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Wei S, Freeman D, Harris V, Rovira A. A randomised controlled test in virtual reality of the effects on paranoid thoughts of virtual humans' facial animation and expression. Sci Rep 2024; 14:17102. [PMID: 39048648 PMCID: PMC11269571 DOI: 10.1038/s41598-024-67534-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/12/2024] [Indexed: 07/27/2024] Open
Abstract
Virtual reality (VR) is increasingly used in the study and treatment of paranoia. This is based on the finding that people who mistakenly perceive hostile intent from other people also perceive similar threat from virtual characters. However, there has been no study of the programming characteristics of virtual characters that may influence their interpretation. We set out to investigate how the animation and expressions of virtual humans may affect paranoia. In a two-by-two factor, between-groups, randomized design, 122 individuals with elevated paranoia rated their perceptions of virtual humans, set in an eye-tracking enabled VR lift scenario, that varied in facial animation (static or animated) and expression (neutral or positive). Both facial animation (group difference = 102.328 [51.783, 152.872], p < 0.001,η p 2 = 0.125) and positive expressions (group difference = 53.016 [0.054, 105.979], p = 0.049,η p 2 = 0.033) led to less triggering of paranoid thoughts about the virtual humans. Facial animation (group difference = 2.442 [- 4.161, - 0.724], p = 0.006,η p 2 = 0.063) but not positive expressions (group difference = 0.344 [- 1.429, 2.110], p = 0.681,η p 2 = 0.001) significantly increased the likelihood of neutral thoughts about the characters. Our study shows that the detailed programming of virtual humans can impact the occurrence of paranoid thoughts in VR. The programming of virtual humans needs careful consideration depending on the purpose of their use.
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Affiliation(s)
- Shu Wei
- Department of Psychiatry, University of Oxford, Oxford, UK.
- Department of Experimental Psychology, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK.
| | - Daniel Freeman
- Department of Experimental Psychology, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - Victoria Harris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Aitor Rovira
- Department of Experimental Psychology, University of Oxford, Radcliffe Observatory Quarter, Oxford, OX2 6GG, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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2
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Bird M, O'Neill E, Riches S. Digitally Enhanced Psychological Assessment and Treatment of Paranoia: A Systematic Review. Clin Psychol Psychother 2024; 31:e3019. [PMID: 38940680 DOI: 10.1002/cpp.3019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND Paranoia is relatively common but can lead to significant distress, impairment and need for care. Digital technologies offer a valuable extension to service provision and are increasingly being integrated into healthcare. This systematic review evaluated feasibility, acceptability, and effectiveness of digitally enhanced psychological assessments and treatments for paranoia across the paranoia continuum (PROSPERO: CRD42023393257). METHODS Databases PsychINFO, EMBASE, MEDLINE and Web of Science were searched until 12 June 2023; the Effective Public Health Practice Project (EPHPP) quality assessment tool evaluated studies; and a narrative synthesis was conducted. RESULTS Twenty-seven studies met inclusion criteria (n = 3457, 23 assessment and 4 treatment, 2005-2023, most in Europe). Technologies included virtual reality (VR, n = 23), experience sampling methodology (ESM, n = 2), an app (n = 1) and a combination of VR and ESM (n = 1). Assessments involved monitoring paranoia under various virtual conditions or in everyday life. Treatments were generally integrated with Cognitive Behaviour Therapy (CBT), which involved using VR to test out threat beliefs and drop safety behaviours or using an app to support slowing down paranoid thinking. EPHPP ratings were strong (n = 8), moderate (n = 12) and weak (n = 7). CONCLUSIONS Digitally enhanced assessments and treatments showed promising acceptability, feasibility and treatment effectiveness. Limitations of studies include small sample sizes, lack of comparison groups and long-term data and limited randomised controlled trials. Results support the potential future integration of VR in the assessment of paranoia and show promise for treatments such as CBT, although further clinical trials are required. Investigation of other technologies is limited.
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Affiliation(s)
- Molly Bird
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, London, UK
| | - Emma O'Neill
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, London, UK
| | - Simon Riches
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Psychology and Psychotherapy, South London and Maudsley NHS Foundation Trust, London, UK
- Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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3
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McDonald H, Valmaggia L, Antonova E, Chadwick P. Taking the edge off: a feasibility randomized controlled trial of an online mindfulness-based intervention to reduce suspiciousness/paranoia in high positive schizotypy. Front Psychol 2024; 15:1380077. [PMID: 38962229 PMCID: PMC11221385 DOI: 10.3389/fpsyg.2024.1380077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/16/2024] [Indexed: 07/05/2024] Open
Abstract
Positive schizotypy can uniquely predict the development of psychosis with suspiciousness/paranoia having emerged as a key risk factor, pointing to significant worth in reducing this aspect in individuals with high positive schizotypy. Reduced paranoia in the general population following brief online mindfulness training has been previously reported. This study investigated the feasibility of a 40-day online mindfulness-based intervention (MBI) (n = 12) in the individuals with high positive schizotypy characterized by high suspiciousness/paranoia and to estimate its effect on paranoia as compared with an active control condition using reflective journaling (n = 12). The outcome measures were self-reported trait and VR-induced state paranoia, completed at baseline, after 10 days and post-intervention. The feasibility criteria included retention, adherence, engagement, and acceptability. There was 100% retention, excellent adherence to content and engagement, with an average MBI session completion rate of 91%. Acceptability, indexed by a self-rated motivation to continue practice post-intervention, was also high. No MBI effect on trait paranoia was observed; however, the MBI group showed a reduction in the VR-induced state paranoia with a medium-to-large effect (d = 0.63). The findings support conducting larger-scale randomized controlled trials to evaluate the effects of online MBIs on reducing suspiciousness/paranoia to mitigate psychosis risk in individuals with high positive schizotypy. Clinical Trial Registration:https://www.isrctn.com/, identifier ISRCTN78697391.
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Affiliation(s)
- Heather McDonald
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- ORYGEN, Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Department of Psychiatry, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Elena Antonova
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Centre for Cognitive and Clinical Neuroscience, Division of Psychology, Department of Life Sciences, College of Health, Medicine and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Paul Chadwick
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
- Department of Psychology, Bath Centre for Mindfulness and Compassion, University of Bath, Bath, United Kingdom
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Wiebe A, Kannen K, Selaskowski B, Mehren A, Thöne AK, Pramme L, Blumenthal N, Li M, Asché L, Jonas S, Bey K, Schulze M, Steffens M, Pensel MC, Guth M, Rohlfsen F, Ekhlas M, Lügering H, Fileccia H, Pakos J, Lux S, Philipsen A, Braun N. Virtual reality in the diagnostic and therapy for mental disorders: A systematic review. Clin Psychol Rev 2022; 98:102213. [PMID: 36356351 DOI: 10.1016/j.cpr.2022.102213] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 08/21/2022] [Accepted: 10/11/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Virtual reality (VR) technologies are playing an increasingly important role in the diagnostics and treatment of mental disorders. OBJECTIVE To systematically review the current evidence regarding the use of VR in the diagnostics and treatment of mental disorders. DATA SOURCE Systematic literature searches via PubMed (last literature update: 9th of May 2022) were conducted for the following areas of psychopathology: Specific phobias, panic disorder and agoraphobia, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder, eating disorders, dementia disorders, attention-deficit/hyperactivity disorder, depression, autism spectrum disorder, schizophrenia spectrum disorders, and addiction disorders. ELIGIBILITY CRITERIA To be eligible, studies had to be published in English, to be peer-reviewed, to report original research data, to be VR-related, and to deal with one of the above-mentioned areas of psychopathology. STUDY EVALUATION For each study included, various study characteristics (including interventions and conditions, comparators, major outcomes and study designs) were retrieved and a risk of bias score was calculated based on predefined study quality criteria. RESULTS Across all areas of psychopathology, k = 9315 studies were inspected, of which k = 721 studies met the eligibility criteria. From these studies, 43.97% were considered assessment-related, 55.48% therapy-related, and 0.55% were mixed. The highest research activity was found for VR exposure therapy in anxiety disorders, PTSD and addiction disorders, where the most convincing evidence was found, as well as for cognitive trainings in dementia and social skill trainings in autism spectrum disorder. CONCLUSION While VR exposure therapy will likely find its way successively into regular patient care, there are also many other promising approaches, but most are not yet mature enough for clinical application. REVIEW REGISTRATION PROSPERO register CRD42020188436. FUNDING The review was funded by budgets from the University of Bonn. No third party funding was involved.
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Affiliation(s)
- Annika Wiebe
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Kyra Kannen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Benjamin Selaskowski
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Aylin Mehren
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Ann-Kathrin Thöne
- School of Child and Adolescent Cognitive Behavior Therapy (AKiP), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lisa Pramme
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Nike Blumenthal
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mengtong Li
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Laura Asché
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Stephan Jonas
- Institute for Digital Medicine, University Hospital Bonn, Bonn, Germany
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Marcel Schulze
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Maria Steffens
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Max Christian Pensel
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Matthias Guth
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Felicia Rohlfsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Mogda Ekhlas
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Lügering
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Helena Fileccia
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julian Pakos
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Silke Lux
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Alexandra Philipsen
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Niclas Braun
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany.
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Jeppesen UN, Due AS, Mariegaard L, Pinkham A, Vos M, Veling W, Nordentoft M, Glenthøj LB. Face Your Fears: Virtual reality-based cognitive behavioral therapy (VR-CBT) versus standard CBT for paranoid ideations in patients with schizophrenia spectrum disorders: a randomized clinical trial. Trials 2022; 23:658. [PMID: 35971137 PMCID: PMC9377061 DOI: 10.1186/s13063-022-06614-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/02/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Schizophrenia spectrum disorders cause suffering for patients, relatives, and the surrounding society. Paranoid ideations, encompassing ideas of social reference and manifest persecutory delusions, are among the most frequent symptoms in this population and a cause of significant distress. Recent meta-analyses of cognitive behavioral therapy (CBT) for psychosis show small to moderate effect sizes in reducing paranoid ideations. Virtual reality-based CBT (VR-CBT) could improve therapy efficacy as exposure and behavioral experiments in VR can be optimized, individualized, and carried out in a safe environment. Few VR-CBT studies exist for paranoid ideations and there is a need for large-scale, methodologically rigorous trials. METHODS This study is a randomized, assessor-blinded parallel-groups multi-center superiority clinical trial, fulfilling the CONSORT criteria for non-pharmacological treatment. A total of 256 patients diagnosed with schizophrenia spectrum disorder, including schizotypal disorder (ICD-10 F20-29), will be allocated to either 10 sessions of symptom-specific CBT-VR plus treatment as usual-versus 10 sessions of standard symptom-specific CBT for paranoid ideations (CBT) plus treatment as usual. All participants will be assessed at baseline, treatment end (3 months post baseline), and then 9 months post baseline. A stratified block-randomization with concealed randomization sequence will be conducted. Independent assessors blinded to the treatment will evaluate the outcome. Analysis of outcome will be carried out with the intention to treat principles. The primary outcome is ideas of social reference measured with Green Paranoid Thought Scale Part A (GPTS-A) at the cessation of treatment at 3 months post baseline. Secondary outcomes are ideas of persecution (GPTS-B), Social Interaction Anxiety Scale (SIAS), Personal and Social Performance scale (PSP), Safety Behavior Questionnaire (SBQ), and CANTAB Emotion Recognition Task. DISCUSSION The trial will elucidate whether VR-CBT can enhance therapy efficacy for paranoid ideations. Additionally, Trial findings will provide evidence on the effectiveness and cost-effectiveness of VR-CBT for paranoid ideations that can guide the possible dissemination and implementation into clinical practice. TRIAL REGISTRATION ClinicalTrials.gov NCT04902066 . Initial release April 9th, 2021.
