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Belli H. Are dissociative psychosis and dissociative schizophrenia reality? World J Psychiatry 2025; 15:102008. [DOI: 10.5498/wjp.v15.i4.102008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2024] [Revised: 02/21/2025] [Accepted: 03/05/2025] [Indexed: 03/25/2025] Open
Abstract
Even if dissociation has various facets, it is clear that knowledge of dissociative psychosis and a dissociative schizophrenia-based viewpoint may provide new perspectives on mental disorders. Many researchers screening for comorbid symptoms of “childhood traumatic experiences” and “dissociation”, where specific characteristics are significant to the presence of psychosis and schizophrenia, may lead to an acceptable definition. In recent years, researchers have also reported crucial advances in the understanding of dissociative psychosis and dissociative schizophrenia. Although clinical studies in this area have been ongoing for a long time, research has not demonstrated that a clear and valid relationship exists between dissociation, childhood traumatic experiences, and schizophrenia or psychotic spectrum disorders. However, some results of statistical comparisons have supported the existence of the clinical manifestation known as dissociative psychosis and dissociative schizophrenia. Dissociation, childhood traumatic experiences, and positive psychotic symptoms may be a prominent part of dissociative psychosis and schizophrenia. The intense presence of negative symptoms may indicate classical schizophrenia. In research and clinical practice, researchers and clinicians may use psychometric tests to detect symptoms of dissociative psychosis. Psychotic persons with traumatic experiences likely benefit from treatment focused on trauma symptomatolgy.
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Affiliation(s)
- Hasan Belli
- Department of Psychiatry, Health Science University, Bagcilar Education and Research Hospital, Istanbul 34400, Türkiye
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Javier A, Jaworska N, Fiedorowicz J, Magnotta V, Richards JG, Barsotti EJ, Wemmie JA. Characteristics of people with bipolar disorder I with and without auditory verbal hallucinations. Int J Bipolar Disord 2025; 13:4. [PMID: 39953335 PMCID: PMC11828762 DOI: 10.1186/s40345-025-00369-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2024] [Accepted: 01/18/2025] [Indexed: 02/17/2025] Open
Abstract
BACKGROUND Approximately half of people with bipolar disorder type I (BD-I) report the presence of psychotic symptoms at least at some point during their illness. Previous data suggest that more than 20% of people with BD-I report the presence of auditory verbal hallucinations (AVHs), or "voice-hearing" in particular. While work in other disorders with psychotic features (e.g., schizophrenia) indicates that the presence vs. absence of AVHs is associated with poorer clinical outcomes, little is known about their effects on clinical and socioeconomic features in BD-I. METHODS We investigated whether people with BD-I (N = 119) with AVHs (n = 36) and without AVHs (n = 83) in their lifetime differ in terms of demographic features and clinical measures. Relations with AVHs and other positive symptoms were explored. RESULTS People with BD-I and AVHs vs. without AVHs had higher manic and positive symptom scores (i.e., higher scores on the hallucinations, delusions, and bizarre behavior subscales). Further, a greater proportion of those with vs. without AVHs reported lower subjective socioeconomic status and tended to have higher rates of unemployment, thus, speaking to the longer-term consequences of AVH presence. CONCLUSION Our findings suggest that people with BD-I with AVHs exhibit more severe psychotic features and manic symptoms compared to those without. This might be associated with more socioeconomic hardship. More in-depth characterization of people with BD-I with/without AVHs is needed to fully understand this subgroup's unique challenges and needs. LIMITATIONS The modest sample size of the AVH group and a study population with low racial diversity/representation may limit generalizability.
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Affiliation(s)
- Aster Javier
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada
- Department of Neuroscience, Carleton University, Ottawa, Canada
| | - Natalia Jaworska
- University of Ottawa Institute of Mental Health Research, Ottawa, Canada.
- Department of Neuroscience, Carleton University, Ottawa, Canada.
