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González-Domenech P, Gutiérrez B, Muñoz-Negro JE, Molina E, Rivera M, Cervilla JA. Epidemiology of social phobia in Andalusia. SPANISH JOURNAL OF PSYCHIATRY AND MENTAL HEALTH 2024; 17:88-94. [PMID: 38720187 DOI: 10.1016/j.rpsm.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 08/24/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Population studies on social anxiety disorder (SAD) are relatively scarce and there is no previous reported evidence on prevalence or correlates of SAD in an Andalusian general population sample. MATERIAL AND METHODS We used a random representative sample previously identified via standard stratification procedures. Thus, a final sample of 4507 participants were included (response rate 83.7%). Interviewees were thoroughly assessed on sociodemographic, clinical and psychosocial factors, including: exposures to threatening life events (TLEs), childhood abuse, personality disorder and traits (neuroticism, impulsivity, paranoia), global functioning, physical health and toxics consumption. SAD diagnosis was ascertained using the Mini International Neuropsychiatric Interview. Both, pooled prevalences (with 95% confidence intervals) and risk correlates for SAD were estimated using binary logistic regression. RESULTS Estimated prevalence for SAD was 1.1% (95% CI=0.8-1.4). Having a SAD diagnosis was independently and significantly associated with younger age, poorer global functioning, higher neuroticism and paranoia personality traits, having suffered childhood abuse and exposure to previous TLEs. Furthermore, SAD was significantly associated with comorbid personality disorder, major depression, panic disorder and alcohol abuse. CONCLUSIONS Among this large Andalusian population sample, the prevalence of SAD and its associated factors are relatively similar to previously reported international studies, although no population study had previously reported such a strong association with paranoia.
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Affiliation(s)
| | - Blanca Gutiérrez
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, España; Instituto de Neurociencias, Universidad de Granada, Granada, España
| | - José Eduardo Muñoz-Negro
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, España; Hospital Universitario Clínico San Cecilio, Granada, España
| | - Esther Molina
- Instituto de Neurociencias, Universidad de Granada, Granada, España; Hospital Universitario Clínico San Cecilio, Granada, España
| | - Margarita Rivera
- Instituto de Neurociencias, Universidad de Granada, Granada, España; Departamento de Enfermería, Facultad de Medicina, Universidad de Granada, Granada, España
| | - Jorge A Cervilla
- Departamento de Psiquiatría, Facultad de Medicina, Universidad de Granada, Granada, España; Instituto de Neurociencias, Universidad de Granada, Granada, España; Hospital Universitario Clínico San Cecilio, Granada, España.
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Varese F, Sellwood W, Pulford D, Awenat Y, Bird L, Bhutani G, Carter LA, Davies L, Aseem S, Davis C, Hefferman-Clarke R, Hilton C, Horne G, Keane D, Logie R, Malkin D, Potter F, van den Berg D, Zia S, Bentall RP. Trauma-focused therapy in early psychosis: results of a feasibility randomized controlled trial of EMDR for psychosis (EMDRp) in early intervention settings. Psychol Med 2024; 54:874-885. [PMID: 37882058 DOI: 10.1017/s0033291723002532] [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] [Indexed: 10/27/2023]
Abstract
BACKGROUND Trauma is prevalent amongst early psychosis patients and associated with adverse outcomes. Past trials of trauma-focused therapy have focused on chronic patients with psychosis/schizophrenia and comorbid Post-Traumatic Stress Disorder (PTSD). We aimed to determine the feasibility of a large-scale randomized controlled trial (RCT) of an Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) intervention for early psychosis service users. METHODS A single-blind RCT comparing 16 sessions of EMDRp + TAU v. TAU only was conducted. Participants completed baseline, 6-month and 12-month post-randomization assessments. EMDRp and trial assessments were delivered both in-person and remotely due to COVID-19 restrictions. Feasibility outcomes were recruitment and retention, therapy attendance/engagement, adherence to EMDRp treatment protocol, and the 'promise of efficacy' of EMDRp on relevant clinical outcomes. RESULTS Sixty participants (100% of the recruitment target) received TAU or EMDR + TAU. 83% completed at least one follow-up assessment, with 74% at 6-month and 70% at 12-month. 74% of EMDRp + TAU participants received at least eight therapy sessions and 97% rated therapy sessions demonstrated good treatment fidelity. At 6-month, there were signals of promise of efficacy of EMDRp + TAU v. TAU for total psychotic symptoms (PANSS), subjective recovery from psychosis, PTSD symptoms, depression, anxiety, and general health status. Signals of efficacy at 12-month were less pronounced but remained robust for PTSD symptoms and general health status. CONCLUSIONS The trial feasibility criteria were fully met, and EMDRp was associated with promising signals of efficacy on a range of valuable clinical outcomes. A larger-scale, multi-center trial of EMDRp is feasible and warranted.
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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - William Sellwood
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Daniel Pulford
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Leanne Bird
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Gita Bhutani
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Lesley-Anne Carter
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Saadia Aseem
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biological, Medical and Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Claire Davis
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | | | - Claire Hilton
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Georgia Horne
- Research & Development, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - David Keane
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Robin Logie
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Debra Malkin
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Fiona Potter
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | | | - Shameem Zia
- Lancashire & South Cumbria Traumatic Stress Service, Lancashire and South Cumbria NHS Foundation Trust, Chorley, UK
| | - Richard P Bentall
- Clinical Psychology Unit, Department of Psychology, University of Sheffield, Sheffield, UK
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Wolny J, Moussa-Tooks AB, Bailey AJ, MacDonald Iii AW, Mervis JE, Hetrick WP. Measurement invariance of the Revised-Green Paranoid Thought Scale across Black and White Americans. Schizophr Res 2024; 266:227-233. [PMID: 38428120 PMCID: PMC10961092 DOI: 10.1016/j.schres.2024.02.024] [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: 04/27/2023] [Revised: 11/11/2023] [Accepted: 02/17/2024] [Indexed: 03/03/2024]
Abstract
Given the culturally diverse landscape of mental healthcare and research, ensuring that our psychological constructs are measured equivalently across diverse populations is critical. One construct for which there is significant potential for inequitable assessment is paranoia, a prominent feature in psychotic disorders that can also be driven by culture and racial marginalization. This study examined measurement invariance-an analytic technique to rigorously investigate whether a given construct is being measured similarly across groups-of the Revised-Green Paranoid Thought Scale (R-GPTS; Freeman et al., 2021) across Black and White Americans in the general population. Racial group differences in self-reported paranoia were also examined. The analytic sample consisted of 480 non-Hispanic White and 459 non-Hispanic Black Americans. Analyses demonstrated full invariance (i.e., configural, metric, and scalar invariance) of the R-GPTS across groups, indicating that the R-GPTS appropriately captures self-reported paranoia between Black and White Americans. Accordingly, it is reasonable to compare group endorsement: Black participants endorsed significantly higher scores on both the ideas of reference and ideas of persecution subscales of the R-GPTS (Mean ± SD = 10.91 ± 7.12 versus 8.21 ± 7.17 and Mean ± SD = 10.18 ± 10.03 versus 6.35 ± 8.35, for these subscales respectively). Generalized linear modeling revealed that race remained a large and statistically significant predictor of R-GPTS total score (β = -0.38756, p < 0.001) after controlling for relevant demographic factors (e.g., sex, age). This study addresses a critical gap within the existing literature as it establishes that elevations in paranoia exhibited by Black Americans in the R-GPTS reflect actual differences between groups rather than measurement artifacts.
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Affiliation(s)
- J Wolny
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America.
| | - Alexandra B Moussa-Tooks
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America; Program in Neuroscience, Indiana University Bloomington, IN, United States of America; Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, IN, United States of America
| | - Allen J Bailey
- Division of Alcohol, Drugs, and Addiction, McClean Hospital, Belmont, MA; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Angus W MacDonald Iii
- Department of Psychology, University of Minnesota, Minneapolis, MN, United States of America; Department of Psychiatry and Behavioral Sciences, University of Minnesota Medical Center, Minneapolis, MN, United States of America
| | - Joshua E Mervis
- Department of Psychology, Temple University, Philadelphia, PA, United States of America
| | - William P Hetrick
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, United States of America; Program in Neuroscience, Indiana University Bloomington, IN, United States of America; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, United States of America
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Bott A, Steer HC, Faße JL, Lincoln TM. Visualizing threat and trustworthiness prior beliefs in face perception in high versus low paranoia. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:40. [PMID: 38509135 PMCID: PMC10954723 DOI: 10.1038/s41537-024-00459-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
Predictive processing accounts of psychosis conceptualize delusions as overly strong learned expectations (prior beliefs) that shape cognition and perception. Paranoia, the most prevalent form of delusions, involves threat prior beliefs that are inherently social. Here, we investigated whether paranoia is related to overly strong threat prior beliefs in face perception. Participants with subclinical levels of high (n = 109) versus low (n = 111) paranoia viewed face stimuli paired with written descriptions of threatening versus trustworthy behaviors, thereby activating their threat versus trustworthiness prior beliefs. Subsequently, they completed an established social-psychological reverse correlation image classification (RCIC) paradigm. This paradigm used participants' responses to randomly varying face stimuli to generate individual classification images (ICIs) that intend to visualize either facial prior belief (threat vs. trust). An independent sample (n = 76) rated these ICIs as more threatening in the threat compared to the trust condition, validating the causal effect of prior beliefs on face perception. Contrary to expectations derived from predictive processing accounts, there was no evidence for a main effect of paranoia. This finding suggests that paranoia was not related to stronger threat prior beliefs that directly affected face perception, challenging the assumption that paranoid beliefs operate on a perceptual level.
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Affiliation(s)
- Antonia Bott
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany.
| | - Hanna C Steer
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Julian L Faße
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
| | - Tania M Lincoln
- Clinical Psychology and Psychotherapy, Faculty of Psychology and Human Movement Science, Universität Hamburg, Hamburg, Germany
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Misiak B, Gawęda Ł, Moustafa AA, Samochowiec J. Insomnia moderates the association between psychotic-like experiences and suicidal ideation in a non-clinical population: a network analysis. Eur Arch Psychiatry Clin Neurosci 2024; 274:255-263. [PMID: 37516979 PMCID: PMC10914899 DOI: 10.1007/s00406-023-01653-3] [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: 03/08/2023] [Accepted: 07/17/2023] [Indexed: 08/01/2023]
Abstract
Psychotic-like experiences (PLEs) have been associated with poor sleep quality and increased suicide risk. However, the association between PLEs, insomnia and suicide risk has not been thoroughly investigated in prior studies. In this study, we aimed to explore as to whether insomnia moderates the association between PLEs and suicidal ideation. The study was performed in 4203 young adults (aged 18-35 years, 63.8% females). Data were collected using self-reports. Moderation analysis demonstrated that PLEs are associated with higher levels of the current suicidal ideation only in participants with greater severity of insomnia (B = 0.003, p < 0.001). This analysis included age, gender, education, occupation and depressive symptoms as covariates. Moreover, the network analysis demonstrated that nodes representing PLEs are connected to the node of current suicidal ideation only in participants with greater severity of insomnia. The nodes of PLEs connected to the current suicidal ideation node captured PLEs representing deja vu experiences, auditory hallucination-like experiences and paranoia (edge weights between 0.011 and 0.083). Furthermore, nodes representing PLEs were the three most central nodes in the network analysis of individuals with higher levels of insomnia (strength centrality between 0.96 and 1.10). In turn, the three most central nodes were represented by depressive symptoms in the network analysis of individuals with lower levels of insomnia (strength centrality between 0.67 and 0.79). Findings from this study indicate that insomnia might be an important risk factor of suicide in people with PLEs, especially those reporting deja vu experiences, auditory hallucination-like experiences and paranoia.
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Affiliation(s)
- Błażej Misiak
- Department of Psychiatry, Wroclaw Medical University, Pasteura 10 Street, 50-367, Wroclaw, Poland.
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - Ahmed A Moustafa
- School of Psychology & Centre for Data Analytics, Faculty of Society and Design, Bond University, Gold Coast, QLD, Australia
- Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Jerzy Samochowiec
- Department of Psychiatry, Wroclaw Medical University, Wroclaw, Poland
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Bennert K, Brosnan M, Canning A, Roberts G, Russell A. Paranoia and Data-Gathering Biases in Autism. J Autism Dev Disord 2024:10.1007/s10803-024-06301-w. [PMID: 38421502 DOI: 10.1007/s10803-024-06301-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
Previous research has identified contradictory patterns in autism upon probabilistic reasoning tasks, and high levels of self-report paranoia symptoms have also been reported. To explore this relationship, the present study assessed 64 non-autistic and 39 autistic adults on two variants of a probabilistic reasoning task which examined the amount of evidence required before making a decision and 'jumping to conclusions' (a neutral beads task and an emotionally-salient words variant). The autism group was found to require significantly more evidence before making a decision and to have significantly less jumping to conclusions than the non-autistic group. For those with relatively low levels of paranoia, the emotionally-salient variant impacted on the non-autistic group, but not the autism group.