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Affiliation(s)
- U. N. Jeppesen
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - A. S. Due
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark
| | - L. Mariegaard
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark
| | - A. Pinkham
- grid.267323.10000 0001 2151 7939School of Behavioral and Brain Sciences, University of Texas at Dallas, Richardson, USA
| | - M. Vos
- grid.4494.d0000 0000 9558 4598Faculty of Medical Sciences, University Medical Center Groningen, Center of Psychiatry, University of Groningen, Groningen, Netherlands
| | - W. Veling
- grid.4494.d0000 0000 9558 4598Faculty of Medical Sciences, University Medical Center Groningen, Center of Psychiatry, University of Groningen, Groningen, Netherlands
| | - M. Nordentoft
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark
| | - L. B. Glenthøj
- grid.5254.60000 0001 0674 042XCopenhagen Research Centre on Mental Health (CORE), University of Copenhagen, Copenhagen, Denmark ,grid.5254.60000 0001 0674 042XDepartment of Psychology, University of Copenhagen, Copenhagen, Denmark
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Monaghesh E, Samad-Soltani T, Farhang S. Virtual reality-based interventions for patients with paranoia: A systematic review. Psychiatry Res 2022; 307:114338. [PMID: 34922239 DOI: 10.1016/j.psychres.2021.114338] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 12/07/2021] [Accepted: 12/09/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVE Paranoia is an important psychiatric symptom with a remarkable effect on daily life. Virtual reality (VR)-based treatments are influential and safe for patients with paranoia. This study aimed to evaluate the effectiveness, and define the clinical and technical characteristics of available VR strategies for the treatment of patients with paranoia. MATERIALS AND METHODS Studies published up to 25/11/2021 reporting VR-based interventions for the treatment of patients with paranoia were reviewed in five databases, including PubMed, Embase, Web of Science, PsycINFO, and Scopus. RESULTS Out of 302 initial search results, eight were included in the present study based on the inclusion criteria. Six studies were randomized clinical trials with the interventions in the experimental group being based on VR, compared to routine interventions as controls. Two were before-after studies. The most commonly used hardware and software were head-mounted display and Unity3D, respectively. Interventions had a range of 1-16 sessions with follow-up durations of 0-6 months. All investigations showed positive results in the main target, including improved social participation, reduced level of anxiety, as well as diminished suspicious ideas and paranoid symptoms. CONCLUSIONS Our findings demonstrated that VR-based interventions are effective treatments. Although the use of VR technology is limited for a variety of reasons, such as cost, it improves symptoms in patients with paranoia.
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Affiliation(s)
- Elham Monaghesh
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Taha Samad-Soltani
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sara Farhang
- Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran; University of Groningen, University medical center Groningen, University Center for Psychiatry, Rob Giel research center, Hanzeplein 1, Postbus: 30.001, HPC CC72, Groningen, RB 9700, Netherlands.
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Lau JYF, Watkins-Muleba R, Lee I, Pile V, Hirsch CR. Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples' lived experiences. BMC Psychiatry 2021; 21:403. [PMID: 34429091 PMCID: PMC8386061 DOI: 10.1186/s12888-021-03320-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect "active ingredients" in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations. METHODS We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were consulted on the relevance of these strategies in managing emotions in their daily lives and also whether there were additional strategies that could be targeted to promote adaptive thinking styles. RESULTS Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Lived experience representatives suggested that strategies such as deliberately recalling positive past experiences or positive aspects of oneself to counteract negative thinking. DISCUSSION CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged "toolboxes" to develop resilient thinking patterns in youth is empowering.
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Affiliation(s)
- Jennifer Y. F. Lau
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK ,grid.4868.20000 0001 2171 1133Youth Resilience Research Unit, Queen Mary University of London, London, UK
| | - Rebecca Watkins-Muleba
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Isabelle Lee
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
| | - Victoria Pile
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK ,grid.4970.a0000 0001 2188 881XRoyal Holloway University of London, London, UK
| | - Colette R. Hirsch
- grid.13097.3c0000 0001 2322 6764Psychology Department, IOPPN, King’s College London, Denmark Hill, London, SE5 8AF UK
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Bell IH, Nicholas J, Alvarez-Jimenez M, Thompson A, Valmaggia L. Virtual reality as a clinical tool in mental health research and practice
. DIALOGUES IN CLINICAL NEUROSCIENCE 2021; 22:169-177. [PMID: 32699517 PMCID: PMC7366939 DOI: 10.31887/dcns.2020.22.2/lvalmaggia] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Virtual reality (VR) is a potentially powerful technology for enhancing assessment
in mental health. At any time or place, individuals can be transported into immersive
and interactive virtual worlds that are fully controlled by the researcher or clinician.
This capability is central to recent interest in how VR might be harnessed in both
treatment and assessment of mental health conditions. The current review provides a
summary of the advantages of using VR for assessment in mental health, focusing on
increasing ecological validity of highly controlled environments, enhancing
personalization and engagement, and capturing real-time, automated data in real-world
contexts. Considerations for the implementation of VR in research and clinical settings
are discussed, including current issues with cost and access, developing evidence base,
technical challenges, and ethical implications. The opportunities and challenges of VR
are important to understand as researchers and clinicians look to harness this
technology to improve mental health outcomes.
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Affiliation(s)
- Imogen H Bell
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Jennifer Nicholas
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Mario Alvarez-Jimenez
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia
| | - Andrew Thompson
- Orygen, Melbourne, Australia; Centre for Youth Mental Health, The University of Melbourne, Australia; University of Warwick - Division of Mental Health and Wellbeing, University of Warwick, UK
| | - Lucia Valmaggia
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, UK; South London and Maudsley NHS Foundation Trust, London, UK
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Riches S, Pisani S, Bird L, Rus-Calafell M, Garety P, Valmaggia L. Virtual reality-based assessment and treatment of social functioning impairments in psychosis: a systematic review. Int Rev Psychiatry 2021; 33:337-362. [PMID: 34121587 DOI: 10.1080/09540261.2021.1918648] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
People with psychosis can experience social functioning impairments. Virtual reality (VR) has been used to assess and treat these difficulties. This systematic review (Prospero CRD42015026288) provides an evaluation of these VR applications. PsycINFO, MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus were searched until May 2020. The Effective Public Health Practice Project (EPHPP) Quality Assessment Tool was used to assess studies. Database searching identified 3810 titles. Fifty-eight studies (published 2005-2020; N = 2,853), comprising twenty-six head-mounted display studies (20 assessment, 6 treatment) and thirty-two immersive 2D screen studies (23 assessment, 9 treatment), were included. There were forty-eight observational studies and ten randomised controlled trials, with 1570 participants (of which, 185 were at ultra-high risk of psychosis) in VR test groups. Nearly half the studies were published since 2016. Assessments targeted cognitive and behavioural indicators of social functioning, e.g. paranoia, eye gaze, or interpersonal distance. Treatments promoted cognitive-behavioural social skills or job interview training. Studies indicate feasibility, acceptability, and effectiveness of VR for social functioning impairments in psychosis. Limitations of studies include the narrow scope of social functioning, small sample sizes, and limited randomised controlled trials and standardised interventions. Findings suggest VR has potential to be integrated with existing psychological approaches.
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Affiliation(s)
- Simon Riches
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Sara Pisani
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK.,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Leanne Bird
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Mar Rus-Calafell
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,Mental Health Research and Treatment Center, Faculty of Psychology, Ruhr-Universität Bochum, Bochum, Germany
| | - Philippa Garety
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Lucia Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
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Self-Reported Cognitive Functions Predict the Trajectory of Paranoid Ideation Over a 15-Year Prospective Follow-Up. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10142-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Abstract
Background
This study investigated whether self-reported cognitive functions (i.e. task orientation, distractibility, persistence, flexibility, and perseverance) predict the trajectory of paranoid ideation over a 15-year prospective follow-up in adulthood.
Methods
The participants came from the population-based Young Finns study (N = 1210‒1213). Paranoid ideation was assessed with the Paranoid Ideation Scale of the Symptom Checklist-90 Revised (SCL-90R) in 1997, 2001, 2007, and 2012. Self-reported cognitive functions were evaluated in 1997 with the Task orientation, Distractibility, Persistence, and Flexibility scales of the DOTS-R (the Revised Dimensions of Temperament Survey) and the Perseverance scale of the FCB-TI (the Formal Characteristics of Behaviour – Temperament Inventory). The data was analyzed using growth curve models that were adjusted for age, sex, and socioeconomic factors in childhood and adulthood.
Results
Low self-reported task orientation, low persistence, high distractibility, low flexibility, and high perseverance predicted higher level of paranoid ideation over the 15-year follow-up.
Conclusions
Self-reported cognitive functions seem to predict paranoid ideation over a long-term follow-up. Promoting cognitive functions in early interventions may have long-term protective influences against the development of paranoid ideation in non-clinical populations.
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11
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Sun J, Zhang X, Wang Y, Wang J, Li J, Cao F. The associations of interpersonal sensitivity with mental distress and trait aggression in early adulthood: a prospective cohort study. J Affect Disord 2020; 272:50-57. [PMID: 32379620 DOI: 10.1016/j.jad.2020.03.161] [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: 10/23/2019] [Revised: 02/20/2020] [Accepted: 03/29/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND To explore the longitudinal associations of interpersonal sensitivity (IS) with mental distress and trait aggression among participants passing through adolescence into adulthood. METHODS A total of 306 participants were recruited at baseline and received a 24-month follow-up. Questionnaires investigating sociodemographics; IS; depression, anxiety, and stress; and trait aggression were used. Univariable and multivariable logistic regression and cross-lagged analyses were also performed. RESULTS At base, 22.5%, 18.3%, 24.2%, and 9.2% of the participants reported higher levels of IS, depressive, anxious, and stressful symptoms. IS at baseline was a partial risk factor for new problems, including anxiety, stress, and anger at follow-up. Newly developed or persistent IS was significantly associated with ongoing symptoms. Discontinued IS, however, only resolved the association with stress and anxiety symptoms. Similarly, newly developed or persistent IS was significantly associated with increased persistence of some problems (anxiety symptoms and physical aggression), while the discontinuation of IS was associated with a lessening of these outcomes. Cross-lagged analyses revealed bidirectional associations of IS with anxiety symptom and stress symptom. LIMITATIONS All subjects were recruited from one medical college, which could limit applicability. This study had a relatively small sample size. Self-reported questionnaires can lead to recall bias. Further research is needed to test causality. CONCLUSIONS IS can predict adolescents' newly developed partial mental distress and aggression. Our findings highlight the crucial role of early recognition of both higher levels of interpersonal sensitivity and associated behavioral problems.
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Affiliation(s)
- Jiwei Sun
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Xuan Zhang
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Ying Wang
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Juan Wang
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Jiahuan Li
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
| | - Fenglin Cao
- School of Nursing, Shandong University, No.44 Wenhua Xi Road, Jinan, China.
