Search

Purpose: Following its introduction in the early 1990s, cognitive behavioural therapy for psychosis (CBTp) has been evaluated in a large number of clinical trials and is now established as a recommended treatment in the UK National Health Service and elsewhere in the world. Meta‐analyses, however, indicate modest effects compared to treatment as usual or comparison therapies such as supportive counselling. Here, we seek to identify factors impacting the effectiveness of CBTp, and avenues for future psychotherapy research that may improve outcomes. Method: We outline two recent umbrella reviews and discuss factors likely to impact the effectiveness of CBTp. Results: Modest effect sizes from meta‐analyses mask heterogeneous outcomes, with some people benefiting and others possibly being harmed by therapy. Common factors such as the therapeutic alliance play an important role in determining outcomes but have been largely neglected by CBTp researchers. There is also the promise of improving outcomes by identifying and targeting the psychological mechanisms that either maintain psychotic symptoms (e.g. worry) or are causally implicated (e.g. trauma). Conclusions: It is unlikely that everyone with psychosis will be equally responsive to the same therapeutic protocols. We need a new, personalised psychotherapy approach to CBTp research and practice, and can learn from research for anxiety and depression examining predictors of therapeutic response to inform treatment decisions. Precision psychological therapies informed by a combination of individual characteristics, common factors and a focus on specific mechanisms will require new research strategies and are likely to lead to improved outcomes for people with psychosis. [ABSTRACT FROM AUTHOR]

Following the 2016 EU referendum on Britain's membership in the European Union, many people described themselves as "Leavers" or "Remainers." Here, we examine the emotional responses associated with Brexit identities using survey data collected from two nationally representative samples of the British public in 2019 (N = 638) and 2021 (N = 2,058). Confirmatory factor analysis indicated that many in both samples had coherent Leave or Remain identities. Remain and, to a lesser extent, Leave identities (regardless of how people actually voted in the referendum) predicted distress about Brexit‐related events and clinical symptoms of depression and anxiety at both time points. Structural equation models suggested that the effect of identities on symptoms was largely mediated by distress about Brexit‐related events. We demonstrate a lasting impact of Brexit on the mental health of UK citizens and show that the formation of novel political identities has been more important in this process than voting behavior. [ABSTRACT FROM AUTHOR]

An editorial is presented discussing the current state of cognitive and behavioral therapies for psychosis, including CBT, third-wave therapies, and the challenges in implementing evidence-based interventions. Topics include the effectiveness of various therapies, the importance of addressing trauma, and the need for personalized and technology-assisted interventions to improve global mental health provision.

Background: Efficacy trials of medications and/or psychological interventions for bipolar disorders (BD) aim to recruit homogenous samples of patients who are euthymic and such populations show high levels of adherence to the treatments offered. This study describes a secondary analysis of a large-scale multi-centre pragmatic effectiveness randomized controlled trial (RCT) of cognitive behaviour therapy plus treatment as usual (CBT) or treatment as usual alone (TAU) and explores outcomes in individuals who were: (i) recruited in depressive episodes, or (ii) receiving suboptimal doses of or no mood stabilizers (MS). Methods: Data were extract on two separate subsamples (out of 253 RCT participants). Sample 1 comprised 67 individuals in a depressive episode (CBT: 34; TAU: 33); Sample 2 comprised 39 individuals receiving suboptimal MS treatment (CBT: 19; TAU: 20). Survival analyses (adjusted for confounding variables) were used to explore recovery in Sample 1 and relapse in Sample 2. Results: In Sample 1 (individuals with depression), Cox proportional hazards regression model revealed that the median time to recovery was significantly shorter in the CBT group (10 weeks; 95% confidence intervals (CI) 8, 17) compared to the TAU group (17 weeks; 95% CI 9, 30) [Adjusted Hazard Ratio (HR) 1.89; 95% CI 1.04, 3.4; p < 0.035]. In Sample 2 (suboptimal MS), the median time to any relapse was significantly longer in the CBT group compared to the TAU group (~ 35 versus ~ 20 weeks; Adjusted HR 2.01; 95% CI 1.01, 3.96; p < 0.05) with the difference in survival time to first depressive relapse also reaching statistical significance (X2 = 14.23, df 6, p 0.027). Conclusions: Adjunctive use of CBT appears to have benefits for individuals diagnosed with BD who are highly representative of the patients seen in routine clinical practice, but often excluded from efficacy RCTs. However, as this is a secondary analysis of 42% of the original RCT sample, it is important to replicate these findings in independent larger scale studies specifically designed for purpose. [ABSTRACT FROM AUTHOR]

