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Gómez Bergin AD, Valentine AZ, Rennick-Egglestone S, Slade M, Hollis C, Hall CL. Identifying and Categorizing Adverse Events in Trials of Digital Mental Health Interventions: Narrative Scoping Review of Trials in the International Standard Randomized Controlled Trial Number Registry. JMIR Ment Health 2023; 10:e42501. [PMID: 36811940 PMCID: PMC9996423 DOI: 10.2196/42501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 11/11/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND To contextualize the benefits of an intervention, it is important that adverse events (AEs) are reported. This is potentially difficult in trials of digital mental health interventions, where delivery may be remote and the mechanisms of actions less understood. OBJECTIVE We aimed to explore the reporting of AEs in randomized controlled trials of digital mental health interventions. METHODS The International Standard Randomized Controlled Trial Number database was searched for trials registered before May 2022. Using advanced search filters, we identified 2546 trials in the category of mental and behavioral disorders. These trials were independently reviewed by 2 researchers against the eligibility criteria. Trials were included where digital mental health interventions for participants with a mental health disorder were evaluated through a completed randomized controlled trial (protocol and primary results publication published). Published protocols and primary results publications were then retrieved. Data were extracted independently by 3 researchers, with discussion to reach consensus when required. RESULTS Twenty-three trials met the eligibility criteria, of which 16 (69%) included a statement on AEs within a publication, but only 6 (26%) reported AEs within their primary results publication. Seriousness was referred to by 6 trials, relatedness by 4, and expectedness by 2. More interventions delivered with human support (9/11, 82%) than those with only remote or no support (6/12, 50%) included a statement on AEs, but they did not report more AEs. Several reasons for participant dropout were identified by trials that did not report AEs, of which some were identifiable or related to AEs, including serious AEs. CONCLUSIONS There is significant variation in the reporting of AEs in trials of digital mental health interventions. This variation may reflect limited reporting processes and difficulty recognizing AEs related to digital mental health interventions. There is a need to develop guidelines specifically for these trials to improve future reporting.
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Affiliation(s)
- Aislinn D Gómez Bergin
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Althea Z Valentine
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Stefan Rennick-Egglestone
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
| | - Mike Slade
- School of Health Sciences, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Faculty of Medicine and Health Sciences, Nord University, Namsos, Norway
| | - Chris Hollis
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Charlotte L Hall
- National Institute for Health and Care Research MindTech MedTech Co-operative, Institute of Mental Health, School of Medicine, University of Nottingham, Nottingham, United Kingdom
- National Institute for Health and Care Research Nottingham Biomedical Research Centre, Institute of Mental Health, University of Nottingham, Nottingham, United Kingdom
- Mental Health and Clinical Neurosciences, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Datta R, Vishwanath R, Shenoy S. Are remote psychotherapy/remediation efforts accessible and feasible in patients with schizophrenia? A narrative review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022; 58:136. [PMID: 36415756 PMCID: PMC9673189 DOI: 10.1186/s41983-022-00574-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/24/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cognitive remediation (CR) therapy provides an effective way to improve cognitive impairments in schizophrenia. With the advent of telehealth services, especially during COVID 19 pandemic, a suitable alternative can be found in computer and cell phone-based mental health interventions. Previous studies have proven that remote mental health interventions have by and large been successful. Remote psychotherapy/CR services can now be accessed through smartphone apps, iPads, laptops and wearable devices. This has the advantage of reaching a wider population in resource-limited settings. The lack of access to technology, difficulty in using these online interventions and lack of privacy provide impediments to the delivery of care through these online platforms. Further, as some previous studies have shown, there may be a high rate of dropout in people using remote mental health resources. We aim to look at the factors, which influence the accessibility of remote mental health interventions in schizophrenia. Additionally, we test the feasibility of these interventions and look at how they compare and the potential they hold for implementation in future clinical settings. Results We found remote cognitive remediation to be both accessible and feasible. Concerning features, however, are the high attrition rates and the concentration of the studies in Western populations. Conclusions Remote interventions are a viable alternative to in-person psychotherapy when in-person resources may not always be present. They are efficacious in improving health outcomes among patients with schizophrenia. Further research into the widespread implementation of remote CR will be beneficial in informing clinical decision-making.
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Bremer W, Sarker A. Recruitment and retention in mobile application-based intervention studies: a critical synopsis of challenges and opportunities. Inform Health Soc Care 2022; 48:139-152. [PMID: 35656732 DOI: 10.1080/17538157.2022.2082297] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Use of mobile health applications (mHealth apps) is becoming increasingly popular for the management of chronic illnesses, but mHealth-based intervention studies often have limitations associated with subject recruitment and retention. In this synopsis, we focus on targeted aspects of mHealth-based intervention studies, specifically: (i) subject recruitment, (ii) cohort sizes, and (iii) retention rates. We used the Google Scholar (meta-search) and Galileo search engines to identify sample articles focusing on mHealth apps and interventions published between 2010 and 2020 and selected 21 papers for detailed review. Most studies recruited relatively small cohorts (minimum: 20, maximum: 510). Retention rates had high variance with only five studies managing >80% subject retention throughout the study duration, 10.4% being the lowest. Eighty-five percent of the studies expressed concerns regarding study duration, app usage, and lack of proper implementation. The use of mHealth interventions generally yielded positive outcomes, but most studies discussed facing challenges associated with recruitment and retention. There is a clear need to identify strategies for recruiting larger cohorts and improving retention rates, and ultimately increasing the reliability of mHealth app-based intervention studies. We advise that potential underutilized opportunities lie at the intersection of mHealth and social media to address the limitations identified in the synopsis.
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Affiliation(s)
- Whitney Bremer
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Abeed Sarker
- Department of Biomedical Informatics, School of Medicine, Emory University, Atlanta, Georgia, USA
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4
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Fischer R, Scheunemann J, Bohlender A, Duletzki P, Nagel M, Moritz S. 'You are trying to teach us to think more slowly!': Adapting Metacognitive Training for the acute care setting-A case report. Clin Psychol Psychother 2022; 29:1877-1885. [PMID: 35586971 DOI: 10.1002/cpp.2755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/13/2022] [Accepted: 05/17/2022] [Indexed: 11/11/2022]
Abstract
Psychological group interventions for the acute inpatient care setting are scarce. Whereas Metacognitive Training for patients with Psychosis (MCT) provides a widely accessible, easy-to-implement intervention for patients with mild to moderate symptoms, it is less adequate for the acute care setting with respect to length and density of information. We present the adaptation process and the resulting adaptation of MCT, MCT-Acute, for the acute inpatient care setting. We report the case of a first patient, NK, who participated in MCT-Acute during her mandated stay on the locked acute ward due to an exacerbation of schizophrenia. NK participated in MCT-Acute 12 times, evaluated the training overall as positive and reported that she used exercises she had learned during training to improve her mood. She also described changing her behaviour in everyday life to think more slowly and make less hasty decisions, which is a central topic discussed in MCT and MCT-Acute. Conducting an adapted version of MCT in the acute care setting is feasible, and the present case report suggests that MCT-Acute may be a useful complement to a multidisciplinary treatment plan to stabilize patients with severe mental illness in acute inpatient care.