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12
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Tognin S, Catalan A, Modinos G, Kempton MJ, Bilbao A, Nelson B, Pantelis C, Riecher-Rössler A, Bressan R, Barrantes-Vidal N, Krebs MO, Nordentoft M, Ruhrmann S, Sachs G, Rutten BPF, van Os J, de Haan L, van der Gaag M, McGuire P, Valmaggia LR. Emotion Recognition and Adverse Childhood Experiences in Individuals at Clinical High Risk of Psychosis. Schizophr Bull 2020; 46:823-833. [PMID: 32080743 PMCID: PMC7345818 DOI: 10.1093/schbul/sbz128] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To investigate the association between facial affect recognition (FAR) and type of adverse childhood experiences (ACEs) in a sample of clinical high risk (CHR) individuals and a matched sample of healthy controls (HCs). METHODS In total, 309 CHR individuals and 51 HC were recruited as part of an European Union-funded multicenter study (EU-GEI) and included in this work. During a 2-year follow-up period, 65 CHR participants made a transition to psychosis (CHR-T) and 279 did not (CHR-NT). FAR ability was measured using a computerized version of the Degraded Facial Affect Recognition (DFAR) task. ACEs were measured using the Childhood Experience of Care and Abuse Questionnaire, the Childhood Trauma Questionnaire, and the Bullying Questionnaire. Generalized regression models were used to investigate the relationship between ACE and FAR. Logistic regressions were used to investigate the relationship between FAR and psychotic transition. RESULTS In CHR individuals, having experienced emotional abuse was associated with decreased total and neutral DFAR scores. CHR individuals who had experienced bullying performed better in the total DFAR and in the frightened condition. In HC and CHR, having experienced the death of a parent during childhood was associated with lower DFAR total score and lower neutral DFAR score, respectively. Analyses revealed a modest increase of transition risk with increasing mistakes from happy to angry faces. CONCLUSIONS Adverse experiences in childhood seem to have a significant impact on emotional processing in adult life. This information could be helpful in a therapeutic setting where both difficulties in social interactions and adverse experiences are often addressed.
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Affiliation(s)
- Stefania Tognin
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK,To whom correspondence should be addressed; tel: +44(0)2078480415, fax: +44 (0)20 7848 0287, e-mail:
| | - Ana Catalan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Psychiatry, Basurto University Hospital, Bilbao, Spain,Department of Neuroscience, University of the Basque Country, Leioa, Spain
| | - Gemma Modinos
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Neuroimaging, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Matthew J Kempton
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Amaia Bilbao
- Research Unit, Basurto University Hospital, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, Australia,Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Christos Pantelis
- Center for Neuropsychiatric Schizophrenia Research (CNSR) and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research (CINS), Mental Health Centre Glostrup, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Rodrigo Bressan
- LiNC – Lab Integrative Neuroscience, Depto Psiquiatria, Escola Paulista de Medicina, Universidade Federal de São Paulo – UNIFESP, São Paulo, Brazil
| | - Neus Barrantes-Vidal
- Departament de Psicologia Clínica i de la Salut (Universitat Autònoma de Barcelona), Fundació Sanitària Sant Pere Claver, Spanish Mental Health Research Network (CIBERSAM), Madrid, Spain
| | - Marie-Odile Krebs
- INSERM, IPNP UMR S1266, Laboratoire de Physiopathologie des Maladies Psychiatriques, Université Paris Descartes, Université de Paris, CNRS, GDR3557-Institut de Psychiatrie, Paris, France,Faculté de Médecine Paris Descartes, GHU Paris – Sainte-Anne, Service Hospitalo-Universitaire, Paris, France
| | - Merete Nordentoft
- Mental Health Center Copenhagen and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Center Glostrup, Mental Health Services in the Capital Region of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Stephan Ruhrmann
- Department of Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Gabriele Sachs
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Bart P F Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience (MHeNS), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands,Department of Psychiatry, UMC Utrecht Brain Center, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Lieuwe de Haan
- Department of Early Psychosis, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology and Amsterdam Public Mental Health research institute, Faculty of Behavioural and Movement Sciences, VU University, Amsterdam, The Netherlands,Department of Psychosis Research, Parnassia Psychiatric Institute, The Hague, The Netherlands
| | | | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,Outreach and Support in South London (OASIS) Service, South London and Maudsley NHS Foundation Trust, London, UK,National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Lucia R Valmaggia
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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13
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Salokangas R, Patterson P, Heinimaa M, Svirskis T, From T, Vaskelainen L, Klosterkötter J, Ruhrmann S, von Reventlow H, Juckel G, Linszen D, Dingemans P, Birchwood M. Perceived negative attitude of others predicts transition to psychosis in patients at risk of psychosis. Eur Psychiatry 2020; 27:264-6. [DOI: 10.1016/j.eurpsy.2010.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 11/19/2010] [Accepted: 11/21/2010] [Indexed: 11/30/2022] Open
Abstract
AbstractAimOur previous study (Salokangas et al., 2009) suggested that the subjective experience of negative attitude of others (NAO) towards oneself is an early indicator of psychotic development. The aim of this prospective follow-up study was to test this hypothesis.MethodsA total of 55 young psychiatric outpatients assessed as being at current risk of psychosis (CROP) were followed for up to 60 months and rates of transition to psychosis (TTP) identified. CROP was assessed employing the Bonn Scale for assessment of basic symptoms (Schultze-Lutter and Klosterkötter, 2002) and the Structured Interview for prodromal symptoms (Miller et al., 2002). TTP was defined by a psychotic episode lasting for more than one week. Associations between NAO at baseline and TTP were analyzed by a Cox regression survival analysis.ResultsEight (14.5%) TTP were identified: four (57.1%) within seven NAO patients and four (8.7%) within forty-six non-NAO patients. In the multivariate Cox regression analysis, NAO at baseline significantly (P = 0.007) predicted TTP.ConclusionThe prospective follow-up results support our hypothesis that subjective experience of NAO is an early indicator of psychotic in development.
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14
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Barnby JM, Deeley Q, Robinson O, Raihani N, Bell V, Mehta MA. Paranoia, sensitization and social inference: findings from two large-scale, multi-round behavioural experiments. ROYAL SOCIETY OPEN SCIENCE 2020; 7:191525. [PMID: 32269791 PMCID: PMC7137981 DOI: 10.1098/rsos.191525] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 02/10/2020] [Indexed: 05/09/2023]
Abstract
The sensitization model suggests that paranoia is explained by over-sensitivity to social threat. However, this has been difficult to test experimentally. We report two preregistered social interaction studies that tested (i) whether paranoia predicted overall attribution and peak attribution of harmful intent and (ii) whether anxiety, interpersonal sensitivity and worry predicted the attribution of harmful intent. In Study 1, we recruited a large general population sample (N = 987) who serially interacted with other participants in multi-round dictator games and matched to fair, partially fair or unfair partners. Participants rated attributions of harmful intent and self-interest after each interaction. In Study 2 (N = 1011), a new sample of participants completed the same procedure and additionally completed measures of anxiety, worry and interpersonal sensitivity. As predicted, prior paranoid ideation was associated with higher and faster overall harmful intent attributions, whereas attributions of self-interest were unaffected, supporting the sensitization model. Contrary to predictions, neither worry, interpersonal sensitivity nor anxiety was associated with harmful intent attributions. In a third exploratory internal meta-analysis, we combined datasets to examine the effect of paranoia on trial-by-trial attributional changes when playing fair and unfair dictators. Paranoia was associated with a greater reduction in harmful intent attributions when playing a fair but not unfair dictator, suggesting that paranoia may also exaggerate the volatility of beliefs about the harmful intent of others.
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Affiliation(s)
- J. M. Barnby
- Social and Cultural Neuroscience Research Group, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Author for correspondence: J. M. Barnby e-mail:
| | - Q. Deeley
- Social and Cultural Neuroscience Research Group, Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - O. Robinson
- Institute of Cognitive Neuroscience, University College London, London, UK
| | - N. Raihani
- Psychology and Language Sciences, University College London, London, UK
| | - V. Bell
- Social and Cultural Neuroscience Research Group, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Research Department of Clinical, Educational, and Healthy Psychology, University College London, London, UK
| | - M. A. Mehta
- Social and Cultural Neuroscience Research Group, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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15
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Riches S, Bird L, Chan N, Garety P, Rus‐Calafell M, Valmaggia L. Subjective experience of paranoid ideation in a virtual reality social environment: A mixed methods cross‐sectional study. Clin Psychol Psychother 2020; 27:337-345. [DOI: 10.1002/cpp.2431] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Simon Riches
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
- Social, Genetic and Developmental Psychiatry CentreInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
| | - Leanne Bird
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
- Lancashire Care NHS Foundation Trust, Sceptre Point, Sceptre Way, Walton Summit Preston UK
| | - Narelle Chan
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
| | - Philippa Garety
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
| | - Mar Rus‐Calafell
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
| | - Lucia Valmaggia
- Department of PsychologyInstitute of Psychiatry, Psychology & Neuroscience, King's College London London UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital Kent UK
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16
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Reilly T, Mechelli A, McGuire P, Fusar-Poli P, Uhlhaas PJ. E-Clinical High Risk for Psychosis: Viewpoint on Potential of Digital Innovations for Preventive Psychiatry. JMIR Ment Health 2019; 6:e14581. [PMID: 31584006 PMCID: PMC6915798 DOI: 10.2196/14581] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/28/2019] [Accepted: 06/28/2019] [Indexed: 12/12/2022] Open
Abstract
E-mental health is an emerging area of research that has the potential to overcome some of the current barriers to progress in working with people at clinical high risk for psychosis (CHR-P). This article provides an overview of how e-mental health could be used in the detection, prediction, and treatment in the CHR-P population. Specifically, we evaluate e-detection, e-prediction, and e-therapeutics for this clinical population. E-mental health holds great promise to improve current management of CHR-P individuals.
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Affiliation(s)
- Thomas Reilly
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Andrea Mechelli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Philip McGuire
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.,Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, King's College London, London, United Kingdom.,OASIS Service, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
| | - Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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17
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Factors Affecting Sense of Presence in a Virtual Reality Social Environment: A Qualitative Study. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2019; 22:288-292. [DOI: 10.1089/cyber.2018.0128] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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18
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Masillo A, Valmaggia LR, Saba R, Brandizzi M, Lo Cascio N, Telesforo L, Venturini P, Izzo A, Mattioli MT, D'Alema M, Girardi P, Fiori Nastro P. Interpersonal sensitivity, bullying victimization and paranoid ideation among help-seeking adolescents and young adults. Early Interv Psychiatry 2019; 13:57-63. [PMID: 28560857 DOI: 10.1111/eip.12447] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 01/12/2017] [Accepted: 03/18/2017] [Indexed: 01/08/2023]
Abstract
AIM The effects of a negative interpersonal experience, such as bullying victimization in childhood and adolescence, can be strong and long lasting. Bullying victimization is associated with paranoid ideation and suspiciousness. Few studies have focused on personality traits of victims of bullying. The aim of this study is to investigate whether a particular personality trait called interpersonal sensitivity may be related to suspiciousness in those who experienced bullying victimization. METHODS The study sample consisted of 147 help-seeking adolescents (mean age 17 years) selected after a screening phase (Prodromal Questionnaire) and evaluated with the Structured Interview for Psychosis-risk Syndromes (SIPS). All participants were specifically asked if they had experienced either psychological bullying or physical bullying, and they completed the Interpersonal Sensitivity Measure (IPSM). RESULTS Of the whole sample, 30 (20%) participants had experienced psychological bullying or physical bullying at least once in their life. Performing a multiple regression, bullying victimization was found to be an independent predictor of subtle paranoid ideation and suspiciousness. Interpersonal sensitivity was also found to be an independent predictor of subtle paranoid ideation; in particular, two IPSM subscales, fragile inner-self and separation anxiety, showed a significant correlation with subtle paranoid ideation. CONCLUSIONS Our results confirmed that bullying victimization is a negative interpersonal experience associated with paranoid ideation and suspiciousness. However, being overly sensitive and having negative beliefs about the self as fragile and vulnerable to threat also lead to a tendency to attribute experiences as externally caused and, in turn, facilitate the formation and maintenance of paranoid ideation.