The over-purchasing and hoarding of necessities is a common response to crises, especially in developed economies where there is normally an expectation of plentiful supply. This behaviour was observed internationally during the early stages of the Covid-19 pandemic. In the absence of actual scarcity, this behaviour can be described as 'panic buying' and can lead to temporary shortages. However, there have been few psychological studies of this phenomenon. Here we propose a psychological model of over-purchasing informed by animal foraging theory and make predictions about variables that predict over-purchasing by either exacerbating or mitigating the anticipation of future scarcity. These variables include additional scarcity cues (e.g. loss of income), distress (e.g. depression), psychological factors that draw attention to these cues (e.g. neuroticism) or to reassuring messages (eg. analytical reasoning) or which facilitate over-purchasing (e.g. income). We tested our model in parallel nationally representative internet surveys of the adult general population conducted in the United Kingdom (UK: N = 2025) and the Republic of Ireland (RoI: N = 1041) 52 and 31 days after the first confirmed cases of COVID-19 were detected in the UK and RoI, respectively. About three quarters of participants reported minimal over-purchasing. There was more over-purchasing in RoI vs UK and in urban vs rural areas. When over-purchasing occurred, in both countries it was observed across a wide range of product categories and was accounted for by a single latent factor. It was positively predicted by household income, the presence of children at home, psychological distress (depression, death anxiety), threat sensitivity (right wing authoritarianism) and mistrust of others (paranoia). Analytic reasoning ability had an inhibitory effect. Predictor variables accounted for 36% and 34% of the variance in over-purchasing in the UK and RoI respectively. With some caveats, the data supported our model and points to strategies to mitigate over-purchasing in future crises. [ABSTRACT FROM AUTHOR]

Evidence suggests that social identities, which provide purpose and a sense of belonging, enhance resilience against psychological strain and safeguard well‐being. This applies to first‐generation migrant populations facing adverse experiences, including prejudice and disconnection from previous identities during host country integration, negatively impacting their well‐being. The importance of social identity also extends to first‐generation migrant descendants, confronting dual‐identity challenges and experiencing exclusion and discrimination despite being native born. Building on the social identity approach to mental health, 20 semi‐structured interviews were conducted to investigate how migrants construct their social identities, their perspective on the challenges and changes they experience in relation to group memberships and ultimately, the influence this has on their psychological well‐being. Findings emphasize the significance of social identity continuity and gain pathways in first‐generation migrants' successful adjustment and psychological well‐being. For second‐generation migrants, dual‐identity development is especially difficult during adolescence due to social exclusion and discrimination in schools. Even in early adulthood, pressure to maintain heritage identity can lead to negative mental health outcomes over time. The current study contributes to and strengthens the social identity approach to migrant mental health and has wider implications for psychological interventions and policy. [ABSTRACT FROM AUTHOR]

Purpose: A conspiracy world view may be a form of mistrust that is typically corrosive to individual and societal well-being. Our aim was to establish the correlates of conspiracy thinking in an epidemiologically representative sample.Methods: US National Comorbidity Survey-Replication (NCS-R) data were analysed from 5645 people who had completed the item "I am convinced there is a conspiracy behind many things in the world." Results were weighted to be representative of the US adult English speaking household population.Results: 1618 people (weighted 26.7%) endorsed the conspiracy belief item. These individuals were more likely to be: male; currently unmarried; less educated; in a lower income household; outside the labour force; from an ethnic minority group; not attending religious services; taking a weapon outside; and perceiving themselves as of lower social standing compared to others. Individuals endorsing the conspiracy belief item had lower levels of physical and psychological well-being, higher levels of suicidal ideation, weaker social networks, less secure attachment style, difficult childhood family experiences, and were more likely to meet criteria for a psychiatric disorder. There were no differences between those who endorsed conspiracy beliefs and those who did not in age, importance of religious beliefs in daily life, body mass index, or in having a gun at home.Conclusions: Viewing conspiracies in the world is associated with a raised risk of a wide range of adverse circumstances. It is a type of cognitive style that requires systematic empirical study, including monitoring of prevalence, tests of causation, and modelling of propagation. [ABSTRACT FROM AUTHOR]

Objectives: This study investigated whether there were differences in coping strategies and self-esteem between offspring of parents with bipolar disorder (high-risk) and offspring of unaffected parents (control), and whether these psychological factors predicted the onset and recurrence of mood episodes. Methods: High-risk and control offspring were followed longitudinally as part of the Flourish Canadian high-risk bipolar offspring cohort study. Offspring were clinically assessed annually by a psychiatrist using semi-structured interviews and completed a measure of coping strategies and self-esteem. Results: In high-risk offspring, avoidant coping strategies significantly increased the hazard of a new onset Diagnostic and Statistical Manual of Mental Disorders, 4th Edition twice revised mood episode or recurrence (hazard ratio: 1.89, p = 0.04), while higher self-esteem significantly decreased this hazard (hazard ratio: 2.50, p < 0.01). Self-esteem and avoidant coping significantly interacted with one another (p < 0.05), where the risk of a Diagnostic and Statistical Manual of Mental Disorders, 4th Edition twice revised new onset mood episode or recurrence was only significantly increased among high-risk offspring with both high avoidant coping and low self-esteem. Conclusion: A reduction of avoidant coping strategies in response to stress and improvement of self-esteem may be useful intervention targets for preventing the new onset or recurrence of a clinically significant mood disorder among individuals at high familial risk. [ABSTRACT FROM AUTHOR]

Social events may provide important cues that influence the sense of reality, including the perception that conspiracy theories are plausible. Using longitudinal panel data collected in the UK from March 2020 to December 2021, this study aims to identify whether social events influenced the strength of the association between conspiracy mentality and vaccine intentions during the COVID-19 pandemic. Consistent with previous research, the conspiracy mentality was a significant predictor of vaccine intentions across three-time points, but also that conspiracy mentality measured in March 2020 predicted that participants were more hesitant to the vaccines in December 2020. The primary finding was that different social events moderated the strength of the correlation between conspiracy mentality and vaccine intentions within similar participants. Conspiracy mentality became more vital to evaluate COVID-19 vaccines in December 2020, when the vaccination program was about to commence. [ABSTRACT FROM AUTHOR]