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Affiliation(s)
- Kristina Bennert
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK
| | - Mark Brosnan
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK.
| | - Amy Canning
- Fromeside Secure Services, Avon and Wiltshire Mental Health Partnership Trust, Bristol, UK
| | - Ged Roberts
- Specialist Nurse, Bristol Autism Spectrum Service, Bristol, UK
| | - Ailsa Russell
- Centre for Applied Autism Research, Department of Psychology, University of Bath, Bath, BA2 7AY, UK
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Schlier B, Lincoln TM, Kingston JL, So SH, Gaudiano BA, Morris EMJ, Ellett L. Cross-cultural validation of the revised Green et al., paranoid thoughts scale. Psychol Med 2024:1-7. [PMID: 38314511 DOI: 10.1017/s0033291724000072] [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: 02/06/2024]
Abstract
BACKGROUND With efforts increasing worldwide to understand and treat paranoia, there is a pressing need for cross-culturally valid assessments of paranoid beliefs. The recently developed Revised Green et al., Paranoid Thoughts Scale (R-GPTS) constitutes an easy to administer self-report assessment of mild ideas of reference and more severe persecutory thoughts. Moreover, it comes with clinical cut-offs for increased usability in research and clinical practice. With multiple translations of the R-GPTS already available and in use, a formal test of its measurement invariance is now needed. METHODS Using data from a multinational cross-sectional online survey in the UK, USA, Australia, Germany, and Hong Kong (N = 2510), we performed confirmatory factory analyses on the R-GPTS and tested for measurement invariance across sites. RESULTS We found sufficient fit for the two-factor structure (ideas of reference, persecutory thoughts) of the R-GPTS across cultures. Measurement invariance was found for the persecutory thoughts subscale, indicating that it does measure the same construct across the tested samples in the same way. For ideas of reference, we found no scalar invariance, which was traced back to (mostly higher) item intercepts in the Hong Kong sample. CONCLUSION We found sufficient invariance for the persecutory thoughts scale, which is of substantial practical importance, as it is used for the screening of clinical paranoia. A direct comparison of the ideas of reference sum-scores between cultures, however, may lead to an over-estimation of these milder forms of paranoia in some (non-western) cultures.
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Affiliation(s)
- Björn Schlier
- Universität Hamburg, Hamburg, Germany
- University of Wuppertal, Wuppertal, Germany
| | | | | | - Suzanne H So
- The Chinese University of Hong Kong, Hong Kong SAR
| | | | | | - Lyn Ellett
- University of Southampton, Southampton, UK
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Oker A, Laraki Y, Anders R, Fongaro E, Capdevielle D, Raffard S. Validation of the French COVID-Related Thoughts and Behavioral Symptoms Questionnaire (Cov-Tabs): A self-report assessment. L'ENCEPHALE 2024:S0013-7006(23)00217-8. [PMID: 38311477 DOI: 10.1016/j.encep.2023.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 11/11/2023] [Accepted: 11/14/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVES The COVID-Related Thoughts and Behavioral Symptoms (Cov-Tabs) is a self-reported questionnaire developed to identify the presence of psychological distress and anxiety-related behavior associated with COVID-19. This scale has been used since the first episodes of mass contamination of COVID-19 disease in the USA without psychometric validation analysis. The objective of this paper is to validate the French version of the Cov-TaBS. METHOD In this study, we assessed a French translation of Cov-Tabs in 300 subjects from the general population. Moreover, we assessed convergent and discriminant validities using an anxiety and depression scale and a paranoid ideation scale. Statistical analyses consisted of evaluating internal consistency, test-retest reliability, and construct validity as well. RESULTS The French translation of the Cov-Tabs demonstrated high internal consistency and reliability, as well as good temporal stability over a period of less than 2 weeks. It also showed strong convergent validity with anxiety and depression traits and divergent validity with paranoid ideation. CONCLUSION Our study indicates that the French version of the Cov-Tabs has robust psychometric properties and is a valid tool for evaluating behavioral symptomatology and thoughts related to COVID-19 disease. Therefore, the French version of the Cov-Tabs is a valid tool that can be used in French-speaking individuals.
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Affiliation(s)
- Ali Oker
- Université de Reims Champagne-Ardenne, C2S, Reims, France.
| | - Yasmine Laraki
- CHU de Montpellier, Montpellier, France; Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France
| | - Royce Anders
- Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France
| | | | - Delphine Capdevielle
- CHU de Montpellier, Montpellier, France; Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France; IGF, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Stéphane Raffard
- CHU de Montpellier, Montpellier, France; Laboratoire EPSYLON (EA 4556), Université Paul-Valéry Montpellier 3, Université de Montpellier, Montpellier, France
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Raffard S, de Connor A, Freeman D, Bortolon C. [Recent developments in the modeling and psychological management of persecutory ideation]. L'ENCEPHALE 2024; 50:99-107. [PMID: 37748987 DOI: 10.1016/j.encep.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/05/2023] [Accepted: 08/05/2023] [Indexed: 09/27/2023]
Abstract
Persecutory ideas are a major clinical problem and are associated with impaired functioning, reduced compliance with medication and increased risk of hospitalization. Persecutory ideation is defined as the false conviction that others are threatening or conspiring against one. Although persecutory delusions are mainly described and experienced in schizophrenia spectrum disorders, they also occur in other neurological and psychiatric diagnoses including Alzheimer disease, epilepsy, depression, mania, dementia and post-traumatic stress disorder. Moreover, epidemiological data from general and clinical populations indicated that paranoid beliefs occur on a hierarchy of severity and are present to a lesser degree in the general population, with paranoid delusions representing the severe end of a continuum. In this review we focus on the important advances following a decade of research from psychological sciences, and more particularly the work of Daniel Freeman and Philippa Garety in England. Their work has demonstrated that a range of causal factors are involved in the development and maintenance of delusions beyond the traditional cognitive and behavioural models. Indeed, there is now well-validated evidence that sleep disturbances, worry proneness, reasoning biases, such as failure to consider alternative explanations or belief confirmation bias, abnormal experiences such as hallucinations, negative self-beliefs, and safety behaviours, are central factors that contribute to the paranoid phenomenon. In this review, we describe each of these causal factors in detail as well as the clinical interventions developed by Freeman and his collaborators, including the integrative and modular "Feeling Safe" intervention. Broadly speaking, the aim of this psychological intervention is for patients to relearn safety by exposing them to situations they consider as potentially dangerous after reduction of the influence of the maintenance factors described above. A recent publication showed that the Feeling Safe program led to recovery in persecutory delusions for 50% of patients having poor response to antipsychotic medication, making the intervention as the most effective psychological treatment for persecutory delusions. Finally, we will critically discuss the efficacy data from the numerous clinical studies validating its effectiveness. Prospects for the implementation of the Feeling Safe program in France also is discussed.
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Affiliation(s)
- Stéphane Raffard
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France; Laboratoire Epsylon, EA 4556, université Paul-Valéry-Montpellier, 3, route de Mende, 34199 Montpellier cedex 5, France.
| | - Alexandre de Connor
- Service universitaire de psychiatrie adulte, CHU de Montpellier, 39, avenue Charles-Flahaut, 34295 Montpellier cedex 5, France
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, Royaume-Uni; Oxford Health NHS Foundation Trust, Oxford, Royaume-Uni; NIHR Oxford Health Biomedical Research Centre, Oxford, Royaume-Uni
| | - Catherine Bortolon
- Départment de psychologie, université de Grenoble-Alpes, université Savoie-Mont-Blanc, LIP/PC2S, Grenoble, France; Département de psychologie, institut universitaire de France, Paris, France
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Muñoz-Negro JE, Gutiérrez B, Rivera M, Molina E, González Díaz M, Jabalera Ruz P, Cervilla JA. An epidemiological survey on personality disorder in Andalusia (the PISMA-ep PD study). Int J Soc Psychiatry 2024; 70:209-217. [PMID: 37840279 DOI: 10.1177/00207640231204216] [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] [Indexed: 10/17/2023]
Abstract
BACKGROUND Despite a significant clinical and social burden, there is a relative scarcity of epidemiological studies on Personality Disorder (PD). AIM To determine the current prevalence of PD and the psychosocial correlates associated with this in the Andalusian population. METHOD We carried out a cross-sectional population mental-health survey in Andalusia, southern Spain. Thus, 4,518 randomly selected participants were interviewed following sampling using different standard stratification levels. We used the Spanish version of the SAPAS to estimate PD prevalence. In addition, a full battery of other instruments was utilized to explore global functionality, childhood abuse, maltreatment, threatening life events, personality traits (neuroticism, impulsivity and paranoia), medical and psychiatric comorbidities, family history of psychological problems and other potential risk factors for PD. RESULTS PD prevalence (10.8%; 95% CI [9.8, 11.7]) and ran two different multivariate models for PD. We obtained the highest PD prevalence in those affected by any mental disorder plus those reporting having suffered childhood abuse, particularly sexual abuse. Additional potential risk factors or correlates of PD identified were: younger age, lower levels of functioning, less social support, poorer general health, having suffered maltreatment, threatening life events, higher suicidal risk scores and higher levels of both neuroticism and impulsivity. CONCLUSIONS This study reports PD prevalence and risk correlates in consonance with similar findings reported in other Western populations. However, longitudinal studies are needed to elicit a more thorough group of prospective determinants of PD.
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Affiliation(s)
| | - Blanca Gutiérrez
- Departament of Psychiatry, University of Granada, Spain
- Institute of Neurosciences, Biomedical Research Centre, University of Granada, Spain
- Instituto de Investigación Biosanitaria ibs Granada, Spain
| | - Margarita Rivera
- Institute of Neurosciences, Biomedical Research Centre, University of Granada, Spain
- Instituto de Investigación Biosanitaria ibs Granada, Spain
- Department of Biochemistry and Molecular Biology II, Faculty of Pharmacy, University of Granada, Spain
| | - Esther Molina
- Institute of Neurosciences, Biomedical Research Centre, University of Granada, Spain
- Instituto de Investigación Biosanitaria ibs Granada, Spain
- Department of Nursing, Faculty of Health Sciences, University of Granada, Spain
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Gordon S, Mote J, Fulford D. Qualitative Analysis of Paranoia Reported in Clinical Interviews With Black and White Adults With Schizophrenia. Psychiatr Serv 2023; 74:1263-1269. [PMID: 37254507 PMCID: PMC10687302 DOI: 10.1176/appi.ps.20220089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Black adults in the United States are more likely to be diagnosed as having schizophrenia spectrum disorders and to report experiences of paranoia than are White adults. Cultural mistrust, or marginalized groups' adaptive skepticism toward dominant historically White institutions, is associated with paranoia among Black individuals, suggesting that experiences of paranoia may be culturally mediated. The authors aimed to explore thematic differences between Black and White adults with schizophrenia spectrum disorders in their experiences of paranoia, including potential differences in persecutory content, cultural mistrust, and related themes. The authors conducted a thematic content analysis of archival qualitative data on experiences of paranoia reported by Black and White adults with schizophrenia spectrum disorders (N=21) in a structured clinical interview. Distinct themes related to cultural mistrust and persecutory paranoia emerged among the participants, suggesting that lived experiences of persecution and discrimination may affect how Black adults with schizophrenia spectrum disorders interpret threat and express paranoia. These findings highlight the importance of culturally responsive approaches in assessment and conceptualization of clinical paranoia versus cultural mistrust.
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Affiliation(s)
- Shari Gordon
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts (Gordon); Department of Occupational Therapy, Sargent College at Boston University, Boston (Mote, Fulford); Department of Psychological and Brain Sciences, Boston University, Boston (Fulford)
| | - Jasmine Mote
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts (Gordon); Department of Occupational Therapy, Sargent College at Boston University, Boston (Mote, Fulford); Department of Psychological and Brain Sciences, Boston University, Boston (Fulford)
| | - Daniel Fulford
- Department of Counseling, Developmental, and Educational Psychology, Boston College, Chestnut Hill, Massachusetts (Gordon); Department of Occupational Therapy, Sargent College at Boston University, Boston (Mote, Fulford); Department of Psychological and Brain Sciences, Boston University, Boston (Fulford)
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12
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Hogg LI, Smith LGE, Kurz T, Morrison AP. Social identification, identity integration and wellbeing in people who hear voices. Psychol Psychother 2023. [PMID: 37964710 DOI: 10.1111/papt.12509] [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] [Received: 12/21/2022] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVES Hearing voices is associated with public stigma and this can influence readiness to identify as a voice hearer (VH) and psychological wellbeing. In this study, we investigated the relationships between a VH social identity, the integration of that identity with other important social identities and wellbeing. DESIGN Cross-sectional study, with a subset of longitudinal data across three time points. METHODS People who self-identified as voice hearers completed questionnaires (VH social identity, identity integration, wellbeing and perceptions of in-group and out-group empathy) at three time points, spaced at 3-monthly intervals. The final sample comprised 182 participants at T1, 91 at T2 and 75 at T3. Hierarchical linear multiple regression analyses were used to test all hypotheses. RESULTS The integration of a VH social identity was strongly associated with better psychological wellbeing at T1. Identity integration was also associated with static wellbeing scores at 6 months. Effects on wellbeing were not accounted for by either severity of voice-hearing or paranoia. Whilst perceptions of in-group empathy were associated with VH social identification, perceptions of outgroup empathy were important for identity integration. CONCLUSIONS Integrating a VH social identity with other important identities into a coherent sense of self is important for wellbeing in voice hearers; perceived in-group and outgroup empathy are important in this process.