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Affiliation(s)
- Rabea Fischer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alison Bohlender
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patric Duletzki
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany
| | - Matthias Nagel
- Department of Psychiatry and Psychotherapy, Asklepios Clinic North-Wandsbek, Hamburg, Germany.,Clinic for Psychiatry and Psychotherapy, University Clinic Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Díaz-Cutraro L, López-Carrilero R, García-Mieres H, Ferrer-Quintero M, Verdaguer-Rodriguez M, Barajas A, Grasa E, Pousa E, Lorente E, Barrigón ML, Ruiz-Delgado I, González-Higueras F, Cid J, Mas-Expósito L, Corripio I, Birulés I, Pélaez T, Luengo A, Beltran M, Torres-Hernández P, Palma-Sevillano C, Moritz S, Garety P, Ochoa S. The relationship between jumping to conclusions and social cognition in first-episode psychosis. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2022; 8:39. [PMID: 35853903 PMCID: PMC9261088 DOI: 10.1038/s41537-022-00221-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/17/2021] [Indexed: 04/24/2023]
Abstract
Jumping to conclusions (JTC) and impaired social cognition (SC) affect the decoding, processing, and use of social information by people with psychosis. However, the relationship between them had not been deeply explored within psychosis in general, and in first-episode psychosis (FEP) in particular. Our aim was to study the relationship between JTC and SC in a sample with FEP. We conducted a cross-sectional study with 121 patients with FEP, with measures to assess JTC (easy, hard, and salient probability tasks) and SC (emotional recognition, attributional style, and theory of mind). We performed Student's t-test and logistic regression in order to analyse these associations.We found a statistically significant and consistent relationship of small-moderate effect size between JTC (all three tasks) and impaired emotional recognition. Also, our results suggest a relationship between JTC and internal attributions for negative events. Relationships between JTC and theory of mind were not found. These results highlight the importance of psychological treatments oriented to work on a hasty reasoning style and on improving processing of social information linked to emotional recognition and single-cause attributions.
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Affiliation(s)
- Luciana Díaz-Cutraro
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Raquel López-Carrilero
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Helena García-Mieres
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Marta Ferrer-Quintero
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Social and Quantitative Psychology Department, University of Barcelona, Barcelona, Spain
| | - Marina Verdaguer-Rodriguez
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Ana Barajas
- Centre d'Higiene Mental Les Corts, Barcelona, Spain
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
- 'Serra Húnter fellow', Barcelona, Spain
| | - Eva Grasa
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Esther Pousa
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Ester Lorente
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Psychiatry Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - María Luisa Barrigón
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Servicio Andaluz de Salud, Area de Gestión Sanitaria Sur Granada, Motril, Spain
- Department of Psychiatry, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - Isabel Ruiz-Delgado
- Unidad de Salud Mental Comunitaria Malaga Norte. UGC Salud Mental Carlos Haya, Servicio Andaluz de Salud, Málaga, Spain
| | | | - Jordi Cid
- Mental Health & Addiction Research Group, IdiBGi, Institut d'Assistencia Sanitària, Girona, Spain
| | | | - Iluminada Corripio
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | - Trinidad Pélaez
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Ana Luengo
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
- Psychiatry Service, Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Meritxell Beltran
- Mental Health & Addiction Research Group, IdiBGi, Institut d'Assistencia Sanitària, Girona, Spain
| | | | - Carolina Palma-Sevillano
- Psychology Department, FPCEE Blanquerna, Universitat Ramon Llull, Barcelona, Spain
- Hospital de Mataró, Consorci Sanitari del Maresme, Barcelona, Spain
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Philippa Garety
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Susana Ochoa
- Etiopatogènia i tractament dels trastorns mentals greus (MERITT), Institut de Recerca Sant Joan de Déu, Esplugues de Llobregat, Barcelona, Spain.
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain.
- Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain.
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Carpenter-Song E, Acquilano SC, Noel V, Al-Abdulmunem M, Torous J, Drake RE. Individualized Intervention to Support Mental Health Recovery Through Implementation of Digital Tools into Clinical Care: Feasibility Study. Community Ment Health J 2022; 58:99-110. [PMID: 33611684 PMCID: PMC7897361 DOI: 10.1007/s10597-021-00798-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 02/08/2021] [Indexed: 11/28/2022]
Abstract
Myriad digital tools exist to support mental health but there are multiple barriers to using these tools in routine care. This study aimed to assess the feasibility of an intervention incorporating a support role to help the clinical team identify and use technology to promote recovery. The technology specialist intervention is 3 months in duration and comprises four stages: goal setting, researching and evaluating tools, demonstrating and selecting tools, and ongoing support. We implemented the intervention in a community mental health center and a dual diagnosis treatment program, working with eight clients and their case managers. Clients and case managers willingly engaged with the technology specialist and found the intervention beneficial. Integration and collaboration with the care team facilitated implementation of the technology specialist in these real-world settings. Clients reported that the intervention made it easy to try a digital tool. Six of the eight participants stated that they made substantial progress toward their goals. The technology specialist is a promising new role for mental health care delivery to augment traditional services and enhance individualized recovery.
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Affiliation(s)
| | - Stephanie C Acquilano
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Valerie Noel
- ACCESS Open Minds (Pan-Canadian Youth Mental Health Services Research Network), Montréal, QC, Canada.,Douglas Hospital Research Centre, Montréal, QC, Canada
| | | | - John Torous
- Division of Digital Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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7
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Garety P, Ward T, Emsley R, Greenwood K, Freeman D, Fowler D, Kuipers E, Bebbington P, Rus-Calafell M, McGourty A, Sacadura C, Collett N, James K, Hardy A. Effects of SlowMo, a Blended Digital Therapy Targeting Reasoning, on Paranoia Among People With Psychosis: A Randomized Clinical Trial. JAMA Psychiatry 2021; 78:714-725. [PMID: 33825827 PMCID: PMC8027943 DOI: 10.1001/jamapsychiatry.2021.0326] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
IMPORTANCE Persistent paranoia is common among patients with psychosis. Cognitive-behavioral therapy for psychosis can be effective. However, challenges in engagement and effectiveness remain. OBJECTIVE To investigate the effects on paranoia and mechanisms of action of SlowMo, a digitally supported reasoning intervention, plus usual care compared with usual care only. DESIGN, SETTING, AND PARTICIPANTS This parallel-arm, assessor-blinded, randomized clinical trial recruited participants at UK community health services from May 1, 2017, to May 14, 2019. Eligible participants consisted of a referral sample with schizophrenia-spectrum psychosis and distressing, persistent (≥3 months) paranoia. INTERVENTIONS Individuals were randomized 1:1 to SlowMo, consisting of 8 digitally supported face-to-face sessions and a mobile app, plus usual care (n = 181) and usual care only (n = 181). MAIN OUTCOMES AND MEASURES The primary outcome was paranoia, measured by the Green et al Paranoid Thoughts Scale (GPTS) total score at 24 weeks. Secondary outcomes included GPTS total score at 12 weeks and GPTS Part A (reference) and Part B (persecutory) scores, the Psychotic Symptom Rating Scales (PSYRATS Delusion subscale), reasoning (belief flexibility, possibility of being mistaken [Maudsley Assessment of Delusions, rated 0%-100%]), and jumping to conclusions (Beads Task). RESULTS A total of 361 participants were included in intention-to-treat analysis, of whom 252 (69.8%) were male and 249 (69.0%) were White; the mean (SD) age was 42.6 (11.6) years. At 24 weeks, 332 participants (92.0%) provided primary outcome data. Of 181 participants in the SlowMo group, 145 (80.1%) completed therapy. SlowMo plus usual care was not associated with greater reductions than usual care in GPTS total score at 24 weeks (Cohen d, 0.20; 95% CI, -0.02 to 0.40; P = .06). There were significant effects on secondary paranoia outcomes at 12 weeks, including GPTS total score (Cohen d, 0.30; 95% CI, 0.09-0.51; P = .005), Part A score (Cohen d, 0.22; 95% CI, 0.06-0.39; P = .009), and Part B score (Cohen d, 0.32; 95% CI, 0.08-0.56; P = .009), and at 24 weeks, including Part B score (Cohen d, 0.25; 95% CI, 0.01-0.49; P = .04) but not Part A score (Cohen d, 0.12; 95% CI, -0.05 to 0.28; P = .18). Improvements were observed in an observer-rated measure of persecutory delusions (PSYRATS delusion) at 12 weeks (Cohen d, 0.47; 95% CI, 0.17-0.78; P = .002) and 24 weeks (Cohen d, 0.50; 95% CI, 0.20-0.80; P = .001) and belief flexibility at 12 weeks (Cohen d, 0.29; 95% CI, 0.09-0.49; P = .004) and 24 weeks (Cohen d, 0.28; 95% CI, 0.08-0.49; P = .005). There were no significant effects on jumping to conclusions. Improved belief flexibility and worry mediated paranoia change (range mediated, 36%-56%). CONCLUSIONS AND RELEVANCE SlowMo did not demonstrate significant improvements in the primary measure of paranoia at 24 weeks; however, a beneficial effect of SlowMo on paranoia was indicated by the results on the primary measure at an earlier point and on observer-rated paranoia and self-reported persecution at 12 and 24 weeks. Further work to optimize SlowMo's effects is warranted. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN 32448671.
