulnerability. We also found a positive association between avoidant attachment and depersonalization, although on a trend level. Findings indicate that attachment style is associated with self-reported disturbed self-awareness and depersonalization over and above the influence of psychotic or depressive experiences in people across the vulnerability spectrum of psychosis. This supports the importance of attachment style, self-awareness, and depersonalization as potential targets in prevention and treatment interventions in patients with psychotic disorders or those with increased vulnerability.
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Affiliation(s)
- Justine de With
- Early Psychosis Department, Amsterdam UMC (location AMC), Department of Psychiatry; and
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9
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Astill Wright L, McElroy E, Barawi K, Roberts NP, Simon N, Zammit S, Bisson JI. Associations among psychosis, mood, anxiety, and posttraumatic stress symptoms: A network analysis. J Trauma Stress 2023; 36:385-396. [PMID: 36862599 DOI: 10.1002/jts.22916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/30/2022] [Accepted: 12/21/2022] [Indexed: 03/03/2023]
Abstract
The associations among psychotic experiences (i.e., hallucinations and delusions), trauma exposure, and posttraumatic stress symptoms are complex and multidirectional. Using network analysis to understand how psychotic experiences and symptoms of posttraumatic stress disorder (PTSD) relate to one another may identify new interventional targets to treat comorbidity and its underlying pathological processes. This study aimed to use network analysis to examine the associations among psychotic experiences; negative symptoms of psychosis; and symptoms of PTSD, anxiety, and depression. In this population-based cohort study, 4,472 participants (36.7% male) were assessed for psychotic experiences, negative symptoms of psychosis, PTSD, anxiety, and depression at age 23 (M = 23.86 years, SD = 0.520) or 24 years (M = 24.03, SD = 0.848). Associations among symptoms were assessed via network analysis. Exploratory graph analysis identified three clusters of densely connected symptoms within the overall network: psychotic experiences; PTSD symptoms; and depressive and anxiety symptoms and negative symptoms of psychosis. Psychotic experiences had the strongest associations with other symptoms in the network, and symptoms of anxiety played a key role in bridging psychotic experiences, symptoms of PTSD, and depressive symptoms. Consistent with the stress reactivity and affective models for psychotic experiences, the results suggest that symptoms of anxiety and emotional distress (e.g., hyperarousal, panic) may have a key role in the development and maintenance of psychotic experiences and symptoms of PTSD. Targeting these symptoms may ameliorate symptom burden transdiagnostically.
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Affiliation(s)
- Laurence Astill Wright
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Eoin McElroy
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, Leicester, United Kingdom
| | - Kali Barawi
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Neil P Roberts
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
- Directorate of Psychology and Psychological Therapies, Cardiff & Vale University Health Board, Cardiff, United Kingdom
| | - Natalie Simon
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
| | - Stanley Zammit
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
- Centre for Academic Mental Health, Population Health Sciences, University of Bristol, Bristol, United Kingdom
| | - Jonathan I Bisson
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Cardiff, United Kingdom
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10
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Pollard C, Bucci S, Berry K. A systematic review of measures of adult disorganized attachment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:329-355. [PMID: 36775812 DOI: 10.1111/bjc.12411] [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: 09/14/2022] [Revised: 01/13/2023] [Accepted: 01/22/2023] [Indexed: 02/14/2023]
Abstract
BACKGROUND Disorganized attachment has been identified as an important factor in the development and maintenance of mental health problems. Further research is required to understand the mechanism by which this attachment pattern predisposes individuals to develop, and maintain, personal and social difficulties and mental health problems utilizing valid and reliable measurement tools. The assessment of adult disorganized attachment is therefore important for both applied psychologists and researchers. METHOD We conducted a systematic review using the COSMIN guidelines to identify and critically appraise instruments which measure adult disorganized attachment. A systematic database search was performed using MEDLINE, EMBASE, Web of Science, PsychInfo and CINHAL in accordance with PRISMA guidelines. RESULTS Database searching provided 5757 results, with 18 measures identified across 27 eligible papers which were critically evaluated. Measurement properties were promising for the Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale, Attachment Style Questionnaire - Short Form and the Adult Attachment Interview. However, overall, due to inconsistent quality of methodology and reporting of results, it is challenging to reach sufficient conclusions and suggestions regarding the best instrument to use to measure adult disorganized attachment. CONCLUSION The Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale. Attachment Style Questionnaire-Short-Form and Adult Attachment Interview are the best available measures of disorganized attachment in adulthood. This review highlights the need for further psychometric testing of existing measures, or development of new instruments, grounded in sound methodology.