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Affiliation(s)
- Alice Masillo
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Lucia R Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Martina Brandizzi
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Nella Lo Cascio
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
| | - Ludovica Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Paola Venturini
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Aniello Izzo
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | | | - Marco D'Alema
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Faculty of Medicine and Odontology, Sapienza University of Rome, Rome, Italy
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19
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Riches S, Khan F, Kwieder S, Fisher HL. Impact of an auditory hallucinations simulation on trainee and newly qualified clinical psychologists: A mixed‐methods cross‐sectional study. Clin Psychol Psychother 2019; 26:277-290. [DOI: 10.1002/cpp.2349] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Simon Riches
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College London London UK
- Inpatient Psychology ServiceUniversity Hospital Lewisham, South London and Maudsley NHS Foundation Trust London UK
| | - Fareeha Khan
- Inpatient Psychology ServiceUniversity Hospital Lewisham, South London and Maudsley NHS Foundation Trust London UK
| | - Shifaa Kwieder
- Psychosis Studies, Institute of Psychiatry, Psychology and NeuroscienceKing's College London London UK
| | - Helen L. Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and NeuroscienceKing's College London London UK
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20
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McEnery C, Lim MH, Knowles A, Rice S, Gleeson J, Howell S, Russon P, Miles C, D'Alfonso S, Alvarez-Jimenez M. Development of a Moderated Online Intervention to Treat Social Anxiety in First-Episode Psychosis. Front Psychiatry 2019; 10:581. [PMID: 31474889 PMCID: PMC6702333 DOI: 10.3389/fpsyt.2019.00581] [Citation(s) in RCA: 15] [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: 05/02/2019] [Accepted: 07/23/2019] [Indexed: 01/09/2023] Open
Abstract
Background: It is well established that social anxiety disorder (SAD) is a significant clinical problem for individuals with a psychotic disorder. Comorbid social anxiety in individuals with psychosis has been associated with poorer premorbid functioning, increased depression, and a reduced quality of life. Cognitive behavior therapy (CBT) is recommended for people with psychosis as a first-line psychological treatment; however, its focus and evaluation primarily revolves around reducing psychotic symptoms and not necessarily targeting comorbid social anxiety symptoms. We developed a novel online social cognitive behavioral intervention (entitled EMBRACE) specifically designed to treat social anxiety symptoms in first episode psychosis (FEP). Methods: The key clinical and engagement features of the intervention were established through integrating evidence-based material derived from 1) CBT-based treatment models for SAD, 2) relevant literature findings related to psychosis and its clinical correlates (e.g., shame, social rank, and its relationship with social anxiety and paranoia), 3) feedback from youth focus groups in order to inform a user-centered intervention design, and 4) a highly multidisciplinary collaborative development approach to design therapy comics. Results: A detailed description of the final version of the 12-week online social intervention to treat social anxiety in FEP is presented. Conclusion: The EMBRACE intervention was designed to provide young people with the necessary skills and confidence to overcome social anxiety within a supportive, safe online space. By design, it allows young people the opportunity to practice their newly learnt skills to connect with others and in doing so, learn to embrace their true authentic selves.
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Affiliation(s)
- Carla McEnery
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Michelle H Lim
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Iverson Health Innovation Research Institute, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ann Knowles
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Simon Rice
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Simmone Howell
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Penni Russon
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Chris Miles
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
| | - Simon D'Alfonso
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia.,School of Computing and Information Systems, University of Melbourne, Parkville, VIC, Australia
| | - Mario Alvarez-Jimenez
- Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia.,Orygen, The National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
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21
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Beck AT, Himelstein R, Grant PM. In and out of schizophrenia: Activation and deactivation of the negative and positive schemas. Schizophr Res 2019; 203:55-61. [PMID: 29169775 DOI: 10.1016/j.schres.2017.10.046] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 10/27/2017] [Accepted: 10/30/2017] [Indexed: 02/06/2023]
Abstract
Theorists, clinicians, and investigators have attempted to find a common source for the negative and positive symptoms of schizophrenia. We propose that a unified theory, based on a common cognitive structure not only has explanatory value, but can serve as a framework for a psychotherapeutic intervention. Specifically, we propose that the cognitive triad - the negative view of the self, others, and the future - is the source of the content for the negative and positive symptoms. We report literature supporting the relationship between each facet of the negative triad and each of the key symptoms: expressive negative symptoms, delusions, and verbal hallucinations. We conclude that the literature supports the validity of the cognitive model of negative and positive symptoms. The cognitive model furthers the understanding of the positive and negative symptoms of schizophrenia, and we describe how this provides a framework for a psychotherapeutic intervention.
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Affiliation(s)
- Aaron T Beck
- Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Paul M Grant
- Perelman School of Medicine, University of Pennsylvania, USA..
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22
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Adery LH, Ichinose M, Torregrossa LJ, Wade J, Nichols H, Bekele E, Bian D, Gizdic A, Granholm E, Sarkar N, Park S. The acceptability and feasibility of a novel virtual reality based social skills training game for schizophrenia: Preliminary findings. Psychiatry Res 2018; 270:496-502. [PMID: 30326433 PMCID: PMC6314809 DOI: 10.1016/j.psychres.2018.10.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 07/16/2018] [Accepted: 10/07/2018] [Indexed: 11/25/2022]
Abstract
Social impairment is a core feature of schizophrenia that presents a major barrier toward recovery. Some of the psychotic symptoms are partly ameliorated by medication but the route to recovery is hampered by social impairments. Since existing social skills interventions tend to suffer from lack of availability, high-burden and low adherence, there is a dire need for an effective, alternative strategy. The present study examined the feasibility and acceptability of Multimodal Adaptive Social Intervention in Virtual Reality (MASI-VR) for improving social functioning and clinical outcomes in schizophrenia. Out of eighteen patients with schizophrenia who enrolled, seventeen participants completed the pre-treatment assessment and 10 sessions of MASI-VR, but one patient did not complete the post-treatment assessments. Therefore, the complete training plus pre- and post-treatment assessment data are available from sixteen participants. Clinical ratings of symptom severity were obtained at pre- and post-training. Retention rates were very high and training was rated as extremely satisfactory for the majority of participants. Participants exhibited a significant reduction in overall clinical symptoms, especially negative symptoms following 10 sessions of MASI-VR. These preliminary results support the feasibility and acceptability of a novel virtual reality social skills training program for individuals with schizophrenia.
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Affiliation(s)
- Laura H Adery
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Megan Ichinose
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | | | - Joshua Wade
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Heathman Nichols
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Esube Bekele
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Dayi Bian
- Department of Electrical Engineering and Computer Science, Vanderbilt University, Nashville, TN, USA
| | - Alena Gizdic
- Department of Psychology, Vanderbilt University, Nashville, TN, USA
| | - Eric Granholm
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Nilanjan Sarkar
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Sohee Park
- Department of Psychology, Vanderbilt University, Nashville, TN, USA; Global Academy for Future Civilizations, Kyung Hee University, Seoul, Korea.
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Abstract
BACKGROUND Although the ABC model proposed by cognitive behavioral theory has strong empirical support for a wide range of psychological problems, little is known about the role of irrational beliefs (IBs), a central concept of the ABC model, in the aetiology of paranoid thoughts, one of the most common psychotic symptoms. AIMS The present study aimed to investigate the impact of IBs on paranoid thoughts and people's perceptions of others. METHOD Eighty-one non-clinical participants (m age = 21.21 years, SD = 2.72, range 18-33; 83.95% female) recruited for this study were randomly assigned to one of the two conditions: IBs or rational beliefs (RBs). In a role-play paradigm, subjects were asked to imagine holding a list of IBs or RBs, respectively, while being exposed to a neutral social context in a virtual reality environment. RESULTS In line with the ABC model, results indicate that IBs lead to significantly higher levels of state paranoid thoughts and more negative perceptions of others than RBs, even after controlling for participants' baseline irrationality and trait paranoia [F (5,68) = 11.23, p < .001, Wilk's λ = .54, partial η2 = .45]. CONCLUSIONS The findings of this paper suggest that IBs might play an aetiological role in the occurrence of paranoid thoughts. Practical and theoretical implications of these results are also considered.
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Abstract
Paranoid ideation is a core feature of psychosis, and models of paranoia have long proposed that it arises in the context of disturbances in the perception of the self. However, to develop targeted interventions, there is a benefit in clarifying further, which aspects of self-perception are implicated. Interpersonal sensitivity is a personality trait which has been associated with the risk of paranoid thinking in the general population. However, not all studies have found this link. We aimed to review the empirical literature assessing the association between interpersonal sensitivity and paranoia in both general population and clinical samples; and to explore if associations found differed depending on whether state or trait paranoia was assessed. The review followed PRISMA guidelines. Articles were identified through a literature search in OVID (PsychINFO, MEDLINE) and Web of Science up to December 2016. Fourteen studies with a total of 12 138 participants were included. All studies were of 'fair' or 'good' quality. A robust association was found between interpersonal sensitivity and paranoia in clinical and general population samples alike, regardless of the method of assessment of both paranoia and interpersonal sensitivity. Although this finding was more pronounced in studies of trait paranoia, it is likely that differences in study purpose, measurement, and power explain these differences. Findings from this review support the hypothesis that feelings of personal vulnerability and exaggerated socially evaluative concerns are central for both onset and maintenance of paranoid symptoms, suggesting avenues for future research in targeted interventions.
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Affiliation(s)
- Susanne F Meisel
- Department of Psychology,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
| | - Philippa A Garety
- Department of Psychology,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
| | - Daniel Stahl
- Department of Biostatistics and Health Informatics,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
| | - Lucia R Valmaggia
- Department of Psychology,Institute of Psychology,Psychiatry and Neuroscience,King's College London,London,UK
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Riches S, Maskey R, Waddingham R, Benjamin J, Dishman P, Tebrook C, Mundy E, Roberts P, Fisher HL. Altered States of Consciousness: Evaluation of a voice-hearing simulation during an immersive art exhibition. Early Interv Psychiatry 2018; 12:947-950. [PMID: 29116669 DOI: 10.1111/eip.12497] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/17/2017] [Accepted: 08/20/2017] [Indexed: 11/30/2022]
Abstract
AIM To improve public understanding of the subjective experience of auditory hallucinations and increase empathy towards individuals who hear voices and have other unusual sensory experiences. METHODS This pilot study developed a new immersive art exhibition, Altered States of Consciousness, which gave members of the public an individualized voice-hearing simulation experience in 2 real-world settings-an art gallery and the London Underground. A total of 150 visitors completed visual analogue scales immediately before and after their experience of the exhibition. RESULTS Post-exhibition, there were significant increases in understanding what it feels like to hear voices, compassion towards voice hearers, and comfort in talking about these experiences. Participants enjoyed the simulation, felt they learned from their involvement, and did not find it stressful. CONCLUSIONS The exhibition and voice-hearing simulation has further potential for public engagement and stigma reduction.