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Affiliation(s)
- Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Kathryn Greenwood
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom
| | - David Fowler
- University of Sussex School of Psychology, Brighton, United Kingdom,Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - Mar Rus-Calafell
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Alison McGourty
- Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom
| | | | - Nicola Collett
- Department of Psychiatry, Oxford University, Oxford, United Kingdom,Oxford Health NHS Foundation Trust, Oxford, United Kingdom,Oxford Institute of Clinical Psychology Training and Research, Oxford University, Oxford, United Kingdom
| | - Kirsty James
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom,South London and Maudsley NHS (National Health Service) Foundation Trust, London, United Kingdom
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Sedgwick O, Hardy A, Greer B, Newbery K, Cella M. "I wanted to do more of the homework!"-Feasibility and acceptability of blending app-based homework with group therapy for social cognition in psychosis. J Clin Psychol 2021; 77:2701-2724. [PMID: 34101177 DOI: 10.1002/jclp.23193] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 05/03/2021] [Accepted: 05/17/2021] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Evidence suggests social-cognitive difficulties are linked to poor community functioning in people with psychosis, however, there is limited evidence that social-cognition interventions improve functioning. This may be due to poor generalization of therapy learning; digital technologies may be useful to support this. This study evaluates the feasibility of a brief, blended intervention (group therapy plus app) for individuals with psychosis. METHODS A total of 14 clients diagnosed with psychosis-spectrum difficulties participated. Feasibility was assessed by referral, adherence and completion rates, and acceptability via semi-structured interview (thematically analyzed). RESULTS The procedures were considered feasible and acceptable. The face-to-face component of the intervention was particularly valued, and participants reported benefits to their daily lives. The app was experienced as helpful, alongside some difficulties. CONCLUSIONS Development of blended interventions may prove an important avenue to maximize the adherence and reach of psychological interventions. The results of this study reinforce the need to maintain face-to-face components alongside digital.
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Affiliation(s)
- Ottilie Sedgwick
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Ben Greer
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Katie Newbery
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Matteo Cella
- Department of Psychology, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
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Abstract
BACKGROUND Negative beliefs about the self, including low self-compassion, have been identified as a putative causal factor in the occurrence of paranoia. Therefore, improving self-compassion may be one route to reduce paranoia. AIMS To assess the feasibility, acceptability, and potential clinical effects of a brief compassionate imagery intervention for patients with persecutory delusions. METHOD Twelve patients with persecutory delusions received an individual four-session compassionate imagery intervention. Assessments of self-concept and paranoia were completed before treatment, immediately after treatment, and at 1-month follow-up. A qualitative study exploring participants' experiences of the treatment was also completed. RESULTS Twelve out of 14 eligible patients referred to the study agreed to take part. All participants completed all therapy sessions and assessments. Post-treatment, there were improvements in self-compassion (change score -0.64, 95% CI -1.04, -0.24, d = -1.78), negative beliefs about the self (change score 2.42, 95% CI -0.37, 5.20, d = 0.51), and paranoia (change score 10.08, 95% CI 3.47, 16.69, d = 0.61). There were no serious adverse events. Three themes emerged from the qualitative analysis: 'effortful learning', 'seeing change' and 'taking it forward'. Participants described a process of active and effortful engagement in therapy which was rewarded with positive changes, including feeling calmer, gaining clarity, and developing acceptance. CONCLUSION This uncontrolled feasibility study indicates that a brief compassionate imagery intervention for patients with persecutory delusions is feasible, acceptable, and may lead to clinical benefits.
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Sedgwick O, Hardy A, Newbery K, Cella M. A systematic review of adherence to group interventions in psychosis: do people attend? Psychol Med 2021; 51:707-715. [PMID: 33860743 DOI: 10.1017/s0033291721000404] [Citation(s) in RCA: 6] [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: 12/12/2022]
Abstract
BACKGROUND Evidence supports the use of group therapy for symptom reduction and improving functioning in people with psychosis. However, research guidelines highlight the importance of establishing the feasibility of interventions. Adherence is an important indicator of feasibility and an essential step in supporting the development of the evidence base for group interventions. This review aims to estimate adherence, and possible barriers and facilitators, to psychotherapeutic groups in people with psychosis. METHODS Embase, Ovid MEDLINE and PsycINFO databases were searched for cross-referencing terms related to group therapy and psychosis. Studies were assessed against inclusion criteria and methodological quality was evaluated. Data wasextracted from each paper including the average session attendance, demographic, clinical, study and therapy-related characteristics and the impact of these on adherence levels evaluated. RESULTS Fifty-nine original research papers were included, reporting on 52 independent studies which consisted of 66 therapy groups comprised of 2109 participants. Average adherence was 76.4% (s.d. = 17.4). Adherence was improved by receiving incentives and was higher in participants of older age. Study sample size was inversely associated with adherence levels. Study quality was variable with approximately 61.5% found to be at risk of bias. The results support the feasibility of group therapy and suggest that adherence in people with psychosis is not dissimilar to those for people experiencing common mental health difficulties. These findings, alongside efficacy evidence, support the use of group interventions in people with psychosis but also highlight the need for further high-quality research on the efficacy for these approaches.
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Affiliation(s)
- Ottilie Sedgwick
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
| | - Amy Hardy
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
| | - Katie Newbery
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
| | - Matteo Cella
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, LondonSE5 8AF, UK
- South London & Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, KentBR3 3BX, UK
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11
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Freeman D, Loe BS, Kingdon D, Startup H, Molodynski A, Rosebrock L, Brown P, Sheaves B, Waite F, Bird JC. The revised Green et al., Paranoid Thoughts Scale (R-GPTS): psychometric properties, severity ranges, and clinical cut-offs. Psychol Med 2021; 51:244-253. [PMID: 31744588 PMCID: PMC7893506 DOI: 10.1017/s0033291719003155] [Citation(s) in RCA: 105] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 10/02/2019] [Accepted: 10/15/2019] [Indexed: 01/13/2023]
Abstract
BACKGROUND The Green et al., Paranoid Thoughts Scale (GPTS) - comprising two 16-item scales assessing ideas of reference (Part A) and ideas of persecution (Part B) - was developed over a decade ago. Our aim was to conduct the first large-scale psychometric evaluation. METHODS In total, 10 551 individuals provided GPTS data. Four hundred and twenty-two patients with psychosis and 805 non-clinical individuals completed GPTS Parts A and B. An additional 1743 patients with psychosis and 7581 non-clinical individuals completed GPTS Part B. Factor analysis, item response theory, and receiver operating characteristic analyses were conducted. RESULTS The original two-factor structure of the GPTS had an inadequate model fit: Part A did not form a unidimensional scale and multiple items were locally dependant. A Revised-GPTS (R-GPTS) was formed, comprising eight-item ideas of reference and 10-item ideas of persecution subscales, which had an excellent model fit. All items in the new Reference (a = 2.09-3.67) and Persecution (a = 2.37-4.38) scales were strongly discriminative of shifts in paranoia and had high reliability across the spectrum of severity (a > 0.90). The R-GPTS score ranges are: average (Reference: 0-9; Persecution: 0-4); elevated (Reference: 10-15; Persecution: 5-10); moderately severe (Reference: 16-20; Persecution:11-17); severe (Reference: 21-24; Persecution: 18-27); and very severe (Reference: 25+; Persecution: 28+). Recommended cut-offs on the persecution scale are 11 to discriminate clinical levels of persecutory ideation and 18 for a likely persecutory delusion. CONCLUSIONS The psychometric evaluation indicated a need to improve the GPTS. The R-GPTS is a more precise measure, has excellent psychometric properties, and is recommended for future studies of paranoia.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Bao S. Loe
- The Psychometrics Centre, University of Cambridge, Cambridge, UK
| | - David Kingdon
- Academic Department of Psychiatry, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | | | - Laina Rosebrock
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Poppy Brown
- Department of Psychiatry, University of Oxford
| | - Bryony Sheaves
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Jessica C. Bird
- Department of Psychiatry, University of Oxford
- Oxford Health NHS Foundation Trust, Oxford, UK
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12
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Balzan RP, Moritz S. Cognitive biases and psychosis: From bench to bedside. Schizophr Res 2020; 223:368-369. [PMID: 32739344 DOI: 10.1016/j.schres.2020.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Ryan P Balzan
- College of Education, Psychology & Social Work, Flinders University, Australia.
