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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]

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: 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]

Commonly identified patterns of psychological distress in response to adverse events are characterized by resilience (i.e., little to no distress), delayed (i.e., distress that increases over time), recovery (i.e., distress followed by a gradual decrease over time), and sustained (i.e., distress remaining stable over time). This study aimed to examine these response patterns during the COVID‐19 pandemic. Anxiety and depressive symptom data collected across four European countries over the first year of the pandemic were analyzed (N = 3,594). Participants were first categorized into groups based on the four described patterns. Network connectivity and symptom clustering were then estimated for each group and compared. Two thirds (63.6%) of the sample displayed a resilience pattern. The sustained distress network (16.3%) showed higher connectivity than the recovery network (10.0%) group, p =.031; however, the resilient network showed higher connectivity than the delayed network (10.1%) group, p =.016. Regarding symptom clustering, more clusters emerged in the recovery network (i.e., three) than the sustained network (i.e., two). These results replicate findings that resilience was the most common mental health pattern over the first pandemic year. Moreover, they suggest that high network connectivity may be indicative of a stable mental health response over time, whereas fewer clusters may be indicative of a sustained distress pattern. Although exploratory, the network perspective provides a useful tool for examining the complexity of psychological responses to adverse events and, if replicated, could be useful in identifying indicators of protection against or vulnerability to future psychological distress. [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]

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.

Objectives: Established in March 2020, the C19PRC Study monitors the psychological and socio‐economic impact of the pandemic in the UK and other countries. This paper describes the protocol for Wave 6 (August–September 2021). Methods: The survey assessed: COVID‐19 related experiences; experiences of common mental health disorders; psychological characteristics; and social and political attitudes. Adult participants from any previous wave (N = 3170) were re‐invited, and sample replenishment procedures helped manage attrition. Weights were calculated using a survey raking algorithm to ensure the on‐going original panel (from baseline) was nationally representative in terms of gender, age, and household income, amongst other factors. Results: 1643 adults were re‐interviewed at Wave 6 (51.8% retention rate). Non‐participation was higher younger adults, those born outside UK, and adults living in cities. Of the adults recruited at baseline, 54.3% (N = 1100) participated in Wave 6. New respondent (N = 415) entered the panel at this wave, resulting in cross‐sectional sample for Wave 6 of 2058 adults. The raking procedure re‐balanced the longitudinal panel to within 1.3% of population estimates for selected socio‐demographic characteristics. Conclusions: This paper outlines the growing strength of the publicly available C19PRC Study data for COVID‐19‐related interdisciplinary research. [ABSTRACT FROM AUTHOR]

Background: The new International Classification of Diseases came into effect in 2022 (ICD‐11; World Health Organization, 2022) and included updated descriptions and diagnostic rules for "Depressive Episode" and "Generalized Anxiety Disorder." No self‐report measures align with these disorders so this study reports the development and initial validation of the "International Depression Questionnaire" (IDQ) and "International Anxiety Questionnaire" (IAQ). Methods: Items were developed that aligned to the ICD‐11 descriptions and their performance was assessed using data from a community sample (N = 2058) that was representative of the United Kingdom adult population. Results: Item response theory models indicated that the two scales were unidimensional, and the items performed well in terms of difficulty and discrimination. Estimates of internal reliability were high. Based on ICD‐11 derived diagnostic algorithms, 7.4% met requirements for ICD‐11 Depressive Episode and 7.1% for Generalized Anxiety Disorder. Conclusions: The IDQ and the IAQ are short, easy to use, self‐report measures aligned to the new and updated ICD‐11 diagnostic descriptions. This study provides initial evidence that the scales produce scores that are reliable and valid. [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 Psychological Research Consortium (C19PRC) Study was established in March 2020 to monitor the psychological and socio‐economic impact of the pandemic in the UK and other countries. This paper describes the protocol for Wave 5 (March–April 2021). Methods: The survey assessed: COVID‐19 related experiences; experiences of common mental health disorders; psychological characteristics; and social and political attitudes. Adults who participated in any previous wave (N = 4949) were re‐invited to participate. Weights were calculated using a survey raking algorithm to ensure the longitudinal panel was nationally representative in terms of gender, age, and household income, amongst other factors. Results: Overall, 2520 adults participated. A total of 2377 adults who participated in the previous survey wave (November–December 2020) were re‐interviewed at Wave 5 (61.5% retention rate). Attrition between these two waves was predicted by younger age, lower household income, children living in the household, and treatment for mental health difficulties. Of the adults recruited into the C19PRC study at baseline, 57.4% (N = 1162) participated in Wave 5. The raking procedure re‐balanced the longitudinal panel to within 1.5% of population estimates for selected socio‐demographic characteristics. Conclusion: This paper outlines the growing strength of the publicly available C19PRC Study data for COVID‐19‐related interdisciplinary research. [ABSTRACT FROM AUTHOR]

The COVID‐19 pandemic impacted people's lives all over the world, requiring health and safety measures intended to stop the virus from spreading. This study explores whether an unintended consequence of these measures is a new form of ageism. We explore, using qualitative methods, the experiences of older adults living through the pandemic in the United Kingdom and Colombia. Although there were some small differences between countries, for the most part, the experiences were similar. We found that older adults reported that they were seen as a homogenous group and experienced both benevolent and hostile ageism and a loss of autonomy as a consequence of COVID‐19 protection measures. Participants from both countries expressed anger and frustration, and increased anxiety, and felt that their individuality was ignored. We recommend that policy‐makers, the media, and wider society consider the impact of such health and safety measures on older adults in preparing for future pandemics and health challenges. [ABSTRACT FROM AUTHOR]