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Affiliation(s)
- Catherine Pollard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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11
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Lawrence K, Bucci S, Berry K, Carter L, Taylor P. Fluctuations in proximity seeking and paranoia. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1019-1037. [PMID: 35570710 PMCID: PMC9790696 DOI: 10.1111/bjc.12372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 04/19/2022] [Accepted: 04/21/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study aimed to investigate associations between proximity seeking, stress and paranoia in the context of daily life, and whether these relationships are moderated by trait attachment styles. METHODS Sixty non-clinical participants completed 3423 assessments of state stress, proximity seeking and paranoia over a 6-day period using an experience sampling method. Multilevel linear regression was performed to evaluate relationships between variables. RESULTS The post-hoc analysis showed antecedent events subjectively appraised as very unpleasant or very pleasant predicted greater levels of momentary proximity seeking at the subsequent timepoint. Greater stress predicted greater subsequent shifts or variability in proximity seeking. Changes in proximity seeking were not associated with momentary paranoia. However, for individuals with an avoidant attachment style, greater shifts in proximity seeking resulted in greater subsequent reports of paranoia. CONCLUSIONS These findings suggest that, in daily life, the attachment system may become active in response to stress. For those with an avoidant attachment style, an active attachment system may exacerbate paranoid thoughts possibly due to the activation of attachment-related beliefs that one should be fearful of unavailable others and instead rely on one's autonomy to regulate affect. These findings highlight the need to consider attachment in the assessment and formulation of paranoia.
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Affiliation(s)
- Kate Lawrence
- Division of Psychology and Mental HealthManchester Academic Health Science CentreFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Sandra Bucci
- Division of Psychology and Mental HealthManchester Academic Health Science CentreFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Katherine Berry
- Division of Psychology and Mental HealthManchester Academic Health Science CentreFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK,Greater Manchester Mental Health NHS Foundation TrustManchesterUK
| | - Lesley‐Anne Carter
- Division of Psychology and Mental HealthManchester Academic Health Science CentreFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
| | - Peter Taylor
- Division of Psychology and Mental HealthManchester Academic Health Science CentreFaculty of Biology, Medicine and HealthThe University of ManchesterManchesterUK
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12
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Strachan LP, Paulik G, McEvoy PM. A narrative review of psychological theories of post-traumatic stress disorder, voice hearing, and other psychotic symptoms. Clin Psychol Psychother 2022; 29:1791-1811. [PMID: 35578567 PMCID: PMC10084244 DOI: 10.1002/cpp.2754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 05/12/2022] [Accepted: 05/15/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Most voice hearers report childhood trauma. Many voice hearers report comorbid post-traumatic stress symptoms and that the content of their voices (auditory verbal hallucinations) is directly (voices repeat phrases spoken by perpetrators) or indirectly (voice content and trauma is thematically similar) related to their trauma. The factors that maintain trauma-related voices are unknown, and there is limited research in this area. This study aimed to identify potential maintaining factors of trauma-related voices by reviewing models of post-traumatic stress disorder (PTSD) and positive symptoms of psychosis. METHOD Models of PTSD and positive symptoms were reviewed to identify potential factors that are unique and common to both sets of symptoms. RESULTS We reviewed 10 models of PTSD, 4 models of positive symptoms, and 2 trauma-informed models of voice hearing. One model provided a theoretical explanation of different types of trauma-related voices. Twenty-one factors were extracted from 16 theoretical models. No existing model incorporated all these factors. DISCUSSION Existing PTSD and positive symptom models present a range of common and unique factors. There may be value in extending existing integrative models to include a broader range of potential factors that could explain different pathways to, and expressions of, trauma-related voices. A future research agenda is presented to investigate how such an extension could lead to more complete individualized case formulations and targeted treatments.
