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Objectives The current study examined shame in a clinical sample recovering from a first episode of psychosis by focusing on the contribution of different types of shame to post-psychotic trauma while controlling for current affective symptoms. Design The study used a cross-sectional correlational design. Method Fifty individuals who met the criteria for a psychotic disorder whose acute psychotic symptoms were in remission completed measures of internal and external shame associated with psychosis, general shame, post-psychotic trauma, and depression. Results Post-psychotic trauma symptoms were correlated with internal and external shame associated with psychosis and general shame. However, the relation between post-psychotic trauma and external shame associated with psychosis remained after controlling for general shame and current affective symptoms. In addition, internal shame had a stronger association with depression. Thus, internal and external shame due to psychosis had different associations with different types of post-psychotic emotional dysfunction. Conclusions The results support the importance of assessing shame as a multi-faceted construct and suggest that assessing shame directly associated with mental illness is a worthwhile endeavour. Practitioner Points Assessing different types of shame following psychosis can inform assessments, formulations, and interventions with post-psychotic trauma. Our results support the application of Compassionate Mind Therapy to psychosis. However, we did not assess self-criticism or self-reassurance. We also did not investigate the relation between specific psychotic symptoms and different types of shame.

Objective. To further develop the Personal Beliefs about Illness Questionnaire (PBIQ), which reflects current constructs of social rank theory in relation to people experiencing psychosis. Method. Drawing on extensive clinical and research experience and after consultation with other mental health professionals and service users, 17 new items were added to 12 from the original 16 PBIQ questions. These made up five theoretical constructs (entrapment, loss, social marginalization, shame, and control). A total of 150 people who had just experienced a first episode of psychosis completed the newly devised PBIQ-R. To test the validity of its five subscales, a small sub-sample (N= 66) for whom follow-up data was available also completed measures of depression, insight, and other social rank appraisals. Results. All five subscales of the PBIQ-R were found to be reliable, valid, and sensitive to change. Conclusions. Although the PBIQ-R was not designed to produce an overall ‘personal beliefs about illness’ score, its five subscales provide a rapid and valid method to assess and measure common psychological reactions to a first episode of psychosis. It will have relevance for use in older, multiple episode samples although further validation may be needed.

Objectives: Previous research indicates that beliefs about voice power and omnipotence are associated with distress, depression, and compliance. The present study investigates whether acting on voices to mitigate perceived threat, in a broader sense than compliance, is driven by delusional beliefs, as the Chadwick, Birchwood, and Trower cognitive-behavioural model of voices would suggest. The role of safety behaviours in maintaining beliefs about voice omnipotence and distress is also examined. Design: A cross-sectional investigation of 30 individuals with current experience of auditory verbal hallucinations was conducted. Method: Participants were assessed on self-report measures of voice topography, voice-related threat and distress, safety behaviour use, beliefs about voices, and depression and anxiety. Results: Three sources of threat were identified: physical harm, shame, and loss of control. Twenty-six individuals had recently used safety behaviours, believing them to be effective in threat reduction. The degree of safety behaviour use and voice-related distress were associated with voice omnipotence beliefs; mood or voice characteristics did not account for this relationship. The association of safety behaviours with increased distress was mediated by beliefs about voice omnipotence. Conclusions: Acting on voices can be conceptualized as a form of safety seeking, associated with maintaining beliefs about voice omnipotence and distress.

Objectives. Life-events that precede the onset of unipolar depression usually involve an appraisal of loss; recent research has shown that where these events are also appraised as humiliating or involving entrapment and defeat (the absence of a way forward or failure to reaffirm an identity) they are especially potent in triggering depression. Depression in schizophrenia has not been studied from the cognitive or psychosocial perspectives, probably because of its confused nosological status. In a previous study we showed that patients' perceived loss of control and entrapment by psychotic illness (e.g. by recurring relapse) was strongly linked to depression. Design. In this study we follow up the original sample of 49 patients 2.5 years later to examine the hypotheses using more powerful prospective methodology. Two of the sample had died of natural causes and the remaining 47 agreed to be reinterviewed. Method. We used the same measures of patients' appraisal of their illness and symptoms in terms of the extent to which they perceive it as embodying loss, humiliation and entrapment. Results. It was found using multivariate analysis that perceived loss of autonomy and social role, particularly employment, were correlated with depression. The appraisal of entrapment in psychotic illness was found to have high cross-sectional and prospective predictive value independent of illness, symptom and treatment variables and was shown to be influenced by certain aspects of psychiatric treatment, particularly compulsory detention. Conclusion. We propose that episodes of depression in schizophrenia are triggered by psychosis-related events (relapse, compulsory admission, residual voices, loss of job, etc.) that signify the inability to overcome the loss of a cherished personal goal or social role and thereby to affirm an identity. Implications for psychological therapy are discussed.

Clinical observation and retrospective studies have provided considerable information as to the nature of decompensation into acute schizophrenic illness. These themes have been further developed in studies designed to reduce overall exposure to neuroleptics whilst maintaining adequate prophylaxis against relapse. This review extracts from the literature information which could be harnessed to prevent, abort or ameliorate florid schizophrenic relapse. Emphasis is laid upon the coordination of psychological and medical approaches, describing in some detail both the theoretical background and practical intervention strategies in development, and exploring their implications for the role of clinical psychologists.