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Department of Psychiatry and Psychotherapy, Hamburg, Germany
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13
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Brown P, Waite F, Rovira A, Freeman D. Power posing for paranoia: A double-blind randomised controlled experimental test using virtual reality. Behav Res Ther 2020; 132:103691. [PMID: 32688047 DOI: 10.1016/j.brat.2020.103691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/04/2020] [Accepted: 06/22/2020] [Indexed: 10/24/2022]
Abstract
Paranoia is theorised to build upon feelings of inferior social rank. Power posing has been shown to increase feelings of power, and hence could reduce paranoia. One hundred participants with current paranoia and 50 individuals without paranoia were recruited. Using a double-blind randomised controlled experimental design, participants twice held powerful or neutral postures before entering neutral virtual reality social environments. In the paranoid sample, those who held a powerful pose did not significantly increase in feelings of power by the end of testing in comparison to controls (group difference = 0.67, C.I. = -1.12; 1.46; p = 0.098), or decrease in paranoia (group difference = -0.23, C.I. = -1.17; 0.72; p = 0.634). In the non-paranoid sample, there was a small significant increase in powerful feelings by the end of testing in the powerful group (group difference = 1.13, C.I. = 0.23; 2.02; p = 0.013), but no significant decrease in paranoia (group difference = -0.71, C.I. = -2.16; 0.74; p = 0.338). Paranoia status was not a modifier on the relationship between condition and feelings of power. We conclude that power posing results in only very small changes in self-reported feelings of power and has no subsequent effect on paranoia.
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Affiliation(s)
- Poppy Brown
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK; Oxford Health NHS Foundation Trust, UK
| | - Aitor Rovira
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK; Oxford Health NHS Foundation Trust, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, UK; Oxford Health NHS Foundation Trust, UK
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14
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Abstract
Abstract
Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically robust and easy-to-use measures of these thinking styles will assist research and clinical practice. Existing assessments include experimental tasks that are complex to administer or self-report measures that have limitations in comprehensively assessing cognitive biases in paranoia. We have developed the first questionnaire to assess fast and slow thinking biases related to paranoid thoughts, and here report on its evaluation. In study 1, we generated, evaluated, and extracted items reflecting reasoning, and assessed their reliability and validity in a non-clinical sample (n = 209). In study 2, we replicated the factor analysis and psychometric evaluation in a clinical sample (n = 265). The resultant Fast and Slow Thinking (FaST) questionnaire consists of two 5-item scales reflecting fast and slow thinking and is therefore brief and suitable for use in both research and clinical practice. The fast thinking scale is reliable and valid. Reliability and criterion validity of the slow scale shows promise. It had limited construct validity with objective reasoning assessments in the clinical group, possibly due to impaired meta-cognitive awareness of slow thinking. We recommend the FaST questionnaire as a new tool for improving understanding of reasoning biases in paranoia and supporting targeted psychological therapies.
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15
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Brown P, Waite F, Rovira A, Nickless A, Freeman D. Virtual reality clinical-experimental tests of compassion treatment techniques to reduce paranoia. Sci Rep 2020; 10:8547. [PMID: 32444619 PMCID: PMC7244556 DOI: 10.1038/s41598-020-64957-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 04/24/2020] [Indexed: 12/30/2022] Open
Abstract
Paranoia may build on negative beliefs held both about the self and others. Compassionate imagery may be one way of reducing such negative beliefs, and hence paranoia. Two studies tested this idea, one targeting compassion for the self and one targeting compassion for others. Two-hundred individuals from the general population scoring highly for paranoia were recruited. The studies used a randomised controlled experimental design, with embedded tests for mediation. Study one targeted self-compassion via creation of a compassionate coach (CC) image. Study two targeted compassion for others via loving kindness meditation (LKM). Individuals repeatedly entered neutral virtual reality social environments. Changes in compassion and paranoia were assessed. Compared to controls, the CC group increased in self-compassion (group difference = 2.12, C.I. = 1.57;2.67, p = <0.0001, d = 1.4) and decreased in paranoia (group difference = -1.73, C.I. = -2.48; -0.98, p = <0.0001, d = 0.8). Change in self-compassion explained 57% of change in paranoia. Compared to controls, the LKM group increased their compassion for others (group difference = 3.26, C.I. = 2.72;3.80, p = <0.0001, d = 1.7), and decreased in paranoia (group difference = -1.70, C.I. = -2.50; -0.89, p = <0.0001, d = 0.8). Change in compassion for others explained 67% of change in paranoia. Targeting negative beliefs about the self and others using compassionate imagery causes reductions in paranoia. Tests in clinical populations are indicated.
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Affiliation(s)
- Poppy Brown
- Department of Psychiatry, University of Oxford, Oxford, UK.
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | - Aitor Rovira
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
| | | | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK
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16
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Miralles I, Granell C, Díaz-Sanahuja L, Van Woensel W, Bretón-López J, Mira A, Castilla D, Casteleyn S. Smartphone Apps for the Treatment of Mental Disorders: Systematic Review. JMIR Mhealth Uhealth 2020; 8:e14897. [PMID: 32238332 PMCID: PMC7163422 DOI: 10.2196/14897] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 12/05/2019] [Accepted: 01/20/2020] [Indexed: 12/15/2022] Open
Abstract
Background Smartphone apps are an increasingly popular means for delivering psychological interventions to patients suffering from a mental disorder. In line with this popularity, there is a need to analyze and summarize the state of the art, both from a psychological and technical perspective. Objective This study aimed to systematically review the literature on the use of smartphones for psychological interventions. Our systematic review has the following objectives: (1) analyze the coverage of mental disorders in research articles per year; (2) study the types of assessment in research articles per mental disorder per year; (3) map the use of advanced technical features, such as sensors, and novel software features, such as personalization and social media, per mental disorder; (4) provide an overview of smartphone apps per mental disorder; and (5) provide an overview of the key characteristics of empirical assessments with rigorous designs (ie, randomized controlled trials [RCTs]). Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews were followed. We performed searches in Scopus, Web of Science, American Psychological Association PsycNET, and Medical Literature Analysis and Retrieval System Online, covering a period of 6 years (2013-2018). We included papers that described the use of smartphone apps to deliver psychological interventions for known mental disorders. We formed multidisciplinary teams, comprising experts in psychology and computer science, to select and classify articles based on psychological and technical features. Results We found 158 articles that met the inclusion criteria. We observed an increasing interest in smartphone-based interventions over time. Most research targeted disorders with high prevalence, that is, depressive (31/158,19.6%) and anxiety disorders (18/158, 11.4%). Of the total, 72.7% (115/158) of the papers focused on six mental disorders: depression, anxiety, trauma and stressor-related, substance-related and addiction, schizophrenia spectrum, and other psychotic disorders, or a combination of disorders. More than half of known mental disorders were not or very scarcely (<3%) represented. An increasing number of studies were dedicated to assessing clinical effects, but RCTs were still a minority (25/158, 15.8%). From a technical viewpoint, interventions were leveraging the improved modalities (screen and sound) and interactivity of smartphones but only sparingly leveraged their truly novel capabilities, such as sensors, alternative delivery paradigms, and analytical methods. Conclusions There is a need for designing interventions for the full breadth of mental disorders, rather than primarily focusing on most prevalent disorders. We further contend that an increasingly systematic focus, that is, involving RCTs, is needed to improve the robustness and trustworthiness of assessments. Regarding technical aspects, we argue that further exploration and innovative use of the novel capabilities of smartphones are needed to fully realize their potential for the treatment of mental health disorders.