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Affiliation(s)
- Laura P Strachan
- School of Population Health, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia.,Perth Voices Clinic, Murdoch, Western Australia, Australia.,School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- School of Population Health, Curtin University, Perth, Western Australia, Australia.,enAble Institute, Curtin University, Perth, Western Australia, Australia.,Centre for Clinical Interventions, Perth, Western Australia, Australia
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Partridge O, Maguire T, Newman-Taylor K. How does attachment style affect psychosis? A systematic review of causal mechanisms and guide to future inquiry. Psychol Psychother 2022; 95:345-380. [PMID: 34687273 DOI: 10.1111/papt.12371] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 07/19/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The link between attachment and psychosis is now well established, but less is known about the causal mechanisms underlying this relationship. This systematic review synthesises the studies that examine mediating mechanisms in the attachment and psychosis relationship, in both clinical and non-clinical samples. METHOD We conducted a database search (PsychINFO, MEDLINE, Web of Science) to identify all eligible studies irrespective of publication status, the language of article or article date. We assessed methodological quality and completed a narrative synthesis given the heterogeneity of studies to date. RESULTS We identified 17 papers, comprising 3,672 participants. The relationship between attachment and psychosis is mediated by four variables or groups of variables. There is good evidence for the causal role of affective factors (affective dysregulation and affective disturbances) and cognitive factors (e.g., self-beliefs and self-esteem and beliefs about symptoms). Affective factors differed by attachment style. Tentative evidence was found for the role of duration of untreated psychosis and baseline negative symptoms. CONCLUSIONS Cognitive and affective factors mediate the relationship between attachment style and psychosis. Whilst cognitive factors are routinely targeted in recommended psychological interventions for psychosis, affective factors and attachment style are less commonly considered. Psychological therapies may be improved by calibrating cognitive and affective interventions by attachment style, which should be subjected to experimental and then field studies to assess the impact on clinical and recovery outcomes. PRACTITIONER POINTS The relationship between attachment and psychosis is now well established, and studies have started to examine mediating mechanisms. Affective and cognitive factors mediate the attachment-psychosis relationship. Affective factors differ by attachment style. There is limited evidence for the duration of untreated psychosis and negative psychotic symptoms as mediating mechanisms, and research replication is needed. Cognitive factors are routinely targeted in recommended psychological therapies for psychosis, but affective factors and attachment style are less commonly considered. Research should be conducted into the effectiveness of psychological therapies which calibrate cognitive and affective interventions, according to attachment style.
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Affiliation(s)
| | - Tess Maguire
- Department of Psychology, University of Southampton, UK
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Sood M, Carnelley KB, Newman-Taylor K. How does insecure attachment lead to paranoia? A systematic critical review of cognitive, affective, and behavioural mechanisms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:781-815. [PMID: 35178714 PMCID: PMC9542899 DOI: 10.1111/bjc.12361] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Background The relationship between attachment and paranoia is now well established. There is good theoretical reason and evidence to indicate that attachment style affects cognitive, affective, and behavioural processes which, in turn, contribute to the maintenance of paranoia, but this research has not been integrated. We critically and systematically review research that examines relevant cognitive, affective, and behavioural processes, which may explain how attachment insecurity leads to paranoia and constitute key targets in psychotherapeutic interventions for people with psychosis. Method We conducted three systematic searches across six databases (PsycINFO, CINAHL, Medline, Web of Science, Embase, and Google Scholar), from inception to September 2021, to investigate key cognitive, affective, and behavioural processes in the attachment–paranoia association. Results We identified a total of 1930 papers and critically reviewed 16. The literature suggests that negative self‐ and other‐beliefs, inability to defuse from unhelpful cognitions, and use of maladaptive emotion regulation strategies mediate the association between attachment insecurity and paranoia in people with psychosis/psychotic experience. Attachment‐secure people with psychosis are more likely to seek help and engage with services than attachment‐insecure people. Conclusions Attachment styles impact help‐seeking behaviours in people with psychosis and are likely to influence paranoia via self‐ and other‐beliefs, cognition fusion, and emotion regulation – these candidate mechanisms may be targeted in psychological therapy to improve clinical outcomes for people with psychosis, characterized by paranoia. Practitioner points Insecure attachment is likely to lead to paranoia via negative beliefs about self and others, cognitive fusion, and use of maladaptive emotion regulation strategies. These mechanisms can be targeted in psychotherapeutic interventions for psychosis, such as cognitive behaviour therapy, to improve clinical and recovery outcomes. People with psychosis who are attachment‐secure are more likely to seek help and engage with services than those who are attachment‐insecure (particularly avoidant). Attachment style can be assessed to predict service engagement and help‐seeking behaviours in people with psychosis. Attachment styles are important predictors of key cognitive, affective, and behavioural processes in people with psychosis. These processes can be assessed and incorporated into individualised formulations, and then targeted in therapy to effect psychotherapeutic change.
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Affiliation(s)
- Monica Sood
- School of Psychology, University of Southampton, UK
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15
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Formulating psychosis: a thematic analysis of CBTp trainees’ experiences. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Abstract
The NICE guidance states that cognitive behavioural therapy (CBT) should now be offered to everyone with psychosis in the UK. This has rightly resulted in an increased demand for adherent therapy from qualified clinicians. Individualised formulation is a key component of CBT for psychosis, yet many trainees struggle to make sense of and apply the theoretical models on which these are based. This study explored trainee and recently qualified therapists’ experience of formulating CBT for psychosis, to help us understand how best to guide training and clinical practice. We ran focus groups with trainees who were completing, or had recently completed, postgraduate training in CBT for psychosis. We then analysed verbatim transcripts of the semi-structured interviews. and completed a thematic analysis of the data using inductive open coding. Three over-arching themes were generated: (1) purpose of formulation, (2) formulation in practice, and (3) (reflection on) learning to formulate. Training programmes and clinical supervisors should focus on fostering trainees’ and newly qualified therapists’ ability to develop simple, targeted formulations. These will draw on maintenance and developmental models of psychosis, depending on the person’s needs and goals. Opportunities for procedural learning are likely to improve skilful formulation, and use as the basis for therapeutic change.