High risk of mental health problems is associated with loneliness resulting from social distancing measures and "lockdowns" that have been imposed globally due to the COVID‐19 pandemic. This study explores the interconnectedness of loneliness, anxiety and depression on a symptom level using network analysis. A representative sample of participants (N = 1041), who were of at least 18 years of age, was recruited from the Republic of Ireland (ROI). Loneliness, anxiety and depression were assessed using validated instruments. Network analysis was used to identify the network structure of loneliness, anxiety and depression. Loneliness was found to be largely isolated from anxiety and depression nodes in the network. Anxiety and depression were largely interconnected. "Trouble relaxing," "feeling bad about oneself" and "not being able to stop or control worrying" were suggested as the most influential nodes of the network. Despite the expectation that loneliness would be implicated more robustly in the anxiety and depression network of symptoms, the results suggest loneliness as a distinct construct that is not interwoven with anxiety and depression. [ABSTRACT FROM AUTHOR]

Objectives: This paper outlines fieldwork procedures for Wave 4 of the COVID‐19 Psychological Research Consortium (C19PRC) Study in the UK during November–December 2020. Methods: Respondents provided data on socio‐political attitudes, beliefs, and behaviours, and mental health disorders (anxiety, depression, and posttraumatic stress). In Phase 1, adults (N = 2878) were reinvited to participate. At Phase 2, new recruitment: (i) replenished the longitudinal strand to account for attrition; and (ii) oversampled from the devolved UK nations to facilitate robust between‐country analyses for core study outcomes. Weights were calculated using a survey raking algorithm to ensure the longitudinal panel was representative of the baseline sample characteristics. Results: In Phase 1, 1796 adults were successfully recontacted and provided full interviews at Wave 4 (62.4% retention rate). In Phase 2, 292 new respondents were recruited to replenish the panel, as well as 1779 adults from Wales, Scotland, and Northern Ireland, who were representative of the socio‐political composition of the adult populations in these nations. The raking procedure successfully re‐balanced the longitudinal panel to within 1% of population estimates for selected socio‐demographic characteristics. Conclusion: The C19PRC Study offers a unique opportunity to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Introduction: Little is known about the lifetime prevalence of different indicators of suicidality in the Irish general population; whether suicidality has increased during the COVID‐19 pandemic; and what factors associated with belonging to different points on a continuum of suicidality risk. Methods: A nationally representative sample of Irish adults (N = 1,032) completed self‐report measures in May 2020 and a follow‐up in August 2020 (n = 715). Results: Lifetime prevalence rates were 29.5% for suicidal ideation, 12.9% for non‐suicidal self‐injury (NSSI), and 11.2% for attempted suicide. There were no changes in past two‐week rates of NSSI and attempted suicide during the pandemic. Correlations between the indicators of suicidality supported a progression from ideation to NSSI to attempted suicide. Suicidal ideation alone was associated with being male, unemployed, higher loneliness, and lower religiosity. NSSI (with no co‐occurring attempted suicide) was associated with a history of mental health treatment. Attempted suicide was associated with ethnic minority status, lower education, lower income, PTSD, depression, and history of mental health treatment. Conclusion: Suicidal ideation, NSSI, and attempted suicide are relatively common phenomena in the general adult Irish population, and each has unique psychosocial correlates. These findings highlight important targets for prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

Aim: Traumatic events are involved in the development and maintenance of psychotic symptoms. There are few trials exploring trauma‐focused treatments as interventions for psychotic symptoms, especially in individuals with early psychosis. This trial will evaluate the feasibility and acceptability of conducting a definitive trial of Eye Movement Desensitization and Reprocessing for psychosis (EMDRp) in people with early psychosis. Methods: Sixty participants with first episode psychosis and a history of a traumatic/adverse life event(s)will be recruited from early intervention services in the North West of England and randomized to receive16 sessions of EMDRp + Treatment as Usual (TAU) or TAU alone. Participants will be assessed at baseline, 6 and 12 months post‐randomization using several measures of psychotic symptoms, trauma symptoms, anxiety, depression, functioning, service‐user defined recovery, health economics indicators and quality of life. Two nested qualitative studies to assess participant feedback of therapy and views of professional stakeholders on the implementation of EMDRp into services will also be conducted. The feasibility of a future definitive efficacy and cost‐effectiveness evaluation of EMDRp will be tested against several outcomes, including ability to recruit and randomize participants, trial retention at 6‐ and 12‐month follow‐up assessments, treatment engagement and treatment fidelity. Conclusions: If it is feasible to deliver a multi‐site trial of this intervention, it will be possible to evaluate whether EMDRp represents a beneficial treatment to augment existing evidence‐based care of individuals with early psychosis supported by early intervention services. [ABSTRACT FROM AUTHOR]

