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Background Voice-hearing experiences can be distressing and impairing, and existing psychological treatments show modest effectiveness. Ecological momentary assessment and intervention (EMA/I) are two promising approaches which may be used as digital tools to support and enhance existing psychological therapies. The aim of this study was to investigate the potential clinical utility of smartphone-based EMA/I in a blended, coping focused therapy for voice-hearing experiences. Method: This pilot RCT focused on feasibility, acceptability and preliminary estimations of efficacy. Thirty-four participants with persisting and distressing voices were randomised to receive the four-session intervention along-side treatment-as-usual (TAU) or TAU-only. Results: Findings supported the feasibility and acceptability of the approach, with good engagement and satisfaction rates, and clinical outcomes showed the intervention holds promise for improving coping, overall severity of voices and to some degree their negative impact. Conclusion: This is the first examination of the use of EMA/I in a blended therapy for psychotic experiences, with findings suggesting these technologies show promise as clinical tools.

Common approaches to the psychological treatment of distressing voice hearing experiences, such as cognitive behavioural therapy, aim to promote more adaptive cognitive, emotional and behavioural responses to these experiences. Digital technologies such as smartphones show promise for supporting and enhancing these treatments by linking immediate therapeutic settings to the context of daily life. Two promising technologies include ecological momentary assessment and intervention (EMA/I), which may offer a means of advanced assessment and support in daily life, and inform the tailoring of interventions to suit individual needs. In this study, a highly novel intervention approach was developed involving four face-to-face sessions with a psychologist blended with EMA/I between sessions in order to improve coping with distressing voice hearing experiences. The authors describe the background and development of this approach along-side a single case illustration, which supported feasibility and acceptability. This study details how digital technologies such as EMA/I may be used in future as clinical tools to enhance standard psychological treatments and clinical care of people with persisting and distressing experiences., Highlights • Self-monitoring of voice hearing experiences using smartphones has potential for improving awareness and understanding of voices • Summaries of individual momentary assessment data has potential to be used as a clinical tool for informing functional analysis of voices • Using smartphones to prompt the use of self-management strategies for voices can reinforce their use and improve coping in daily life • It is possible to blend smartphone technology with standard face-to-face therapy for hearing voices, however a larger trial is needed

The personal recovery movement in mental health has emphasised consumers' individual responsibility and autonomy in defining and directing their own recovery journey. Self-efficacy, or an individual's belief that they can achieve their desired outcomes, is likely to be a key predictor of recovery success. However, there is no established measure of self-efficacy for personal recovery. The Self-Efficacy for Personal Recovery Scale was developed and its psychometric properties evaluated as part of a broader research program investigating a recovery-focused digital intervention in psychosis. Scale reliability and validity were investigated in a sample of 178 adults with persisting psychosis, and test-retest reliability was evaluated in a subset of 32 participants. The scale showed high internal consistency, test-retest reliability, and convergent validity, including correlating positively with hope, personal recovery, and generalised self-efficacy, whilst showing independence from social desirability, insight, and positive symptoms. This measure may be useful for research into the processes underlying recovery, and for understanding how self-efficacy for personal recovery may be enhanced in people with severe mental illness.

Cognitive impairment is common in first-episode psychosis (FEP); however, the relationship between duration of untreated psychosis (DUP) and neurocognition remains controversial, and no studies have examined the relationship between DUP and social cognition. This study involved secondary data analysis of baseline data from a randomised controlled trial of supported employment; 122 out 146 young people with FEP met inclusion criteria for this study. Results showed that DUP was not associated with neurocognitive or social cognitive performance. Results do not provide support for the neurotoxicity hypothesis of psychosis.

Findings are unclear as to whether cannabis use is associated with better cognitive functioning in individuals with psychosis.To elucidate the association between cannabis use, neurocognition and social cognition in first-episode psychosis (FEP).Secondary data analysis was conducted on data from 133 FEP participants who had enrolled in a randomized controlled trial of a vocational intervention. Participants completed a neurocognitive and social cognitive battery and characteristics of cannabis use were documented (disorder, recency, frequency and dose). Principal axis factor analysis was used to determine the underlying structure of the cognitive batteries. Regression techniques were used to examine cognitive predictors of current cannabis use disorder (CUD), and recency and frequency of cannabis use. Bivariate correlations were used to examine associations between cognition and dose of cannabis consumption.Male gender (p=.037) was the only significant predictor of having a current CUD. Better processing speed (p=.022) and social cognition (p=.039), male gender (p.001), and fewer negative symptoms (p=.036) predicted recency of cannabis use. Faster processing speed (p=.007) and male gender (p=.006) also predicted frequency of cannabis use. No variables were significantly associated with dose of cannabis consumption.Better social cognition and processing speed abilities predicting recency and frequency of cannabis use are consistent with cannabis users having higher cognitive abilities. A positive relationship between cannabis use and cognition may be the result of more drug taking opportunities in less cognitively impaired individuals with psychosis.

Anorexia Nervosa (AN) is an eating disorder characterised by distorted cognitions about body weight and shape; but little is known about the phenomenological characteristics of these beliefs. In this study, multidimensional and insight-based measurements were used to compare beliefs about body weight and shape in AN to body image dissatisfaction in the general population, and delusional beliefs in schizophrenia. Twenty participants with clinical and sub-clinical AN, 27 participants with schizophrenia and schizoaffective disorder, and 23 healthy controls completed the Brown Assessment of Beliefs Scale and the Psychotic Symptom Rating Scale in relation to a dominant belief regarding body weight/shape (or body dissatisfaction in healthy controls) or a current delusion. All groups completed the Peters Delusions Inventory to assess the prevalence of a range of delusion-like beliefs. Participants with clinical and subclinical AN experienced significantly higher preoccupation and distress for their belief in comparison to both participants with schizophrenia/schizoaffective disorder rating a delusional belief and the healthy controls rating a belief of body dissatisfaction. Both clinical groups were comparable on ratings of belief conviction and disruption. The data raise questions regarding the current frameworks that are used to describe beliefs in AN.

This article reviews the state of knowledge about strategies used by people with a diagnosis of schizophrenia to cope with hallucinated voices, and considers the role of coping in psychological treatments for persisting symptoms. The use of self-initiated ('natural') coping strategies appears almost universal amongst voice-hearers. These strategies are similar across cultures, and include diverse behaviours, only a minority of which is specific to hallucinations. Most strategies are reported by at least some users to be effective, but more sophisticated outcome studies are lacking. Some evidence for the efficacy of certain behavioural techniques of coping, for the manipulation of auditory input, and for strategies involving subvocalisation, is available from experimental studies. Therapeutic enhancement of natural coping strategies for persisting symptoms has demonstrated some efficacy, but its benefit for voices is unknown. Despite this, it has become an established part of some CBT interventions for psychosis. Further advances in knowledge and practice may come from utilisation of coping models in research, longitudinal and ideographic methods of study and a movement away from descriptive coping lists to investigations of coping styles, mechanisms of action, and the process of coping.