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Affiliation(s)
- Simon Riches
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | | | | | | | | | - Eve Mundy
- Voice Collective, Mind in Camden, London, UK
| | | | - Helen L Fisher
- MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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26
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Masillo A, Brandizzi M, Nelson B, Lo Cascio N, Saba R, Lindau JF, Telesforo L, Montanaro D, D'Alema M, Girardi P, McGorry P, Fiori Nastro P. Youth mental health services in Italy: An achievable dream? Early Interv Psychiatry 2018; 12:433-443. [PMID: 27061589 DOI: 10.1111/eip.12328] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 12/15/2015] [Accepted: 02/08/2016] [Indexed: 11/30/2022]
Abstract
AIM "Liberiamo il futuro" (LIF) project was designed to assess psychological problems of adolescents and young adults and to identify individuals at high-risk for developing a psychosis through a collaboration between a University team, Child and Adolescent Mental Health Services and Adult Mental Health Services. This paper presents the baseline demographic and clinical characteristics of the cohort, particularly the nature and severity of psychopathology. METHOD All help-seeking young people aged 12-35 years residing in the health district involved in LIF were invited to participate in the study and completed a battery of self- report and interviewer-administered measures of psychopathology and functioning at baseline. RESULTS A total of 338 adolescents and young people (mean age 17.42) participated in the study. The majority of the sample (n = 107, 35%) had an anxiety disorder, followed by mood disorders (n = 62, 21%). Only 35 (12%) participants had no psychiatric diagnosis. After a screening phase, 166 (52%) individuals were assessed to detect the presence of an Ultra High Risk (UHR) state. Of these, 38.60% (n = 64) met UHR criteria. Overall, the majority of the sample resulted moderately functionally impaired at baseline. CONCLUSIONS LIF project showed that psychological problems, associated with impaired psychosocial functioning, are very common among help-seeking young people. The help-seeking behaviour of young people is in contrast with the barriers presented by the Italian community mental health system that is modelled around adults' requirements. A need of a strong, stigma-free, young oriented system of care for young people up to the mid-20s emerged.
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Affiliation(s)
- Alice Masillo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome, Italy
| | - Martina Brandizzi
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome, Italy
| | - Barnaby Nelson
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Nella Lo Cascio
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome, Italy.,Department of Neurosciences and Neuro-rehabilitation, Bambino Gesù Children's Hospital, Rome, Italy
| | - Riccardo Saba
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome, Italy
| | - Juliana Fortes Lindau
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Ludovica Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Dori Montanaro
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - Marco D'Alema
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - Patrick McGorry
- Orygen, The National Centre of Excellence in Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Paolo Fiori Nastro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome, Italy
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Pot-Kolder R, Veling W, Counotte J, van der Gaag M. Self-reported Cognitive Biases Moderate the Associations Between Social Stress and Paranoid Ideation in a Virtual Reality Experimental Study. Schizophr Bull 2018; 44:749-756. [PMID: 29040776 PMCID: PMC6007229 DOI: 10.1093/schbul/sbx119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Cognitive biases are associated with psychosis liability and paranoid ideation. This study investigated the moderating relationship between pre-existing self-reported cognitive biases and the occurrence of paranoid ideation in response to different levels of social stress in a virtual reality environment. METHODS This study included 170 participants with different levels of psychosis liability (55 recent onset psychosis, 20 ultrahigh risk for psychosis, 42 siblings of psychotic patients, and 53 controls). All participants were exposed to virtual environments with different levels of social stress. The level of experienced paranoia in the virtual environments was measured with the State Social Paranoia Scale. Cognitive biases were assessed with a self-report continuous measure. Also, cumulative number of cognitive biases was calculated using dichotomous measures of the separate biases, based on general population norm scores. RESULTS Higher belief inflexibility bias (Z = 2.83, P < .001), attention to threat bias (Z = 3.40, P < .001), external attribution bias (Z = 2.60, P < .001), and data-gathering bias (Z = 2.07, P < .05) were all positively associated with reported paranoid ideation in the social virtual environments. Level of paranoid response increased with number of cognitive biases present (B = 1.73, P < .001). The effect of environmental stressors on paranoid ideation was moderated by attention to threat bias (Z = 2.78, P < .01) and external attribution bias (Z = 2.75, P < .01), whereas data-gathering bias and belief inflexibility did not moderate the relationship. CONCLUSION There is an additive effect of separate cognitive biases on paranoid response to social stress. The effect of social environmental stressors on paranoid ideation is further enhanced by attention to threat bias and external attribution bias.
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Affiliation(s)
- Roos Pot-Kolder
- Department of Clinical Psychology, VU University and Public Mental Health Research Institute, Amsterdam, the Netherlands,Parnassia Psychiatric Institute, The Hague, the Netherlands,To whom correspondence should be addressed; tel: +31-651108129; fax: +31-503611699; e-mail:
| | - Wim Veling
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | | | - Mark van der Gaag
- Department of Clinical Psychology, VU University and Public Mental Health Research Institute, Amsterdam, the Netherlands,Parnassia Psychiatric Institute, The Hague, the Netherlands
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28
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Trait paranoia shapes inter-subject synchrony in brain activity during an ambiguous social narrative. Nat Commun 2018; 9:2043. [PMID: 29795116 PMCID: PMC5966466 DOI: 10.1038/s41467-018-04387-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 04/26/2018] [Indexed: 01/21/2023] Open
Abstract
Individuals often interpret the same event in different ways. How do personality traits modulate brain activity evoked by a complex stimulus? Here we report results from a naturalistic paradigm designed to draw out both neural and behavioral variation along a specific dimension of interest, namely paranoia. Participants listen to a narrative during functional MRI describing an ambiguous social scenario, written such that some individuals would find it highly suspicious, while others less so. Using inter-subject correlation analysis, we identify several brain areas that are differentially synchronized during listening between participants with high and low trait-level paranoia, including theory-of-mind regions. Follow-up analyses indicate that these regions are more active to mentalizing events in high-paranoia individuals. Analyzing participants’ speech as they freely recall the narrative reveals semantic and syntactic features that also scale with paranoia. Results indicate that a personality trait can act as an intrinsic “prime,” yielding different neural and behavioral responses to the same stimulus across individuals. Reactions to the same event can vary vastly based on multiple factors. Here the authors show that people with high trait-level paranoia process ambiguous information in a narrative differently and this can be attributed to greater activity in mentalizing brain regions during the moments of ambiguity.
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29
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Masillo A, Brandizzi M, Valmaggia LR, Saba R, Lo Cascio N, Lindau JF, Telesforo L, Venturini P, Montanaro D, Di Pietro D, D'Alema M, Girardi P, Fiori Nastro P. Interpersonal sensitivity and persistent attenuated psychotic symptoms in adolescence. Eur Child Adolesc Psychiatry 2018; 27:309-318. [PMID: 28918440 DOI: 10.1007/s00787-017-1047-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Accepted: 09/01/2017] [Indexed: 01/10/2023]
Abstract
Interpersonal sensitivity defines feelings of inner-fragility in the presence of others due to the expectation of criticism or rejection. Interpersonal sensitivity was found to be related to attenuated positive psychotic symptom during the prodromal phase of psychosis. The aims of this study were to examine if high level of interpersonal sensitivity at baseline are associated with the persistence of attenuated positive psychotic symptoms and general psychopathology at 18-month follow-up. A sample of 85 help-seeking individuals (mean age = 16.6, SD = 5.05) referred an Italian early detection project, completed the interpersonal sensitivity measure and the structured interview for prodromal symptoms (SIPS) at baseline and were assessed at 18-month follow-up using the SIPS. Results showed that individuals with high level of interpersonal sensitivity at baseline reported high level of attenuated positive psychotic symptoms (i.e., unusual thought content) and general symptoms (i.e., depression, irritability and low tolerance to daily stress) at follow-up. This study suggests that being "hypersensitive" to interpersonal interactions is a psychological feature associated with attenuated positive psychotic symptoms and general symptoms, such as depression and irritability, at 18-month follow-up. Assessing and treating inner-self fragilities may be an important step of early detection program to avoid the persistence of subtle but very distressing long-terms symptoms.
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Affiliation(s)
- Alice Masillo
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy.
| | - M Brandizzi
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - L R Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.,South London and Maudsley NHS Trust, London, UK
| | - R Saba
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - N Lo Cascio
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - J F Lindau
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
| | - L Telesforo
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - P Venturini
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - D Montanaro
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - D Di Pietro
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - M D'Alema
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - P Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - P Fiori Nastro
- Faculty of Medicine and Odontology, Department of Neurology and Psychiatry, Sapienza University of Rome, UOD Psicoterapia "Villa Tiburtina" via Casal de' Pazzi 16, 00156, Rome, Italy
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30
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Rus-Calafell M, Garety P, Sason E, Craig TJK, Valmaggia LR. Virtual reality in the assessment and treatment of psychosis: a systematic review of its utility, acceptability and effectiveness. Psychol Med 2018; 48:362-391. [PMID: 28735593 DOI: 10.1017/s0033291717001945] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Over the last two decades, there has been a rapid increase of studies testing the efficacy and acceptability of virtual reality in the assessment and treatment of mental health problems. This systematic review was carried out to investigate the use of virtual reality in the assessment and the treatment of psychosis. Web of Science, PsychInfo, EMBASE, Scopus, ProQuest and PubMed databases were searched, resulting in the identification of 638 articles potentially eligible for inclusion; of these, 50 studies were included in the review. The main fields of research in virtual reality and psychosis are: safety and acceptability of the technology; neurocognitive evaluation; functional capacity and performance evaluation; assessment of paranoid ideation and auditory hallucinations; and interventions. The studies reviewed indicate that virtual reality offers a valuable method of assessing the presence of symptoms in ecologically valid environments, with the potential to facilitate learning new emotional and behavioural responses. Virtual reality is a promising method to be used in the assessment of neurocognitive deficits and the study of relevant clinical symptoms. Furthermore, preliminary findings suggest that it can be applied to the delivery of cognitive rehabilitation, social skills training interventions and virtual reality-assisted therapies for psychosis. The potential benefits for enhancing treatment are highlighted. Recommendations for future research include demonstrating generalisability to real-life settings, examining potential negative effects, larger sample sizes and long-term follow-up studies. The present review has been registered in the PROSPERO register: CDR 4201507776.
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Affiliation(s)
- M Rus-Calafell
- King's College London, Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - P Garety
- King's College London, Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - E Sason
- King's College London, Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - T J K Craig
- King's College London, Institute of Psychiatry, Psychology and Neuroscience,London,UK
| | - L R Valmaggia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience,London,UK
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31
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Appiah-Kusi E, Fisher HL, Petros N, Wilson R, Mondelli V, Garety PA, Mcguire P, Bhattacharyya S. Do cognitive schema mediate the association between childhood trauma and being at ultra-high risk for psychosis? J Psychiatr Res 2017; 88:89-96. [PMID: 28103519 DOI: 10.1016/j.jpsychires.2017.01.003] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 12/09/2016] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Abstract
Exposure to childhood trauma has been associated with psychotic symptoms, being at ultra-high risk for psychosis (UHR), and psychotic disorders such as schizophrenia. Negative self-beliefs have been shown to partially mediate the relationship between childhood trauma and paranoia and have been shown to be characteristic of patients with psychosis. However, whether the association between childhood trauma and being at high risk of developing psychosis (e.g., UHR) and paranoia symptoms is mediated by altered cognitive schema is unknown and warrants investigation to inform preventive interventions. Data was collected on 30 UHR patients from Outreach and Support in South London about exposure to childhood trauma, cognitive schema, paranoia and cannabis use. Relative to healthy controls (n = 38), UHR patients were significantly more likely to report exposure to various types of childhood trauma (emotional and sexual abuse, and emotional and physical neglect), had more negative schema and less positive schema about themselves and others, and were more likely to use cannabis more than once a month. Emotional neglect was found to be significantly associated with UHR status even after controlling for the effects of previous exposure to cannabis use (b = 0.262, 95% CI: 0.115-0.408), and this association was partially mediated by negative self-schema (b = 0.045, 95% CI: 0.004-0.159). Similarly, emotional neglect was significantly associated with paranoia (b = 1.354, 95% CI: 0.246-2.462), and this association was partially mediated by negative self-schema (b = 0.988, 95% CI: 0.323-1.895). These findings provide preliminary evidence about the cognitive mechanisms that may underlie the association between childhood trauma and later risk for psychosis.