Objectives: The COVID‐19 Psychological Research Consortium (C19PRC) Study aims to assess the impact of the COVID‐19 pandemic in the adult population in multiple countries. This paper describes the third wave of the UK survey (the 'parent' strand of the Consortium) during July‐August 2020. Methods: Adults (N = 2025) who participated in the baseline and/or first follow‐up surveys were reinvited to participate in this survey, which assessed: (1) COVID‐19 related knowledge, attitudes, and behaviours; (2) the occurrence of common mental disorders; as well as the role of (3) psychological factors and (4) social and political attitudes, in influencing the public's response to the pandemic. Weights were calculated using a survey raking algorithm to ensure that the cross‐sectional sample is nationally representative in terms of gender, age, and household income, and representative of the baseline sample characteristics for household composition, ethnicity, urbanicity and born/raised in UK. Results: 1166 adults (57.6% of baseline participants) provided full interviews at Wave 3. The raking procedure successfully re‐balanced the cross‐sectional sample to within 1% of population estimates across selected socio‐demographic characteristics. Conclusion: This paper demonstrates the strength of the C19PRC Study data to facilitate and stimulate interdisciplinary research addressing important public health questions relating to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Objectives: Paranoia is known to be associated with insecure attachment, with negative self‐esteem as a mediator, but this pathway is insufficient to explain the paranoid individual's beliefs about malevolent others. Mistrust is a likely additional factor as it is a core feature of paranoid thinking also associated with insecure attachment styles. In this study, we tested whether mistrust – operationalized as judgements about the trustworthiness of unfamiliar faces – constitutes a second pathway from insecure attachment to paranoia. Design: The design of the study was cross‐sectional. Methods: A nationally representative British sample of 1,508 participants aged 18–86, 50.8% female, recruited through the survey company Qualtrics, completed measurements of attachment style, negative self‐esteem, and paranoid beliefs. Usable data were obtained from 1,121 participants. Participants were asked to make trustworthiness judgements about computer‐generated faces, and their outcomes were analysed by conducting signal detection analysis, which provided measures of bias (the tendency to assume untrustworthiness in conditions of uncertainty) and sensitivity (accuracy in distinguish between trustworthy and untrustworthy faces). Results: Results using structural equation modelling revealed a good model fit (RMSEA =.071, 95% CI: 0.067–0.075, SRMR =.045, CFI =.93, TLI =.92). We observed indirect effects through bias towards mistrust both for the relationship between attachment anxiety and avoidance (β =.003, 95% CI: 0.001–0.005,p <.001) and attachment anxiety and paranoia (β =.003, 95% CI 0.002–0.006, p <.001). We observed an indirect effect through negative self‐esteem only for the relationship between attachment anxiety and paranoia (β =.064, 95% CI: 0.053–0.077, p <.001). Trust judgements and negative self‐esteem were not associated with each other. Conclusions: We find that a bias towards mistrust is associated with greater paranoia. We also find indirect effects through bias towards mistrust between attachment styles and paranoia. Finally, we reaffirm the strong indirect effect through negative self‐esteem between attachment anxiety and paranoia. Limitations of the study are discussed. Practitioner points: When working with individuals suffering from paranoia, clinicians should consider not only explicit, deliberative cognitive processes of the kind addressed in cognitive behaviour therapy (e.g. cognitive restructuring) but also the way in which their patients make perceptual judgements (e.g., their immediate reactions on encountering new people) and consider interventions targeted at these judgements, for example, bias modification training.Assessment and clinical interventions for people should consider the role of trust judgements and the way in which they combine with low self‐esteem to provoke paranoid beliefs.Psychological interventions targeting paranoid beliefs should focus on both attachment anxiety and attachment avoidance. [ABSTRACT FROM AUTHOR]

Objectives: The C19PRC study aims to assess the impact of the COVID‐19 pandemic in the adult population of the UK, Republic of Ireland, and Spain. This paper describes the conduct of the first two waves of the UK survey (the "parent" strand of the Consortium) during March–April 2020. Methods: A longitudinal, internet panel survey was designed to assess: (1) COVID‐19 related knowledge, attitudes, and behaviors; (2) the occurrence of common mental health disorders as well as the role of (3) psychological factors and (4) social and political attitudes, in influencing the public's response to the pandemic. Quota sampling (age, sex, and household income) was used to recruit a nationally representative sample of adults. Results: Two thousand and twenty five adults were recruited at baseline, and 1406 were followed‐up one‐month later (69.4% retention rate). The baseline sample was representative of the UK population in relation to economic activity, ethnicity, and household composition. Attrition was predicted by key socio‐demographic characteristics, and an inverse probability weighting procedure was employed to ensure the follow‐up sample was representative of the baseline sample. Conclusion: The C19PRC study data has strong generalizability to facilitate and stimulate interdisciplinary research on important public health questions relating to the COVID‐19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Grandiose delusions are arguably the most neglected psychotic experience in research. Objectives: We aimed to discover from patients: whether grandiose delusions have harmful consequences; the psychological mechanisms that maintain them; and what help patients may want from clinical services. Design: A qualitative interview design was used to explore patients' experiences of grandiose delusions. Method: Fifteen patients with past or present experiences of grandiose delusions who were attending psychiatric services were interviewed. Thematic analysis and grounded theory were used to analyse the data. Results: Participants reported physical, sexual, social, occupational, and emotional harms from grandiose delusions. All patients described the grandiose belief as highly meaningful: it provided a sense of purpose, belonging, or self‐identity, or it made sense of unusual or difficult events. The meaning from the belief was not synonymous with extreme superiority or arrogance. The meaning obtained appeared to be a key driver of the persistence of the beliefs. Other maintenance factors were subjectively anomalous experiences (e.g., voices), symptoms of mania, fantasy elaboration, reasoning biases, and immersive behaviours. Participants described insufficient opportunities to talk about their grandiose beliefs and related experiences and were generally positive about the possibility of a psychological therapy. Conclusions: We conclude that grandiosity is a psychologically rich experience, with a number of maintenance factors that may be amenable to a targeted psychological intervention. Importantly, the term 'grandiose delusion' is an imprecise description of the experience; we suggest 'delusions of exceptionality' may be a credible alternative. Practitioner points: Harm from grandiose delusions can occur across multiple domains (including physical, sexual, social, occupational, and emotional) and practitioners should assess accordingly.However, grandiose delusions are experienced by patients as highly meaningful: they provide a sense of purpose, belonging, or self‐identity, or make sense of unusual or difficult events.Possible psychological maintenance mechanisms that could be a target for intervention include the meaning of the belief, anomalous experiences, mania, fantasy elaboration, reasoning biases, and immersive behaviours.Patients are keen to have the opportunity to access talking therapies for this experience. Taking extra time to talk at times of distress, 'going the extra mile', and listening carefully can help to facilitate trust. [ABSTRACT FROM AUTHOR]