Background: Aberrant attributional styles are counted to a set of circumscribed cognitive biases that are implicated in the pathogenesis of (paranoid) psychosis. However, evidence for a specific profile (e.g., an exaggerated self-serving bias, other-blaming bias) has become equivocal over the years. More recently, one-sided (monocausal) attributions have been reported in patients with psychosis.Methods: We compared a large sample of patients with diagnosed schizophrenia (n=145) to nonclinical controls (n=30) on a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R). In this task, participants have to assign probability estimates to each of three potential causes (i.e., myself, others, circumstances) for a specific (negative or positive) event.Results: Participants with schizophrenia displayed an abolished self-serving bias and showed a significant preference for one-sided/monocausal attributions, which was neither correlated with jumping to conclusions nor overconfidence in errors. School education correlated with less monocausal attributions. We did not find any congruence between attributional styles with core delusional ideas.Conclusions: Our study corroborates earlier investigations showing that monocausal attributions may play a role in the pathogenesis of psychosis; this bias unlikely represents an epiphenomenon of established biases. Unexpectedly, attributional styles (e.g., external-blaming) did not shape delusional contents. The true prevalence of monocausal attributions in psychosis is perhaps underestimated in the study, as groups were equated on school education, which was correlated with monocausal attributions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Psychotic experiences including persecutory beliefs are elevated among immigrant and minority populations, especially when living in low ethnic density neighbourhoods (the ethnic density effect). Discrimination, victimization and experiencing a sense of 'not belonging' are hypothesized to play a role in this effect. Because a secure ethnic identity protects against poor self-esteem it may also protect against paranoia. This study explores the relationship between language proficiency (Arabic/English), in-group identity (implicit and explicit) and paranoia in female Emirati university students.Methods: Female citizens of the United Arab Emirates (UAE), Emirati college women (N = 208), reported English/Arabic language proficiencies, and performed a computerized affective priming task engineered to implicitly assess in-group (Emirati) versus out-group (American) positivity. Participants also completed self-report measures of in-group identity (MIIS), and paranoia (PaDs).Results: Arabic proficiency was negatively correlated with paranoia, as was implicit in-group positivity. Furthermore, participants reporting English language dominance, and those demonstrating an implicit out-group preference, reported the highest levels of paranoia.Limitations: The study is limited by its use of an all female sample.Conclusions: Implicit in-group attitudes and linguistic competence protect against paranoia and may help to explain the ethnic density effect. [ABSTRACT FROM AUTHOR]

Epidemiological studies have suggested that there may be associations between specific adversities and specific psychotic symptoms. There is also evidence that beliefs about justice may play a role in paranoid symptoms. In this study, we determined whether these associations could be replicated in a patient sample and whether beliefs about a just world played a specific role in the relationship between adversity and paranoia. We examined associations between childhood trauma, belief in justice, and paranoia and hallucinatory experiences in 144 individuals: 72 individuals with a diagnosis of schizophrenia spectrum disorders and 72 comparison controls. There was a dose-response relationship between cumulative trauma and psychosis. When controlling for comorbidity between symptoms, childhood sexual abuse predicted hallucinatory experiences, and experiences of childhood emotional neglect predicted paranoia. The relationship between neglect and paranoia was mediated by a perception of personal injustice. The findings replicate in a patient sample previous observations from epidemiological research. [ABSTRACT FROM AUTHOR]

Objectives: Although the cyclic nature of bipolarity is almost by definition a network system, no research to date has attempted to scrutinize the relationship of the two bipolar poles using network psychometrics. We used state-of-the-art network and machine learning methodologies to identify symptoms, as well as relations thereof, that bridge depression and mania. Methods: Observational study that used mental health data (12 symptoms for depression and 12 for mania) from a large, representative Canadian sample (the Canadian Community Health Survey of 2002). Complete data (N = 36,557; 54.6% female) were analysed using network psychometrics, in conjunction with a random forest algorithm, to examine the bidirectional interplay of depressive and manic symptoms. Results: Centrality analyses pointed to symptoms relating to emotionality and hyperactivity as being the most central aspects of depression and mania, respectively. The two syndromes were spatially segregated in the bipolar model and four symptoms appeared crucial in bridging them: sleep disturbances (insomnia and hypersomnia), anhedonia, suicidal ideation, and impulsivity. Our machine learning algorithm validated the clinical utility of central and bridge symptoms (in the prediction of lifetime episodes of mania and depression), and suggested that centrality, but not bridge, metrics map almost perfectly onto a data-driven measure of diagnostic utility. Conclusions: Our results replicate key findings from past network studies on bipolar disorder, but also extend them by highlighting symptoms that bridge the two bipolar poles, while also demonstrating their clinical utility. If replicated, these endophenotypes could prove fruitful targets for prevention/intervention strategies for bipolar disorders. [ABSTRACT FROM AUTHOR]