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Affiliation(s)
- E Appiah-Kusi
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
| | - H L Fisher
- King's College London, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 80, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - N Petros
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - R Wilson
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - V Mondelli
- King's College London, Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 92, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - P A Garety
- King's College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 77, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - P Mcguire
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK
| | - S Bhattacharyya
- King's College London, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), Box PO 67, 16 De Crespigny Park, Denmark Hill, London SE5 8AF, UK.
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van Bennekom MJ, de Koning PP, Denys D. Virtual Reality Objectifies the Diagnosis of Psychiatric Disorders: A Literature Review. Front Psychiatry 2017; 8:163. [PMID: 28928677 PMCID: PMC5591833 DOI: 10.3389/fpsyt.2017.00163] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 08/21/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND To date, a diagnosis in psychiatry is largely based on a clinical interview and questionnaires. The retrospective and subjective nature of these methods leads to recall and interviewer biases. Therefore, there is a clear need for more objective and standardized assessment methods to support the diagnostic process. The introduction of virtual reality (VR) creates the possibility to simultaneously provoke and measure psychiatric symptoms. Therefore, VR could contribute to the objectivity and reliability in the assessment of psychiatric disorders. OBJECTIVE In this literature review, we will evaluate the assessment of psychiatric disorders by means of VR environments. First, we investigate if these VR environments are capable of simultaneously provoking and measuring psychiatric symptoms. Next, we compare these measures with traditional diagnostic measures. METHODS We performed a systematic search using PubMed, Embase, and Psycinfo; references of selected articles were checked for eligibility. We identified studies from 1990 to 2016 on VR used in the assessment of psychiatric disorders. Studies were excluded if VR was used for therapeutic purposes, if a different technique was used, or in case of limitation to a non-clinical sample. RESULTS A total of 39 studies were included for further analysis. The disorders most frequently studied included schizophrenia (n = 15), developmental disorders (n = 12), eating disorders (n = 3), and anxiety disorders (n = 6). In attention-deficit hyperactivity disorder, the most comprehensive measurement was used including several key symptoms of the disorder. Most of the studies, however, concerned the use of VR to assess a single aspect of a psychiatric disorder. DISCUSSION In general, nearly all VR environments studied were able to simultaneously provoke and measure psychiatric symptoms. Furthermore, in 14 studies, significant correlations were found between VR measures and traditional diagnostic measures. Relatively small clinical sample sizes were used, impeding definite conclusions. Based on this review, the innovative technique of VR shows potential to contribute to objectivity and reliability in the psychiatric diagnostic process.
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Affiliation(s)
- Martine J van Bennekom
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Pelle P de Koning
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands
| | - Damiaan Denys
- Academic Medical Center, Department of Psychiatry, University of Amsterdam, Amsterdam, Netherlands.,The Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam, Netherlands
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Veling W, Counotte J, Pot-Kolder R, van Os J, van der Gaag M. Childhood trauma, psychosis liability and social stress reactivity: a virtual reality study. Psychol Med 2016; 46:3339-3348. [PMID: 27619196 DOI: 10.1017/s0033291716002208] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Childhood trauma is associated with higher risk for mental disorders, including psychosis. Heightened sensitivity to social stress may be a mechanism. This virtual reality study tested the effect of childhood trauma on level of paranoid ideations and distress in response to social stress, in interaction with psychosis liability and level of social stress exposure. METHOD Seventy-five individuals with higher psychosis liability (55 with recent onset psychotic disorder and 20 at ultra-high risk for psychosis) and 95 individuals with lower psychosis liability (42 siblings and 53 controls) were exposed to a virtual café in five experiments with 0-3 social stressors (crowded, other ethnicity and hostility). Paranoid ideation was measured after each experiment. Subjective distress was self-rated before and after experiments. Multilevel random regression analyses were used to test main effects of childhood trauma and interaction effects. RESULTS Childhood trauma was more prevalent in individuals with higher psychosis liability, and was associated with higher level of (subclinical) psychotic and affective symptoms. Individuals with a history of childhood trauma responded with more subjective distress to virtual social stress exposures. The effects of childhood trauma on paranoia and subjective distress were significantly stronger when the number of virtual environmental stressors increased. Higher psychosis liability increased the effect of childhood trauma on peak subjective distress and stress reactivity during experiments. CONCLUSIONS Childhood trauma is associated with heightened social stress sensitivity and may contribute to psychotic and affective dysregulation later in life, through a sensitized paranoid and stress response to social stressors.
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Affiliation(s)
- W Veling
- Department of Psychiatry,University of Groningen, University Medical Center Groningen,Groningen,The Netherlands
| | - J Counotte
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - R Pot-Kolder
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - J van Os
- Department of Psychiatry and Neuropsychology,Maastricht University,Maastricht,the Netherlands
| | - M van der Gaag
- Parnassia Psychiatric Institute,The Hague,The Netherlands
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Veling W, Pot-Kolder R, Counotte J, van Os J, van der Gaag M. Environmental Social Stress, Paranoia and Psychosis Liability: A Virtual Reality Study. Schizophr Bull 2016; 42:1363-1371. [PMID: 27038469 PMCID: PMC5049523 DOI: 10.1093/schbul/sbw031] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The impact of social environments on mental states is difficult to assess, limiting the understanding of which aspects of the social environment contribute to the onset of psychotic symptoms and how individual characteristics moderate this outcome. This study aimed to test sensitivity to environmental social stress as a mechanism of psychosis using Virtual Reality (VR) experiments. Fifty-five patients with recent onset psychotic disorder, 20 patients at ultra high risk for psychosis, 42 siblings of patients with psychosis, and 53 controls walked 5 times in a virtual bar with different levels of environmental social stress. Virtual social stressors were population density, ethnic density and hostility. Paranoia about virtual humans and subjective distress in response to virtual social stress exposures were measured with State Social Paranoia Scale (SSPS) and self-rated momentary subjective distress (SUD), respectively. Pre-existing (subclinical) symptoms were assessed with the Community Assessment of Psychic Experiences (CAPE), Green Paranoid Thoughts Scale (GPTS) and the Social Interaction Anxiety Scale (SIAS). Paranoia and subjective distress increased with degree of social stress in the environment. Psychosis liability and pre-existing symptoms, in particular negative affect, positively impacted the level of paranoia and distress in response to social stress. These results provide experimental evidence that heightened sensitivity to environmental social stress may play an important role in the onset and course of psychosis.
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Affiliation(s)
- Wim Veling
- *To whom correspondence should be addressed; Department of Psychiatry, University of Groningen, University Medical Center Groningen, PO Box 30.001, 9700 RB Groningen, the Netherlands; tel: +31-50-3612132, fax: +31-50-3619049, e-mail:
| | - Roos Pot-Kolder
- Research Department, Parnassia Psychiatric Institute, The Hague, the Netherlands;,Department of Clinical Psychology, VU University, Amsterdam, the Netherlands
| | - Jacqueline Counotte
- Research Department, Parnassia Psychiatric Institute, The Hague, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, the Netherlands;,King’s College London, King’s Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Mark van der Gaag
- Research Department, Parnassia Psychiatric Institute, The Hague, the Netherlands;,Department of Clinical Psychology, VU University, Amsterdam, the Netherlands
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Shaikh M, Ellett L, Dutt A, Day F, Laing J, Kroll J, Petrella S, McGuire P, Valmaggia LR. Perceived ethnic discrimination and persecutory paranoia in individuals at ultra-high risk for psychosis. Psychiatry Res 2016; 241:309-14. [PMID: 27232552 DOI: 10.1016/j.psychres.2016.05.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 05/02/2016] [Accepted: 05/04/2016] [Indexed: 01/15/2023]
Abstract
Despite a consensus that psychosocial adversity plays a role in the onset of psychosis, the nature of this role in relation to persecutory paranoia remains unclear. This study examined the complex relationship between perceived ethnic discrimination and paranoid ideation in individuals at Ultra High Risk (UHR) for psychosis using a virtual reality paradigm to objectively measure paranoia. Data from 64 UHR participants and 43 healthy volunteers were analysed to investigate the relationship between perceived ethnic discrimination and persecutory ideation in a virtual reality environment. Perceived ethnic discrimination was higher in young adults at UHR in comparison to healthy controls. A positive correlation was observed between perceived ethnic discrimination and paranoid persecutory ideation in the whole sample. Perceived ethnic discrimination was not a significant predictor of paranoid persecutory ideation in the VR environment. Elevated levels of perceived ethnic discrimination are present in individuals at UHR and are consistent with current biopsychosocial models in which psychosocial adversity plays a key role in the development of psychosis and attenuated symptomatology.
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Affiliation(s)
- Madiha Shaikh
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; North East London NHS Foundation Trust, London, United Kingdom.
| | - Lyn Ellett
- Department of Psychology, Royal Holloway, University of London, London, United Kingdom
| | - Anirban Dutt
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Fern Day
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jennifer Laing
- South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Jasmine Kroll
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Sabrina Petrella
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Philip McGuire
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Lucia R Valmaggia
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom; South London and Maudsley NHS Foundation Trust, London, United Kingdom
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Valmaggia LR, Day F, Rus-Calafell M. Using virtual reality to investigate psychological processes and mechanisms associated with the onset and maintenance of psychosis: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2016; 51:921-36. [PMID: 27262562 DOI: 10.1007/s00127-016-1245-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 05/26/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE In the last decade researchers have embraced virtual reality to explore the psychological processes and mechanisms that are involved in the onset and maintenance of psychosis. A systematic review was conducted to synthesise the evidence of using virtual reality to investigate these mechanisms. METHODS Web of Science, PsycINFO, Embase, and Medline were searched. Reference lists of collected papers were also visually inspected to locate any relevant cited journal articles. In total 6001 articles were potentially eligible for inclusion; of these, 16 studies were included in the review. RESULTS The review identified studies investigating the effect of interpersonal sensitivity, childhood bullying victimisation, physical assault, perceived ethnic discrimination, social defeat, population density and ethnic density on the real-time appraisal of VR social situations. Further studies demonstrated the potential of VR to investigate paranoid ideation, anomalous experiences, self-confidence, self-comparison, physiological activation and behavioural response. CONCLUSIONS The reviewed studies suggest that VR can be used to investigate psychological processes and mechanisms associated with psychosis. Implications for further experimental research, as well as for assessment and clinical practise are discussed. The present review has been registered in the PROSPERO register: CRD42016038085.
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Affiliation(s)
- Lucia R Valmaggia
- Department of Psychology (PO 77), Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK. .,South London and Maudsley NHS Trust, London, UK.
| | - Fern Day
- Department of Psychology (PO 77), Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,City University London, London, UK
| | - Mar Rus-Calafell
- Department of Psychology (PO 77), Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, UK.,South London and Maudsley NHS Trust, London, UK
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van Os J, Reininghaus U. Psychosis as a transdiagnostic and extended phenotype in the general population. World Psychiatry 2016; 15:118-24. [PMID: 27265696 PMCID: PMC4911787 DOI: 10.1002/wps.20310] [Citation(s) in RCA: 342] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A large body of research indicates that weak expressions of positive psychotic symptoms ("psychotic experiences") can be measured in the general population, and likely represent the behavioural manifestation of distributed multifactorial (genetic and non-genetic) risk for psychosis. Psychotic experiences are a transdiagnostic phenomenon: the majority of individuals with these experiences have a diagnosis of non-psychotic disorder, particularly common mental disorder, in which psychotic experiences predict greater illness severity and poorer treatment response. Some of the people with common mental disorder and psychotic experiences will present to mental health services meeting criteria for "clinical high risk". Treatment of the transdiagnostic dimension of psychosis in individuals with common mental disorder who meet "clinical high risk" criteria thus may improve outcome (which cannot be interpreted as prevention of "schizophrenia"). Subthreshold psychotic experiences are transitory in about 80% of individuals, while around 20% go on to develop persistent psychotic experiences and 7% a psychotic disorder, with an annual transition rate of 0.5-1%. Persistence is associated, on the one hand, with environmental exposures, particularly childhood trauma, and, on the other, with network-type dynamic interactions between psychotic experiences themselves (e.g., interactions between hallucinatory experiences and delusional ideation) and between symptom dimensions (e.g., interactions between affective symptoms and psychotic experiences, or interactions between subthreshold negative symptoms and psychotic experiences). The study of psychotic experiences is helping to elucidate the mechanisms by which environmental and genetic influences shape the transdiagnostic expression of psychosis proneness, that is mostly transitory but may first become persistent over time and eventually give rise to transition to a psychotic disorder.