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Affiliation(s)
- Lorna I Hogg
- Department of Psychology, University of Bath, Bath, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
- Harris Manchester College, University of Oxford, Oxford, UK
| | | | - Tim Kurz
- Department of Psychology, University of Bath, Bath, UK
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, Manchester, UK
- Greater Manchester Mental Health NHS Trust, Manchester, UK
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13
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Gaudiano BA, Marks R, Ellett L, So SHW, Lincoln TM, Morris EMJ, Kingston JL. The role of general vs pandemic-specific paranoid ideation in the use of recommended health behaviors and vaccine willingness during a worldwide pandemic: An international study in the general public. J Psychiatr Res 2023; 167:110-118. [PMID: 37862907 DOI: 10.1016/j.jpsychires.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 08/24/2023] [Accepted: 10/12/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND The public's adherence to recommended COVID-19 preventative behaviors, including vaccinations and social distancing, has been low in certain groups and has contributed to many preventable deaths worldwide. An examination of general and pandemic-specific aspects of nonclinical paranoid ideation may aid in the understanding of the public's response to the pandemic, given that it is a global threat event. METHODS A representative international sample of general adults (N = 2,510) from five international sites were recruited with stratified quota sampling. Structural equation modeling (SEM) was used to examine the relationships among general paranoid ideation, pandemic paranoid ideation (interpersonal mistrust, conspiratorial thinking, and persecutory threat), general distress (depression, anxiety), vaccine willingness, and other preventative behaviors (masking, social distancing, hygiene). RESULTS Although general distress and paranoid ideation were associated with vaccination willingness and preventative behaviors, their effects were inconsistent or weak. Pandemic paranoid ideation showed robust direct and indirect effects that differentially predicted COVID-19 preventative behaviors, with higher interpersonal mistrust associated with higher adherence to all behaviors, higher conspiratorial thinking related to lower adherence to all behaviors, and higher persecutory threat related to higher vaccine willingness, but lower adherence to other preventative behaviors. CONCLUSIONS Examination of pandemic-specific paranoid ideation leads to more precise prediction of the public's adherence to recommended health behaviors during the COVID-19 outbreak. This information could be used to inform intervention strategies for micro-targeting different subgroups with nonclinical paranoid thinking, as well as for improving responses to future pandemics and vaccination efforts for other common illnesses.
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Affiliation(s)
| | | | | | - Suzanne Ho-Wai So
- The Chinese University of Hong Kong, Hong Kong Special Administrative Region of China
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14
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Fanti E, Di Sarno M, Di Pierro R. In search of hidden threats: A scoping review on paranoid presentations in personality disorders. Clin Psychol Psychother 2023; 30:1215-1233. [PMID: 37727949 DOI: 10.1002/cpp.2913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/25/2023] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Recent diagnostic developments suggest that paranoia is a transdiagnostic characteristic common to several personality disorders rather than a personality disorder per se. Nonetheless, empirical literature fails to provide comprehensive and univocal findings on whether and how paranoid presentations relate to different personality disorders. In the present scoping review, we map the empirical literature on paranoid presentations in personality disorders, considering the entire spectrum of paranoid manifestations (i.e., the paranoia hierarchy). In selecting original quantitative studies on paranoid presentations in personality-disordered patients, we screened 4,433 records in PsycArticles, PsycInfo and PUBMED. We eventually included 47 eligible studies in the review. Our synthesis indicates consistent empirical evidence of a wide range of paranoid presentations in Paranoid, Schizotypal and Borderline personality disorders. Conversely, little empirical literature exists on paranoid presentations in other personality disorders. Preliminary findings suggest broad-severity paranoid presentations, ranging from milder to severe forms, in Paranoid, Schizotypal and Borderline personality disorders. There is also some evidence of milder forms of paranoia in Avoidant, Antisocial and Narcissistic personality disorders. Conversely, there is poor evidence of paranoid presentations in Schizoid, Histrionic, Dependent or Obsessive-compulsive personality disorders. Research gaps and recommendations for improving empirical research on paranoid presentations in personality disorders are discussed.
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Affiliation(s)
- Erika Fanti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Marco Di Sarno
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
| | - Rossella Di Pierro
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
- Personality Disorder Lab (PDLab), Milan-Parma, Italy
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15
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Yiend J, Lam CLM, Schmidt N, Crane B, Heslin M, Kabir T, McGuire P, Meek C, Mouchlianitis E, Peters E, Stahl D, Trotta A, Shergill S. Cognitive bias modification for paranoia (CBM-pa): a randomised controlled feasibility study in patients with distressing paranoid beliefs. Psychol Med 2023; 53:4614-4626. [PMID: 35699135 PMCID: PMC10388312 DOI: 10.1017/s0033291722001520] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/30/2022] [Accepted: 05/09/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive Bias Modification for paranoia (CBM-pa) is a novel, theory-driven psychological intervention targeting the biased interpretation of emotional ambiguity associated with paranoia. Study objectives were (i) test the intervention's feasibility, (ii) provide effect size estimates, (iii) assess dose-response and (iv) select primary outcomes for future trials. METHODS In a double-blind randomised controlled trial, sixty-three outpatients with clinically significant paranoia were randomised to either CBM-pa or an active control (text reading) between April 2016 and September 2017. Patients received one 40 min session per week for 6 weeks. Assessments were given at baseline, after each interim session, post-treatment, and at 1- and 3-months post-treatment. RESULTS A total of 122 patients were screened and 63 were randomised. The recruitment rate was 51.2%, with few dropouts (four out of 63) and follow-up rates were 90.5% (1-month) and 93.7% (3-months). Each session took 30-40 min to complete. There was no statistical evidence of harmful effects of the intervention. Preliminary data were consistent with efficacy of CBM-pa over text-reading control: patients randomised to the intervention, compared to control patients, reported reduced interpretation bias (d = -0.48 to -0.76), improved symptoms of paranoia (d = -0.19 to -0.38), and lower depressed and anxious mood (d = -0.03 to -0.29). The intervention effect was evident after the third session. CONCLUSIONS CBM-pa is feasible for patients with paranoia. A fully powered randomised control trial is warranted.
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Affiliation(s)
- Jenny Yiend
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Charlene L. M. Lam
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong
- Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong
| | - Nora Schmidt
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Bryony Crane
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Margaret Heslin
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | | | - Philip McGuire
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Christopher Meek
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Elias Mouchlianitis
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Emmanuelle Peters
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Daniel Stahl
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - Antonella Trotta
- Laboratory of Clinical Psychology and Affective Neuroscience, The University of Hong Kong, Hong Kong
- South London & Maudsley NHS Foundation Trust, London, UK
| | - Sukhwinder Shergill
- Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
- Kent and Medway Medical School, Canterbury, UK
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16
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Raffard S, Madouini C, Laraki Y, Eisenblaetter M, Broc G, Capdevielle D, Bayard S. "Green et al. Paranoid Thoughts Scale-revised": Structural invariance and clinical utility of a brief version in schizophrenia. J Psychiatr Res 2023; 163:9-13. [PMID: 37196518 DOI: 10.1016/j.jpsychires.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 04/25/2023] [Accepted: 05/03/2023] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Persecutory ideas are highly frequent in psychotic disorders and particularly in schizophrenia. Although several measures exist to assess persecutory ideas in both clinical and non-clinical samples, there is a need for brief and psychometrically sound measures to capture the multidimensional aspects of paranoia in people diagnosed with schizophrenia. Our aim was to validate a brief version of the revised Green et al., Paranoid Thoughts Scale (R-GPTS) in schizophrenia in order to minimize time-consuming assessment. METHODS 100 individuals with schizophrenia and 72 non-clinical controls were recruited. We used the GPTS-8, a brief 8-item version of the R-GPTS recently developed and validated in the French general population. Psychometric properties of the scale were investigated including its factor structure, internal consistency, and convergent/divergent validities. RESULTS Confirmatory factor analysis supported the original two-factor structure (social reference and persecution subscales) of the GPTS-8. The GPTS-8 was positively and moderately correlated with the Positive and Negative Syndrome Scale (PANSS) suspiciousness item indicating good internal consistency. Concerning divergent validity, no correlations were found between the GPTS-8 and the Montreal cognitive assessment (MoCA). Importantly patients with schizophrenia reported higher scores on the GTPS-8 than controls demonstrating its clinical validity. CONCLUSIONS The French GPTS 8-item brief scale-8 retains the psychometric strengths of the R-GPTS in schizophrenia with relevant clinical validity. The GPTS-8 can consequently be used as a short and quick measure of paranoid ideations in individuals with a diagnosis of schizophrenia.
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Affiliation(s)
- Stéphane Raffard
- Univ Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France; University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France.
| | - Clarisse Madouini
- Univ Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France
| | - Yasmine Laraki
- Univ Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France; University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France
| | | | - Guillaume Broc
- Univ Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, Montpellier, France; IGF, Univ. Montpellier, CNRS, INSERM, Montpellier, France
| | - Sophie Bayard
- Univ Paul Valéry Montpellier 3, EPSYLON EA 4556, Montpellier, France
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17
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Williams TF, Walker EF, Strauss GP, Woods SW, Powers AR, Corlett PR, Schiffman J, Waltz JA, Gold JM, Silverstein SM, Ellman LM, Zinbarg RE, Mittal VA. The reliability and validity of the revised Green et al. paranoid thoughts scale in individuals at clinical high-risk for psychosis. Acta Psychiatr Scand 2023; 147:623-633. [PMID: 36905387 PMCID: PMC10463775 DOI: 10.1111/acps.13545] [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: 09/29/2022] [Revised: 01/27/2023] [Accepted: 02/21/2023] [Indexed: 03/12/2023]
Abstract
INTRODUCTION Paranoia is a common and impairing psychosis symptom, which exists along a severity continuum that extends into the general population. Individuals at clinical high-risk for psychosis (CHR) frequently experience paranoia and this may elevate their risk for developing full psychosis. Nonetheless, limited work has examined the efficient measurement of paranoia in CHR individuals. The present study aimed to validate an often-used self-report measure, the revised green paranoid thoughts scale (RGPTS), in this critical population. METHOD Participants were CHR individuals (n = 103), mixed clinical controls (n = 80), and healthy controls (n = 71) who completed self-report and interview measures. Confirmatory factor analysis (CFA), psychometric indices, group differences, and relations to external measures were used to evaluate the reliability and validity of the RGPTS. RESULTS CFA replicated a two-factor structure for the RGPTS and the associated reference and persecution scales were reliable. CHR individuals scored significantly higher on both reference and persecution, relative to both healthy (ds = 1.03, 0.86) and clinical controls (ds = 0.64, 0.73). In CHR participants, correlations between reference and persecution and external measures were smaller than expected, though showed evidence of discriminant validity (e.g., interviewer-rated paranoia, r = 0.24). When examined in the full sample, correlation magnitude was larger and follow-up analyses indicated that reference related most specifically to paranoia (β = 0.32), whereas persecution uniquely related to poor social functioning (β = -0.29). CONCLUSION These results demonstrate the reliability and validity of the RGPTS, though its scales related more weakly to severity in CHR individuals. The RGPTS may be useful in future work aiming to develop symptom-specific models of emerging paranoia in CHR individuals.
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Affiliation(s)
- Trevor F. Williams
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
| | - Elaine F. Walker
- Department of Psychology and Program in Neuroscience, Emory University, Atlanta, GA, 30322, USA
| | - Gregory P. Strauss
- Departments of Psychology and Neuroscience, University of Georgia, Athens, GA, 30602, USA
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Albert R. Powers
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Philip R. Corlett
- Department of Psychiatry, Yale University, New Haven, CT, 06519, USA
| | - Jason Schiffman
- Department of Psychological Science, 4201 Social and Behavioral Sciences Gateway, University of California, Irvine, CA, 92697, USA
| | - James A. Waltz
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - James M. Gold
- Maryland Psychiatric Research Center, Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, 21228, USA
| | - Steven M. Silverstein
- Departments of Psychiatry, Neuroscience and Ophthalmology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Lauren M. Ellman
- Department of Psychology & Neuroscience, Temple University, Philadelphia, PA, 19122, USA
| | - Richard E. Zinbarg
- Department of Psychology, Northwestern University, Evanston, IL, 60208, USA
| | - Vijay A. Mittal
- Institutes for Policy Research (IPR) and Innovations in Developmental Sciences (DevSci), Departments of Psychology, Psychiatry, Medical Social Sciences, Northwestern University, Evanston, IL, 60208, USA
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18
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Șoflău R, Szentágotai-Tătar A, Oltean LE. Childhood Adversity, Resilience, and Paranoia During the COVID-19 Outbreak. The Mediating Role of Irrational Beliefs and Affective Disturbance. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2023:1-16. [PMID: 37360924 PMCID: PMC10221745 DOI: 10.1007/s10942-023-00511-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/28/2023]
Abstract
Childhood adversity (CA) and resilience may impact on paranoia, but mechanisms underlying these associations are largely unknown. In this study, we investigated two potential candidates: irrational beliefs and affective disturbance. Moreover, we investigated the potential moderating role of COVID-19 perceived stress in these associations. A community sample (N = 419, m age = 27.32 years, SD = 8.98; 88.10% females) completed self-report measures. Results indicated that paranoia was significantly associated with CA and resilience (p < .05), and both irrational beliefs and affective disturbance (i.e., depressive and anxiety symptoms) mediated the associations between CA and paranoia. Moreover, depressive and anxiety symptoms partially explained the mediating role of irrational beliefs. These predictive models explained up to 23.52% of variance in paranoia (F(3,415) = 42.536, p < .001). Findings on resilience and paranoia replicated these results, and COVID-19 perceived stress moderated the association between resilience and ideas of persecution. Overall, these findings underscore the importance of irrational beliefs, depressive and anxiety symptoms in high CA or low resilience individuals experiencing paranoia. Supplementary Information The online version contains supplementary material available at 10.1007/s10942-023-00511-4.