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Affiliation(s)
| | | | | | | | - Juana Bretón-López
- Universitat Jaume I, Castellón de la Plana, Spain.,CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain
| | - Adriana Mira
- Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
| | - Diana Castilla
- CIBER of Physiopathology of Obesity and Nutrition CIBERobn, Castellón, Spain.,Department of Personality, Evaluation and Psychological Treatment, University of Valencia, Valencia, Spain
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17
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Baumann PS, Söderström O, Abrahamyan Empson L, Söderström D, Codeluppi Z, Golay P, Birchwood M, Conus P. Urban remediation: a new recovery-oriented strategy to manage urban stress after first-episode psychosis. Soc Psychiatry Psychiatr Epidemiol 2020; 55:273-283. [PMID: 31667561 DOI: 10.1007/s00127-019-01795-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/09/2019] [Indexed: 12/31/2022]
Abstract
PURPOSE Urban living is a major risk factor for psychosis. Considering worldwide increasing rates of urbanization, new approaches are needed to enhance patients' wellbeing in cities. Recent data suggest that once psychosis has emerged, patients struggle to adapt to urban milieu and that they lose access to city centers, which contributes to isolation and reduced social contacts. While it is acknowledged that there are promising initiatives to improve mental health in cities, concrete therapeutic strategies to help patients with psychosis to better handle urban stress are lacking. We believe that we should no longer wait to develop and test new therapeutic approaches. METHOD In this review, we first focus on the role of urban planning, policies, and design, and second on possible novel therapeutic strategies at the individual level. We review how patients with psychosis may experience stress in the urban environment. We then review and describe a set of possible strategies, which could be proposed to patients with the first-episode psychosis. RESULTS We propose to group these strategies under the umbrella term of 'urban remediation' and discuss how this novel approach could help patients to recover from their first psychotic episode. CONCLUSION The concepts developed in this paper are speculative and a lot of work remains to be done before it can be usefully proposed to patients. However, considering the high prevalence of social withdrawal and its detrimental impact on the recovery process, we strongly believe that researchers should invest this new domain to help patients regain access to city centers.
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Affiliation(s)
- Philipp S Baumann
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland. .,Center for Psychiatric Neurosciences, Department of Psychiatry, Lausanne University Hospital CHUV, Lausanne, Switzerland.
| | - Ola Söderström
- Institute of Geography, University of Neuchâtel, Espace Louis-Agassiz, 2000, Neuchâtel, Switzerland
| | - Lilith Abrahamyan Empson
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland
| | | | - Zoe Codeluppi
- Institute of Geography, University of Neuchâtel, Espace Louis-Agassiz, 2000, Neuchâtel, Switzerland
| | - Philippe Golay
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland
| | - Max Birchwood
- Warwick Medical School, University of Warwick, Coventry, CV4 7AL, UK
| | - Philippe Conus
- Treatment and early Intervention in Psychosis Program (TIPP), Service of General Psychiatry, Department of Psychiatry, Lausanne University Hospital CHUV, Avenue d'Echallens 9, 1004, Lausanne, Switzerland
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18
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García-Mieres H, Usall J, Feixas G, Ochoa S. Placing Cognitive Rigidity in Interpersonal Context in Psychosis: Relationship With Low Cognitive Reserve and High Self-Certainty. Front Psychiatry 2020; 11:594840. [PMID: 33324260 PMCID: PMC7725761 DOI: 10.3389/fpsyt.2020.594840] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 10/29/2020] [Indexed: 01/28/2023] Open
Abstract
Introduction: People with psychosis show impairments in cognitive flexibility, a phenomenon that is still poorly understood. In this study, we tested if there were differences in cognitive and metacognitive processes related to rigidity in patients with psychosis. We compared individuals with dichotomous interpersonal thinking and those with flexible interpersonal thinking. Methods: We performed a secondary analysis using two groups with psychosis, one with low levels of dichotomous interpersonal thinking (n = 42) and the other with high levels of dichotomous interpersonal thinking (n = 43). The patients were classified by splitting interpersonal dichotomous thinking (measured using the repertory grid technique) to the median. The groups were administered a sociodemographic questionnaire, a semi-structured interview to assess psychotic symptoms [Positive and Negative Syndrome Scale (PANSS)], a self-report of cognitive insight [Beck Cognitive Insight Scale (BCIS)], neurocognitive tasks [Wisconsin Card Sorting Test (WCST) and Wechsler Adult Intelligence Scale (WAIS)], and the repertory grid technique. We used a logistic regression model to test which factors best differentiate the two groups. Results: The group with high dichotomous interpersonal thinking had earlier age at onset of the psychotic disorder, higher self-certainty, impaired executive functioning, affected abstract thinking, and lower estimated cognitive reserve than the group with flexible thinking. According to the logistic regression model, estimated cognitive reserve and self-certainty were the variables that better differentiated between the two groups. Conclusion: Cognitive rigidity may be a generalized bias that affects not only neurocognitive and metacognitive processes but also the sense of self and significant others. Patients with more dichotomous interpersonal thinking might benefit from interventions that target this cognitive bias on an integrative way and that is adapted to their general level of cognitive abilities.