Abstract: Accumulated evidence over the past decade consistently demonstrates a relationship between childhood adversity and psychosis in adulthood. There is some evidence of specific associations between childhood sexual abuse and hallucinations, and between insecure attachment and paranoia. Data from the National Comorbidity Survey were used in assessing whether current attachment styles influenced the association between adverse childhood experiences and psychotic symptoms in adulthood. Hallucinations and paranoid beliefs were differentially associated with sexual abuse (rape and sexual molestation) and neglect, respectively. Sexual abuse and neglect were also associated with depression. The relationship between neglect and paranoid beliefs was fully mediated via anxious and avoidant attachment. The relationship between sexual molestation and hallucinations was independent of attachment style. The relationship between rape and hallucinations was partially mediated via anxious attachment; however this effect was no longer present when depression was included as a mediating variable. The findings highlight the importance of addressing and understanding childhood experiences within the context of current attachment styles in clinical interventions for patients with psychosis. [Copyright &y& Elsevier]

Purpose: Although there is considerable evidence that adversities in childhood such as social deprivation, sexual abuse, separation from parents, neglect and exposure to deviant parental communication are associated with psychosis in later life, most studies have considered broad diagnoses as outcomes. In this review we consider evidence for pathways between specific types of adversity and specific symptoms of psychosis. Methods: We present theoretical arguments for expecting some degree of specificity (although by no means perfect specificity) between different kinds of adversity and different symptoms of psychosis. We review studies that have investigated social-environmental risk factors for thought disorder, auditory-verbal hallucinations and paranoid delusions, and consider how these risk factors may impact on specific psychological and biological mechanisms. Results: Communication deviance in parents has been implicated in the development of thought disorder in offspring, childhood sexual abuse has been particularly implicated in auditory-verbal hallucinations, and attachment-disrupting events (e.g. neglect, being brought up in an institution) may have particular potency for the development of paranoid symptoms. Current research on psychological mechanisms underlying these symptoms suggests a number of symptom-specific mechanisms that may explain these associations. Conclusions: Few studies have considered symptoms, underlying mechanisms and different kinds of adversity at the same time. Future research along these lines will have the potential to elucidate the mechanisms that lead to severe mental illness, and may have considerable clinical implications. [ABSTRACT FROM AUTHOR]

The study investigated the role of early interactions with parents in the paranoid process. Student participants (N= 302) completed questionnaires measuring parental style, emotional invalidation, attachment, self-esteem, experiential avoidance (EA) and paranoia. Analyses using structural equation modelling confirmed a model in which cold and overprotective parenting was associated with insecure attachment and negative self-views. Childhood emotional invalidation, including punishment, belittlement, and distress on the part of the parents in response to children’s displays of negative emotions predicted EA in later life. Negative self-beliefs and avoidance of negative mental states, in turn, predicted paranoid ideation. In line with previous research, our data suggest that suboptimal parenting fosters paranoid thinking later in life. Our findings are also consistent with the idea that paranoia arises as a result of dysfunctional attempts to maintain a positive view of the self. [ABSTRACT FROM AUTHOR]

Objectives This paper aims to study dysfunctional self-schematic processes, abnormal coping styles, over-responsiveness to reward stimuli (indicative of an over-sensitive behavioural activation system) and stability of self-esteem in relation to subclinical hypomania. Design Three cross-sectional studies were conducted on selected students on the basis of their scores on the Hypomanic Personality Scale (HPS) (study 1) and on elevated HPS and Dysfunctional Attitude Scale scores (studies 2 and 3). Methods In studies 1 and 2, participants completed questionnaires and kept a self-esteem diary for 6 days. In study 3, the experience sampling method was used to assess momentary self-esteem, emotion and use of different coping styles over a 6-day period. Results Study 1 demonstrated that hypomanic traits are associated with high fluctuations in self-esteem. In study 2, high scores on both the HPS and the Dysfunctional Attitude Scale, but not the HPS alone, were associated with bipolar spectrum symptoms. These participants showed more evidence of alcohol and substance abuse, greater self-esteem fluctuation and dysfunctional coping styles (rumination and risk-taking) compared with controls. Changes in self-esteem were related to the use of these strategies. Conclusions Vulnerability to bipolar disorder is associated with a combination of depression-related and reward-related processes. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: An influential model of hallucinations proposed by Morrison et al. (1995. Behavioural and Cognitive Psychotherapy, 23(3), 265–280) assumes that dysfunctional metacognitive beliefs lead to the misattribution of intrusive thoughts to external sources, therefore generating hallucinatory experiences. Following a comprehensive review of the literature, a series of meta-analyses was carried out to summarize the empirical findings on the association between hallucination-proneness and different metacognitive beliefs. The results of this research synthesis found little support for the existence of specific associations between hallucinations and dysfunctional metacognitive beliefs. While metacognitive beliefs are robustly associated with hallucination-proneness in non-clinical studies, they were only moderately associated with hallucinations in clinical samples. Additional analyses revealed that, after controlling for the effect of comorbid symptoms, hallucination-proneness was only weakly associated with metacognitive beliefs, suggesting that the large associations observed in previous research might stem from the failure to consider the covariation between different symptoms. These findings have important implications in relation to the role of metacognitive factors in psychopathological symptoms, as well as for the implementation of metacognitive-focused cognitive behavioural techniques for the treatment of psychosis. [Copyright &y& Elsevier]