Key learning aims
(1)
CBT for psychosis is best guided by individualised formulation.
(2)
The range and complexity of current theoretical models is challenging.
(3)
A qualitative analysis of trainee and recently qualified therapists’ experiences highlights means of facilitating understanding and application of these models.
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Hardy A, O'Driscoll C, Steel C, van der Gaag M, van den Berg D. A network analysis of post-traumatic stress and psychosis symptoms. Psychol Med 2021; 51:2485-2492. [PMID: 32419682 DOI: 10.1017/s0033291720001300] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Understanding the interplay between trauma-related psychological mechanisms and psychotic symptoms may improve the effectiveness of interventions for post-traumatic stress reactions in psychosis. Network theory assumes that mental health problems persist not because of a common latent variable, but from dynamic feedback loops between symptoms, thereby addressing the heterogeneous and overlapping nature of traumagenic and psychotic diagnoses. This is a proof-of-concept study examining interactions between post-traumatic stress symptoms, which were hypothesized to reflect trauma-related psychological mechanisms, and auditory hallucinations and delusions. METHOD Baseline data from two randomised controlled trials (N = 216) of trauma-focused therapy in people with post-traumatic stress symptoms (87.5% met diagnostic criteria for PTSD) and psychotic disorder were analysed. Reexperiencing, hyperarousal, avoidance, trauma-related beliefs, auditory hallucinations and delusional beliefs were used to estimate a Gaussian graphical model along with expected node influence and predictability (proportion of explained variance). RESULTS Trauma-related beliefs had the largest direct influence on the network and, together with hypervigilance, were implicated in the shortest paths from flashbacks to delusions and auditory hallucinations. CONCLUSIONS These findings are in contrast to previous research suggesting a central role for re-experiencing, emotional numbing and interpersonal avoidance in psychosis. Trauma-related beliefs were the psychological mechanism most associated with psychotic symptoms, although not all relevant mechanisms were measured. This work demonstrates that investigating multiple putative mediators may clarify which processes are most relevant to trauma-related psychosis. Further research should use network modelling to investigate how the spectrum of traumatic stress reactions play a role in psychotic symptoms.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, De Crespigny Park, SE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent, BR3 3BX, UK
| | - Ciaran O'Driscoll
- Research Department of Clinical, Educational and Health Psychology, University College London, Gower Street, London, WC1E 6BT, UK
| | - Craig Steel
- The Oxford Institute of Clinical Psychology Training, Oxford, UK
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Health Research, VU University, van der Boehorsttraat 7, 1081 BTAmsterdam, The Netherlands
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HNDen Haag, Netherlands
| | - David van den Berg
- Department of Clinical Psychology and Amsterdam Public Health Research, VU University, van der Boehorsttraat 7, 1081 BTAmsterdam, The Netherlands
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HNDen Haag, Netherlands
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17
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Barnes GL, Garety PA, Emsley R, Jameel L, Hardy A. Is there an association between caregiver antipathy and psychosis? A systematic review. Psychol Psychother 2021; 94:798-821. [PMID: 33595172 DOI: 10.1111/papt.12328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/22/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Existing reviews of trauma and psychosis have identified associations between childhood emotional abuse (CEA) and psychosis. However, conceptual issues relating to assessment of CEA limit the conclusions that can be drawn from the literature. The aim of this review was to identify and evaluate studies reporting an association between childhood experiences of caregiver antipathy (i.e. criticism, hostility, coldness, or rejection from a parental figure experienced prior to age 17 years) and psychosis symptoms/diagnosis. METHODS Five databases were systematically searched for articles published until May 2020. Studies were evaluated against inclusion/exclusion criteria, and a narrative synthesis of findings was completed. Study quality was assessed by two independent raters. RESULTS Fourteen studies comprised of 1,848 participants met inclusion criteria. Twelve of these studies found significant associations between caregiver antipathy and psychosis, and two did not. There was evidence that adults with schizophrenia-spectrum diagnoses report more severe caregiver antipathy in childhood than non-clinical controls and that caregiver antipathy severity is positively correlated with psychosis symptom severity. Most studies received weak or moderate quality ratings and all used cross-sectional or case-control designs which showed associations, rather than causal relationships, between childhood caregiver antipathy and later psychosis. CONCLUSIONS Future research would benefit from more rigorous and valid assessment of CEA, use of multivariate methods to account for possible patterns of co-occurrence, and longitudinal study designs to make more robust causal claims. The findings may have important implications for the delivery of psychological care for people with psychosis who report adverse caregiving experiences. PRACTITIONER POINTS People with schizophrenia-spectrum diagnoses may report more severe caregiver antipathy in childhood than non-clinical controls. Caregiver antipathy severity appears to be positively correlated with psychosis symptom severity in clinical and non-clinical populations. Clinicians should consider the possible impact of caregiver antipathy on psychosis symptoms, their content and distress maintenance. Clinicians should also recognise the potential impact of adverse caregiving experiences on therapeutic relationships, patterns of help-seeking and service engagement. Best practice in clinical services would be to adopt individual, formulation-based approaches within trauma-informed models of care.