- , 1145 Carling Avenue, Room 3129, Ottawa, ON, K17 7K4, Canada.
| | - Jess Fiedorowicz
- Cellular & Molecular Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
| | | | | | | | - John A Wemmie
- Department of Psychiatry, University of Iowa, Ottawa, USA
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Bortolon C, Nardelli C. Relations between psychosis and emotion regulation in daily life: A systematic review and meta-analyses of studies using experience sampling methods. Neurosci Biobehav Rev 2025; 169:106004. [PMID: 39793683 DOI: 10.1016/j.neubiorev.2025.106004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 08/27/2024] [Accepted: 01/03/2025] [Indexed: 01/13/2025]
Abstract
Research has shown that heightened emotionality often precedes psychotic experiences. Understanding how individuals cope with these emotions is crucial for psychosis. While prior studies on emotion regulation (ER) and psychosis have mainly relied on self-report questionnaires, recent research has increasingly utilised daily life methods. This systematic review and meta-analysis seek to examine the relationship between daily ER and psychotic experiences. In total, 15 studies were included in the meta-analysis (21 in the systematic review). The results of Experience Sampling Methods (ESM) studies indicated that ER strategies of avoidance, reappraisal, repetitive thinking, and emotional suppression are not associated with psychotic experiences in daily life. The effect was not moderated by type of sample (clinical vs non-clinical), symptom (hallucination vs delusions), relation (contemporaneous vs perspective), or other methodological variables. Acceptance was found to be negatively associated with psychotic experiences, but the effect was small. These results indicate that ER in daily life might not impact directly on psychotic experiences. The results are discussed in light of conceptual and methodological limitations in the field.
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Affiliation(s)
- Catherine Bortolon
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble 38000, France; Institut Universitaire de France (IUF), France; Centre Référent Réhabilitation Psychosociale et Remédiation Cognitive (C3R), Centre Hospitalier Alpes Isère, Grenoble 38000, France.
| | - Carla Nardelli
- Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble 38000, France
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Akbudak M, Belli H, Gökçay H, Takım U. Dissociative psychosis or dissociative schizophrenia? Comparison of two phenomena. BMC Psychiatry 2025; 25:62. [PMID: 39838357 PMCID: PMC11753170 DOI: 10.1186/s12888-025-06477-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2024] [Accepted: 01/03/2025] [Indexed: 01/23/2025] Open
Abstract
BACKGROUND In recent years, researchers have reported crucial advances in the understanding of "Dissociative psychosis" and "Dissociative schizophrenia". While clinical studies in this area have been sustained for well, it remains to be established for some aspects that a clear and valid relationship exists between dissociation, childhood traumatic experiences, and schizophrenia or psychotic spectrum disorders. METHODS To test such hypotheses, we divided the patients into two groups; the first group consisted of patients with psychotic disorders not otherwise specified (PNOS), and the second group consisted of schizophrenic patients. Further, we have investigated the symptoms of dissociation, its relation to childhood traumatic experiences, and psychotic symptoms. The study included 81 patients diagnosed with schizophrenia according to DSM-5 diagnostic criteria and 81 patients diagnosed with PNOS. Researchers assessed participants using the Dissociation Questionnaire (DIS-Q), the Childhood Trauma Questionnaire (CTQ, and the Positive and Negative Syndrome Scale (PANSS). RESULTS The present study showed that patients with PNOS have higher dissociation and childhood traumatic experiences scores than the schizophrenic group and that the patients with the PNOS group yielded elevated physical abuse, emotional abuse, emotional neglect, sexual abuse, and bodily neglect scores as compared to the schizophrenic group. However, the PNOS group exhibited significantly lower PANSS total, PANSS negative, and PANSS general psychopathology scores compared to the schizophrenia group. DIS-Q and total CTQ level were also significant predictors of PNOS. CONCLUSION Our results of statistical comparisons have supported the existence of the clinical manifestation known as dissociative psychosis, not dissociative schizophrenia.