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Affiliation(s)
- Radu Șoflău
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Aurora Szentágotai-Tătar
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Lia-Ecaterina Oltean
- Department of Clinical Psychology and Psychotherapy, Babeș-Bolyai University, Cluj-Napoca, Romania
- The International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
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19
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Buck B, Wingerson M, Chander A, Tauscher JS. A preliminary study examining terminology used by individuals with lived experience describing beliefs about being targeted or harmed by others. Psychiatry Res 2023; 323:115129. [PMID: 36881949 PMCID: PMC10106418 DOI: 10.1016/j.psychres.2023.115129] [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: 12/12/2022] [Revised: 02/18/2023] [Accepted: 02/20/2023] [Indexed: 03/09/2023]
Abstract
While recent studies have prompted re-evaluation of the term "schizophrenia," few have examined the use of terms to describe persecutory ideation (PI) or paranoia. This study examines the preferences and terms used by a cross-diagnostic population of individuals (N = 184) with lived experience using an online survey. Participants most commonly described their PI in terms of the perceived source of threat, followed by clinical language, most commonly variants of "paranoia" and "anxiety." Of five selected terms assessed quantitatively - "anxiety," "paranoia," "persecutory thoughts," "suspiciousness," and "threat thoughts" - participants were more likely to report that "anxiety" aligned with their experience of PI, followed by "suspiciousness." Endorsement of terms more specific to PI was associated with self-report PI severity, while a preference for "anxiety" over other terms was both associated with less severe PI and lower scores on a measure of stigma. These results suggest that the heterogeneity of terms used by individuals with lived experience support a person-centered approach to language describing such experiences.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States.
| | - Mary Wingerson
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States
| | - Justin S Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195, United States
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20
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Southward MW, Cheavens JS, Coccaro EF. Defining the p-factor: an empirical test of five leading theories. Psychol Med 2023; 53:2732-2743. [PMID: 35711145 PMCID: PMC10235655 DOI: 10.1017/s0033291722001635] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/25/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite statistical evidence of a general factor of psychopathology (i.e., p-factor), there is little agreement about what the p-factor represents. Researchers have proposed five theories: dispositional negative emotionality (neuroticism), impulsive responsivity to emotions (impulsivity), thought dysfunction, low cognitive functioning, and impairment. These theories have primarily been inferred from patterns of loadings of diagnoses on p-factors with different sets of diagnoses included in different studies. Researchers who have directly examined these theories of p have examined a subset of the theories in any single sample, limiting the ability to compare the size of their associations with a p-factor. METHODS In a sample of adults (N = 1833, Mage = 34.20, 54.4% female, 53.3% white) who completed diagnostic assessments, self-report measures, and cognitive tests, we evaluated statistical p-factor structures across modeling approaches and compared the strength of associations among the p-factor and indicators of each of these five theories. RESULTS We found consistent evidence of the p-factor's unidimensionality across one-factor and bifactor models. The p-factor was most strongly and similarly associated with neuroticism (r = .88), impairment (r = .88), and impulsivity (r = .87), χ2(1)s < .15, ps > .70, and less strongly associated with thought dysfunction (r = .78), χ2(1)s > 3.92, ps < .05, and cognitive functioning (r = -.25), χ2(1)s > 189.56, ps < .01. CONCLUSIONS We discuss a tripartite definition of p that involves the transaction of impulsive responses to frequent negative emotions leading to impairment that extends and synthesizes previous theories of psychopathology.
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Affiliation(s)
| | | | - Emil F. Coccaro
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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21
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Nijman SA, Pijnenborg GHM, Vermeer RR, Zandee CER, Zandstra DC, van der Vorm D, de Wit-de Visser AC, Meins IA, Geraets CNW, Veling W. Dynamic Interactive Social Cognition Training in Virtual Reality (DiSCoVR) versus Virtual Reality Relaxation (VRelax) for People With a Psychotic Disorder: A Single-Blind Multicenter Randomized Controlled Trial. Schizophr Bull 2023; 49:518-530. [PMID: 36413388 PMCID: PMC10016415 DOI: 10.1093/schbul/sbac166] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND HYPOTHESIS Social cognition training (SCT), an intervention for social cognition and social functioning, might be improved by using virtual reality (VR), because VR may offer better opportunities to practice in a potentially more realistic environment. To date, no controlled studies have investigated VR-SCT. This study investigated a VR-SCT, "DiSCoVR". We hypothesized that DiSCoVR would improve social cognition and social functioning. STUDY DESIGN Participants were randomized to DiSCoVR (n = 41) or VR relaxation ('VRelax', n = 40), an active control condition, and completed 16 twice-weekly sessions. Three assessments (baseline, posttreatment, and 3-month follow-up) were performed by blinded assessors. The primary outcome was social cognition (emotion perception and theory of mind). Secondary outcomes included social functioning (measured with an interview and experience sampling), psychiatric symptoms, information processing, and self-esteem. Data were analyzed using mixed-models regression analysis. Treatment effects were evaluated by the time by condition interaction terms. STUDY RESULTS No significant time by condition interactions were found for any of the outcome variables, indicating an absence of treatment effects. Between-group effect sizes ranged from negligible to moderate (Cohen's d < |0.53|). Main effects of time were found for several outcomes. CONCLUSIONS These results suggest that DiSCoVR was not effective, possibly because of inadequate simulation of emotional expressions in VR. This lack of efficacy may indicate that current SCT protocols are relatively unsuitable for improving social functioning. Previous studies showed small to moderate effects on higher order social cognition, but the SCT approach may need critical reevaluation, as it may not sufficiently lead to functional improvement.
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Affiliation(s)
- S A Nijman
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - G H M Pijnenborg
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - R R Vermeer
- GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands
| | - C E R Zandee
- GGZ Delfland, Sint Jorisweg 2, 2612 GA, Delft, The Netherlands
| | - D C Zandstra
- Zeeuwse Gronden, Axelsestraat 8/A, 4537 AJ, Terneuzen, The Netherlands
| | - D van der Vorm
- GGZ Westelijk Noord-Brabant, Hoofdlaan 8, PO Box 371, 4600AJ, Bergen op Zoom, The Netherlands
| | - A C de Wit-de Visser
- GGZ Westelijk Noord-Brabant, Hoofdlaan 8, PO Box 371, 4600AJ, Bergen op Zoom, The Netherlands.,Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Professor Cobbenhagenlaan 125, PO Box 90153, 5000LE Tilburg, The Netherlands
| | - I A Meins
- Department of Psychotic Disorders, GGZ Drenthe, Dennenweg 9, PO Box 30007, 9404 LA, Assen, The Netherlands.,University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands.,Department of Clinical and Developmental Neuropsychology, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | - C N W Geraets
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
| | - W Veling
- University Center of Psychiatry, University Medical Center Groningen, University of Groningen, Hanzeplein 1, PO Box 30.001, 9700 RB, Groningen, The Netherlands
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22
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Della Libera C, Simon J, Larøi F, Quertemont E, Wagener A. Using 360-degree immersive videos to assess multiple transdiagnostic symptoms: A study focusing on fear of negative evaluation, paranoid thoughts, negative automatic thoughts, and craving. VIRTUAL REALITY 2023:1-16. [PMID: 37360803 PMCID: PMC9996573 DOI: 10.1007/s10055-023-00779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 02/20/2023] [Indexed: 06/28/2023]
Abstract
Over the last 20 years, virtual reality (VR) has gained a great interest for both assessment and treatment of various psychopathologies. However, due to high costs and material specificity, VR remains disadvantageous for clinicians. Adopting a multiple transdiagnostic approach, this study aims at testing the validity of a 360-degree immersive video (360IV) for the assessment of five common psychological symptoms (fear of negative evaluation, paranoid thoughts, negative automatic thoughts, craving for alcohol and for nicotine). A 360IV was constructed in the Darius Café and included actors behaving naturally. One hundred and fifty-eight adults from the general population were assessed in terms of their proneness towards the five symptoms, were then exposed to the 360IV and completed measures for the five state symptoms, four dimensions of presence (place, plausibility, copresence and social presence illusions) and cybersickness. Results revealed that the five symptoms occurred during the immersion and were predicted by the participants' proneness towards these symptoms. The 360IV was also able to elicit various levels of the four dimensions of presence while producing few cybersickness. The present study provides evidence supporting the use of the 360IV as a new accessible, ecological, and standardized tool to assess multiple transdiagnostic symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s10055-023-00779-y.
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Affiliation(s)
- Clara Della Libera
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), University of Liège, Liège, Belgium
| | - Jessica Simon
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), University of Liège, Liège, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), University of Liège, Liège, Belgium
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Norwegian Center for Mental Disorders Research, University of Oslo, Oslo, Norway
| | - Etienne Quertemont
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), University of Liège, Liège, Belgium
| | - Aurélie Wagener
- Psychology and Neuroscience of Cognition Research Unit (PsyNCog), University of Liège, Liège, Belgium
- Research Unit for a life-Course Perspective on Health and Education (RUCHE), Health Psychology, Department of Psychology, University of Liège, Liège, Belgium
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23
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Burger SR, Hardy A, van der Linden T, van Zelst C, de Bont PAJ, van der Vleugel B, Staring ABP, de Roos C, de Jongh A, Marcelis M, van Minnen A, van der Gaag M, van den Berg DPG. The bumpy road of trauma-focused treatment: Posttraumatic stress disorder symptom exacerbation in people with psychosis. J Trauma Stress 2023; 36:299-309. [PMID: 36719408 DOI: 10.1002/jts.22907] [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] [Received: 08/02/2022] [Revised: 11/29/2022] [Accepted: 11/29/2022] [Indexed: 02/01/2023]
Abstract
Concern for symptom exacerbation and treatment drop-out is an important barrier to the implementation of trauma-focused therapy (TFT), especially in people with a psychotic disorder. This study, which was part of a multicenter randomized controlled trial, investigated posttraumatic stress disorder (PTSD) symptom exacerbation during eye movement desensitization reprocessing (EMDR) therapy and prolonged exposure (PE) in a sample of 99 participants with PTSD and psychosis. Symptom exacerbations during the first four sessions (early exacerbation) and between-session exacerbations over the course of therapy were monitored using the PTSD Symptom Scale-Self Report. Analyses of covariance and chi-square tests were conducted to investigate exacerbation rates and their associations with treatment response and drop-out. Both early exacerbation and between-session exacerbation were relatively common (32.3% and 46.5%, respectively) but were unrelated to poor treatment response or an increased likelihood of treatment drop-out. Both clinicians and patients need to be aware that symptom exacerbation during TFT is common and not related to poor outcomes. Symptom exacerbation can be part of the therapeutic process, should be acknowledged and guided, and should not be a barrier to the implementation of TFT in people with psychosis.
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Affiliation(s)
- Simone R Burger
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Department of Psychosis research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Amy Hardy
- Institute of Psychiatry, Psychology, and Neuroscience; King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Tineke van der Linden
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Department of Research and Innovation, GGzE Mental Health Institute, Eindhoven, the Netherlands
| | - Catherine van Zelst
- Department of Psychosis research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Paul A J de Bont
- GGZ Oost-Brabant Mental Health Institute, Boekel, the Netherlands
| | | | | | - Carlijn de Roos
- Academic Centre for Child and Adolescent Psychiatry Levvel, Amsterdam University Medical Centre (location AMC), The Netherlands
| | - Ad de Jongh
- Behavourial Science Institute, Radboud Universiteit Nijmegen, the Netherlands.,PSYTREC Mental Health Institute, Bilthoven, the Netherlands
| | - Machteld Marcelis
- Department of Research and Innovation, GGzE Mental Health Institute, Eindhoven, the Netherlands.,Departement of Psychiatry and Neuropsychology, Maastricht University, the Netherlands
| | - Agnes van Minnen
- Behavourial Science Institute, Radboud Universiteit Nijmegen, the Netherlands.,PSYTREC Mental Health Institute, Bilthoven, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.,Department of Psychosis research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - David P G van den Berg
- Department of Psychosis research and Innovation, Parnassia Psychiatric Institute, The Hague, The Netherlands.,Academic Centre for Dentistry Amsterdam, University of Amsterdam and VU University Amsterdam, Department of Behavioural Sciences, Amsterdam, the Netherlands
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24
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Beattie L, Robb F, Spanswick M, Henry AL, Waxmonsky J, Gumley A. Exploring digital cognitive behavioural therapy for insomnia in an early intervention in psychosis service - A study protocol for an initial feasibility study with process evaluation. Early Interv Psychiatry 2023; 17:519-526. [PMID: 36639129 DOI: 10.1111/eip.13388] [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] [Received: 05/16/2022] [Revised: 11/21/2022] [Accepted: 01/01/2023] [Indexed: 01/15/2023]
Abstract
AIM Early psychosis may be a critical time at which clinical trajectories are still evolving, and sleep interventions hold promise to improve outcomes at this stage. Although cognitive behavioural therapy (CBT) for insomnia shows promise in psychosis, there has been limited evaluation of delivery within current care. This study aims to evaluate the feasibility and acceptability of providing fully-automated digital CBT for insomnia (CBT-I) within an early intervention in psychosis service. METHODS We will conduct a single-arm feasibility trial within an early psychosis intervention service, and up to 40 individuals experiencing a first episode of psychosis and with evidence of insomnia can be enrolled (May 2021 - August 2022). Additional service user inclusion criteria are capacity to consent and access to a suitable technological device to access digital CBT. Participants will be offered access to a fully-automated digital CBT-I program (Sleepio) delivered using web and/or mobile app. The study comprises pre- and post- intervention questionnaire assessments and interviews with service users and staff to provide initial outcome signals. RESULTS Quantitative questionnaire data will be analysed descriptively, alongside rates of eligibility, consent, uptake and completion. Qualitative data will be analysed using thematic analysis. Results will be used to develop a logic model describing feasibility and implementation. CONCLUSIONS From this study, we hope to better understand how to deliver digital CBT for insomnia within an early intervention in psychosis service. This study will help inform further research, including how best to support staff in using Sleepio, and inform the design of subsequent trials in this area.