Objectives. The evidence to date for a causal role of emotions in the generation of paranoid symptoms is scarce, mainly because of a lack of studies investigating the longitudinal association between emotional processes and paranoia. The primary aim of this study was to investigate whether momentary emotional experiences (anxiety, depression, anger/irritability) and self-esteem predicted the onset and duration of a paranoid episode. We also studied whether levels of emotional experiences and self-esteem were respectively higher and lower during a paranoid episode. Design. A 1-week, prospective momentary assessment study. Methods. Data were collected using the experience sampling method, a structured self-assessment diary technique. The sample consisted of 158 individuals who ranged across the paranoia continuum. Participants with a psychotic disorder were recruited from in-patient and out-patient mental health services. Participants without psychotic disorder were sampled from the general population. Results. Specific aspects of emotional experience were implicated in the onset and persistence of paranoid episodes. Both an increase in anxiety and a decrease in self-esteem predicted the onset of paranoid episodes. Cross-sectionally, paranoid episodes were associated with high levels of all negative emotions and low level of self-esteem. Initial intensity of paranoia and depression was associated with longer, and anger/irritability with shorter duration of paranoid episodes. Conclusions. Paranoid delusionality is driven by negative emotions and reductions in self-esteem, rather than serving an immediate defensive function against these emotions and low self-esteem. Clinicians need to be aware of the central role of emotion-related processes and especially self-esteem in paranoid thinking. [ABSTRACT FROM AUTHOR]

Background. Trower and Chadwick argued that there are two types of paranoia: 'poor me', in which persecution is seen as undeserved, and 'bad me', in which it is perceived to be deserved. These authors outlined a theory which accounts for both types of paranoia and makes predictions regarding their stability. Aims and objectives. To examine whether different degrees of persecutory ideation and deservedness are associated with different coping strategies in non-clinical populations. Methodology. Six hundred and eight university students from two European countries (UK and Portugal) took part via the Internet, and were assessed in terms of the severity of persecution and deservedness (Persecution and Deservedness Scale), mood (Beck Depression Inventory), and coping strategies (Response Styles to Depression Questionnaire and COPE Questionnaire). Results. Deservedness was associated with acceptance and with engaging in dangerous activities. Conclusions. 'Poor me' and 'bad me' paranoia may represent separate phases of the same unstable defensive phenomenon. The effectiveness of the existing psychological interventions in prodromal psychosis could be increased by addressing the negative impact of safety behaviours and of substance misuse and by encouraging the practice of more adaptive ways of dealing with everyday problems. [ABSTRACT FROM AUTHOR]

Objective. The present study uses an indirect measure to explore whether dysfunctional attitudes are characteristic of all phases of bipolar disorder. Previous studies with bipolar patients using indirect measurements have uncovered depression-like responses that were otherwise undetected. Design. A cross-sectional study design was adopted to explore the presence of dysfunctional attitudes within each phase of the illness. Method. Manic patients, depressed bipolar patients, remitted bipolar patients, and healthy controls were compared on a sentence stem completion task designed to implicitly assess dysfunctional attitudes. Results. The manic, depressed, and remitted patients all exceeded the controls on implicit measures of dysfunctional attitudes. Conclusions. The findings are consistent with the hypothesis that all phases of bipolar disorder are associated with depressogenic dysfunctional attitudes. [ABSTRACT FROM AUTHOR]

Abstract: Although there is clear evidence that bipolar disorder runs in families, the mechanisms by which this illness is transmitted across generations are poorly understood. In particular, there has been limited consideration of nature of the psychosocial risk factors that might be present in offspring of bipolar parents and of how these factors might increase the likelihood of transition to illness. Recent research has begun to explore psychosocial factors in both healthy and diagnosed children of bipolar parents. This review explores the findings that have been obtained to date in terms of personality, cognitive functioning, life events and family factors. Three potential theoretical frameworks are then considered which might prove fruitful for facilitating theoretically driven empirical studies in this important area. Implications for future research and therapy are noted. [Copyright &y& Elsevier]

Abstract: The aim of the current study was to reduce the number of items in the 48-item hypomanic personality scale (HPS) and determine whether a unidimensional scale of the hypomanic trait could be derived. Previously collected HPS data from University students (n =318) were applied to the Rasch model (one-parameter item response theory). Overall scale and individual item fit statistics were used to judge fit to the model and item maps employed to determine coverage of the trait. Cronbach’s Alpha and correlations with other questionnaires pre- and post-item reduction were evaluated. Rasch analysis indicated that the original HPS was not unidimensional, had significant redundancy and differential item functioning by age and gender. An iterative process of item reduction produced a 20-item HPS (HPS-20) that retained the concepts of the original HPS and had excellent fit to the Rasch model (χ2 p =0.27). Unidimensionality of the HPS-20 was confirmed. The traditional psychometric properties of the HPS-20 and coverage of the underlying hypomanic construct were similar to the original. It was possible to derive a unidimensional measure of the hypomanic trait. Further use of the HPS-20 is encouraged as it may increase understanding of the risk factors for affective disorders. [Copyright &y& Elsevier]