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Affiliation(s)
- Georgina L Barnes
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
| | - Philippa A Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
| | - Richard Emsley
- Department of Biostatistics & Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Leila Jameel
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK.,South London & Maudsley NHS Trust, Maudsley Hospital, London, UK
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Varela LF, Wong KHT, Shergill SS, Fett AKJ. Attachment styles moderate Theory of Mind differences between persons with schizophrenia, first-degree relatives and controls. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 60:339-356. [PMID: 34036577 DOI: 10.1111/bjc.12308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 05/04/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Theory of Mind (ToM) plays a role in social functioning and is impaired in patients with schizophrenia and to a lesser degree in first-degree relatives, compared to healthy controls. This study investigates whether attachment styles moderate these observed group differences in ToM. METHODS This cross-sectional study included a sample of 51 patients, 23 first-degree relatives, and 49 controls who completed assessments of anxious and avoidant attachment (Psychosis Attachment Measure), ToM (Reading the Mind in the Eyes Test), and estimated cognitive ability. Patients' symptoms were assessed with the Positive and Negative Syndrome Scale. RESULTS Patients differed from controls and relatives in ToM performance but not in attachment avoidance or attachment anxiety. Attachment anxiety showed an interaction with group over ToM. The interaction was significant only between patients and controls but not between patients and relatives or relatives and controls. Post-hoc analysis showed that patients and controls showed differential ToM performance at average and high attachment anxiety. In patients, symptom levels did not moderate the association between attachment and ToM. CONCLUSIONS Attachment anxiety is related to poorer levels of ToM in patients, suggesting this may have a contributory role in schizophrenia. The findings stress the need for longitudinal research into the directionality of the relationship between ToM and attachment anxiety. PRACTITIONER POINTS Relationships with significant others might be a factor that influences the way in which social information is processed by persons with a diagnosis of a psychotic disorder. In patients, higher levels of attachment anxiety - that is, low self-worth, fear of abandonment and rejection, continuous vigilance of threat-related cues - were associated with a lower ability to understand the mental states of others. However, at lower levels of attachment anxiety, their ToM performance was comparable to that of relatives and controls. This effect was not influenced by symptom severity. Further research is required to confirm the potential influence of attachment insecurity on ToM ability as the latter is strongly related to patient's functional outcomes.
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Affiliation(s)
- Luis F Varela
- Unidad de Psiquiatría, Escuela de Medicina, Facultad de Medicina, Universidad Andres Bello, Santiago, Chile.,Servicio de Psiquiatría y Salud Mental, Hospital CRS El Pino, Servicio de Salud Metropolitano Sur, Santiago, Chile.,Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Katie H T Wong
- Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Sukhi S Shergill
- Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Anne-K J Fett
- Cognition, Schizophrenia and Imaging Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK.,Department of Psychology, School of Arts and Social Sciences, City, University of London, UK
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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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20
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Pipkin A, Hogg L, Armitage S. 'Someone on my level': A Meta-Ethnographic Review of Therapeutic Relationships in Cognitive Behavioural Therapy for Psychosis. Clin Psychol Psychother 2021; 28:1297-1313. [PMID: 33605515 DOI: 10.1002/cpp.2578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Cognitive Behavioural Therapy for Psychosis (CBTp) demonstrates variable and at times mild to moderate effect sizes; thus, its therapeutic processes are important to explore. Establishing a secure therapeutic relationship is one such key process where barriers may exist, including those related to psychotic symptoms and associated stigma. This review synthesizes the available qualitative research pertaining to the experience of the therapeutic relationship from the perspective of those experiencing psychosis. METHODS A systematic review was undertaken using PRISMA guidelines. Search terms included variants of 'psychosis', 'therapy' and 'qualitative'. PsycInfo, CINAHL, EmBase, MedLine and Web of Science were searched, and reference lists were hand-scanned. Yardley's quality appraisal tool was utilized and Noblit and Hare's seven-stage process for conducting a meta-ethnographic review. A line-of-argument synthesis is presented. RESULTS Fourteen papers were identified using inclusion and exclusion criteria. Twelve papers were deemed to have satisfactory quality. The line-of-argument synthesis used attachment theory to propose four semi-distinct stages to establishing a therapeutic relationship: beginning; safety, hope and trust; the practicalities of therapy; and branching out. Findings suggest that the therapist's persona and use of CBTp techniques such as collaboration and shared agency over the process were important in establishing for the patient a sense of self as normal, equal and worthwhile. CONCLUSIONS Attachment security may be an important strand of CBTp and warrants further research and clinical investigation as a process and an outcome. Future research can benefit from increased transparency regarding researcher positionality as a potential source of bias.