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Affiliation(s)
- Louise Beattie
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Fiona Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,ESTEEM, NHS Greater Glasgow & Clyde, Glasgow, UK
| | | | - Alasdair L Henry
- Big Health Ltd., London, UK.,Big Health Ltd., San Francisco, California, USA.,Nuffield Department of Clinical Neurosciences, Sir Jules Thorn Sleep and Circadian Neuroscience Institute, University of Oxford, Oxford, UK
| | - Jeanette Waxmonsky
- Big Health Ltd., London, UK.,Big Health Ltd., San Francisco, California, USA
| | - Andrew Gumley
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.,ESTEEM, NHS Greater Glasgow & Clyde, Glasgow, UK
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25
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De Rossi G, Georgiades A. Thinking biases and their role in persecutory delusions: A systematic review. Early Interv Psychiatry 2022; 16:1278-1296. [PMID: 35396904 PMCID: PMC10084105 DOI: 10.1111/eip.13292] [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] [Received: 08/14/2021] [Revised: 01/21/2022] [Accepted: 03/13/2022] [Indexed: 01/15/2023]
Abstract
AIM Thinking biases are posited to be involved in the genesis and maintenance of delusions. Persecutory delusions are one of the most commonly occurring delusional subtypes and cause substantial distress and disability to the individuals experiencing them. Their clinical relevance confers a rationale for investigating them. Particularly, this review aims to elucidate which cognitive biases are involved in their development and persistence. METHODS MEDLINE, Embase, PsycINFO and Global Health were searched from the year 2000 to June 2020. A formal narrative synthesis was employed to report the findings and a quality assessment of included studies was conducted. RESULTS Twenty five studies were included. Overall, 18 thinking biases were identified. Hostility and trustworthiness judgement biases appeared to be specific to persecutory delusions while jumping to conclusions, self-serving attributional biases and belief inflexibility were proposed to be more closely related to other delusional subtypes. While the majority of the biases identified were suggested to be involved in delusion maintenance, hostility biases, need for closure and personalizing attributional biases were believed to also have aetiological influences. CONCLUSIONS These findings show that some cognitive biases are specific to paranoid psychosis and appear to be involved in the formation and/or persistence of persecutory delusions.
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Affiliation(s)
- Giorgia De Rossi
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), London, England
| | - Anna Georgiades
- King's College London, Institute of Psychiatry, Psychology, and Neuroscience (IoPPN), London, England.,Brent Early Intervention Service, CNWL, NHS Foundation Trust, London, UK
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26
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Martinez Agulleiro L, de Filippis R, Rosson S, Patil B, Prizgint L, Talasazan N, Meltzer HY, Kane JM, Gibbons RD, Guinart D. Awareness of illness moderates self-assessment of psychotic symptoms. Aust N Z J Psychiatry 2022; 56:1287-1294. [PMID: 34784772 DOI: 10.1177/00048674211057480] [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: 11/16/2022]
Abstract
OBJECTIVE Self-reports or patient-reported outcome measures are seldom used in psychosis due to concerns about the ability of patients to accurately report their symptomatology, particularly in cases of low awareness of illness. The aim of this study was to assess the effect of insight on the accuracy of self-reported psychotic symptoms using a computerized adaptive testing tool (CAT-Psychosis). METHODS A secondary analysis of data drawn from the CAT-Psychosis development and validation study was performed. The Brief Psychiatric Rating Scale and the Scale of Unawareness of Mental Disorders were administered by clinicians. Patients completed the self-reported version of the CAT-Psychosis. Patients were median-split regarding their insight level to compare the correlation between the two psychosis severity measures. A subgroup sensitivity analysis was performed only on patients with schizophrenia spectrum disorders. RESULTS A total of 159 patients with a psychotic disorder who completed both CAT-Psychosis and Scale of Unawareness of Mental Disorders were included. For the whole sample, CAT-Psychosis scores showed convergent validity with Brief Psychiatric Rating Scale ratings (r = 0.517, 95% confidence interval = [0.392, 0.622], p < 0.001). Insight was found to moderate this correlation (β = -0.511, p = 0.005), yet agreement between both measures remained statistically significant for both high (r = 0.621, 95% confidence interval = [0.476, 0.733], p < 0.001) and low insight patients (r = 0.408, 95% confidence interval = [0.187, 0.589], p < 0.001), while psychosis severity was comparable between these groups (for Brief Psychiatric Rating Scale: U = 3057, z = -0.129, p = 0.897; disorganization: U = 2986.5, z = -0.274, p = 0.784 and for CAT-Psychosis: U = 2800.5, z = -1.022, p = 0.307). Subgroup of patients with schizophrenia spectrum disorders showed very similar results. CONCLUSIONS Insight moderates the correlation between self-reported and clinician-rated severity of psychosis, yet CAT-Psychosis remains valid in patients with both high and low awareness of illness.
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Affiliation(s)
- Luis Martinez Agulleiro
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Psychiatry Department, Complexo Hospitalario Universitario de Ferrol, Ferrol, Spain
| | - Renato de Filippis
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Psychiatric Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Stella Rosson
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Psychiatric Unit, Department of Mental Health, Azienda ULSS 3 Serenissima, Venice, Italy.,Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padua, Italy
| | - Bhagyashree Patil
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Lara Prizgint
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | - Nahal Talasazan
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA
| | | | - John M Kane
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Institute for Behavioral Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Manhasset, NY, USA
| | - Robert D Gibbons
- Center for Health Statistics and Departments of Medicine, Public Health Sciences (Biostatistics), Psychiatry, Comparative Human Development, and the Committee on Quantitative Methods, University of Chicago, Chicago, IL, USA
| | - Daniel Guinart
- Department of Psychiatry Research, Zucker Hillside Hospital, Glen Oaks, NY, USA.,Institute for Behavioral Health, Feinstein Institutes for Medical Research, Manhasset, NY, USA.,Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Manhasset, NY, USA.,Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Institut de Neuropsiquiatria i Addiccions (INAD), Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Departament de Psiquiatria, Universitat Autònoma de Barcelona, Barcelona, Spain
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27
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Archer M, Shnyien A, Mansfield S, Draycott S. Mentalizing in first-episode psychosis: Correlates with symptomatology and traits of borderline personality disorder. Early Interv Psychiatry 2022. [PMID: 36181363 DOI: 10.1111/eip.13356] [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] [Received: 03/21/2022] [Revised: 07/13/2022] [Accepted: 09/18/2022] [Indexed: 11/28/2022]
Abstract
AIM To explore the associations between mentalizing, positive and negative symptoms of psychosis, and traits of borderline personality disorder, in a sample of patients with first-episode psychosis, and in a non-clinical sample. METHODS A quantitative cross-sectional design was employed. Thirty-two adults with first-episode psychosis and 148 non-clinical participants were assessed using the reflective functioning questionnaire. The questionnaire measures two dimensions of mentalizing, certainty and uncertainty about mental states. Traits of borderline personality disorder and symptoms of psychosis were measured using the self-report version of the Zanarini rating scale, the Community Assessment of Psychotic Experiences, and the Green et al., paranoid thought scale. RESULTS Patients with first-episode psychosis reported increased mentalizing impairments, characterized as hypomentalizing tendencies, compared to the non-clinical group. Regression analysis showed significant associations between higher scores on the uncertainty about mental states scale and negative symptoms of psychosis in both groups. No associations were found between mentalizing impairments and traits of borderline personality disorder in the clinical sample, although associations were found in the non-clinical sample. CONCLUSIONS The present findings suggests that impairments in mentalizing may be associated with negative symptoms of psychosis across both clinical and non-clinical samples. Mentalizing impairments was found to be associated with traits of borderline personality disorder, but this finding was only confirmed in the non-clinical sample. Mentalizing should therefore be considered in the early assessment and treatment of patients experiencing difficulties with negative symptoms of psychosis.
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Affiliation(s)
| | - Ali Shnyien
- University of Surrey, Guildford, England, UK
| | - Sarah Mansfield
- South West London and St George's Mental Health Trust, London, England, UK
| | - Simon Draycott
- University of Surrey, Guildford, England, UK.,West London NHS Trust, London, England, UK
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28
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Wendt LP, Jankowsky K, Schroeders U, Nolte T, Fonagy P, Montague PR, Zimmermann J, Olaru G. Mapping established psychopathology scales onto the Hierarchical Taxonomy of Psychopathology (HiTOP). Personal Ment Health 2022; 17:117-134. [PMID: 36162810 DOI: 10.1002/pmh.1566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/05/2022]
Abstract
The Hierarchical Taxonomy of Psychopathology (HiTOP) organizes phenotypes of mental disorder based on empirical covariation, offering a comprehensive organizational framework from narrow symptoms to broader patterns of psychopathology. We argue that established self-report measures of psychopathology from the pre-HiTOP era should be systematically integrated into HiTOP to foster cumulative research and further the understanding of psychopathology structure. Hence, in this study, we mapped 92 established psychopathology (sub)scales onto the current HiTOP working model using data from an extensive battery of self-report assessments that was completed by community participants and outpatients (N = 909). Content validity ratings of the item pool were used to select indicators for a bifactor-(S-1) model of the p factor and five HiTOP spectra (i.e., internalizing, thought disorder, detachment, disinhibited externalizing, and antagonistic externalizing). The content-based HiTOP scales were validated against personality disorder diagnoses as assessed by standardized interviews. We then located established scales within the taxonomy by estimating the extent to which scales reflected higher-level HiTOP dimensions. The analyses shed light on the location of established psychopathology scales in HiTOP, identifying pure markers and blends of HiTOP spectra, as well as pure markers of the p factor (i.e., scales assessing mentalizing impairment and suspiciousness/epistemic mistrust).
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Affiliation(s)
- Leon P Wendt
- Department of Psychology, University of Kassel, Kassel, Germany
| | | | | | | | - Tobias Nolte
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK.,Anna Freud National Centre for Children and Families, London, UK
| | - Peter Fonagy
- Anna Freud National Centre for Children and Families, London, UK.,Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - P Read Montague
- Wellcome Trust Centre for Neuroimaging, University College London, London, UK.,Fralin Biomedical Research Institute, Department of Psychology, Virginia Tech, Roanoke, Virginia, USA
| | | | - Gabriel Olaru
- Department of Developmental Psychology, Tilburg University, Tilburg, Netherlands
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29
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Greenwood KE, Gurnani M, Ward T, Vogel E, Vella C, McGourty A, Robertson S, Sacadura C, Hardy A, Rus‐Calafell M, Collett N, Emsley R, Freeman D, Fowler D, Kuipers E, Bebbington P, Dunn G, Michelson D, Garety P. The service user experience of SlowMo therapy: A co-produced thematic analysis of service users' subjective experience. Psychol Psychother 2022; 95:680-700. [PMID: 35445520 PMCID: PMC9873386 DOI: 10.1111/papt.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/18/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVES SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention. DESIGN Qualitative co-produced sub-study of an RCT. METHODS Participants were 22 adult service users with schizophrenia-spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24-week follow-up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co-produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were used to reach a consensus on the final theme structure. RESULTS Six core themes were identified: (i) starting the SlowMo journey; (ii) the central role of the supportive therapist; (iii) slowing things down; (iv) value and learning from social connections; (v) approaches and challenges of technology; and (vi) improvements in paranoia and well-being. CONCLUSIONS For these service users, slowing down for a moment was helpful, and integrated into thinking over time. Learning from social connections reflected reduced isolation, and enhanced learning through videos, vignettes, and peers. The central role of the supportive therapist and the triangle of alliance between service user, therapist, and digital platform were effective in promoting positive therapeutic outcomes.
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Affiliation(s)
- Kathryn E. Greenwood
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | | | - Tom Ward
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | - Evelin Vogel
- Sussex Partnership NHS Foundation TrustWorthingUK
| | - Claire Vella
- Sussex Partnership NHS Foundation TrustWorthingUK
| | | | | | | | - Amy Hardy
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | | | - Richard Emsley
- Department of Biostatistics and Health InformaticsInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK
| | - Daniel Freeman
- Oxford Health NHS Foundation TrustOxfordUK,Department of PsychiatryOxford UniversityOxfordUK
| | - David Fowler
- School of PsychologyUniversity of SussexBrightonUK,Sussex Partnership NHS Foundation TrustWorthingUK
| | - Elizabeth Kuipers
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
| | | | - Graham Dunn
- Centre for BiostatisticsSchool of Health SciencesManchester Academic Health Science CentreThe University of ManchesterManchesterUK
| | | | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology and NeuroscienceKing’s College LondonLondonUK,South London and Maudsley NHS Foundation TrustLondonUK
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30
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Jeppesen UN, Due AS, Mariegaard L, Pinkham A, Vos M, Veling W, Nordentoft M, Glenthøj LB. Face Your Fears: Virtual reality-based cognitive behavioral therapy (VR-CBT) versus standard CBT for paranoid ideations in patients with schizophrenia spectrum disorders: a randomized clinical trial. Trials 2022; 23:658. [PMID: 35971137 PMCID: PMC9377061 DOI: 10.1186/s13063-022-06614-0] [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] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/02/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Schizophrenia spectrum disorders cause suffering for patients, relatives, and the surrounding society. Paranoid ideations, encompassing ideas of social reference and manifest persecutory delusions, are among the most frequent symptoms in this population and a cause of significant distress. Recent meta-analyses of cognitive behavioral therapy (CBT) for psychosis show small to moderate effect sizes in reducing paranoid ideations. Virtual reality-based CBT (VR-CBT) could improve therapy efficacy as exposure and behavioral experiments in VR can be optimized, individualized, and carried out in a safe environment. Few VR-CBT studies exist for paranoid ideations and there is a need for large-scale, methodologically rigorous trials. METHODS This study is a randomized, assessor-blinded parallel-groups multi-center superiority clinical trial, fulfilling the CONSORT criteria for non-pharmacological treatment. A total of 256 patients diagnosed with schizophrenia spectrum disorder, including schizotypal disorder (ICD-10 F20-29), will be allocated to either 10 sessions of symptom-specific CBT-VR plus treatment as usual-versus 10 sessions of standard symptom-specific CBT for paranoid ideations (CBT) plus treatment as usual. All participants will be assessed at baseline, treatment end (3 months post baseline), and then 9 months post baseline. A stratified block-randomization with concealed randomization sequence will be conducted. Independent assessors blinded to the treatment will evaluate the outcome. Analysis of outcome will be carried out with the intention to treat principles. The primary outcome is ideas of social reference measured with Green Paranoid Thought Scale Part A (GPTS-A) at the cessation of treatment at 3 months post baseline. Secondary outcomes are ideas of persecution (GPTS-B), Social Interaction Anxiety Scale (SIAS), Personal and Social Performance scale (PSP), Safety Behavior Questionnaire (SBQ), and CANTAB Emotion Recognition Task. DISCUSSION The trial will elucidate whether VR-CBT can enhance therapy efficacy for paranoid ideations. Additionally, Trial findings will provide evidence on the effectiveness and cost-effectiveness of VR-CBT for paranoid ideations that can guide the possible dissemination and implementation into clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT04902066 . Initial release April 9th, 2021.