Objectives: People from ethnic minority groups experience higher rates of paranoid delusions compared with people from ethnic majority groups. Identifying with social groups has been shown to protect against mental health symptoms; however, no studies have investigated the relationship between social identification and paranoia in ethnic minority populations. Here, we investigated the association between British identification and paranoia in a sample of people from African and African Caribbean backgrounds living in the United Kingdom. We also assessed the role of potential mediating (self‐esteem and locus of control) and moderating (contact with White British people) factors. Design: Cross‐sectional quantitative survey design. Methods: We recruited 335 people from African and African Caribbean backgrounds who completed online self‐report measures of identification with Great Britain, self‐esteem, locus of control, positive and negative contact with White British people, and paranoia. Results: A parallel moderated mediation model indicated that British identification was associated with lower paranoia when participants experienced primarily positive contact with White British people. British identification was associated with higher paranoia when participants had primarily negative contact with White British people. Both effects were mediated by changes in locus of control, but self‐esteem was not implicated in either pathway. Conclusions: Identification with the majority culture is associated both positively and negatively with paranoid beliefs depending on the types of social interactions people experience. The findings have implications for preventative social prescribing initiatives and for understanding the causes of the high rates of psychosis in ethnic minority populations. Practitioner points: People from African and African Caribbean backgrounds experience high rates of paranoia, which may stem from social causes such as lack of belonging and negative social experiences.Among people from African backgrounds living in the UK, British identification is associated with lower paranoia when people's social experiences with White British people are positive and higher paranoia when their social experiences with White British people are negative.It is recommended that social interventions designed to reduce paranoia in vulnerable groups foster positive social contact and community belonging, which should enhance feelings of personal control.Understanding the complex interplay between social identity and social contact in the development of paranoia may help therapists and researchers better understand the phenomenology and risk factors of paranoid symptomology. [ABSTRACT FROM AUTHOR]

This study aimed to estimate the association between anxiety associated with COVID-19 and somatic symptoms, using data from a large, representative sample (N = 2,025) of the UK adult population. Results showed that moderate to high levels of anxiety associated with COVID-19 were significantly associated with general somatic symptoms and in particular with gastrointestinal and fatigue symptoms. This pattern of associations remained significant after controlling for generalized anxiety disorder (GAD), pre-existing health problems, age, gender, and income. This is the first evidence that anxiety associated with COVID-19 makes a unique contribution to somatization, above and beyond the effect of GAD. [ABSTRACT FROM AUTHOR]

Objectives: The COVID-19 pandemic is one of the greatest global health threats facing humanity in recent memory. This study aimed to explore influences on hygienic practices, a set of key transmission behaviours, in relation to the Capability, Opportunity, Motivation-Behaviour (COM-B) model of behaviour change (Michie et al., 2011).Design: Data from the first wave of a longitudinal survey study were used, launched in the early stages of the UK COVID-19 pandemic.Methods: Participants were 2025 adults aged 18 and older, representative of the UK population, recruited by a survey company from a panel of research participants. Participants self-reported motivation, capability, and opportunity to enact hygienic practices during the COVID-19 outbreak.Results: Using regression models, we found that all three COM-B components significantly predicted good hygienic practices, with motivation having the greatest influence on behaviour. Breaking this down further, the subscales psychological capability, social opportunity, and reflective motivation positively influenced behaviour. Reflective motivation was largely driving behaviour, with those highest in reflective motivation scoring 51% more on the measure of hygienic practices compared with those with the lowest scores.Conclusions: Our findings have clear implications for the design of behaviour change interventions to promote hygienic practices. Interventions should focus on increasing and maintaining motivation to act and include elements that promote and maintain social support and knowledge of COVID-19 transmission. Groups in particular need of targeting for interventions to increase hygienic practices are males and those living in cities and suburbs. [ABSTRACT FROM AUTHOR]

Objective: Sexual minorities have an increased risk of psychosis, potentially explained by experiences of social adversity. Sexual minorities may also have a specific risk of paranoid symptoms. The current study aimed to determine whether sexual minorities have increased risk of psychosis, whether they have a specific increased risk of paranoia when compared to auditory verbal hallucinations (AVHs), and whether social adversity such as bullying, recent discrimination, lack of social support, and drug use can explain this risk. Methods: The study used data from the Adult Psychiatric Morbidity Survey 2007 (n = 7,403), exploring both sexual identity and past sexual behaviour. Associations between sexual minority status and probable psychosis, paranoia, and AVH were analysed using logistic regression. Mediation analysis was also conducted using the Karlson–Holm–Breen method, with bullying, recent discrimination, social support, and drug use as mediators assessing pathways between sexual minority status and paranoia/AVH. Socio‐demographic confounders were included in analyses. Results: Sexual minority status did not significantly predict probable psychosis. Findings generally indicated a specific association between sexual minority status and paranoia when contrasted with AVH. However, sexual behaviour remained significantly associated with AVH in logistic regression models. Bullying, lack of social support, and drug use partially mediated the association between sexual minority status and paranoia. Conclusions: Sexual minority status appears to have a specific association with paranoia symptoms, which may be partially explained by experiences of social adversity. However, the cross‐sectional nature of the study limits direct inference about causality of such symptoms. Practitioner points: Sexual minority groups may be more likely to experience symptoms of paranoia.It may be important to consider experiences of social adversity such as bullying, lack of social support, and also history of drug use in the context of paranoia within these groups. [ABSTRACT FROM AUTHOR]

The prevalence of posttraumatic stress disorder (PTSD) as it relates to individuals' experiences of the COVID-19 pandemic has yet to be determined. This study was conducted to determine rates of COVID-19-related PTSD in the Irish general population, the level of comorbidity with depression and anxiety, and the sociodemographic risk factors associated with COVID-19-related PTSD. A nationally representative sample of adults from the general population of the Republic of Ireland (N = 1,041) completed self-report measures of all study variables. The rate of COVID-19-related PTSD was 17.7% (n = 184), 95% CI [15.35%, 19.99%], and there was a high level of comorbidity with generalized anxiety (49.5%) and depression (53.8%). Meeting the diagnostic requirement for COVID-19-related PTSD was associated with younger age, male sex, living in a city, living with children, moderate and high perceived risk of COVID-19 infection, and screening positive for anxiety or depression. Posttraumatic stress symptoms related to the COVID-19 pandemic are common in the general population. Our results show that health professionals responsible for responding to the COVID-19 pandemic should expect to routinely encounter symptoms and concerns related to posttraumatic stress. [ABSTRACT FROM AUTHOR]