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Affiliation(s)
- Alastair Pipkin
- Senior Clinical Psychologist, Northamptonshire Gender Service, Northamptonshire Healthcare NHS Foundation Trust, Northamptonshire, UK
| | - Lorna Hogg
- Deputy Director and Consultant Clinical Psychologist, Oxford Institute of Clinical Psychology Training, University of Oxford and Oxford Health NHS Foundation Trust, Oxford, UK
| | - Sarah Armitage
- Clinical Psychologist, Berkshire Early Intervention in Psychosis Service, Berkshire Healthcare NHS Foundation Trust, Bracknell, UK
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21
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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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22
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Scott M, Rossell SL, Meyer D, Toh WL, Thomas N. Childhood trauma, attachment and negative schemas in relation to negative auditory verbal hallucination (AVH) content. Psychiatry Res 2020; 290:112997. [PMID: 32470717 DOI: 10.1016/j.psychres.2020.112997] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/30/2022]
Abstract
Auditory verbal hallucinations (AVHs, or hearing voices) are particularly characterized by negative content such as criticism and threats. The extent of negative content is a major predictor of distress, yet there is limited research on what contributes to the content of AVHs. The current study aimed to assess the relationships between childhood trauma, attachment styles (anxious and avoidant) and negative self schemas as plausible mechanisms underlying negative AVH content. Structural equation modelling was used to test a theoretical model, including these constructs, in a transdiagnostic sample of 140 people with AVHs. Findings indicated that collectively, emotional trauma during childhood, insecure anxious attachment and negative self schemas predicted the proportion of negative AVH content experienced by voice hearers. Whereby, trauma predicted attachment, which predicted schemas and in turn negative AVH content. This study marks an important step towards understanding the underlying mechanisms involved in negative AVHs. The results highlight the importance of recognising early experiences of trauma, adult attachment styles and self schemas in developing formulations and effective treatments for negative and distressing AVHs. Psychological interventions that target these underlying mechanisms of negative AVHs may lead to a reduction in negative content, thereby reducing voice related distress.
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Affiliation(s)
- Monique Scott
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Psychiatry, St Vincent's Hospital Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Alfred Health, Melbourne, Australia.
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‘Felt security’ as a means of facilitating imagery rescripting in psychosis: a clinical protocol and illustrative case study. COGNITIVE BEHAVIOUR THERAPIST 2020. [DOI: 10.1017/s1754470x20000288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
People with psychosis do not have routine access to trauma-focused cognitive behavioural therapy (CBT) interventions such as imagery rescripting (IR), partly due to clinical caution. This case study describes the use of a simple imagery task designed to engender ‘felt security’, as a means of facilitating IR with a woman struggling with distressing memory intrusions, linked to her voices and paranoia. We assessed the impact of the felt security task, which was used before IR to enable Kip to engage in reprocessing of her trauma memories, and again after IR so that she would leave sessions feeling safe. The brief imagery task was effective in improving felt security before IR sessions. Felt security then reduced during IR, when distressing material was recalled and reprocessed, and increased again when the task was repeated. It is not yet clear whether trauma-focused interventions such as IR need to be routinely adapted for people with psychosis. In the event that individuals express concerns about IR, if the person’s formulation indicates that high levels of arousal may trigger an exacerbation of voices, paranoia or risk, or where clinicians are otherwise concerned about interventions likely to increase emotional arousal in the short term, the felt security task may facilitate safe and effective reprocessing of trauma memories. This in turn may increase access to trauma-focused CBT for people with psychosis.
Key learning aims
(1)
To understand that people with psychosis need access to trauma-focused CBT.
(2)
To be familiar with a simple attachment-based imagery task designed to foster ‘felt security’.
(3)
To learn that this task may facilitate imagery rescripting in people with psychosis.