Aversive processing plays a central role in human phobic fears and may also be important in some symptoms of psychosis. We developed a temporal-difference model of the conditioned avoidance response, an important experimental model for aversive learning which is also a central pharmacological model of psychosis. In the model, dopamine neurons reported outcomes that were better than the learner expected, typically coming from reaching safety states, and thus controlled the acquisition of a suitable policy. The model accounts for normal conditioned avoidance learning, the persistence of responding in extinction, and critical effects of dopamine blockade, notably that subjects experiencing shocks under dopamine blockade, and hence failing to avoid them, nevertheless develop avoidance responses when both shocks and dopamine blockade are subsequently removed. These postulated roles of dopamine in aversive learning can thus account for many of the effects of dopaminergic modulation seen in laboratory models of psychopathological processes. [ABSTRACT FROM AUTHOR]

Studies investigating the relationship between self-esteem and paranoia have specifically focused on self-esteem level, but have neglected the dynamic aspects of self-esteem. In the present article, the authors investigated the relationship between self-esteem and paranoia in two different ways. First, 154 individuals ranging across the continuum in level of paranoia were studied with the Experience Sampling Method (a structured self-assessment diary technique) to assess the association between trait paranoia and level and fluctuation of self-esteem in daily life. Results showed that trait paranoia was associated with both lower levels and higher instability of self-esteem. Second, the temporal relationship between momentary (state) paranoia and self-esteem was investigated in the daily life of these individuals. Results showed that a decrease in self-esteem was associated with an immediate increase in paranoia. The findings indicate that paranoid individuals are not only characterized by a lower level of self-esteem but also by more fluctuations in their self-esteem and that fluctuations in self-esteem predict the degree of subsequent paranoia. These results are consistent with the hypothesis that paranoia is associated with dysfunctional strategies of self-esteem regulation. [ABSTRACT FROM AUTHOR]

We describe instrumental variable (IV) methods for the estimation of the 'dose'-response effects of psychological interventions in randomized controlled trials in which there is variability in the patients' adherence to the allocated therapy (that is, variability in the actual number of sessions of therapy attended) and also variability in the strength of the therapeutic alliance between patients and their therapists. The effect of the therapy on outcome is assumed to be a function of both the number of sessions attended and the strength of the therapeutic alliance, with no intervention effects in the absence of any sessions attended (an exclusion restriction) and the effect of the strength of the alliance being represented by a multiplicative term (interaction) in the treatment-effect model. The IV methods that are described allow for: (a) hidden confounding between sessions, alliance and outcome; (b) measurement errors in the alliance; and (c) that alliance is only measured in those receiving treatment. Three two-stage estimation procedures are illustrated, and their equivalence demonstrated, through Monte Carlo simulation and analysis of the results of an actual trial. [ABSTRACT FROM AUTHOR]

Purpose. It has recently been recognized that psychosis represents the end-point of abnormal developmental pathways. The neurodevelopmental framework, within which this observation has typically been interpreted, has a number of limitations, particularly its failure to take account of recent advances in our understanding of the psychology of unusual experiences, such as hallucinations and delusions. The purpose of the present review is to highlight the advantages of considering psychosis within the framework of mainstream developmental psychology. The approach we advocate integrates findings from neurodevelopmental research with research on typical cognitive and sociocognitive development and the psychology of psychotic symptoms. Method. We review selected research on the developmental precursors of psychosis and on the role of cognitive processes in psychotic symptoms, together with relevant literature addressing the development of these processes in healthy children, Results. Developmental psychology provides clues about the cognitive and sociocognitive abnormalities that may be involved in hallucinations and delusions. An integration of these findings with existing knowledge on the neurodevelopment of psychosis suggests new avenues of research for investigators working at both biological and psychological levels of explanation. Conclusions. The literature on typical cognitive and sociocognitive development provides a rich source of hypotheses about the ontogenetic pathways leading to psychosis. [ABSTRACT FROM AUTHOR]

A qualitative study, investigating the representations and explanatory models of 'madness' held by indigenous and religious healers, was undertaken in urban Uganda. Case vignettes of individuals with a diagnosis of a psychotic disorder were discussed by the healers in terms of phenomenology, causality, intervention and outcome. Indigenous healers primarily understood 'madness' as spiritual or physiological, whereas religious healers also held psychological models. Healers' understandings of 'madness' are inextricably linked with the historical and sociopolitical context and may be useful to individuals with psychotic experiences, however, it is likely that these models are dynamic and continually changing. [ABSTRACT FROM AUTHOR]

Paranoid delusions have recently become the focus of empirical research. In this article, we review studies of the psychological mechanisms that might be involved in paranoid thinking and discuss their implications for forensic behaviour science. Paranoia has not been consistently associated with any specific neuropsychological abnormality. However, evidence supports three broad types of mechanism that might be involved in delusional thinking in general and paranoia in particular: anomalous perceptual experiences, abnormal reasoning, and motivational factors. There is some evidence that paranoia may be associated with hearing loss, and good evidence that paranoid patients attend excessively to threatening information. Although general reasoning ability seems to be unaffected, there is strong evidence that a jumping- to-conclusions style of reasoning about data is implicated in delusions in general, but less consistent evidence specifically linking paranoia to impaired theory of mind. Finally, there appears to be a strong association between paranoia and negative self-esteem, and some evidence that attempts to protect self-esteem by attributing negative events to external causes are implicated. Some of these processes have recently been implicated in violent behaviour, and they therefore have the potential to explain the apparent association between paranoid delusions and offending. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background. Attributions play an important role in depression and paranoia. However, contrary to most attributional models of psychopathology, there is evidence that attributional style is not a stable trait but is affected by recent experiences. Method. Paranoid, depressed, and healthy participants were exposed to a mild stressor in the form of the requirement to complete an anagram task, which included insoluble items. Before and afterwards, they completed measures of attributional style for negative events and a contingency judgment task. Results. Replicating previous findings, paranoid patients initially showed low internality scores for negative events and high judgments of control on the contingency judgment task, whereas the depressed participants showed high internality for negative events and low judgments of control. Following the anagram task, both clinical groups showed increased internality for hypothetical negative events. The paranoid participants also gave increased estimates of control on the contingency judgment task. Conclusions. Attributional style is more labile in paranoid and depressed patients than in healthy individuals, Implications for attributional theories of psychopathology are discussed. [ABSTRACT FROM AUTHOR]