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Affiliation(s)
- Helena García-Mieres
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Mental Health Networking Biomedical Research Center, CIBERSAM, Madrid, Spain
| | - Judith Usall
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Mental Health Networking Biomedical Research Center, CIBERSAM, Madrid, Spain
| | - Guillem Feixas
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, Barcelona, Spain.,The Institute of Neurosciences, University of Barcelona, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain.,Mental Health Networking Biomedical Research Center, CIBERSAM, Madrid, Spain
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19
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Allan S, Bradstreet S, Mcleod H, Farhall J, Lambrou M, Gleeson J, Clark A, Gumley A. Developing a Hypothetical Implementation Framework of Expectations for Monitoring Early Signs of Psychosis Relapse Using a Mobile App: Qualitative Study. J Med Internet Res 2019; 21:e14366. [PMID: 31651400 PMCID: PMC6838692 DOI: 10.2196/14366] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/16/2022] Open
Abstract
Background Relapse is a common experience for people diagnosed with psychosis, which is associated with increased service costs and profound personal and familial distress. EMPOWER (Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery) is a peer worker–supported digital intervention that aims to enable service users to self-monitor their mental health with the aim of encouraging self-management and the shared use of personal data to promote relapse prevention. Digital interventions have not been widely used in relapse prevention and, therefore, little is currently known about their likely implementation—both within trials and beyond. Objective Seeking the perspectives of all relevant stakeholder groups is recommended in developing theories about implementation because this can reveal important group differences in understandings and assumptions about whether and for whom the intervention is expected to work. However, the majority of intervention implementation research has been retrospective. This study aimed to discover and theoretically frame implementation expectations in advance of testing and synthesize these data into a framework. Methods To develop a hypothetical implementation framework, 149 mental health professionals, carers, and people diagnosed with psychosis participated in 25 focus groups in both Australia and the United Kingdom. An interview schedule informed by the normalization process theory was used to explore stakeholders’ expectations about the implementation of the EMPOWER intervention. Data were analyzed using thematic analysis and then theoretically framed using the Medical Research Council guidelines for understanding the implementation of complex interventions. Results All groups expected that EMPOWER could be successfully implemented if the intervention generated data that were meaningful to mental health staff, carers, and service users within their unique roles. However, there were key differences between staff, carers, and service users about what facilitators and barriers that stakeholders believe exist for intervention implementation in both the cluster randomized controlled trial stage and beyond. For example, service user expectations mostly clustered around subjective user experiences, whereas staff and carers spoke more about the impact upon staff interactions with service users. Conclusions A hypothetical implementation framework synthesized from stakeholder implementation expectations provides an opportunity to compare actual implementation data gathered during an ongoing clinical trial, giving valuable insights into the accuracy of these stakeholders’ previous expectations. This is among the first studies to assess and record implementation expectations for a newly developed digital intervention for psychosis in advance of testing in a clinical trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262
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Affiliation(s)
- Stephanie Allan
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Maria Lambrou
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrea Clark
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Andrew Gumley
- Mental Health and Wellbeing, Institute of Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
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20
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Freeman D, Taylor KM, Molodynski A, Waite F. Treatable clinical intervention targets for patients with schizophrenia. Schizophr Res 2019; 211:44-50. [PMID: 31326234 DOI: 10.1016/j.schres.2019.07.016] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 04/19/2019] [Accepted: 07/11/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Treatment approaches for patients with psychosis need major improvement. Our approach to improvement is twofold: target putative causal mechanisms for psychotic experiences that are treatable and also that patients wish treated. This leads to greater treatment engagement and clinical benefit. To inform mental health service provision we assessed the presence of treatable causal mechanisms and patient treatment preferences. METHODS Patients with non-affective psychosis attending NHS mental health services completed assessments of paranoia, hallucinations, anxious avoidance, worry, self-esteem, insomnia, analytic reasoning, psychological well-being, and treatment preferences. RESULTS 1809 patients participated. Severe paranoia was present in 53.4% and frequent voices in 48.2%. Of the causal mechanisms, severe worry was present in 67.7%, avoidance at agoraphobic levels in 64.5%, analytic reasoning difficulties in 55.9%, insomnia in 50.1%, poor psychological well-being in 44.3%, strongly negative self-beliefs in 36.6%, and weak positive self-beliefs in 19.2%. Treatment target preferences were: feeling happier (63.2%), worrying less (63.1%), increasing self-confidence (62.1%), increasing activities (59.6%), improving decision-making (56.5%), feeling safer (53.0%), sleeping better (52.3%), and coping with voices (45.3%). Patients with current paranoia and/or hallucinations had higher levels of the causal factors and of wanting these difficulties treated. CONCLUSIONS Patients with non-affective psychosis have high levels of treatable problems such as agoraphobic avoidance, worry, low self-esteem, and insomnia and they would like these difficulties treated. Successful treatment of these difficulties is also likely to decrease psychotic experiences such as paranoia.
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Affiliation(s)
- Daniel Freeman
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK.
| | - Kathryn M Taylor
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Andrew Molodynski
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | - Felicity Waite
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
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21
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Reininghaus U, Rauschenberg C, Ten Have M, de Graaf R, van Dorsselaer S, Simons CJP, Gunther N, Pries LK, Guloksuz S, Radhakrishnan R, Bak M, van Os J. Reasoning bias, working memory performance and a transdiagnostic phenotype of affective disturbances and psychotic experiences in the general population. Psychol Med 2019; 49:1799-1809. [PMID: 30160228 DOI: 10.1017/s0033291718002209] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The jumping to conclusions (JTC) reasoning bias and decreased working memory performance (WMP) are associated with psychosis, but associations with affective disturbances (i.e. depression, anxiety, mania) remain inconclusive. Recent findings also suggest a transdiagnostic phenotype of co-occurring affective disturbances and psychotic experiences (PEs). This study investigated whether JTC bias and decreased WMP are associated with co-occurring affective disturbances and PEs. METHODS Data were derived from the second Netherlands Mental Health Survey and Incidence Study (NEMESIS-2). Trained interviewers administered the Composite International Diagnostic Interview (CIDI) at three time points in a general population sample (N = 4618). The beads and digit-span task were completed to assess JTC bias and WMP, respectively. CIDI was used to measure affective disturbances and an add-on instrument to measure PEs. RESULTS Compared to individuals with neither affective disturbances nor PEs, the JTC bias was more likely to occur in individuals with co-occurring affective disturbances and PEs [moderate psychosis (1-2 PEs): adjusted relative risk ratio (RRR) 1.17, 95% CI 0.98-1.41; and high psychosis (3 or more PEs or psychosis-related help-seeking behaviour): adjusted RRR 1.57, 95% CI 1.19-2.08], but not with affective disturbances and PEs alone, whereas decreased WMP was more likely in all groups. There was some evidence of a dose-response relationship, as JTC bias and decreased WMP were more likely in individuals with affective disturbances as the level of PEs increased or help-seeking behaviour was reported. CONCLUSION The findings suggest that JTC bias and decreased WMP may contribute to a transdiagnostic phenotype of co-occurring affective disturbances and PEs.
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Affiliation(s)
- Ulrich Reininghaus
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Christian Rauschenberg
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Margreet Ten Have
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Ron de Graaf
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Saskia van Dorsselaer
- Department of Epidemiology,Netherlands Institute of Mental Health and Addiction,Utrecht,The Netherlands
| | - Claudia J P Simons
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Nicole Gunther
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Lotta-Katrin Pries
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Sinan Guloksuz
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Rajiv Radhakrishnan
- Department of Psychiatry,Yale University School of Medicine,New Haven, CT,USA
| | - Maarten Bak
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
| | - Jim van Os
- Department of Psychiatry and Psychology,Maastricht University Medical Centre,Maastricht,The Netherlands
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22
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Bucci S, Schwannauer M, Berry N. The digital revolution and its impact on mental health care. Psychol Psychother 2019; 92:277-297. [PMID: 30924316 DOI: 10.1111/papt.12222] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Indexed: 11/27/2022]
Abstract
The digital revolution is evolving at an unstoppable pace. Alongside the unprecedented explosion of digital technology facilities and systems, mental health care is under greater pressure than ever before. With its emphasis on big data, computing power, mobile technology, and network information, digital technology is set to transform health care delivery. This article reviews the field of digital health technology assessment and intervention primarily in secondary service mental health care, including the barriers and facilitators to adopting and implementing digitally mediated interventions in service delivery. We consider the impact of digitally mediated communication on human interaction and its potential impact on various mental states such as those linked to mood, anxiety but also well-being. These developments point to a need for both theory- and data-driven approaches to digital health care. We argue that, as developments in digital technology are outpacing the evaluation of rigorous digital health interventions, more advanced methodologies are needed to keep up with the pace of digital technology development. The need for co-production of digital tools with and for people with chronic and mental health difficulties, and implications of digital technology for psychotherapy practice, will be central to this development. PRACTITIONER POINTS: Mental health problems are one of the main causes of global and societal burden and are a growing public health. People with mental health problems around the world have limited, if any, chance of accessing psychological help at all. Technological innovations and solutions are being considered in an attempt to address the size and scale of the mental health crisis worldwide. Digital platforms allow people to self-monitor and self-manage in a way that face-to-face/paper-based methods of assessment have up until now not allowed. We provide examples of digital tools that are being developed and used in the secondary setting and identify a number of challenges in the digital health field that require careful consideration.