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Affiliation(s)
- Mahir Akbudak
- Department of Psychiatry, University of Health Sciences, Mardin Training and Research Hospital, Mardin, 47100, Turkey
| | - Hasan Belli
- Department of Psychiatry, University of Health Sciences, Bagcilar Training and Research Hospital, Istanbul, 34100, Turkey
| | - Hasan Gökçay
- Department of Psychiatry, Sarkisla State Hospital, Sivas, 58100, Sivas, Turkey.
| | - Uğur Takım
- Department of Psychiatry, University of Health Sciences, Erzurum City Hospital, Erzurum, 25100, Turkey
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Chen YJ, Lu ML, Chiu YH, Chen C, Santos VHJ, Goh KK. Linking childhood trauma to the psychopathology of schizophrenia: the role of oxytocin. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2024; 10:24. [PMID: 38388569 PMCID: PMC10883944 DOI: 10.1038/s41537-024-00433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 12/31/2023] [Indexed: 02/24/2024]
Abstract
Childhood trauma has been linked to schizophrenia, but underlying biological mechanisms remain elusive. This study explored the potential role of plasma oxytocin as a mediator in the relationship between childhood trauma and the psychopathology of schizophrenia. 160 patients with schizophrenia and 80 age- and sex-matched healthy controls were assessed for childhood trauma experiences using the Childhood Trauma Questionnaire and structured interviews. Psychopathology was evaluated using the Positive and Negative Syndrome Scale and plasma oxytocin levels were measured. Results showed that patients with schizophrenia had lower oxytocin levels and higher childhood trauma scores than healthy controls. There was a significant correlation between childhood trauma scores and psychopathology, with plasma oxytocin levels being inversely associated with psychopathology, except for positive symptoms. Hierarchical regression analysis indicated that both childhood trauma scores and plasma oxytocin levels significantly predicted psychopathology. Plasma oxytocin levels partially mediated the relationship between childhood trauma and schizophrenia psychopathology. This study underscores the potential role of oxytocin in bridging the gap between childhood trauma and schizophrenia.
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Affiliation(s)
- Yuan-Jung Chen
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Mong-Liang Lu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hang Chiu
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chenyi Chen
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan
- The Innovative and Translational Research Center of Brain Consciousness, Taipei Medical University, Taipei, Taiwan
| | - Vitor Hugo Jesus Santos
- Department of Psychiatry and Mental Health, Faculty of Health Sciences (FCS-UBI), Cova da Beira University Hospital Center, Covilhã, Portugal
| | - Kah Kheng Goh
- Department of Psychiatry, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Psychiatric Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
- Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
- Graduate Institute of Injury Prevention and Control, College of Public Health, Taipei Medical University, Taipei, Taiwan.
- The Innovative and Translational Research Center of Brain Consciousness, Taipei Medical University, Taipei, Taiwan.
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Gleeson JF, McGuckian TB, Fernandez DK, Fraser MI, Pepe A, Taskis R, Alvarez-Jimenez M, Farhall JF, Gumley A. Systematic review of early warning signs of relapse and behavioural antecedents of symptom worsening in people living with schizophrenia spectrum disorders. Clin Psychol Rev 2024; 107:102357. [PMID: 38065010 DOI: 10.1016/j.cpr.2023.102357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 11/03/2023] [Accepted: 11/14/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Identification of the early warning signs (EWS) of relapse is key to relapse prevention in schizophrenia spectrum disorders, however, limitations to their precision have been reported. Substantial methodological innovations have recently been applied to the prediction of psychotic relapse and to individual psychotic symptoms. However, there has been no systematic review that has integrated findings across these two related outcomes and no systematic review of EWS of relapse for a decade. METHOD We conducted a systematic review of EWS of psychotic relapse and the behavioural antecedents of worsening psychotic symptoms. Traditional EWS and ecological momentary assessment/intervention studies were included. We completed meta-analyses of the pooled sensitivity and specificity of EWS in predicting relapse, and for the prediction of relapse from individual symptoms. RESULTS Seventy two studies were identified including 6903 participants. Sleep, mood, and suspiciousness, emerged as predictors of worsening symptoms. Pooled sensitivity and specificity of EWS in predicting psychotic relapse was 71% and 64% (AUC value = 0.72). There was a large pooled-effect size for the model predicting relapse from individual symptom which did not reach statistical significance (d = 0.81, 95%CIs = -0.01, 1.63). CONCLUSIONS Important methodological advancements in the prediction of psychotic relapse in schizophrenia spectrum disorders are evident with improvements in the precision of prediction. Further efforts are required to translate these advances into effective clinical innovations.