Objectives: Psychological models of voice‐hearing propose that auditory‐verbal hallucinations occur when inner speech is attributed to a source external to the self. Approximately half of the world's population is multilingual, and the extent to which they use a second language for inner speech depends on their experience and competency in it. Bilingualism therefore provides a natural window into the processes operating in auditory‐verbal hallucinations, but no systematic study of voice‐hearing in bilinguals has hitherto been conducted. Design: A mixed‐methods observational study of psychiatric service users who hear voices and who are Welsh–English bilingual. Methods: Thirty‐seven participants were interviewed about their history and use of Welsh and English and divided into three groups: those who learnt Welsh first (L1 Welsh), those who learnt English first (L1 English), and those who learnt the two languages simultaneously. Detailed phenomenological data were collected using The Mental Health Research Institute Unusual Perceptions Schedule. Results: Both qualitative and quantitative data indicated very considerable variation in the extent to which voices were in Welsh, English, or both, with some voice‐hearers reporting that the predominant language of their voices had changed with time. There were modest but statistically significant associations between the predominant language of voices and age of language acquisition (late Welsh learners did not hear voices in Welsh), frequency of language use (more frequent use of Welsh was associated with more Welsh voices), and subjective language proficiency (proficiency in English was associated with a tendency to hear English voices). Conclusions: Although this was a small study, it was the first of its kind. There is a need for more research on the implications of bilingualism for psychosis in particular and mental illness more generally. The results are broadly consistent with the hypothesis that hallucinated voices are misattributed inner speech. Practitioner points: Assessments of people with mental health difficulties should routinely inquire whether they are multilingual and, if so, which language they prefer to use.People with mental health difficulties may have difficulty expressing complex issues and emotions in a second language, despite apparent fluency.When working with bilingual people who hear voices, mental health professionals should consider the language used by the voices when conducting assessments and proposing formulations. [ABSTRACT FROM AUTHOR]

Negative ‐self and ‐others core schemas have been implicated in the development and maintenance of psychotic experiences. One component of the self‐system is gender‐role strain (GRS; perceived discrepancy between actual self and gender‐role norms). Although the role of gender in the formation of core schemas has been underscored in social and developmental psychology literatures, GRS has not been investigated in relation to psychosis. We examined whether it might be associated with negative schemas and psychotic experiences in women consistent with the trend toward sex‐ and gender‐based analysis (SGBA) in health research. Forty‐four women with a schizophrenia spectrum disorder diagnosis and 48 female nonclinical participants completed a series of questionnaires measuring GRS, femininity ideology, core schemas, childhood trauma, and implicit femininity stereotypes (The Gender Stereotype Implicit Association Test). Half the total sample comprised women with minority‐ethnic status. Women in the psychosis group reported higher levels of GRS than comparison participants. Differences in endorsement of femininity ideology between the two groups narrowly missed significance with a trend toward greater femininity ideology in the psychosis group and significantly greater endorsement of the sexual purity domain for minority‐ethnic women. There was no difference in implicit femininity stereotypes. Analyses suggested that the relationship between GRS and symptoms was mediated by negative ‐self and ‐others schemas. Childhood sexual trauma, though higher for women with psychosis, was associated with gender‐role strain in the nonclinical sample only. Findings warrant further investigation with larger samples. SGBA has the potential to fill gaps in our current knowledge with regard to psychosis theory, research, and practice. [ABSTRACT FROM AUTHOR]

A substantial body of literature suggests that migrants are at greater risk of developing psychotic symptoms, such as paranoia, compared to non-migrants. To date, researchers have been unable to identify the primary cause of this effect, finding scarce support for biological, diagnostic, and economic explanations. Social determinants have received little empirical attention in this domain, which we assert is a critical gap in the literature. Here, we propose that the social identity approach offers a framework to help explain the elevated rates of psychosis among migrants, and in turn inform policies and interventions to address this important mental health issue. We propose that cultural identities play a central role in mitigating the psychological precursors of psychosis and that disidentification and social disconnection subsequent to migration could initiate or exacerbate psychosis for multiple generations. We draw together research from social and clinical psychology to detail a social identity approach to psychosis in migrant populations, and make recommendations for future research. [ABSTRACT FROM AUTHOR]

Objectives Research has suggested that the extent to which voices (i.e., auditory verbal hallucinations) are experienced as distressing might be influenced by negative beliefs about voices as well as maladaptive metacognitive styles involving the negative appraisal and maladaptive control of mental experiences. This cross-sectional study examined the contribution of both specific appraisals of voices and a metacognitive factor (i.e., experiential avoidance) to voice-related distress. Methods Self-report measurers of voice characteristics (voice frequency, duration as well as amount and intensity of voice-related distress), experiential avoidance, and appraisals of voices were collected in a sample of 101 voice-hearers. Results Experiential avoidance and negative beliefs about voices were associated with higher levels of voice-related distress, but not to measures of voice frequency and duration. Experiential avoidance and negative 'metaphysical' beliefs about voices were significant predictors of voice-related distress even after accounting for the effect of frequency and duration of voices, and explained similar proportions of unique variance in distress. Conclusions These findings suggest that the appraisals of voices and experiential avoidance are predictive of voice-related distress and that cognitive-behavioural interventions targeting both voice-specific appraisals and general maladaptive metacognitive processes could prove useful treatment approaches for clients with distressing voices. Practitioner points Experiential avoidance ( EA) and negative appraisals predict voice-related distress caused by voices, but not their frequency and duration., Interventions for voices should consider targeting EA and negative appraisals (e.g., cognitive-behavioural therapy, Acceptance and Commitment Therapy) to ameliorate distress. [ABSTRACT FROM AUTHOR]