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Affiliation(s)
- Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, UK
| | | | - Natalie Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester, UK
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23
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Hardy A, Wojdecka A, West J, Matthews E, Golby C, Ward T, Lopez ND, Freeman D, Waller H, Kuipers E, Bebbington P, Fowler D, Emsley R, Dunn G, Garety P. How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo. JMIR Ment Health 2018; 5:e11222. [PMID: 30518514 PMCID: PMC6300708 DOI: 10.2196/11222] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 07/27/2018] [Accepted: 08/02/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. OBJECTIVE This study aimed to optimize the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface. METHODS We conducted inclusive, user-centered design research characterized by purposive sampling of extreme users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's double diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping, and a mood board; define, consisting of workshops to synthesize findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded. RESULTS Consistent with our previous work, the Thinking Well case series showed medium to large effects on paranoia and well-being and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia, and provide tailored interpersonal support from therapists and peers, although they reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalization and normalization, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with 2 key concepts of thoughts visualized as bubbles and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A Web app supports the delivery of 8 face-to-face sessions, which are synchronized to a native mobile app. CONCLUSIONS SlowMo makes use of personalization, ambient information, and visual metaphors to tailor the appeal, engagement, and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multicentered randomized controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface to optimize its impact in daily life.
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Affiliation(s)
- Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Anna Wojdecka
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Jonathan West
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | - Ed Matthews
- Helen Hamlyn Centre for Design, Royal College of Art, London, United Kingdom
| | | | - Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Natalie D Lopez
- Department of Psychology, Royal Holloway, Egham, United Kingdom
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Helen Waller
- South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Elizabeth Kuipers
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
| | - Paul Bebbington
- Division of Psychiatry, University College London, London, United Kingdom
| | - David Fowler
- Department of Psychology, University of Sussex, Sussex, United Kingdom
| | - Richard Emsley
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Graham Dunn
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,South London & Maudsley NHS Foundation Trust, London, United Kingdom
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24
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Bell IH, Fielding-Smith SF, Hayward M, Rossell SL, Lim MH, Farhall J, Thomas N. Smartphone-based ecological momentary assessment and intervention in a blended coping-focused therapy for distressing voices: Development and case illustration. Internet Interv 2018; 14:18-25. [PMID: 30510910 PMCID: PMC6258111 DOI: 10.1016/j.invent.2018.11.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 02/07/2023] Open
Abstract
Common approaches to the psychological treatment of distressing voice hearing experiences, such as cognitive behavioural therapy, aim to promote more adaptive cognitive, emotional and behavioural responses to these experiences. Digital technologies such as smartphones show promise for supporting and enhancing these treatments by linking immediate therapeutic settings to the context of daily life. Two promising technologies include ecological momentary assessment and intervention (EMA/I), which may offer a means of advanced assessment and support in daily life, and inform the tailoring of interventions to suit individual needs. In this study, a highly novel intervention approach was developed involving four face-to-face sessions with a psychologist blended with EMA/I between sessions in order to improve coping with distressing voice hearing experiences. The authors describe the background and development of this approach along-side a single case illustration, which supported feasibility and acceptability. This study details how digital technologies such as EMA/I may be used in future as clinical tools to enhance standard psychological treatments and clinical care of people with persisting and distressing experiences.
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Affiliation(s)
- Imogen H. Bell
- Centre for Mental Health, Swinburne University of Technology, Australia
| | | | - Mark Hayward
- Sussex Partnership NHS Foundation Trust, UK
- School of Psychology, University of Sussex, UK
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University of Technology, Australia
- Department of Psychiatry, St. Vincent's Hospital, Australia
| | - Michelle H. Lim
- Centre for Mental Health, Swinburne University of Technology, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia
- North Western Mental Health, Melbourne Health, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University of Technology, Australia
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25
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Greenwood K, Alford K, O’Leary I, Peters E, Hardy A, Cavanagh K, Field AP, de Visser R, Fowler D, Davies M, Papamichail A, Garety P. The U&I study: study protocol for a feasibility randomised controlled trial of a pre-cognitive behavioural therapy digital 'informed choice' intervention to improve attitudes towards uptake and implementation of CBT for psychosis. Trials 2018; 19:644. [PMID: 30458850 PMCID: PMC6247503 DOI: 10.1186/s13063-018-3023-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2018] [Accepted: 10/26/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND At least 40% of people with psychosis have persistent distressing symptoms despite optimal medication treatment. Cognitive behaviour therapy for psychosis (CBTp) is the only NICE-recommended individual therapy for psychosis, with effects on symptoms, distress and quality of life. Yet <10% of service-users receive it and 94% of trusts struggle to provide it. Of those offered it, 22-43% refuse or do not attend. We have developed a new pre-CBTp informed choice intervention to address knowledge and attitudes that influence uptake and implementation and now want to test it in a feasibility trial. METHODS The design is a two-arm, feasibility randomised controlled trial (RCT), with 1:1 randomisation, stratified by participant group and site. Participants are 40 psychosis patients and 40 clinicians, who are ambivalent towards uptake or implementation of CBTp. Sites are community and inpatient services in Sussex and London. The intervention is a pre-CBT digital psychoeducation intervention designed to address identified knowledge and attitudinal barriers to uptake and implementation of CBTp, incorporating behaviour change mechanisms, and supported by animated introductory, patient and clinician stories. The comparator is the NHS choices website for CBT. The primary aim is to assess clinical feasibility (recruitment, randomisation, acceptability, use, delivery, outcome measurement, retention). A secondary aim is a preliminary evaluation of efficacy. Outcomes will be assessed at baseline, post intervention, and one-month follow-up (blind to treatment arm). The primary efficacy outcome is likelihood of offering/taking up CBTp. Secondary outcomes include knowledge and attitudes towards CBTp, illness perceptions, empowerment, psychological wellbeing (patients only) and CBTp implementation (clinicians only). Use of the intervention and CBT behaviours during the follow-up period will be recorded and captured in a feedback questionnaire. Use, acceptability and experience of outcome assessment will be explored in qualitative interviews with participants (n = 6 per group). The efficacy evaluation will report descriptive data, key model parameters and 95% highest probability density intervals in a Bayesian growth model. DISCUSSION This is the first feasibility trial of a digital 'informed choice' decision aid for the implementation of CBTp. If the trial proves feasible and demonstrates preliminary evidence of efficacy, a large multi-site trial will be warranted. TRIAL REGISTRATION ISRCTN registry, ISRCTN53107879 . Registered prospectively on 2 August 2017.
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Affiliation(s)
- Kathryn Greenwood
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Katie Alford
- Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9RP UK
| | - Ian O’Leary
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- PICuP Clinic, South London and Maudsley NHS Foundation Trust, Maudsley Hospital, Denmark Hill, London, SE5 8NZ UK
| | - Amy Hardy
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX UK
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Andy P. Field
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Richard de Visser
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - David Fowler
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
- School of Psychology, University of Sussex, Pevensey Building, Falmer, Brighton, East Sussex BN1 9RP UK
| | - Matthew Davies
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Alexandra Papamichail
- R&D Department, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Millview Hospital Site, Nevill Avenue, Hove, BN3 7HZ UK
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, Denmark Hill, London, SE5 8AF UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Monks Orchard Road, Beckenham, Kent BR3 3BX UK
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26
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Abstract
PURPOSE OF REVIEW The purpose of this update is to provide an overview of the breadth of research studies published from April 2017 to April 2018 on mobile-based interventions for mental health, with a special emphasis on smartphone-based interventions. RECENT FINDINGS Several studies during the review period have described the process of applying user-centred design in the development of mental health apps and novel approaches to enhance user-engagement. Studies on consumer perspectives indicate largely positive findings about open-ness to utilize mental health apps. There is a scarcity of similar studies on health providers. Efficacy studies have provided evidence for apps for a variety of psychiatric disorders. There are fewer studies on preventive and promotive interventions. Although a plethora of mental health apps is available for public, most have not undergone scientific evaluation. Many well researched apps are not accessible to public. The potential of smartphone technology in enhancing healthcare service delivery in low-resource settings has also been examined in a few studies. SUMMARY Evidence for acceptability, feasibility and efficacy of mobile-based mental health interventions for facilitating recovery is on the rise. More research is needed on implementation and integration of these interventions in diverse real-world clinical and community contexts.