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Affiliation(s)
- U. N. Jeppesen
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - A. S. Due
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark
| | - L. Mariegaard
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark
| | - A. Pinkham
- grid.267323.10000 0001 2151 7939School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, USA
| | - M. Vos
- grid.4494.d0000 0000 9558 4598Faculty of Medical Sciences, University Medical Center Groningen, Center of Psychiatry, University of Groningen, Groningen, Netherlands
| | - W. Veling
- grid.4494.d0000 0000 9558 4598Faculty of Medical Sciences, University Medical Center Groningen, Center of Psychiatry, University of Groningen, Groningen, Netherlands
| | - M. Nordentoft
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark
| | - L. B. Glenthøj
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, University of Copenhagen, Copenhagen, Denmark
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Carrillo de Albornoz CM, Gutiérrez B, Ibanez-Casas I, Cervilla JA. Paranoia and Suicidality: A Cross-Sectional Study in the General Population. Arch Suicide Res 2022; 26:1587-1599. [PMID: 34286675 DOI: 10.1080/13811118.2021.1950589] [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: 01/04/2023]
Abstract
Paranoia and suicidality seem to be common traits expressing in the general population to varying degrees. This study aims to explore the association between both and to identify determinants of comorbidity. We interviewed a representative sample of the population in Andalusia (n = 4507) and assessed paranoia and suicidality utilizing the Spanish Green's Paranoid Thoughts Scale (S-GPTS) and the suicidality section of the MINI Neuropsychiatric Interview, respectively. We gathered data on socio-demographics, personality, substance abuse, social support, and environmental distress. We found that paranoia and suicidality were rather common with 6.4% (95% CI: 5.7-7.12) of the sample admitting to some (vs. none) level of suicidality. We also found a robust association between paranoia and suicidality, independent of age and sex (F:298.2; p =.0001; Eta2: .065); 0.5% (95% CI: 0.32-0.76) of the sample (n = 21) presented combinedly high levels of paranoia and some suicidality risk and were considered as having paranoia-suicidality comorbidity (PSC). We identified factors associating with PSC, including poor social support, childhood maltreatment, threatening life-events and increasing personality disorder, and nicotine dependence scores. Paranoia and suicidality are common traits in the general population and their comorbidity seems to associate with low social support, environmental adversity and disordered personality. Suicidality and paranoia are common traits present dimensionally in a representative nonclinical sample. Paranoia strongly and independently associates with suicidality risk in a large population-based study. Paranoia and suicidality comorbidity may be commonly determined by poor social support, disordered personality, previous childhood maltreatment, and exposure to threatening life-events.
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Latteur A, Larøi F, Bortolon C. Translation and Validation of the French Version of the Revised Green et al., Paranoid Thoughts Scale (R-GPTS) in Two Samples: Non-Clinical and Clinical Adults. Psychol Belg 2022; 62:208-217. [PMID: 35692717 PMCID: PMC9165671 DOI: 10.5334/pb.1134] [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: 10/19/2021] [Accepted: 04/28/2022] [Indexed: 11/20/2022] Open
Abstract
Paranoia consists of unfounded beliefs that harm will be caused with intent to hurt the subject. Paranoid thoughts exist on a continuum of severity from severe forms in several psychological pathologies to milder forms in a significant minority of individuals of the general population (Freeman, 2007). It can be measured using several types of questionnaires. One recent questionnaire that measures paranoia in both clinical and non-clinical populations is the revised Green et al., Paranoid Thoughts Scale (R-GPTS) (Freeman et al., 2019). This questionnaire is an improved version of the Green et al., Paranoid Thoughts Scale (GPTS) (Green et al., 2008) and has excellent psychometric properties. In the present study, the R-GPTS was translated into French and the psychometric properties of the new French version were evaluated in a sample of the general population (N = 600) and in a clinical sample (N = 22). Confirmatory factor analysis supported the original two-factor structure (social reference and persecution subscales) of the R-GPTS. Evidence of excellent internal consistency of the R-GPTS was found. Furthermore, good convergent and discriminant validity was also found. Test-retest reliability showed significant positive correlations over a 1-month period. The findings discussed above were found in the non-clinical sample. Lastly, the R-GPTS revealed good preliminary criterion validity established from the comparison between the clinical and the non-clinical groups. In conclusion, the French version of the R-GPTS is a valid and reliable tool to measure paranoia in the general population. Due to the small sample size of the clinical sample, further studies are needed in order to confirm good psychometric properties in clinical populations, even though our preliminary findings are promising.
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Affiliation(s)
- Alizée Latteur
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Belgium
- Department of Psychology, University of Oslo, Norway
- Norwegian Center of Excellence for Mental Disorders Research, University of Oslo, Norway
| | - Catherine Bortolon
- Université Grenoble-Alpes, Laboratoire Interuniversitaire de Psychologie (LIP/PC2S), France
- C3R Centre Référent Réhabilitation Psychosociale et Remédiation, Centre Hospitalier Alpes-Isère, Grenoble, France
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Ceballos-Munuera C, Senín-Calderón C, Fernández-León S, Fuentes-Márquez S, Rodríguez-Testal JF. Aberrant Salience and Disorganized Symptoms as Mediators of Psychosis. Front Psychol 2022; 13:878331. [PMID: 35496226 PMCID: PMC9039361 DOI: 10.3389/fpsyg.2022.878331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Ideas of reference (IR) are frequent in psychopathology, mainly in psychotic disorders. The frequency of IR and preoccupation about them are related to the psychotic dimension, and to a lesser extent, to negative or emotional disorganized dimensions. Aberrant salience (AS), has been proposed as an indicator of the onset of psychosis, particularly of schizophrenia. This study analyzed the mediating role of AS, disorganized symptoms and preoccupation about IR in the relationship between IR and the psychotic dimension. Method The sample consisted of 330 participants (116 university students and 214 clinically active patients), 62.4% of whom were women aged 18-79. The Referential Thinking Scale, the Aberrant Salience Inventory, and the Brief Psychiatric Rating Scale were administered. Results Evidence of a partial mediation model showed that the relationships between IR and the psychotic dimension were mediated jointly by AS and the disorganized dimension, and preoccupation about IR no longer had a role. This relationship was significantly influenced by participant age. The variables in the model explained 54.16% of the variance. Conclusion The model proposed enabled a set of vulnerabilities (unusual thought content) to be predicted that could lead to a high-risk general pathological state and proneness to psychosis in particular. These findings are discussed with regard to early detection and prevention of psychosis.
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Affiliation(s)
- Celia Ceballos-Munuera
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Seville, Spain
| | | | | | | | - Juan Fco Rodríguez-Testal
- Personality, Evaluation and Psychological Treatment Department, University of Seville, Seville, Spain
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Vass Á, Polner B. Paranoia and game theory: Altered interpersonal functioning through the lens of interactive games. Schizophr Res 2022; 241:116-118. [PMID: 35121435 DOI: 10.1016/j.schres.2022.01.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 10/19/2022]
Affiliation(s)
- Ágota Vass
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary; Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary.
| | - Bertalan Polner
- Department of Cognitive Science, Budapest University of Technology and Economics, Budapest, Hungary
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So SHW, Zhu C, Lincoln TM, Gaudiano BA, Kingston JL, Ellett L, Morris EMJ. Pandemic paranoia, general paranoia, and their relationships with worry and beliefs about self/others - A multi-site latent class analysis. Schizophr Res 2022; 241:122-129. [PMID: 35121437 DOI: 10.1016/j.schres.2022.01.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 01/18/2022] [Accepted: 01/22/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, an increase in paranoid thinking has been reported internationally. The development of the Pandemic Paranoia Scale (PPS) has provided a reliable assessment of various facets of pandemic paranoia. This study aimed to (i) identify classes of individuals with varying levels of general paranoia and pandemic paranoia, and (ii) examine associations between classification and worry, core beliefs, and pro-health behaviours. METHODS An international sample of adults (N = 2510) across five sites completed the Revised-Green Paranoid Thoughts Scale and the PPS. Latent class analysis (LCA) was conducted using these two paranoia variables. Classes were compared on trait worry (Penn State Worry Questionnaire), beliefs about self/others (Brief Core Schema Scales), and pro-health behaviour. RESULTS Three latent classes emerged: Class 1 with low R-GPTS and PPS scores, Class 2 with a high R-GPTS score and a moderate PPS score, and Class 3 with high R-GPTS and PPS scores. Compared to Class 1, Classes 2-3 were associated with more worry and negative self- and other-beliefs. Class 3 was further characterised by greater positive-self beliefs and less engagement in pro-health behaviours. Engagement in pro-health behaviours was positively correlated with interpersonal mistrust and negatively correlated with paranoid conspiracy and persecutory threat. CONCLUSIONS Individuals with a general paranoia tendency were more likely to respond to the global health threats in a suspicious and distrusting way. Our findings suggested that worry and negative self/other beliefs may contribute to not just general paranoia but also pandemic paranoia. The preliminary finding of a link between pro-health behaviours and interpersonal mistrust warrants further examination.
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Affiliation(s)
| | - Chen Zhu
- The Chinese University of Hong Kong, Hong Kong, China
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Satherley RM, Lerigo F, Higgs S, Howard R. An interpretative phenomenological analysis of the development and maintenance of gluten-related distress and unhelpful eating and lifestyle patterns in coeliac disease. Br J Health Psychol 2022; 27:1026-1042. [PMID: 35170152 PMCID: PMC9544439 DOI: 10.1111/bjhp.12588] [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] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/03/2022] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Estimates indicate that individuals with coeliac disease are more likely to experience disordered eating and impaired well-being than healthy controls, but less is known about the mechanisms by which these factors are related. The aim of this study was to understand experiences of coeliac disease and influence on subsequent unhelpful eating and lifestyle patterns. METHODS An online focus group discussion, hosted through a synchronous chat log, with adults living with coeliac disease was conducted. Seven individuals discussed their condition, lifestyle, and dietary changes post-diagnosis. Discussions were analysed using an interpretative phenomenological approach, a technique that enables new practical or research insight into health conditions based upon participants' experiences of their condition. RESULTS Three themes were identified: (i) Nobody knew what was happening to my body; (ii) I am so afraid of being 'glutened' that it is central to my thoughts and anxieties; and (iii) I am frightened but I can keep myself safe by being a 'good' coeliac. These appeared to contribute to participant distress or unhelpful eating or lifestyle behaviours. Participants appeared to develop severe anxiety around gluten, and implausible beliefs around diet and lifestyle management that appear to initiate and maintain unhelpful eating behaviours and maladaptive lifestyles changes, that contribute to distress. CONCLUSIONS Extending current knowledge, we propose a novel cognitive perspective on the development and maintenance of disordered eating in coeliac disease. Implications for how health providers can better support individuals with coeliac disease, and the role of dietary management, anxiety, and gastrointestinal symptoms in the development of disordered eating are discussed.
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Affiliation(s)
- Rose-Marie Satherley
- Department of Psychological Interventions, School of Psychology, University of Surrey, Guildford, UK
| | - Fiona Lerigo
- Division of Population Health, Health Services Research & Primary Care, University of Manchester, UK
| | - Suzanne Higgs
- School of Psychology, University of Birmingham, Edgbaston, UK
| | - Ruth Howard
- School of Psychology, University of Birmingham, Edgbaston, UK
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Coleman EP, Croft RJ, Barkus E. The profile of unusual beliefs associated with metacognitive thinking and attributional styles. Psych J 2022; 11:296-309. [PMID: 35168296 PMCID: PMC9305741 DOI: 10.1002/pchj.528] [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: 09/10/2021] [Revised: 12/19/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022]
Abstract
Cognitive interpretations of daily events may differ in people from the general population who hold unusual beliefs. It is also important to understand whether different belief profiles exist to appreciate which patterns of beliefs are less psychologically healthy. Cluster analysis was used to form unusual belief profiles in a general population sample (n = 578; Mage = 22 years, SD = 6.98; 80% female) across paranoid, paranormal, and magical ideation beliefs, and we assessed whether they differed in attribution style and metacognitive beliefs about worry. Four clusters were formed: low on all measures (low all); high on all measures (high all); comparably higher on paranormal beliefs (paranormal group); and comparably higher on paranoid beliefs (paranoid group). For total Metacognitions Questionnaire‐30, the high all and high paranoid clusters did not differ, and both clusters scored higher than the high paranormal group, who all scored higher than the low all cluster. For attributional styles (Attributional Styles Questionnaire), lower scores on internal positive attribution were found for the high all and high paranoid clusters compared to the low all and high paranormal clusters. The high paranormal cluster had higher scores than the high paranoid cluster on self‐serving bias. Differences in attributional style appeared to be driven by mental health diagnosis. Our results suggest different profiles of unusual beliefs are detectable in the general population that differ in their metacognitive beliefs and perceived causation of events in their environment. Future studies investigating delusional proneness need to consider multiple unusual beliefs as well as assessing mood state and distress.