Background Bipolar disorder is a highly heritable illness, with a positive family history robustly predictive of its onset. It follows that studying biological children of parents with bipolar disorder may provide information about developmental pathways to the disorder. Moreover, such studies may serve as a useful test of theories that attribute a causal role in the development of mood disorders to psychological processes. Method Psychological style (including self-esteem, coping style with depression, domain-specific risk-taking, sensation-seeking, sensitivity to reward and punishment, and hypomanic personality and cognition) was assessed in 30 offspring of bipolar parents and 30 children of well parents. Parents of both child groups completed identical assessments. Results Although expected differences between parents with bipolar disorder and well parents were detected (such as low self-esteem, increased rumination, high sensitivity to reward and punishment), offspring of bipolar parents were, as a group, not significantly different from well offspring, apart from a modest trend towards lower adaptive coping. When divided into affected and non-affected subgroups, both groups of index children showed lower novelty-seeking. Only affected index children showed lower self-esteem, increased rumination, sensitivity to punishment, and hypomanic cognitions. Notably, these processes were associated with symptoms of depression. Conclusion Psychological abnormalities in index offspring were associated with having met diagnostic criteria for psychiatric illnesses and the presence of mood symptoms, rather than preceding them. Implications of the present findings for our understanding of the development of bipolar disorder, as well as for informing early interventions, are discussed. Practitioner points Decreased active coping and seeking for novel stimuli might be one of first psychological indications relevant to the future development of mood disorders., Psychological abnormalities typical for individuals with mood disorders were present only in already affected offspring of parents with bipolar disorder., Limitations of the study This was a cross-sectional study; longitudinal design would greatly enhance our understanding of the association between psychological processes and symptoms., The sample size in this study was modest. [ABSTRACT FROM AUTHOR]

Objectives The study examined (1) the role of experiential avoidance ( EA), conceptualized as intolerance towards aversive mental states, in paranoid delusions and (2) the mechanisms underlying EA. Design A 6-day prospective momentary assessment study. Methods Paranoid patients ( N = 41) were studied using the experience sampling method ( ESM), a structured diary technique, assessing psychopathology and current context in daily life. Results The results showed that both low self-esteem and EA contributed to paranoid thinking. The relationship between low self-esteem and paranoia was partially mediated by EA and the relationship between EA and paranoia was partially mediated by low self-esteem. The detrimental effect of EA on self-esteem was more pronounced under high activity-related stress. Both EA and social stress were independently associated with low self-esteem. EA was associated with self-esteem instability. Conclusions Our results implicate mental control strategies in the development of paranoia and are compatible with the attributional model of paranoia, which suggests that persecutory delusions arise as a result of dysfunctional attempts to avoid unpleasant thoughts about the self. Practitioner points Interventions for paranoid individuals should target low tolerance towards negative mental states, for example using mindfulness and ACT therapeutic approaches., Interventions designed for individuals suffering from persecutory delusions should also address unfavourable views about the self., Limitations Avoidance of unpleasant mental states may operate outside the individual's awareness and self-report measures of EA may be unable to adequately tap this process., Self-reflection abilities of psychotic patients may be impaired. [ABSTRACT FROM AUTHOR]

Objectives Self-esteem is a key feature of bipolar symptomatology. However, so far no study has examined the interaction between explicit and implicit self-esteem in individuals vulnerable to bipolar disorder. Design Cross-sectional design was employed. Methods Thirty children of parents with bipolar disorder and 30 offspring of control parents completed Hamilton Rating Scale for Depression, the Bech-Rafaelson Mania Scale, the Self-esteem Rating Scale and the Implicit Association Test. Results No differences between groups were revealed in levels of explicit or implicit self-esteem. However, bipolar offspring showed increased levels of symptoms of depression and mania. Furthermore, depressive symptoms were associated with low explicit self-esteem, whilst symptoms of mania were associated with low implicit self-esteem. When self-esteem discrepancies were examined, damaged self-esteem (i.e., low explicit but high implicit self-esteem) was associated with depression, whilst no associations between mania and self-esteem discrepancies were found. Conclusions Not only explicit, but also implicit self-esteem, and the interactions between the two are of relevance in bipolar symptoms. Clinical implications and future research directions are discussed. Practitioner points Explicit as well as implicit SE, and particularly their relationship, are relevant for mental health., Fluctuations in implicit SE may serve as an early indicator for risk of bipolarity., Psychotherapeutic approaches may be more suitable for one kind of SE challenge than the other. [ABSTRACT FROM AUTHOR]

Aim There is evidence that psychotic-like phenomena can be detected within the general population and that psychotic experiences lie on a continuum that also spans affective states. We aimed to investigate comparisons of a first-episode psychosis group, an 'at-risk mental state group' and a help-seeking control group with non-patients to explore whether affective states lie on a continuum of psychosis. Method Measures of psychotic-like experiences, social anxiety and depression were administered to 20 patients experiencing first-episode psychosis ( FEP), 113 patients experiencing an 'at-risk' mental state ( ARMS), 28 patients who were help-seeking but not experiencing a FEP or ARMS ( HSC) and 30 non-clinical participants ( NC). Results For distress in relation to psychotic-like experiences, the FEP, ARMS and HSC groups scored significantly higher than the NC group for the perceptual abnormalities and non-bizarre ideas. In terms of severity of psychotic experiences, the FEP scored the highest, followed by the ARMS group, followed by the HSC and NC groups. The clinical groups scored significantly higher for depression than the non-clinical group. Interestingly, only the FEP and the ARMS groups scored significantly higher than non-patients for social anxiety. Conclusions These findings suggest that a psychosis continuum exists; however, this does not suggest that both psychosis and affective symptoms lie on the same continuum, rather it would appear the presence of such affective states that may affect help-seeking behaviour and clinical status. The implications of these findings for clinical practice are discussed. [ABSTRACT FROM AUTHOR]