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Loewenstein RJ. Firebug! Dissociative Identity Disorder? Malingering? Or …? An Intensive Case Study of an Arsonist. PSYCHOLOGICAL INJURY & LAW 2020. [DOI: 10.1007/s12207-020-09377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AbstractCourts struggle with questions of how to assess competency to stand trial (CTS) and not guilty by reason of insanity (NGRI) in dissociative identity disorder (DID). Concerns about CTS include dissociative amnesia and unpredictable switching behaviors that could cause inconsistent information transfer across self states, with the defendant unable to access important legal information about his/her defense and to collaborate with his/her attorney; DID defendants could not conform their conduct to the law or know right from wrong due to dissociative amnesia, the seemingly independent actions of self states, and the disruption of reality testing by switching. The author presents the case of a woman charged with both a witnessed and an unwitnessed burglary and arson, the latter at the home of her former therapist. The author was the fourth forensic evaluator in the case. Disagreements included whether the defendant met diagnostic criteria for DID or was malingering, and whether she was CTS and/or NGRI. In clinical work with DID, “the whole human being” is held responsible for all behavior, despite reported amnesia or lack of subjective agency. The Discrete Behavioral States (DBS) model of DID avoids reification of the DID self states and their conflation as separate “people.” This model supports evaluating the defendant at the level of specific self states, the self-state system, and that of the whole human being. The author concluded that the defendant met diagnostic criteria for DID and also was malingering its severity. She was competent to stand trial and legally sane.
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Pollard C, Bucci S, MacBeth A, Berry K. The revised Psychosis Attachment Measure: Measuring disorganized attachment. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2020; 59:335-353. [PMID: 32415698 PMCID: PMC7496745 DOI: 10.1111/bjc.12249] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/03/2020] [Indexed: 11/30/2022]
Abstract
Objectives The Psychosis Attachment Measure (PAM) is currently the most widely used and validated measure of attachment in psychosis. However, the PAM does not assess disorganized attachment, the type of attachment that has been most closely linked with vulnerability to psychosis. This study aimed to expand the PAM to capture the concept of disorganized attachment and to examine its psychometric properties in a psychosis sample. Methods Clinical and academic experts in the field of psychosis and service user representatives were asked to assess the comprehensiveness and comprehensibility of the pool of disorganized items. This process resulted in 12 items hypothesized to capture disorganized attachment that were included with the original items of the PAM. A sample of 144 individuals with either a self‐reported diagnosis of, or treatment for, a psychosis‐related condition completed a battery of online measures comprising the revised PAM, existing measures of adult disorganized attachment and constructs hypothesized to be conceptually related to disorganized attachment. Results An exploratory factor analysis was conducted with three factors retained; these were labelled anxious, avoidant and disorganized attachment. The factors displayed good internal consistency and test–retest reliability and the disorganized factor displayed good construct validity with related measures and constructs. Conclusions These results provide preliminary evidence that the revised PAM captures the concept of disorganized attachment. However, confirmatory psychometric evaluation of the revised PAM is required, within a separate psychosis sample, to confirm its factor structure. The relationship between these results and the current literature, in addition to the clinical and research implications, are discussed. Practitioner points We present an expanded version of the Psychosis Attachment Measure (PAM), revised to capture the concept of disorganised attachment in adulthood. This expanded measure showed good reliability and the new disorganized subscale demonstrated construct validity. These results provide preliminary evidence that disorganized attachment can be measured using a simple self‐report measure with individuals with psychosis. Further research is required to confirm the structural dimensionality of the revised PAM within a new sample using confirmatory factor analysis. Following further psychometric validation the use of this measure has the potential to be expanded to other mental health conditions in which disorganized attachment has been implicated in the development and maintenance of difficulties, for example, trauma‐related conditions and borderline personality disorder.
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Affiliation(s)
- Catherine Pollard
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
| | - Angus MacBeth
- School of Health in Social Science, University of Edinburgh, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Sciences, The University of Manchester, UK
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Lavin R, Bucci S, Varese F, Berry K. The relationship between insecure attachment and paranoia in psychosis: A systematic literature review. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:39-65. [PMID: 31390076 PMCID: PMC7028113 DOI: 10.1111/bjc.12231] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/05/2019] [Indexed: 12/15/2022]
Abstract
Objectives Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment theory has been proposed as a key model in explaining this causal pathway. Previous reviews highlight evidence of associations between insecure attachment styles and overall severity of psychotic symptoms. Studies report on associations between insecure attachment and paranoia, but to date, this literature has not been adequately synthesized. The aim of the current review was to report the strength and consistency of associations between paranoia and insecure attachment across published studies, and provide systematic appraisal of study quality. Method We carried out a systematic review of electronic databases using search terms to capture concepts of adult attachment, paranoia, and psychosis. We pre‐registered the review protocol and followed PRISMA guidelines. Results Significant associations were reported in 11 out of 12 studies between an insecure attachment and paranoia, with associations remaining significant in studies that controlled for comorbid symptoms. The strongest, most commonly reported relationship was between an anxious attachment style and paranoia. Conclusions The findings support the proposed role of attachment insecurity in the development and maintenance of paranoia in psychosis and highlight the need to address insecure attachment representations in the treatment of paranoia. Practitioner points There is consistent evidence of associations between insecure attachment style and paranoia. Insecure anxious attachment is more consistently associated with paranoia than an insecure avoidant attachment. Associations between attachment and paranoia remain significant when key confounders are controlled for in the analyses. Interventions that address insecure attachment representations and promote a more secure attachment are likely to help reduce paranoia.