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Affiliation(s)
- J F Gleeson
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia.
| | - T B McGuckian
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - D K Fernandez
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M I Fraser
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - A Pepe
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - R Taskis
- Healthy Brain and Mind Research Centre, School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, VIC, Australia
| | - M Alvarez-Jimenez
- Orygen, Parkville, VIC, Australia; Centre for Youth Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - J F Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, VIC, Australia
| | - A Gumley
- Glasgow Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Strachan LP, Paulik G, Preece DA, McEvoy PM. Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation. Psychol Psychother 2023; 96:934-951. [PMID: 37493351 DOI: 10.1111/papt.12486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 07/11/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area. AIMS This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model. MATERIALS The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire. METHODS We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation. RESULTS Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14-.61) and indirect pathways (βs = .01-.08) were significant (ps < .001). DISCUSSION Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation. CONCLUSION Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
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Affiliation(s)
- Laura P Strachan
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology, Murdoch University, Perth, Western Australia, Australia
- Perth Voices Clinic, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - David A Preece
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Perth, Western Australia, Australia
| | - Peter M McEvoy
- Discipline of Psychology, Curtin School of Population Health & enAble Institute, Curtin University, Perth, Western Australia, Australia
- Centre for Clinical Interventions, Perth, Western Australia, Australia
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Piesse E, Paulik G, Mathersul D, Valentine L, Kamitsis I, Bendall S. An exploration of the relationship between voices, dissociation, and post-traumatic stress disorder symptoms. Psychol Psychother 2023; 96:1015-1028. [PMID: 37800445 DOI: 10.1111/papt.12493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVES Extensive research has shown voice hearing to be associated with symptoms of Post-Traumatic Stress Disorder (PTSD) and dissociation. However, most studies have adopted a quantitative design, using cross-sectional data sampling methods, precluding temporal relationships between variables from being defined. DESIGN Using a qualitative design, this study sought to identify potential symptom relationships by addressing the research question: what is the nature of the temporal relationship between voices, dissociation and PTSD symptoms? METHODS Seven voice hearers (aged 27 to 68 years) participated in a semi-structured interview exploring voice hearing, PTSD symptoms, and dissociation. The interviews were analysed using Interpretative Phenomenological Analysis. RESULTS One superordinate theme was identified in the data. Voices were observed to occur in dynamic interrelationship with PTSD symptoms and dissociation, and were frequently experienced before and after PTSD symptoms and dissociative episodes. CONCLUSIONS Implications for theoretical understandings of voice hearing and future research are discussed.
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Affiliation(s)
- Emily Piesse
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
| | - Georgie Paulik
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Perth Voices Clinic, Murdoch University, Murdoch, Western Australia, Australia
- School of Psychological Science, University of Western Australia, Nedlands, Western Australia, Australia
| | - Danielle Mathersul
- School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, Western Australia, Australia
- War Related Illness and Injury Study Center (WRIISC), Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Lee Valentine
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Ilias Kamitsis
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
| | - Sarah Bendall
- Orygen and Centre for Youth Mental Health, University of Melbourne, Parkville, Victoria, Australia
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Puckett J, Sood M, Newman-Taylor K. Does disorganised attachment lead to auditory hallucinations via dissociation? An experimental study with an analogue sample. Psychol Psychother 2023; 96:868-884. [PMID: 37283236 DOI: 10.1111/papt.12477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/29/2023] [Accepted: 05/15/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVES Auditory hallucinations (such as hearing voices) are common in clinical and non-clinical populations. Many people who hear voices also report early adversity and have an insecure attachment style. Current cognitive models suggest that dissociation mediates an association between disorganised attachment and auditory hallucinations, but this has not been tested experimentally. DESIGN We recruited a non-clinical analogue sample highly predisposed to auditory hallucinations and utilised an experimental design to examine the impact of disorganised attachment imagery on hallucinatory experiences, and whether dissociation mediates an expected association. METHODS Participants completed self-report measures of state auditory hallucinations and dissociation before and after random allocation to secure or disorganised attachment conditions. RESULTS Attachment imagery did not affect auditory hallucinations. Both secure and disorganised attachment conditions increased state dissociation. Secure attachment imagery reduced paranoia, but state dissociation did not mediate this effect. An exploratory analysis found that trait dissociation fully accounted for the association between trait-disorganised attachment and hallucinatory experience while controlling for paranoia. CONCLUSIONS Secure attachment imagery reduces paranoia but not auditory hallucinations and the impact on paranoia is not mediated by dissociation. Secure attachment imagery may be useful in reducing fears and distress associated with voices, rather than the frequency or severity of hallucinations. Disorganised attachment may increase hallucinatory experiences for people vulnerable to dissociation. Trait dissociation should be assessed in clinical settings and addressed where indicated as a means of targeting vulnerability to distressing voices.