Morriss R, Yang M, Chopra A, Bentall R, Paykel E, Scott J. Differential effects of depression and mania symptoms on social adjustment: prospective study in bipolar disorder. Bipolar Disord 2013: 15: 80-91. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd. Objectives: Previous studies of social adjustment in bipolar disorder have been cross-sectional and small in sample size, have examined a limited number of roles, or were not controlled for baseline mood and other clinical, social, or treatment confounders. We aimed to prospectively explore the strength and stability of correlations between depression and mania-type symptoms and impairment in a broad range of social adjustment roles and domains. Methods: Multilevel modeling analysis of correlation coefficients between depression and mania-type symptoms with roles and domains of the modified social adjustment scale (overall, work, social/leisure, extended family, marital, parental social adjustment roles, performance, interpersonal behavior, friction, dependency, overactivity domains) was used. Interview assessments were made at eight-week intervals beginning at eight weeks and continuing through 72 weeks after baseline in 253 patients in a multicenter randomized controlled trial. Results: After controlling for baseline mood episodes, and other clinical, social, and treatment variables, depression symptoms showed strong and stable correlations over time with performance, overall social adjustment, and the work role; and a moderate but stable relationship with interpersonal behavior. The relationships of depression symptoms with the other roles were weak, non-significant, or not stable. For mania-type symptoms, only the correlation with interpersonal friction was moderately strong and reasonably stable over time. Mood episodes, substance use disorder, and borderline/antisocial personality disorder increased role impairment, while employment and marriage mildly decreased it. Conclusions: Depression and mania-type symptoms have specific effects on social adjustment in bipolar I disorder. Depression symptoms are correlated strongly with performance and moderately with interpersonal behavior, while mania-type symptoms are correlated moderately with interpersonal friction. [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]

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]

Much research has begun to focus on the identification of people who are at high risk of developing psychosis, and clinical services have been initiated for this population. However, only a small number of studies have reported on the efficacy of interventions for preventing or delaying the onset of psychosis. The results of prior work suggest that cognitive therapy (CT) may be an effective, well-tolerated treatment. We report on the rationale and design for a large-scale, multi-site randomized, controlled trial of CT for people who are assessed to be at high risk of psychosis because of either state or state-plus-trait risk factors. The study employs a single-blind design in which all participants receive frequent mental-state monitoring, which will efficiently detect transition to psychosis, and half are randomized to weekly sessions of CT for up to 6 months. Participants will be followed-up for a minimum of 12 months and to a maximum of 2 years. We report the characteristics of the final sample at baseline ( n = 288). Our study aimed to expand the currently limited evidence base for best practice in interventions for individuals at high risk of psychosis. [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]

Objectives. To determine how security of adult attachment style is related to the mania, major depression and euthymic mood states in bipolar 1 (BP1) disorder. Design. An observational cross-sectional study. Method. One hundred and seven BP1 patients (34 in a manic type episode, 30 in major depressive episode, and 43 in remission) and 41 healthy controls similar in age, gender, reading age, and education were recruited. The groups were compared on self-reported mean and preferred attachment style controlling for psychiatric comorbidity. Results. Preferred attachment style was insecure in 84 (78%) BP1 patients but only 13 (32%) healthy controls (χ² = 34.3, df = 3, and p < .001). Healthy controls reported higher secure attachment, lower anxious, and lower preoccupied attachment scores than all groups of patients with bipolar disorder, although the scores for secure attachment in mania and preoccupied attachment in euthymic patients were not significantly different from healthy controls. Overall, within the bipolar groups, anxious attachment style varied little with mood but mania was associated with higher secure and preoccupied attachment style, and depression with higher preoccupied and lower dismissing attachment style scores. Conclusions. Insecure attachment is found in most patients with BP1 disorder. Attachment style is affected by mood episodes so it should be assessed when a patient with bipolar disorder is in remission with minimal residual depressive or manic symptoms. [ABSTRACT FROM AUTHOR]

Objectives. To design a brief measure to assess both the severity of paranoid thinking and the perceived deservedness of persecution, which can be employed in clinical and non-clinical populations. Background. No existing measure is adequate for these purposes. Methods. In Study 1, we selected 10 items for a persecution and deservedness scale (PaDS) using data from 318 UK and 290 Portuguese undergraduate students, who also completed the Beck Depression Inventory and the Fenigstein's Paranoia Scale. In Study 2, we made comparisons between 45 clinical participants with a diagnosis of schizophrenia, schizoaffective disorder or delusional disorder and the UK students from Study 1. The psychometric properties of the PaDS were analysed for separate persecution (P) and deservedness (D) subscales. Results. The 10-item PaDS subscales were internally reliable for both clinical and student samples. Correlations with other measures of depressive mood and paranoid thinking indicate that the P subscale has concurrent validity. Higher P and D scores were observed in UK students compared to Portuguese students. The clinical participants' P scores subscale were significantly higher than the students' scores but their D scores were lower. Conclusions. The PaDS is a reliable and valid measure of paranoid thinking and perceived deservedness of persecution, which is sensitive for use in clinical and non-clinical populations. Paranoid thinking appears to be mainly bad-me in non-clinical groups but poor-me in psychotic psychiatric patients. [ABSTRACT FROM AUTHOR]

Objectives. To examine relationships between parental communication styles and family environment in parents with bipolar disorder (BD) and their children (CBP). Methods. On measures of parental communication styles and family environment, 20 BD parents and their 23 children (CBP) were compared to controls. Children completed a current mood measure. Results. BD parents endorsed more negative communication styles and were less expressive than controls. CBP presented with more current or lifetime mood disorder diagnoses than control children (CC). Current depressive mood was associated with different perceptions of family environment for both CBP and CC. Conclusions. This familial high risk design indicated differences in family environment, parenting style, and in children of bipolar parents' perception of their family environment as it relates to their current mood. [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]

Objectives: Changes in beliefs about the self are a central feature of bipolar disorder, with grandiose self-belief common in mania and low self-esteem evident in periods of depression. We investigated whether unstable self-esteem is a characteristic of bipolar disorder in remission. Methods: We compared 18 patients with DSM-IV bipolar disorder in remission, 16 patients with unipolar disorder in remission, and 19 healthy controls. The primary measure was a diary kept for one week and completed twice each day, measuring self-esteem and positive and negative affect. We also administered Winters and Neale's ( J Abnorm Psychol 1985; 94: 282–290 ) implicit measure of attributional style. Results: Whereas mean levels of self-esteem and affect were not abnormal in the remitted bipolar patients, the bipolar patients showed strong fluctuations in these processes. In common with the unipolar patients, they also showed a pessimistic attributional style on the Pragmatic Inference Task (PIT). Conclusions: Instability of self-esteem and affect is present in bipolar patients, even when their symptoms are in remission, and has previously been found in people at genetic risk of the disorder. It may be a marker of vulnerability to the disorder. [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]