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Affiliation(s)
- Jim van Os
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. Box 616 (DOT12), 6200 MD Maastricht, The Netherlands
- King's College London, King's Health Partners, Department of Psychosis Studies, Institute of Psychiatry, London, UK
| | - Uli Reininghaus
- Department of Psychiatry and Psychology, Maastricht University Medical Centre, P.O. Box 616 (DOT12), 6200 MD Maastricht, The Netherlands
- King's College London, King's Health Partners, Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, London, UK
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Underwood R, Kumari V, Peters E. Cognitive and neural models of threat appraisal in psychosis: A theoretical integration. Psychiatry Res 2016; 239:131-8. [PMID: 27137974 DOI: 10.1016/j.psychres.2016.03.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 02/29/2016] [Accepted: 03/07/2016] [Indexed: 12/29/2022]
Abstract
Cognitive models of psychosis propose that maladaptive appraisals of anomalous experiences contribute to distress and disability in psychosis. Attentional, attributional and reasoning biases are hypothesised to drive these threat-based appraisals. Experimental and self-report data have provided support for the presence of these biases in psychosis populations, but recently there have been calls for neurobiological data to be integrated into these findings. Currently, little investigation has been conducted into the neural correlates of maladaptive appraisals. Experimental and neuroimaging research in social cognition employing threatening stimuli provide the closest equivalent of maladaptive appraisal in psychosis. Consequently, a rapprochement of these two literatures was attempted in order to identify neural networks relevant to threat appraisal in psychosis. This revealed overlapping models of aberrant emotion processing in anxiety and schizophrenia, encompassing the amygdala, insula, hippocampus, anterior cingulate cortex, and prefrontal cortex. These models posit that aberrant activity in these systems relates to altered emotional significance detection and affect regulation, providing a conceptual overlap with threat appraisal in psychosis, specifically attentional and attributional biases towards threat. It remains to be seen if direct examination of these biases using neuroimaging paradigms supports the theoretical integration of extant models of emotion processing and maladaptive appraisals in psychosis.
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Affiliation(s)
- Raphael Underwood
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, UK
| | - Veena Kumari
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, UK; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, UK
| | - Emmanuelle Peters
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, UK; National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust, UK.
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Abstract
Contingency in interpersonal relationships is associated with the development of secure attachment and trust, whereas paranoia arises from the overattribution of negative intentions. We used a new virtual reality paradigm to experimentally investigate the impact of contingent behavior on trust along the paranoia continuum. Sixty-one healthy participants were randomly allocated to have a social interaction with a pleasant virtual human (avatar) programmed to be highly responsive or not (high/low contingency). Perceived trustworthiness and trusting behavior were assessed alongside control variables attachment and anxiety. Higher paranoia and dismissive attachment were associated with larger interpersonal distances. Unexpectedly, extremely paranoid individuals experienced the highly contingent avatar as more trustworthy than their low contingency counterpart. Higher dismissive attachment was also associated with more subjective trust in both conditions. Extreme paranoia is associated with hypersensitivity to noncontingent behavior, which might explain experiences of mistrust when others are not highly responsive in everyday social situations.
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Pot-Kolder R, Veling W, Geraets C, van der Gaag M. Effect of virtual reality exposure therapy on social participation in people with a psychotic disorder (VRETp): study protocol for a randomized controlled trial. Trials 2016; 17:25. [PMID: 26762123 PMCID: PMC4712473 DOI: 10.1186/s13063-015-1140-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 12/21/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many patients with a psychotic disorder participate poorly in society. When psychotic disorders are in partial remission, feelings of paranoia, delusions of reference, social anxiety and self-stigmatization often remain at diminished severity and may lead to avoidance of places and people. Virtual reality exposure therapy (VRET) is an evidence-based treatment for several anxiety disorders. For patients with a psychotic disorder, the VRETp was developed to help them experience exposure to feared social situations. The present study aims to investigate the effects of VRETp on social participation in real life among patients with a psychotic disorder. METHODS/DESIGN The study is a single-blind randomized controlled trial with two conditions: the active condition, in which participants receive the virtual reality treatment together with treatment as usual (TAU), and the waiting list condition, in which participants receive TAU only. The two groups are compared at baseline, at 3 months posttreatment and at 6 months follow-up. All participants on the waiting list are also offered the virtual reality treatment after the follow-up measurements are completed. The primary outcome is social participation. Secondary outcomes are quality of life, interaction anxiety, depression and social functioning in general. Moderator and mediator analyses are conducted with stigma, cognitive schemata, cognitive biases, medication adherence, simulator sickness and presence in virtual reality. If effective, a cost-effectiveness analysis will be conducted. DISCUSSION Results from the posttreatment measurement can be considered strong empirical indicators of the effectiveness of VRETp. The 6-month follow-up data may provide reliable documentation of the long-term effects of the treatment on the outcome variables. Data from pre-treatment and mid-treatment can be used to reveal possible pathways of change. TRIAL REGISTRATION Current Controlled Trials: ISRCTN12929657 . Date of registration: 8 September 2015.
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Affiliation(s)
- Roos Pot-Kolder
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, The Netherlands. .,Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
| | - Wim Veling
- University of Groningen, UMC Groningen, University Center of Psychiatry, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Chris Geraets
- University of Groningen, UMC Groningen, University Center of Psychiatry, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.
| | - Mark van der Gaag
- Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, The Netherlands. .,Department of Clinical Psychology, VU University and EMGO Institute for Health and Care Research, Van der Boechorststraat 1, 1081 BT, Amsterdam, The Netherlands.
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Interpersonal sensitivity and functioning impairment in youth at ultra-high risk for psychosis. Eur Child Adolesc Psychiatry 2016; 25:7-16. [PMID: 25711287 DOI: 10.1007/s00787-015-0692-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/06/2015] [Indexed: 10/23/2022]
Abstract
A personality trait that often elicits poor and uneasy interpersonal relationships is interpersonal sensitivity. The aim of the present study was to explore the relationship between interpersonal sensitivity and psychosocial functioning in individuals at ultra-high risk for psychosis as compared to help-seeking individuals who screened negative for an ultra-high risk of psychosis. A total sample of 147 adolescents and young adult who were help seeking for emerging mental health problems participated in the study. The sample was divided into two groups: 39 individuals who met criteria for an ultra-high-risk mental state (UHR), and 108 (NS). The whole sample completed the Interpersonal Sensitivity Measure (IPSM) and the Global Functioning: Social and Role Scale (GF:SS; GF:RS). Mediation analysis was used to explore whether attenuated negative symptoms mediated the relationship between interpersonal sensitivity and social functioning. Individuals with UHR state showed higher IPSM scores and lower GF:SS and GF:RS scores than NS participants. A statistically negative significant correlation between two IPSM subscales (Interpersonal Awareness and Timidity) and GF:SS was found in both groups. Our results also suggest that the relationship between the aforementioned aspects of interpersonal sensitivity and social functioning was not mediated by negative prodromal symptoms. This study suggests that some aspects of interpersonal sensitivity were associated with low level of social functioning. Assessing and treating interpersonal sensitivity may be a promising therapeutic target to improve social functioning in young help-seeking individuals.
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Social defeat predicts paranoid appraisals in people at high risk for psychosis. Schizophr Res 2015; 168:16-22. [PMID: 26276306 DOI: 10.1016/j.schres.2015.07.050] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 07/28/2015] [Accepted: 07/28/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND The experience of social defeat may increase the risk of developing psychotic symptoms and psychotic disorders. We studied the relationship between social defeat and paranoid appraisal in people at high risk for psychosis in an experimental social environment created using Virtual Reality (VR). METHOD We recruited UHR (N=64) participants and healthy volunteers (N=43). Regression analysis was used to investigate which baseline measures predicted paranoid appraisals during the VR experience. RESULTS At baseline, UHR subjects reported significantly higher levels of social defeat than controls (OR=.957, (CI) .941-.973, p<.000). Following exposure to the VR social environment, the UHR group reported significantly more paranoid appraisals than the controls (p<.000). Within the UHR sample, paranoid appraisals were predicted by the level of social defeat at baseline, as well as by the severity of positive psychotic and disorganised symptoms. CONCLUSION In people who are at high risk of psychosis, a history of social defeat is associated with an increased likelihood of making paranoid appraisals of social interactions. This is consistent with the notion that social defeat increases the risk of developing psychosis.
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Valmaggia LR, Day FL, Kroll J, Laing J, Byrne M, Fusar-Poli P, McGuire P. Bullying victimisation and paranoid ideation in people at ultra high risk for psychosis. Schizophr Res 2015; 168:68-73. [PMID: 26351160 DOI: 10.1016/j.schres.2015.08.029] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2015] [Revised: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Bullying victimisation has been suggested to contribute to paranoid ideation in general population samples and recent evidence found that individuals with an ultra high risk (UHR) for psychosis are twice as likely to have been bullied than controls. AIMS This study sought to examine whether a history of bullying would be associated with higher levels of paranoid ideation in individuals with an UHR and in healthy controls (HCs). METHOD The study included 64 UHR and 43 HC participants. Following the baseline assessment, participants entered a Virtual Reality (VR) London Underground train. Paranoid ideation was measured immediately after the end of the VR experience. RESULTS Compared to HCs, UHR participants described higher levels of childhood bullying (OR 5.19, 95% CI=2.21-12.19, p<.001) and experienced more paranoid ideation during VR (χ(2)(1)=21.06, p<.001). Childhood bullying was associated with paranoid ideation during VR in both groups (χ(2)(1)=5.931, p=,021) but prolonged exposure to bullying was not associated with increased paranoid ideation. CONCLUSION A history of bullying in childhood is particularly common in young adults at high risk for psychosis. However bullying is associated with paranoid ideation in later life, independent of clinical status, consistent with dimensional models of psychotic phenomena.
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Affiliation(s)
- L R Valmaggia
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS, South London and Maudsley NHS Trust, London, United Kingdom.
| | - F L Day
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - J Kroll
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom
| | - J Laing
- OASIS, South London and Maudsley NHS Trust, London, United Kingdom
| | - M Byrne
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS, South London and Maudsley NHS Trust, London, United Kingdom
| | - P Fusar-Poli
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS, South London and Maudsley NHS Trust, London, United Kingdom
| | - P McGuire
- King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, United Kingdom; OASIS, South London and Maudsley NHS Trust, London, United Kingdom
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Veling W, Moritz S, van der Gaag M. Brave new worlds--review and update on virtual reality assessment and treatment in psychosis. Schizophr Bull 2014; 40:1194-7. [PMID: 25193975 PMCID: PMC4193729 DOI: 10.1093/schbul/sbu125] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
In recent years, virtual reality (VR) research on psychotic disorders has been initiated. Several studies showed that VR can elicit paranoid thoughts about virtual characters (avatars), both in patients with psychotic disorders and healthy individuals. Real life symptoms and VR experiences were correlated, lending further support to its validity. Neurocognitive deficits and difficulties in social behavior were found in schizophrenia patients, not only in abstract tasks but also using naturalistic virtual environments that are more relevant to daily life, such as a city or encounters with avatars. VR treatments are conceivable for most dimensions of psychotic disorders. There is a small but expanding literature on interventions for delusions, hallucinations, neurocognition, social cognition, and social skills; preliminary results are promising. VR applications for assessment and treatment of psychotic disorders are in their infancy, but appear to have a great potential for increasing our understanding of psychosis and expanding the therapeutic toolbox.