Objectives. To study the role of self-discrepancies in different phases of bipolar disorder (manic-depression). Method and design. Patients with a diagnosis of bipolar disorder in three groups, currently depressed, currently manic or hypomanic, and currently in remission, together with healthy control participants, were administered a modified version of Higgins' Selves Questionnaire. Consistencies between the self-actual, self-ideal and self-ought representations were calculated, together with consistencies between the self-actual representation and the believed views of generalized others about the self. Results. In contrast to all other groups, bipolar depressed patients showed marked discrepancies between their self-actual and self-ideal representations, and between their self-actual and self-ought representations. Manic or hypomanic patients showed higher self-actual:self-ideal consistency than non-patient controls. The differences between the depressed participants and the other groups appeared to be accounted for by their very negative self-actual descriptions. Participants in all four groups showed high levels of consistency between self-perceptions and the believed perceptions of others about the self. Conclusions. These findings confirm that beliefs about the self differ between different phases of bipolar disorder and are consistent with the hypothesis that the manic phase involves active avoidance of discrepancies between the self and self-ideals. [ABSTRACT FROM AUTHOR]

Responds to comments on an editorial about the wisdom of interventions for people apparently at high-risk of psychosis. Characteristics of high-risk patients justifying the use of antipsychotic drugs; Prediction of the transition to psychosis; Ethical problems of exposing healthy people to hazardous treatment.

Some theories implicate abnormal self-schemas in the development of psychosis in general and in paranoid delusions in particular. Patients with delusions may also be highly intolerant of ambiguity. No study has yet compared remitted and currently ill paranoid patients on schema measures, or on tolerance of ambiguity. Currently ill psychotic patients with persecutory delusions, patients whose persecutory delusions had remitted, and normal participants completed the Personal Style Inventory (PSI), a self-schema measure, and the Need for Closure Scale (NCS), a measure of intolerance of ambiguity. Acutely ill patients scored higher than normal participants on the PSI autonomy scale. This difference became nonsignificant when depression was included as a covariate. III and remitted patients scored higher than normal participants on the NCS. This difference could not be explained entirely by comorbid depression. Currently paranoid and remitted paranoid patients are highly intolerant of ambiguity. It is possible that this contributes to their performance on reasoning measures. The role of self-schemas in paranoid thinking needs to be studied further. [ABSTRACT FROM AUTHOR]

Objectives. To test the hypothesis that the manic defence involves specific response styles to depression, namely distraction and indulging in dangerous activities. Design. A correlational study was conducted with undergraduate participants assessed for hypomanic traits using Eckblad and Chapman's Hypomanic Personality Scale. Method. Participants also completed the Beck Depression Inventory, and an expanded version of Nolen-Hoeksema's Response Styles Questionnaire. Results. Depression was strongly associated with a ruminative response style. Hypomanic traits were associated with rumination, a distraction response style and with indulging in dangerous activities. However, as only 17% of the variance in hypomania scores was accounted for, other factors must play an important role in determining this trait. Conclusions. Hypomania (and possibly mania) may be products of ineffective styles of coping with negative emotions. [ABSTRACT FROM AUTHOR]

Editorial. Discusses the parameters that must be considered before deciding whether to use antipsychotic drugs in preventative interventions. Dreadfulness of psychosis; Accuracy of prediction; Adverse effects of neuroleptics; Case for non-pharmacological interventions.

Conclusions: Treatment incorporating evidence based physiological explanations for symptoms was effective in encouraging self managed graded exercise. This resulted in substantial improvement compared with standardised medical care. [ABSTRACT FROM AUTHOR]

Discusses the relation between schizophrenia and hypnosis in Great Britain. Categories of psychoses; Theory of madness; Causes of psychosis.

Comments on authors Erik Woody and Henry Szechtman's article about hypnotic and psychotic hallucinations. Functional neuroanatomy of hallucinations; Deficits on measures of cognition inhibition; Obsessive-compulsive phenomena.