Objectives: To determine the effects of mood and additional clinical variables on different domains of current interviewer-rated social adjustment reflecting the reported behaviour of patients with bipolar disorder (BD). Method: Multi-center cross-sectional study employing multiple linear regression to investigate whether mood and other clinical features, previously linked to self-rated social adjustment, were associated with eight domains of interviewer-rated social adjustment in 253 BD patients. Baseline variables were entered sequentially in blocks representing current mood, demographic, current other psychiatric, past psychiatric and current treatment variables. Results: Mood episode or symptoms together with five other variables (borderline/antisocial personality disorder, male gender, living alone, hypnotic drug and drugs for physical illness) were associated with impairment on two or more domains of interviewer-rated social adjustment. They explained up to 31% of the variance in social adjustment, although friction, dependence and overactivity were associated with a different pattern of variables. Hypomanic symptoms were associated with increased friction and worse social adjustment with the extended family in the whole sample but improved performance and social and leisure activities in patients who were not in acute bipolar episode. Conclusion: Clinicians may determine up to about 30% of outcome in current social adjustment in BD patients from the patient's current mood episode or symptoms and a small number of other clinical or demographic variables. Hypomanic episodes and symptoms usually worsen friction and overall social adjustment, but in patients who are not in acute episode, hypomanic symptoms can increase performance and social and leisure activities. [ABSTRACT FROM AUTHOR]

Objectives: Disturbances in cognition, affect, sleep and activity have been identified in bipolar disorder (BD) but little is known about the possible role of these factors in the development of the condition. We studied these variables in a familial high-risk sample. Methods: Twenty-five children (13–19 years) of bipolar parents were compared with 22 similar aged children of age- and sex-matched healthy controls. Participants were assessed using Schedule for Affective Disorders and Schizophrenia-Lifetime version (SADS-L) and completed self-report measures of dysfunctional attitudes, behavioural inhibition/activation, social rhythms, coping styles and subjective experience of sleep. Children completed a 7-day recording of actigraphy (sleep and activity) and a 7-day diary measuring self-esteem, positive and negative affect and reactions to positive and negative events. Results: Fifty-six per cent of children of bipolar parents (CBP) reported mood symptoms compared to 9% of children of control parents (CC). The CBP group had coping styles and instability of self-esteem consistent with abnormal strategies for regulating affect. Both groups also differed on sleep measures. The majority of differences observed were between CBP with a current or past mood diagnosis and CC. BD parents reported dysfunctional coping styles and (to a lesser extent) disrupted activity patterns. Conclusions: A familial high-risk strategy for studying the role of psychological factors in BD is feasible and informative. This pilot study indicates that abnormal coping styles, instability of self-esteem and dysregulation of sleep may be early markers of bipolar illness. However, current findings need to be explored further in longitudinal studies to clarify which potential markers are truly predictive of BD. [ABSTRACT FROM AUTHOR]

Objectives. To investigate whether there are two stable types of paranoia, 'poor me' and 'bad me', as described by Trower and Chadwick (1995), and whether beliefs about the deservedness of persecution are associated with psychological measures. Methods. In-patients experiencing persecutory delusions were assigned either to 'poor me' (PM) or 'bad me'(BM) groups, according to their rating of a perceived deservedness scale, which was repeated on subsequent assessments. Participants were assessed for depression (BDI); construction of the self (Self-to-Others Scale); autonomy and sociotropy (PSI); perceived parental behaviour (PBI); attributional style (ASQ) and, meaningful daily events (DEI, devised for the study). A healthy control group was also assessed. Results. Many patients' perceived deservedness of persecution varied across time, so that some patients were PM at one point in time but BM at another. BM paranoia was associated with high levels of depression. PM and BM patients groups both scored higher than the controls on the subscales of Self-to-Others Scale and on the PSI. PM patients exhibited a marked self-serving bias on the ASQ, and reported less parental care on the PSI, compared to the BM patients. Both groups reported less PBI mother care than the controls. BM patients reported more failure events than PM patients or controls. PM patients reported more loss of control events than the than BM patients and controls. Conclusions. PM and BM paranoia may represent separate phases of an unstable phenomenon. The findings are consistent with an attributional account of paranoid thinking. [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]

Objective. This paper examines the relationships between patient suitability, therapeutic alliance, homework compliance and outcome in cognitive–behaviour therapy (CBT) for psychosis. Method. 29 patient and therapist dyads completed patient and therapist versions of the California Psychotherapeutic Alliance Scale (CALPAS) at session 3 and 21 at session 9. The level of patient homework compliance was rated by therapist and patient, using visual analogue scales, at therapy sessions 3 (29 dyads) and 9 (20 dyads). The Positive and Negative Symptoms of Schizophrenia (PANSS) scale was used to measure psychotic symptoms pre- and post-treatment. Patient suitability for the treatment was measured at session 3, using the Suitability for Short-Term Cognitive Therapy Scale. Results. Only two of the specific hypotheses were supported. There was no significant agreement between patients and therapists on the quality of the therapeutic alliance at session 3, but by session 9 two (patient commitment and working strategy consensus) of the four sub-scales were significantly associated, although there was little evidence that the quality improved over time. Lower patient suitability and insight at session three predicted a lower therapeutic alliance. Therapeutic alliance predicted level of homework compliance. The only significant predictor of outcome was the PANSS positive symptoms sub-scale pre-treatment score. Conclusions. These results suggest that patients who experience psychotic symptoms can be successfully engaged early in therapy as can those with affective disorders but that therapeutic alliance may not have a direct effect on outcome. Copyright © 2006 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]