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27
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Metacognition and Mindfulness Integrated Therapy Reduces Severity of Hallucination in a Patient Not Taking Antipsychotic Medication. J Cogn Psychother 2018; 32:192-202. [PMID: 32746435 DOI: 10.1891/0889-8391.32.3.192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Psychological interventions have proven efficacy in treating psychotic symptoms such as delusions and hallucinations. However, the efficacy of these interventions has primarily been evaluated in the context of their use as an adjunct to antipsychotics or on patients who do not respond to adequate trials of antipsychotics. There is paucity of research about the effectiveness of psychological interventions in patients who do not take antipsychotics either because they are not willing to take medications or are not able to tolerate antipsychotics due to the side effects. We report here the case of a patient who had distressing auditory hallucinations and was not able to take antipsychotic medications because of severe reactions. She responded to metacognition and mindfulness integrated therapy for auditory hallucination. A total of eight sessions of therapy with the major focus on enhancement of metacognitive insight into the mechanisms of genesis and maintenance of hallucinations followed by encouraging the patient to use mindfulness-based strategies and regular self-monitoring of hallucinatory experiences were conducted. The patient was assessed pre-post intervention on the auditory hallucination subscale of the Psychotic Symptom Rating Scale (PSYRATS). There was significant improvement as reflected by more than 50% reduction in the PSYRATS score. This case highlights that metacognition and mindfulness integrated therapy has the potential to help patients with hallucination who do not take antipsychotic medications. The insight building helps in developing a detached approach towards hallucinatory experiences which, in turn, reduces distress caused by the hallucinations.
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28
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Bonet L, Llácer B, Hernandez-Viadel M, Arce D, Blanquer I, Cañete C, Escartí M, González-Pinto AM, Sanjuán J. Differences in the Use and Opinions About New eHealth Technologies Among Patients With Psychosis: Structured Questionnaire. JMIR Ment Health 2018; 5:e51. [PMID: 30045835 PMCID: PMC6083047 DOI: 10.2196/mental.9950] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Despite a growing interest in the use of technology in order to support the treatment of psychotic disorders, limited knowledge exists about the viability and acceptability of these eHealth interventions in relation to the clinical characteristics of patients. OBJECTIVE The objective of this study was to assess the access and use of, as well as experiences and interest in, new technologies using a survey of patients diagnosed with early psychosis compared with a survey of patients diagnosed with chronic psychotic disorders. METHODS We designed a structured questionnaire. This questionnaire was divided into five parts: (1) clinical and demographic information, (2) access and use of the internet, (3) use of the internet in relation to mental health, (4) experiences with technology, and (5) patients' interest in eHealth services. In total, 105 patients were recruited from early psychosis units (n=65) and recovery units (n=40). RESULTS In this study, 84.8% (89/105) of the patients had access to the internet and 88.6% (93/105) owned an electronic internet device. In total, 71.3% (57/80) of patients who owned a mobile phone were interested in eHealth systems and 38.2% (37/97) reported negative experiences related to the internet usage. We observed differences between the groups in terms of device ownership (P=.02), the frequency of internet access (P<.001), the use of social media (P=.01), and seeking health information (P=.04); the differences were found to be higher in the early psychosis group. No differences were found between the groups in terms of the use of internet in relation to mental health, experiences and opinions about the internet, or interest in eHealth interventions (P=.43). CONCLUSIONS The availability and use of technology for the participants in our survey were equivalent to those for the general population. The differences found between the groups in relation to the access or use of technology seemed to due to age-related factors. The use of technology involving mental health and the interest in eHealth interventions were mainly positive and equivalent between the groups. Accordingly, this group of patients is a potential target for the emerging eHealth interventions, regardless of their clinical status. However, 28.7% (23/80) of the studied patients rejected the use of internet interventions and 38.2% (37/97) had unpleasant experiences related to its usage; thus, more in-depth studies are needed to better define the profile of patients with psychosis who may benefit from eHealth treatments.
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Affiliation(s)
- Lucia Bonet
- Department of Clinic Medicine, School of Medicine, University of Valencia, Valencia, Spain
| | - Blanca Llácer
- Centre of Biomedical Investigation in Mental Health (CIBERSAM), Spanish Government Carlos III Health Institute, Valencia, Spain
| | - Miguel Hernandez-Viadel
- Department of Mental Health, Sanitary Research Institute of Valencia (INCLIVA), Hospital Clínico of Valencia, Valencia, Spain
| | - David Arce
- Institute of Instrumentation for Molecular Imaging (I3M), Joint centre CSIC & Universitat Politècnica de València, Valencia, Spain
| | - Ignacio Blanquer
- Institute of Instrumentation for Molecular Imaging (I3M), Joint centre CSIC & Universitat Politècnica de València, Valencia, Spain
| | - Carlos Cañete
- Department of Mental Health, Sanitary Research Institute of Valencia (INCLIVA), Hospital Clínico of Valencia, Valencia, Spain
| | - Maria Escartí
- Department of Mental Health, Font of Sant Lluís Primary Care Centre, Valencia, Spain
| | - Ana M González-Pinto
- Centre of Biomedical Investigation in Mental Health (CIBERSAM), Spanish Government Carlos III Health Institute, Vitoria, Spain.,Department of Psychiatry, BioAraba Research Institute, Araba University Hospital, University of the Basque Country (EHU/UPV), Vitoria, Spain
| | - Julio Sanjuán
- Department of Clinic Medicine, School of Medicine, University of Valencia, Valencia, Spain.,Centre of Biomedical Investigation in Mental Health (CIBERSAM), Spanish Government Carlos III Health Institute, Valencia, Spain.,Department of Mental Health, Sanitary Research Institute of Valencia (INCLIVA), Hospital Clínico of Valencia, Valencia, Spain
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29
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Abstract
Purpose of the Review This review identifies the early developmental processes that contribute to schizotypy and suspiciousness in adolescence and adulthood. It includes the most recent literature on these phenomena in childhood. Recent Findings The early developmental processes that affect schizotypy and paranoia in later life are complex. In contrast to existing studies of psychiatric patients and clinical/nonclinical adult populations, the study of schizotypy and suspiciousness in young children and adolescents is possible due to new child-appropriate dimensional assessments. New assessments and the advancement of technology (e.g., virtual reality in mental health) as well as statistical modeling (e.g., mediation and latent-class analyses) in large data have helped identified the developmental aspects (e.g., psychosocial, neurocognitive and brain factors, nutrition, and childhood correlates) that predict schizotypy and suspiciousness in later life. Summary Prospective longitudinal designs in community youths can enhance our understanding of the etiology of schizophrenia-spectrum disorders and, in the future, the development of preventive interventions by extending adult theories and interventions to younger populations.
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Affiliation(s)
- Keri K Wong
- 1Department of Psychology, University of Cambridge, Cambridge, UK.,Cambridge, Cambridgeshire UK
| | - Adrian Raine
- 3Departments of Criminology, Psychiatry, and Psychology, University of Pennsylvania, Philadelphia, PA USA
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