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Affiliation(s)
- Wim Veling
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, The Netherlands;
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Masillo A, Valmaggia LR, Lanna A, Brandizzi M, Lindau JF, Curto M, Solfanelli A, Kotzalidis GD, Patanè M, Godeas L, Leccisi D, Girardi P, Fiori Nastro P. Validation of the Italian version of interpersonal sensitivity measure (IPSM) in adolescents and young adults. J Affect Disord 2014; 156:164-70. [PMID: 24439250 DOI: 10.1016/j.jad.2013.12.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/05/2013] [Accepted: 12/05/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Interpersonal sensitivity is a personality trait that describes as excessive awareness of both the behaviour and feelings of others. High interpersonal sensitivity has been associated with the development and maintenance of mental health problems. This study aimed to examine whether the Italian version of the interpersonal sensitivity measure (IPSM) has good internal consistence and convergent validity. METHODS Validity was established on a sample of 153 Italian adolescents and young adult help seekers for several psychological problems. These subjects were divided in two groups - depressive spectrum disorder group (n=42) and other diagnosis group (n=111) - according to Structured Clinical Interview (SCID-I) for DSM-IV and Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). For convergent validity, we studied the correlation between total and each subscale IPSM scores and the General Symptoms (included depressive and dysphoric symptoms) of Prodromal Questionnaire. RESULTS The internal consistency were adequate and comparable to the original Boyce and Parker study. The validity was good, as indicated by both the convergent validity analysis and the depressive spectrum disorder group and other diagnosis group comparison. LIMITATIONS The absence of another scale measuring interpersonal sensitivity to assess the construct validity of IPSM; the clinical heterogeneity of the sample; the absence of test re-test reliability of the instrument. CONCLUSIONS Analysis of the results of internal consistency and convergent validity of the IPSM indicates that this version translated into Italian is valid and reliable.
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Affiliation(s)
- A Masillo
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy.
| | - L R Valmaggia
- Department of Psychology, King's College London, Institute of Psychiatry, UK; Outreach and Support in South London (OASIS), South London and Maudsley NHS Trust, UK
| | - A Lanna
- Department of Computer, Control, and Management Engineering "A. Ruberti", Sapienza University of Rome, Rome, Italy
| | - M Brandizzi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - J F Lindau
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - M Curto
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - A Solfanelli
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - G D Kotzalidis
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - M Patanè
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
| | - L Godeas
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - D Leccisi
- Community Mental Health Service, ASL Rome H, Rome, Italy
| | - P Girardi
- Neurosciences, Mental Health and Sensory Functions (NESMOS) Department, Sapienza University of Rome, Faculty of Medicine and Psychology, Sant'Andrea Hospital, Rome, Italy
| | - P Fiori Nastro
- Department of Neurology and Psychiatry, Sapienza University of Rome, Faculty of Medicine and Odontology, Rome 00156, Italy
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Rus-Calafell M, Gutiérrez-Maldonado J, Ribas-Sabaté J. A virtual reality-integrated program for improving social skills in patients with schizophrenia: a pilot study. J Behav Ther Exp Psychiatry 2014; 45:81-9. [PMID: 24063993 DOI: 10.1016/j.jbtep.2013.09.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 07/29/2013] [Accepted: 09/01/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Social skills training (SST) intervention has shown its efficacy to improve social dysfunction in patients with psychosis; however the implementation of new skills into patients' everyday functioning is difficult to achieve. In this study, we report results from the application of a virtual reality (VR) integrated program as an adjunct technique to a brief social skills intervention for patients with schizophrenia. It was predicted that the intervention would improve social cognition and performance of patients as well as generalisation of the learned responses into patient's daily life. METHODS Twelve patients with schizophrenia or schizoaffective disorder completed the study. They attended sixteen individual one-hour sessions, and outcome assessments were conducted at pre-treatment, post-treatment and four-month follow-up. RESULTS The results of a series of repeated measures ANOVA revealed significant improvement in negative symptoms, psychopathology, social anxiety and discomfort, avoidance and social functioning. Objective scores obtained through the use of the VR program showed a pattern of learning in emotion perception, assertive behaviours and time spent in a conversation. Most of these gains were maintained at four-month follow-up. LIMITATIONS The reported results are based on a small, uncontrolled pilot study. Although there was an independent rater for the self-reported and informant questionnaires, assessments were not blinded. CONCLUSIONS The results showed that the intervention may be effective for improving social dysfunction. The use of the VR program contributed to the generalisation of new skills into the patient's everyday functioning.
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Affiliation(s)
- Mar Rus-Calafell
- Department of Personality, Assessment and Psychological Treatments, University of Barcelona, Passeig de la Vall d'Hebrón, 171, 08035 Barcelona, Spain; Department of Psychiatry and Mental Health, Igualada General Hospital, Avinguda Catalunya, 11, 08700 Igualada, Spain.
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How do people with persecutory delusions evaluate threat in a controlled social environment? A qualitative study using virtual reality. Behav Cogn Psychother 2013; 43:89-107. [PMID: 24103196 DOI: 10.1017/s1352465813000830] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Environmental factors have been associated with psychosis but there is little qualitative research looking at how the ongoing interaction between individual and environment maintains psychotic symptoms. AIMS The current study investigates how people with persecutory delusions interpret events in a virtual neutral social environment using qualitative methodology. METHOD 20 participants with persecutory delusions and 20 controls entered a virtual underground train containing neutral characters. Under these circumstances, people with persecutory delusions reported similar levels of paranoia as non-clinical participants. The transcripts of a post-virtual reality interview of the first 10 participants in each group were analysed. RESULTS Thematic analyses of interviews focusing on the decision making process associated with attributing intentions of computer-generated characters revealed 11 themes grouped in 3 main categories (evidence in favour of paranoid appraisals, evidence against paranoid appraisals, other behaviour). CONCLUSIONS People with current persecutory delusions are able to use a range of similar strategies to healthy volunteers when making judgements about potential threat in a neutral environment that does not elicit anxiety, but they are less likely than controls to engage in active hypothesis-testing and instead favour experiencing "affect" as evidence of persecutory intention.
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Veling W, Brinkman WP, Dorrestijn E, van der Gaag M. Virtual reality experiments linking social environment and psychosis: a pilot study. CYBERPSYCHOLOGY BEHAVIOR AND SOCIAL NETWORKING 2013; 17:191-5. [PMID: 23992475 DOI: 10.1089/cyber.2012.0497] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Initial studies with healthy subjects and individuals with high risk for psychosis have suggested that virtual reality (VR) environments may be used to investigate social and psychological mechanisms of psychosis. One small study reported that VR can safely be used in individuals with current persecutory delusions. The present pilot study investigated the feasibility and potential negative side effects of exposure to different virtual social risk environments in patients with first episode psychosis and in healthy controls. Seventeen patients with first episode psychosis (FEP) and 24 healthy control subjects (HC) participated in four virtual experiments during which they walked for 3.5-4 minutes in a virtual café, looking for avatars with digits on their clothing. The level of paranoid thoughts, as well as psychological, physiological, and behavioral correlates of paranoid thoughts, were measured in different virtual social risk environments, manipulating two factors: population density and ethnicity of avatars. FEP and HC frequently had paranoid thoughts about avatars. Paranoia in the real world correlated strongly with paranoid thoughts about avatars in virtual environments (Spearman's ρ=0.67 and 0.54 in FEP and HC respectively, p<0.01). FEP kept a smaller distance to avatars than HC. In FEP, but not in HC, galvanic skin response was significantly stronger in virtual environments with avatars of other ethnicity than in the own ethnicity condition. These results suggest that VR is an acceptable and sufficiently realistic method to use in patients with first episode psychosis. VR research may help to increase our understanding of the social and psychological mechanisms of psychosis and to develop new treatment applications.
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Affiliation(s)
- Wim Veling
- 1 Parnassia Psychiatric Institute , The Hague, The Netherlands
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A high-fidelity virtual environment for the study of paranoia. SCHIZOPHRENIA RESEARCH AND TREATMENT 2013; 2013:538185. [PMID: 24455255 PMCID: PMC3877649 DOI: 10.1155/2013/538185] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Accepted: 10/02/2013] [Indexed: 12/01/2022]
Abstract
Psychotic disorders carry social and economic costs for sufferers and society. Recent evidence highlights the risk posed by urban upbringing and social deprivation in the genesis of paranoia and psychosis. Evidence based psychological interventions are often not offered because of a lack of therapists. Virtual reality (VR) environments have been used to treat mental health problems. VR may be a way of understanding the aetiological processes in psychosis and increasing psychotherapeutic resources for its treatment. We developed a high-fidelity virtual reality scenario of an urban street scene to test the hypothesis that virtual urban exposure is able to generate paranoia to a comparable or greater extent than scenarios using indoor scenes. Participants (n = 32) entered the VR scenario for four minutes, after which time their degree of paranoid ideation was assessed. We demonstrated that the virtual reality scenario was able to elicit paranoia in a nonclinical, healthy group and that an urban scene was more likely to lead to higher levels of paranoia than a virtual indoor environment. We suggest that this study offers evidence to support the role of exposure to factors in the urban environment in the genesis and maintenance of psychotic experiences and symptoms. The realistic high-fidelity street scene scenario may offer a useful tool for therapists.
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The role of predisposition to hallucinations on non-clinical paranoid vs. socially anxious individuals after hearing negative affective-laden sounds: an experimental investigation. Behav Cogn Psychother 2012; 41:221-37. [PMID: 22971300 DOI: 10.1017/s1352465812000483] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Research suggested that negative affective-laden sounds act as environmental stressors that elicit negative affect (Bradley and Lang, 2000a). AIMS We tried to test for the role of an interaction between predisposition to hallucinatory experiences and exposure to negative affective laden sounds for the presence of paranoid ideation. METHOD We used an experimental design that followed the vulnerability × stress model. We defined three groups from a sample of students: paranoia group vs. social anxiety group vs. control group. Their psychological characteristics were measured through self-reports of paranoia, anxiety, predisposition to hallucinations and depressive symptoms at Time 1 (before the experiment). Participants had to listen to either negative affective laden sounds (e.g. screaming) or positive affective laden sounds (e.g. sound of ocean waves). Their paranoid ideation and positive vs. negative emotional reactions to sounds were measured through self-reports at Time 2 (after the experiment). RESULTS Data showed that the paranoia group presented more serious psychological vulnerabilities than the social anxiety group. A MANCOVA also showed that the independent variables ("group" and "experimental sound conditions") had statistically significant main effects on general paranoia ideation at Time 2. Furthermore, there was a significant three-way interaction between group x predisposition to hallucinatory experiences × experimental condition of sounds for the presence of general paranoid ideation at Time 2. Limitations included the small sample size and the effects of parasite variables, e.g. noise. CONCLUSIONS Individuals' predisposition for hallucinatory experiences increases the probability of possessing paranoid ideation. This tendency is a characteristic of paranoid non-clinical individuals.
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