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Affiliation(s)
- Elle P Coleman
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Rodney J Croft
- School of Psychology, University of Wollongong, Wollongong, New South Wales, Australia.,Illawarra Health & Medical Research Institute, Wollongong, New South Wales, Australia
| | - Emma Barkus
- Department of Psychology, Northumbria University, Newcastle upon Tyne, UK
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Zheng S, Marcos M, Stewart KE, Szabo J, Pawluk E, Girard TA, Koerner N. Worry, intolerance of uncertainty, negative urgency, and their associations to paranoid thinking. PERSONALITY AND INDIVIDUAL DIFFERENCES 2022. [DOI: 10.1016/j.paid.2021.111382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Buck B, Nguyen J, Porter S, Ben-Zeev D, Reger GM. FOCUS mHealth Intervention for Veterans With Serious Mental Illness in an Outpatient Department of Veterans Affairs Setting: Feasibility, Acceptability, and Usability Study. JMIR Ment Health 2022; 9:e26049. [PMID: 35089151 PMCID: PMC8838564 DOI: 10.2196/26049] [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] [Received: 11/25/2020] [Revised: 02/15/2021] [Accepted: 10/04/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Veterans with serious mental illnesses (SMIs) face barriers to accessing in-person evidence-based interventions that improve illness management. Mobile health (mHealth) has been demonstrated to be feasible, acceptable, effective, and engaging among individuals with SMIs in community mental health settings. mHealth for SMIs has not been tested within the Department of Veterans Affairs (VA). OBJECTIVE This study examines the feasibility, acceptability, and preliminary effectiveness of an mHealth intervention for SMI in the context of VA outpatient care. METHODS A total of 17 veterans with SMIs were enrolled in a 1-month pilot trial of FOCUS, a smartphone-based self-management intervention for SMI. At baseline and posttest, they completed measures examining symptoms and functional recovery. The participants provided qualitative feedback related to the usability and acceptability of the intervention. RESULTS Veterans completed on an average of 85.0 (SD 96.1) interactions with FOCUS over the 1-month intervention period. They reported high satisfaction, usability, and acceptability, with nearly all participants (16/17, 94%) reporting that they would recommend the intervention to a fellow veteran. Clinicians consistently reported finding mHealth-related updates useful for informing their care. Qualitative feedback indicated that veterans thought mHealth complemented their existing VA services well and described potential opportunities to adapt FOCUS to specific subpopulations (eg, combat veterans) as well as specific delivery modalities (eg, groups). In the 1-month period, the participants experienced small improvements in self-assessed recovery, auditory hallucinations, and quality of life. CONCLUSIONS The FOCUS mHealth intervention is feasible, acceptable, and usable among veterans. Future work should develop and examine VA-specific implementation approaches of FOCUS for this population.
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Affiliation(s)
- Benjamin Buck
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Janelle Nguyen
- VA Puget Sound Healthcare System, Seattle, WA, United States
| | - Shelan Porter
- VA Puget Sound Healthcare System, Seattle, WA, United States
| | - Dror Ben-Zeev
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Greg M Reger
- Behavioral Research in Technology and Engineering (BRiTE) Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.,VA Puget Sound Healthcare System, Seattle, WA, United States
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Greenburgh AG, Liefgreen A, Bell V, Raihani N. Factors affecting conspiracy theory endorsement in paranoia. ROYAL SOCIETY OPEN SCIENCE 2022; 9:211555. [PMID: 35116159 PMCID: PMC8790340 DOI: 10.1098/rsos.211555] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 01/04/2022] [Indexed: 05/03/2023]
Abstract
Paranoia and conspiracy thinking are known to be distinct but correlated constructs, but it is unknown whether certain types of conspiracy thinking are more common in paranoia than others. In a large (n = 1000), pre-registered online study we tested if endorsement of items on a new Components of Conspiracy Ideation Questionnaire varied according to whether harm was described as being (a) intentional and (b) self-referential. Our predictions were supported: paranoia was positively associated with endorsement of items on this questionnaire overall and more paranoid individuals were more likely to endorse items describing intentional and self-referential harm. Belief in any item on the Components of Conspiracy Ideation Questionnaire was associated with belief in others and items describing incidental harm and harm to others were found to be more believable overall. Individuals who endorsed conspiracy theory items on the questionnaire were more likely to state that people similar to them would as well, although this effect was not reduced in paranoia, counter to our expectations.
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Affiliation(s)
- A. G. Greenburgh
- Psychology and Language Sciences, University College London, London, UK
| | - A. Liefgreen
- Psychology and Language Sciences, University College London, London, UK
| | - V. Bell
- Research Department of Clinical, Educational, and Healthy Psychology, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - N. Raihani
- Psychology and Language Sciences, University College London, London, UK
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Gorisse G, Senel G, Banakou D, Beacco A, Oliva R, Freeman D, Slater M. Self-observation of a virtual body-double engaged in social interaction reduces persecutory thoughts. Sci Rep 2021; 11:23923. [PMID: 34907279 PMCID: PMC8671390 DOI: 10.1038/s41598-021-03373-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 11/29/2021] [Indexed: 11/29/2022] Open
Abstract
The proportion of the population who experience persecutory thoughts is 10-15%. People then engage in safety-seeking behaviours, typically avoiding social interactions, which prevents disconfirmatory experiences and hence paranoia persists. Here we show that persecutory thoughts can be reduced if prior to engaging in social interaction in VR participants first see their virtual body-double doing so. Thirty non-clinical participants were recruited to take part in a study, where they were embodied in a virtual body that closely resembled themselves, and asked to interact with members of a crowd. In the Random condition (n = 15) they observed their body-double wandering around but not engaging with the crowd. In the Targeted condition the body-double correctly interacted with members of the crowd. The Green Paranoid Thoughts Scale was measured 1 week before and 1 week after the exposure and decreased only for those in the Targeted condition. The results suggest that the observation of the body-double correctly carrying out a social interaction task in VR may lead to anxiety-reducing mental rehearsal for interaction thus overcoming safety behaviours. The results also extend knowledge of the effects of vicarious agency, suggesting that identification with the actions of body-double can influence subsequent psychological state.
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Affiliation(s)
- Geoffrey Gorisse
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- LAMPA, Arts et Métiers Institute of Technology, Changé, France
| | - Gizem Senel
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain
| | - Domna Banakou
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain
| | - Alejandro Beacco
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Ramon Oliva
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - Mel Slater
- Event Lab, Faculty of Psychology, University of Barcelona, Barcelona, Spain.
- Institute of Neurosciences of the University of Barcelona, Barcelona, Spain.
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Ben-Zeev D, Chander A, Tauscher J, Buck B, Nepal S, Campbell A, Doron G. A Smartphone Intervention for People With Serious Mental Illness: Fully Remote Randomized Controlled Trial of CORE. J Med Internet Res 2021; 23:e29201. [PMID: 34766913 PMCID: PMC8663659 DOI: 10.2196/29201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/19/2021] [Accepted: 10/03/2021] [Indexed: 01/23/2023] Open
Abstract
Background People with serious mental illness (SMI) have significant unmet mental health needs. Development and testing of digital interventions that can alleviate the suffering of people with SMI is a public health priority. Objective The aim of this study is to conduct a fully remote randomized waitlist-controlled trial of CORE, a smartphone intervention that comprises daily exercises designed to promote reassessment of dysfunctional beliefs in multiple domains. Methods Individuals were recruited via the web using Google and Facebook advertisements. Enrolled participants were randomized into either active intervention or waitlist control groups. Participants completed the Beck Depression Inventory-Second Edition (BDI-II), Generalized Anxiety Disorder-7 (GAD-7), Hamilton Program for Schizophrenia Voices, Green Paranoid Thought Scale, Recovery Assessment Scale (RAS), Rosenberg Self-Esteem Scale (RSES), Friendship Scale, and Sheehan Disability Scale (SDS) at baseline (T1), 30-day (T2), and 60-day (T3) assessment points. Participants in the active group used CORE from T1 to T2, and participants in the waitlist group used CORE from T2 to T3. Both groups completed usability and accessibility measures after they concluded their intervention periods. Results Overall, 315 individuals from 45 states participated in this study. The sample comprised individuals with self-reported bipolar disorder (111/315, 35.2%), major depressive disorder (136/315, 43.2%), and schizophrenia or schizoaffective disorder (68/315, 21.6%) who displayed moderate to severe symptoms and disability levels at baseline. Participants rated CORE as highly usable and acceptable. Intent-to-treat analyses showed significant treatment×time interactions for the BDI-II (F1,313=13.38; P<.001), GAD-7 (F1,313=5.87; P=.01), RAS (F1,313=23.42; P<.001), RSES (F1,313=19.28; P<.001), and SDS (F1,313=10.73; P=.001). Large effects were observed for the BDI-II (d=0.58), RAS (d=0.61), and RSES (d=0.64); a moderate effect size was observed for the SDS (d=0.44), and a small effect size was observed for the GAD-7 (d=0.20). Similar changes in outcome measures were later observed in the waitlist control group participants following crossover after they received CORE (T2 to T3). Approximately 41.5% (64/154) of participants in the active group and 60.2% (97/161) of participants in the waitlist group were retained at T2, and 33.1% (51/154) of participants in the active group and 40.3% (65/161) of participants in the waitlist group were retained at T3. Conclusions We successfully recruited, screened, randomized, treated, and assessed a geographically dispersed sample of participants with SMI entirely via the web, demonstrating that fully remote clinical trials are feasible in this population; however, study retention remains challenging. CORE showed promise as a usable, acceptable, and effective tool for reducing the severity of psychiatric symptoms and disability while improving recovery and self-esteem. Rapid adoption and real-world dissemination of evidence-based mobile health interventions such as CORE are needed if we are to shorten the science-to-service gap and address the significant unmet mental health needs of people with SMI during the COVID-19 pandemic and beyond. Trial Registration ClinicalTrials.gov NCT04068467; https://clinicaltrials.gov/ct2/show/NCT04068467
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Affiliation(s)
- Dror Ben-Zeev
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Ayesha Chander
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Justin Tauscher
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Benjamin Buck
- Behavioral Research in Technology and Engineering Center, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Subigya Nepal
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Andrew Campbell
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Guy Doron
- School of Psychology, Interdisciplinary Center, Herzliya, Israel
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Yu L, Kazinka R, Pratt D, Kwashie A, MacDonald AW. Resting-State Networks Associated with Behavioral and Self-Reported Measures of Persecutory Ideation in Psychosis. Brain Sci 2021; 11:brainsci11111490. [PMID: 34827489 PMCID: PMC8615751 DOI: 10.3390/brainsci11111490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 10/29/2021] [Accepted: 11/03/2021] [Indexed: 11/17/2022] Open
Abstract
Persecutory ideations are self-referential delusions of being the target of malevolence despite a lack of evidence. Wisner et al. (2021) found that reduced connectivity between the left frontoparietal (lFP) network and parts of the orbitofrontal cortex (OFC) correlated with increased persecutory behaviors among psychotic patients performing in an economic social decision-making task that can measure the anticipation of a partner’s spiteful behavior. If this pattern could be observed in the resting state, it would suggest a functional-structural prior predisposing individuals to persecutory ideation. Forty-four patients in the early course of a psychotic disorder provided data for resting-state functional connectivity magnetic resonance imaging across nine brain networks that included the FP network and a similar OFC region. As predicted, we found a significant and negative correlation between the lFP–OFC at rest and the level of suspicious mistrust on the decision-making task using a within-group correlational design. Additionally, self-reported persecutory ideation correlated significantly with the connectivity between the right frontoparietal (rFP) network and the OFC. We extended the previous finding of reduced connectivity between the lFP network and the OFC in psychosis patients to the resting state, and observed a possible hemispheric difference, such that greater rFP–OFC connectivity predicted elevated self-reported persecutory ideation, suggesting potential differences between the lFP and rFP roles in persecutory social interactions.
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Berkhof M, van der Stouwe ECD, Lestestuiver B, van’t Hag E, van Grunsven R, de Jager J, Kooijmans E, Zandee CER, Staring ABP, Pot-Kolder RMCA, Vos M, Veling W. Virtual reality cognitive-behavioural therapy versus cognitive-behavioural therapy for paranoid delusions: a study protocol for a single-blind multi-Centre randomised controlled superiority trial. BMC Psychiatry 2021; 21:496. [PMID: 34635063 PMCID: PMC8507393 DOI: 10.1186/s12888-021-03473-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Seventy per cent of patients with psychotic disorders has paranoid delusions. Paranoid delusions are associated with significant distress, hospital admission and social isolation. Cognitive-behavioural therapy for psychosis (CBTp) is the primary psychological treatment, but the median effect size is only small to medium. Virtual reality (VR) has a great potential to improve the effectiveness of CBTp. In a previous study, we found that VR based CBT (VRcbt) for paranoid delusions is superior to waiting list. As a next step, a direct comparison with CBTp is needed. The present study aims to investigate whether VRcbt is more effective and cost-effective than regular CBTp in treating paranoid delusions and improving daily life social functioning of patients with psychotic disorders. METHODS A total of 106 patients with DSM-5 diagnosis of psychotic disorder and at least moderate level of paranoid ideations will be recruited for this multicentre randomized controlled trial (RCT). Patients will be randomized to either VRcbt or standard CBTp for paranoid delusions. VRcbt consists of maximum 16 sessions in virtual social situations that trigger paranoid ideations and distress, delivered in an 8-12 week time frame. Standard CBTp also consists of maximum 16 sessions including exposure and behavioural experiments, delivered in an 8-12 week time frame. The two groups will be compared at baseline, post-treatment and six months follow-up. Primary outcome is the level of paranoid ideations in daily life social situations, measured with ecological momentary assessments (EMA) at semi-random moments ten times a day during seven days, before and after treatment. Every session, participants and therapists will rate the level of paranoid ideation and global clinical impression. DISCUSSION Comparison of VRcbt and CBTp will provide information about the relative (cost-) effectiveness of VRcbt for this population. VRcbt may become a preferred psychological treatment for paranoid delusions and social anxiety in patients with psychotic disorder. TRIAL REGISTRATION Netherlands Trial Register, NL7758. Registered on 23 May 2019.