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Affiliation(s)
- Rachel Lavin
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
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Demjén Z, Marszalek A, Semino E, Varese F. Metaphor framing and distress in lived-experience accounts of voice-hearing. PSYCHOSIS 2019. [DOI: 10.1080/17522439.2018.1563626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Zsófia Demjén
- Centre for Applied Linguistics, University College London, London, UK
| | - Agnes Marszalek
- Centre for Applied Linguistics, University College London, London, UK
- Glasgow International College, Glasgow, UK
| | - Elena Semino
- Department of Linguistics and English Language, Lancaster University, Lancaster, UK
| | - Filippo Varese
- School of Health Sciences, Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Varfi N, Rothen S, Jasiowka K, Lepers T, Bianchi-Demicheli F, Khazaal Y. Sexual Desire, Mood, Attachment Style, Impulsivity, and Self-Esteem as Predictive Factors for Addictive Cybersex. JMIR Ment Health 2019; 6:e9978. [PMID: 30664470 PMCID: PMC6360388 DOI: 10.2196/mental.9978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 11/01/2018] [Accepted: 12/12/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND An increasing number of studies are concerned with various aspects of cybersex addiction, the difficulty some persons have in limiting cybersex use despite a negative impact on everyday life. OBJECTIVE The aim of this study was to assess potential links between the outcome variable cybersex addiction, assessed with the Compulsive Internet Use Scale (CIUS) adapted for cybersex use, and several psychological and psychopathological factors, including sexual desire, mood, attachment style, impulsivity, and self-esteem, by taking into account the age, sex, and sexual orientation of cybersex users. METHODS A Web-based survey was conducted in which participants were assessed for sociodemographic variables and with the following instruments: CIUS adapted for cybersex use, Sexual Desire Inventory, and Short Depression-Happiness Scale. Moreover, attachment style was assessed with the Experiences in Close Relationships-Revised questionnaire (Anxiety and Avoidance subscales). Impulsivity was measured by using the Urgency, Premeditation (lack of), Perseverance (lack of), Sensation Seeking, Positive Urgency Impulsive Behavior Scale. Global self-esteem was assessed with the 1-item Self-Esteem Scale. RESULTS A sample of 145 subjects completed the study. Addictive cybersex use was associated with higher levels of sexual desire, depressive mood, avoidant attachment style, and male gender but not with impulsivity. CONCLUSIONS Addictive cybersex use is a function of sexual desire, depressive mood, and avoidant attachment.
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Associations between Trauma, Dissociation, Adult Attachment and Proneness to Hallucinations. Behav Cogn Psychother 2017; 46:292-301. [PMID: 29173211 DOI: 10.1017/s1352465817000716] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Childhood adversity, dissociation and adult attachment have all been implicated in the development of hallucinations or 'voice-hearing'. Testing psychological models in relation to subclinical phenomena, such as proneness to hallucinations in non-clinical samples, provides a convenient methodology to develop understanding of the processes and mechanisms underlying clinical symptoms. AIMS This paper investigates the relative contribution of childhood adversity, dissociation and adult attachment in explaining hallucination proneness in a non-clinical sample. METHODS Students and staff with no previous contact with secondary care at the University of Manchester were recruited. Participants completed a series of self-report measures: the Launay‒Slade Hallucination Scale (LSHS), the Relationship Scale Questionnaire (RSQ), the Childhood Trauma Questionnaire (CTQ), the Dissociative Experiences Schedule (DES II) and the Positive and Negative Affect Schedule (PANAS). RESULTS As hypothesized, insecure attachment, childhood adversity and dissociative symptoms were correlated with hallucination proneness. Multiple regression analysis, controlling for confounds of age and negative affect, indicated that the RSQ, CTQ and DES II predicted hallucination proneness. Only DES II and RSQ avoidant attachment were significant independent predictors in the final model. CONCLUSIONS This study provides further evidence to support the idea that attachment and dissociation are important psychological mechanisms involved in voice-hearing proneness. Further testing is required with a clinical population.
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