Many people dislike the sound of their voices, especially when listening back to audio recordings (voice confrontation). Previous research reports that disliking the sound of one's voice is associated with elevated levels of social anxiety. The present study investigated the relationship between social anxiety and voice dislike and voice misrecognition among a bilingual population: Arabic (L1) and English (L2). Participants (N = 176) completed self‐report measures of social anxiety and own voice liking. Additionally, they performed a novel own voice recognition task, assessing their ability to recognise a recording of their voice, differentiating it from digitally altered versions of the same recording. Social anxiety symptomatology was associated with disliking the sound of one's voice, with a larger effect for L1 than L2. Social anxiety was also associated with own voice misrecognition, but only for L1. Highly negative evaluations about the sound of one's voice may represent a vulnerability for social anxiety disorder. [ABSTRACT FROM AUTHOR]

Introduction : Abnormal causal explanations (attributions) for significant events have been implicated in depression and paranoid delusions. We hypothesised that the speed with which internal (self-blaming) explanations are generated will be affected by the availability of positive and negative self-representations. Methods: Depressed, paranoid, and normal participants were timed as they generated likely causes for hypothetical positive and negative events. Results : Normal participants generated internal explanations more rapidly for positive than for negative events. This bias was absent in the depressed and deluded patients. Conclusions : These findings support the view that explanatory style and self-representations are interrelated cognitive processes. The findings are also consistent with the hypothesis that paranoid patients, like depressed patients, harbour self-representations that are less positive than those of normal people. [ABSTRACT FROM AUTHOR]

Explores some difficulties with the concept of depression from the perspective of critical realism. Professional representations of depression; Differences between professional and lay accounts of depression; Work of George Brown and colleagues on the social origins of depression; Work of Lyn Abramson and colleagues on attributions and depression; Implications for mental health research and practice.

In this brief paper I will suggest that the cognitive approach has four characteristics which must place it at the centre of any complete science of psychopathology: (1) it leads to testable hypotheses about abnormal mental states; (2) it establishes a link between normal psychology and abnormal mental processes, and therefore obviates the need to dichotomise behaviour into the normal and the abnormal; (3) it has the potential to make apparently bizarre and irrational behaviour understandable; and (4) it is neutral with regard to the relative contributions that biology and the environment make to the aetiology of psychiatric disorders. I also identify three limitations of contemporary cognitive models of psychiatric disorders: (1) an over-reliance on conventional methods of psychiatric classification; (2) an underemphasis on social aspects of cognition; and (3) a failure to integrate findings obtained from different models. Once these limitations are overcome, cognitive research is likely to lead to a revolution in our understanding of abnormal behaviour. [ABSTRACT FROM AUTHOR]

Challenges two assumptions that inform much of traditional research into psychosis. Argument about the concept of schizophrenia; Types of psychiatric disorder; Reliability and validity of psychiatric and schizophrenia diagnosis; Brief information about hallucinations and delusions.

A 30-item motivation scale and a locus of control scale were given to 165 heroin users within the first 2 days of a new attempt to withdraw from heroin. Factor analysis of the motivation items revealed three factors, the largest of which was labelled 'private affairs motivation' (factor one), and accounted for 26.5%, of the variance. A significant positive correlation was found between scores on this factor and the I sub-scale for locus of control. The other two factors were labelled 'external constraints' (7.2% of the variance) and 'negative effects of heroin use' (6.6% of the variance). There was a tendency for subjects attending community drug teams to have lower scores on these factors titan those attending other types of agencies, especially in-patient detoxification wards. Further research is required to examine the relationship between the different motivations to withdraw from heroin and other important variables such as withdrawal outcome. [ABSTRACT FROM AUTHOR]

To date few studies have compared heroin users who smoke heroin with those who inject it. In the present study a sample of 38 heroin users, half smokers and half injectors, was investigated using several drugs career indices. Results showed that users display preferences, with the use of some drugs being favoured over time. Injectors used all drugs more frequently than smokers. Although there was much variability in frequency of use the trend over the initial 3 years of use showed no increase in heroin use for either smokers or injectors. Although the majority of smokers had injected heroin there was no evidence that this group favoured injecting over time; rather the data suggested that smoking became the increasingly preferred method of consumption. Smokers were more likely than injectors to use other drugs post-heroin. Contrary to expectation, few periods of abstinence were reported by the subjects in either group. [ABSTRACT FROM AUTHOR]

Questionnaire measures relating to a recent episode of unmodified heroin withdrawal (the target episode) were obtained from 70 subjects. The duration of the target episode, but not reported distress during the episode, correlated with the amount of heroin consumed in the previous 3 months. Data from scales measuring motivation during the target episode were factor analysed and two factors emerged, one relating to motivation concerning private affairs and the other relating to motivation derived from public sources. High scores for private affairs motivation were correlated with success in the target episode whilst there was a trend for public affairs based motivation to be associated with failure. Private affairs motivation was negatively correlated with length of heroin use but positively correlated with the number of coping strategies employed in withdrawal. The implications of these findings for the treatment of heroin users are discussed. [ABSTRACT FROM AUTHOR]

Discusses the role of social cognition in schizophrenia. Difference between social cognition and nonsocial cognition; Differential performance of patients with schizophrenia on social-cognitive versus nonsocial-cognitive tasks; Several social-cognitive models of schizophrenia; Potential implications of a social-cognitive model of schizophrenia for the etiology and development of the disorder.

Five patients suffering from posttraumatic stress disorder and experiencing persistent intrusive imagery were treated with two sessions of relaxation training followed by two sessions of the visual-kinesthetic dissociation technique. Outcome was monitored using a multiple baseline design. Despite the briefness of the intervention, three of the patients showed an almost complete reduction in the frequency of their intrusive images and substantial changes on other measures of psychopathology. One patient showed partial improvement and one patient showed no improvement at all. [ABSTRACT FROM AUTHOR]