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Affiliation(s)
- M. Berkhof
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - E. C. D. van der Stouwe
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - B. Lestestuiver
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - E. van’t Hag
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | | | - J. de Jager
- Mental Health Service Organization GGZ Noord-Holland-Noord, Heiloo, Heerhugowaard, The Netherlands
| | - E. Kooijmans
- grid.491369.00000 0004 0466 1666Pro Persona, Arnhem, Arnhem, The Netherlands
| | - C. E. R. Zandee
- Flexible Assertive Community Treatment Team, Outpatient Treatment Center, GGZ Delfland, Delft, The Netherlands
| | - A. B. P. Staring
- First Episode and Early Detection and Intervention Service, Altrecht Psychiatric Institute, Utrecht, The Netherlands
| | - R. M. C. A. Pot-Kolder
- grid.12380.380000 0004 1754 9227Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - M. Vos
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - W. Veling
- grid.4830.f0000 0004 0407 1981University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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Rossi-Goldthorpe RA, Leong YC, Leptourgos P, Corlett PR. Paranoia, self-deception and overconfidence. PLoS Comput Biol 2021; 17:e1009453. [PMID: 34618805 PMCID: PMC8525769 DOI: 10.1371/journal.pcbi.1009453] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/19/2021] [Accepted: 09/15/2021] [Indexed: 02/04/2023] Open
Abstract
Self-deception, paranoia, and overconfidence involve misbeliefs about the self, others, and world. They are often considered mistaken. Here we explore whether they might be adaptive, and further, whether they might be explicable in Bayesian terms. We administered a difficult perceptual judgment task with and without social influence (suggestions from a cooperating or competing partner). Crucially, the social influence was uninformative. We found that participants heeded the suggestions most under the most uncertain conditions and that they did so with high confidence, particularly if they were more paranoid. Model fitting to participant behavior revealed that their prior beliefs changed depending on whether the partner was a collaborator or competitor, however, those beliefs did not differ as a function of paranoia. Instead, paranoia, self-deception, and overconfidence were associated with participants' perceived instability of their own performance. These data are consistent with the idea that self-deception, paranoia, and overconfidence flourish under uncertainty, and have their roots in low self-esteem, rather than excessive social concern. The model suggests that spurious beliefs can have value-self-deception is irrational yet can facilitate optimal behavior. This occurs even at the expense of monetary rewards, perhaps explaining why self-deception and paranoia contribute to costly decisions which can spark financial crashes and devastating wars.
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Affiliation(s)
- Rosa A. Rossi-Goldthorpe
- Department of Psychiatry, Yale University, New Haven, Connecticut, United States of America
- Interdepartmental Neuroscience Program, Yale University, New Haven, Connecticut, United States of America
| | - Yuan Chang Leong
- Department of Psychology, University of Chicago, Chicago, Illinois, United States of America
| | - Pantelis Leptourgos
- Department of Psychiatry, Yale University, New Haven, Connecticut, United States of America
| | - Philip R. Corlett
- Department of Psychiatry, Yale University, New Haven, Connecticut, United States of America
- Wu Tsai Institute, Yale University, New Haven, Connecticut, United States of America
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Varese F, Sellwood W, Aseem S, Awenat Y, Bird L, Bhutani G, Carter L, Davies L, Davis C, Horne G, Keane D, Logie R, Malkin D, Potter F, van den Berg D, Zia S, Bentall R. Eye movement desensitization and reprocessing therapy for psychosis (EMDRp): Protocol of a feasibility randomized controlled trial with early intervention service users. Early Interv Psychiatry 2021; 15:1224-1233. [PMID: 33225584 PMCID: PMC8451747 DOI: 10.1111/eip.13071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/08/2020] [Accepted: 11/05/2020] [Indexed: 01/05/2023]
Abstract
AIM Traumatic events are involved in the development and maintenance of psychotic symptoms. There are few trials exploring trauma-focused treatments as interventions for psychotic symptoms, especially in individuals with early psychosis. This trial will evaluate the feasibility and acceptability of conducting a definitive trial of Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) in people with early psychosis. METHODS Sixty participants with first episode psychosis and a history of a traumatic/adverse life event(s)will be recruited from early intervention services in the North West of England and randomized to receive16 sessions of EMDRp + Treatment as Usual (TAU) or TAU alone. Participants will be assessed at baseline, 6 and 12 months post-randomization using several measures of psychotic symptoms, trauma symptoms, anxiety, depression, functioning, service-user defined recovery, health economics indicators and quality of life. Two nested qualitative studies to assess participant feedback of therapy and views of professional stakeholders on the implementation of EMDRp into services will also be conducted. The feasibility of a future definitive efficacy and cost-effectiveness evaluation of EMDRp will be tested against several outcomes, including ability to recruit and randomize participants, trial retention at 6- and 12-month follow-up assessments, treatment engagement and treatment fidelity. CONCLUSIONS If it is feasible to deliver a multi-site trial of this intervention, it will be possible to evaluate whether EMDRp represents a beneficial treatment to augment existing evidence-based care of individuals with early psychosis supported by early intervention services.
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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, University of ManchesterAcademic Health Science CentreManchesterUK
- Complex Trauma and Resilience Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | | | - Saadia Aseem
- Division of Psychology and Mental Health, School of Health Sciences, University of ManchesterAcademic Health Science CentreManchesterUK
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Yvonne Awenat
- Division of Psychology and Mental Health, School of Health Sciences, University of ManchesterAcademic Health Science CentreManchesterUK
| | - Leanne Bird
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Gita Bhutani
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Lesley‐Anne Carter
- Division of Population Health, Health Services Research and Primary Care, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Linda Davies
- Division of Population Health, Health Services Research and Primary Care, University of ManchesterManchester Academic Health Science CentreManchesterUK
| | - Claire Davis
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Georgia Horne
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - David Keane
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Robin Logie
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Debra Malkin
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Fiona Potter
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | | | - Shameem Zia
- Lancashire and South Cumbria NHS Foundation TrustPrestonUK
| | - Richard Bentall
- Clinical Psychology Unit, Department of PsychologyUniversity of SheffieldSheffieldUK
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Horita Y. Conjecturing Harmful Intent and Preemptive Strike in Paranoia. Front Psychol 2021; 12:726081. [PMID: 34566811 PMCID: PMC8455818 DOI: 10.3389/fpsyg.2021.726081] [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: 06/16/2021] [Accepted: 08/03/2021] [Indexed: 11/13/2022] Open
Abstract
Paranoia depicts a belief of others having harmful intent. Research using economic games has exhibited the correlation between paranoia and the propensity to characterize ambiguous intentions as harmful. Using a non-clinical sample recruited online from the United States (N=290), we examined whether paranoid thoughts influence aggressive behavior against the subjective perception of harmful intent. We conducted a preemptive strike game wherein aggressive behavior was assumed to be guided by the fear of an opponent. The outcomes indicate that (1) individuals with high paranoia assume harmful intent of an opponent more than those with low paranoia (2) conjecturing an opponent's harmful intent predicted an increase in the probability of a preemptive strike, and (3) paranoia did not have a statistically significant effect on encouraging a preemptive strike. Additionally, the exploratory analysis revealed that paranoia was related to participant's aggressiveness and with suppositions of other's self-interests and competitiveness. This study presents empirical evidence that paranoia is related to the perception of social threats in an uncertain situation. We discuss the possibility that paranoid ideation can promote or inhibit a preemptive strike.
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Affiliation(s)
- Yutaka Horita
- Department of Psychology, Teikyo University, Tokyo, Japan
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48
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Wisman-van der Teen A, Lemmers-Jansen ILJ, Oorschot M, Krabbendam L. Exploring the association between social behaviour, trust, and its neural correlates in first episode psychosis patients and in individuals at clinical high risk for psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:629-646. [PMID: 34529860 PMCID: PMC9541290 DOI: 10.1111/bjc.12327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/09/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Psychosis is characterized by paranoid delusions, social withdrawal, and distrust towards others. Trust is essential for successful social interactions. It remains unknown which aspects of social functioning are associated with reduced trust in psychosis. Therefore, we investigated the association between social behaviour, trust, and its neural correlates in a group of individuals with psychotic symptoms (PS-group), consisting of first episode psychosis patients combined with individuals at clinical high risk. METHODS We compared 24 PS individuals and 25 healthy controls. Affect and social withdrawal were assessed using the Experience Sampling Method. Trust was measured during functional magnetic resonance imaging (fMRI) scanning, using a trust game with a cooperative and unfair counterpart. RESULTS The PS-group showed lower baseline trust compared to controls and reported less positive and more negative general affect. Social withdrawal did not differ between the groups. Social withdrawal and social reactivity in affect (i.e., changes in affect when with others compared to when alone) were not associated with trust. On the neural level, in controls but not in the PS-group, social withdrawal was associated with caudate activation during interactions with an unfair partner. An increase in positive social reactivity, was associated with reduced insula activation in the whole sample. CONCLUSIONS Social withdrawal and social reactivity were not associated with reduced initial trust in the PS-group. Like controls, the PS-group showed a positive response in affect when with others, suggesting a decrease in emotional distress. Supporting patients to keep engaging in social interactions, may alleviate their emotional distress. PRACTITIONER POINTS Individuals with psychotic symptoms show reduced initial trust towards unknown others. Trust in others is not associated with social withdrawal and reported affect when with others, nor when alone. Like controls, individuals with psychotic symptoms showed reduced negative affect and increased positive affect when with others compared to when alone. We emphasize to support individuals with psychotic symptoms to keep engaging in social interactions, given it may reduce social withdrawal and alleviate their emotional distress.
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Affiliation(s)
- Amanda Wisman-van der Teen
- Yulius Mental Health, Dordrecht, The Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (IBBA) Amsterdam, Vrije Universiteit Amsterdam, The Netherlands
| | - Imke L J Lemmers-Jansen
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (IBBA) Amsterdam, Vrije Universiteit Amsterdam, The Netherlands.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | | | - Lydia Krabbendam
- Department of Clinical, Neuro and Developmental Psychology, Faculty of Behavioural and Movement Sciences, Institute for Brain and Behaviour (IBBA) Amsterdam, Vrije Universiteit Amsterdam, The Netherlands
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Della Libera C, Quertemont E, Laloyaux J, Thonon B, Larøi F. Using 360° immersive videos to assess paranoia in a non-clinical population. Cogn Neuropsychiatry 2021; 26:357-375. [PMID: 34284703 DOI: 10.1080/13546805.2021.1956885] [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: 10/20/2022]
Abstract
Introduction: For the past two decades, virtual reality (VR) has proven to be an innovative approach for the assessment of state paranoia. However, the use of VR remains costly, and avatars are still far from realistic in terms of facial and bodily expressions. The present study aimed to test the validity of three 360° immersive videos (360IVs) as an accessible and realistic alternative for the assessment of non-clinical state paranoia.Method: Three 360IVs were created (a Lift, a Library and a Bar) and included actors behaving naturally. One hundred and fifty healthy students were assessed in terms of their proneness towards trait paranoia, were then exposed to one of the three 360IVs, and finally completed measures of state paranoia, sense of presence and cybersickness.Results: Results revealed the presence of various interpretations about the actor's attitudes in the three 360IVs. Also, paranoid thoughts were predicted by proneness towards trait paranoia in two out of the three 360IVs. Furthermore, moderate levels of sense of presence and low levels of cybersickness were observed for each 360IV.Conclusion: The present study provides evidence in favour of the use of 360IVs as a new accessible, realistic, and standardised tool to assess state paranoia in non-clinical samples.
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Affiliation(s)
- Clara Della Libera
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Etienne Quertemont
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Julien Laloyaux
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Bénédicte Thonon
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Frank Larøi
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Norwegian Center for Mental Disorders Research, University of Oslo, Oslo, Norway
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Increasing access to cognitive–behavioural therapy for patients with psychosis by evaluating the feasibility of a randomised controlled trial of brief, targeted cognitive–behavioural therapy for distressing voices delivered by assistant psychologists: the GiVE2 trial. BJPsych Open 2021. [PMCID: PMC8388007 DOI: 10.1192/bjo.2021.983] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background
Cognitive–behavioural therapy (CBT) is recommended for all patients with psychosis, but is offered to only a minority. This is attributable, in part, to the resource-intensive nature of CBT for psychosis. Responses have included the development of CBT for psychosis in brief and targeted formats, and its delivery by briefly trained therapists. This study explored a combination of these responses by investigating a brief, CBT-informed intervention targeted at distressing voices (the GiVE intervention) administered by a briefly trained workforce of assistant psychologists.
Aims
To explore the feasibility of conducting a randomised controlled trial to evaluate the clinical and cost-effectiveness of the GiVE intervention when delivered by assistant psychologists to patients with psychosis.
Method
This was a three-arm, feasibility, randomised controlled trial comparing the GiVE intervention, a supportive counselling intervention and treatment as usual, recruiting across two sites, with 1:1:1 allocation and blind post-treatment and follow-up assessments.
Results
Feasibility outcomes were favourable with regard to the recruitment and retention of participants and the adherence of assistant psychologists to therapy and supervision protocols. For the candidate primary outcomes, estimated effects were in favour of GiVE compared with supportive counselling and treatment as usual at post-treatment. At follow-up, estimated effects were in favour of supportive counselling compared with GiVE and treatment as usual, and GiVE compared with treatment as usual.
Conclusions
A definitive trial of the GiVE intervention, delivered by assistant psychologists, is feasible. Adaptations to the GiVE intervention and the design of any future trials may be necessary.
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