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Affiliation(s)
- Joseph Puckett
- Psychology Department, University of Southampton, Southampton, UK
| | - Monica Sood
- Psychology Department, University of Southampton, Southampton, UK
| | - Katherine Newman-Taylor
- Psychology Department, University of Southampton, Southampton, UK
- Psychology Department, Southern Health NHS Foundation Trust, Southampton, UK
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Heriot‐Maitland C, Gumley A, Wykes T, Longden E, Irons C, Gilbert P, Peters E. A case series study of compassion-focused therapy for distressing experiences in psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:762-781. [PMID: 37635319 PMCID: PMC10946731 DOI: 10.1111/bjc.12437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 08/09/2023] [Accepted: 08/15/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVES Compassion-focused therapy (CFT) is an evolution-informed biopsychosocial approach that seeks to cultivate attachment and care motivational systems and their psychophysiological regulators. These can counteract some of the harmful effects of social threat, inferiority, shame, self-criticism and depression, which are common in people with psychosis and undermine their well-being, social trust and ability to feel safe. This study aimed to test the acceptability of a novel manualized individual CFT intervention for psychosis (CFTp). DESIGN A non-concurrent, multiple-baseline, case series design, with three phases: baseline, intervention and follow-up. METHODS The 26-session CFTp intervention was provided for a sample of eight people with distressing psychotic experiences and a psychosis-related diagnosis. The study aimed to assess acceptability of CFTp and to test clinically reliable improvements while receiving the intervention, compared to a baseline period. RESULTS Seven of eight participants completed the therapy, and clinically reliable improvements were found at both the single-case and group level of analysis. At the single-case level, over half the participants showed improvements in depression (5/7), stress (5/7), distress (5/7), anxiety (4/7) and voices (3/5). One participant showed a deterioration in anxiety (1/7) and dissociation (1/7). At the group level (n = 7), there were significant improvements in depression, stress, distress, voices and delusions. The improvements in voices, delusions and distress were sustained at 6- to 8-week follow-up, but depression and stress dropped slightly to trend-level improvements. CONCLUSIONS CFTp is a feasible and acceptable intervention for psychosis, and further investigation is warranted with a randomized controlled trial.
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Affiliation(s)
- Charles Heriot‐Maitland
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- Glasgow Mental Health Research FacilityUniversity of GlasgowGlasgowUK
| | - Andrew Gumley
- Glasgow Mental Health Research FacilityUniversity of GlasgowGlasgowUK
| | - Til Wykes
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Eleanor Longden
- Psychosis Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
- Division of Psychology and Mental HealthThe University of ManchesterManchesterUK
- Complex Trauma and Resilience Research UnitGreater Manchester Mental Health NHS Foundation TrustManchesterUK
| | | | - Paul Gilbert
- Centre for Compassion Research and Training, College of Health, Psychology and Social CareUniversity of DerbyDerbyUK
- The Compassionate Mind FoundationDerbyUK
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
- South London and Maudsley NHS Foundation TrustLondonUK
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11
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Ghosh CC, McVicar D, Davidson G, Shannon C, Armour C. Exploring the associations between auditory hallucinations and psychopathological experiences in 10,933 patient narratives: moving beyond diagnostic categories and surveys. BMC Psychiatry 2023; 23:307. [PMID: 37131149 PMCID: PMC10155450 DOI: 10.1186/s12888-023-04780-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 04/12/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Previous research suggests that auditory hallucinations are prevalent within both the clinical and general populations. Yet, we know little about how these phenomena are associated with other psychopathology symptoms and experiences. The current study aids investigations towards preventing, predicting and more effectively responding to such distressing occurrences. There have been substantial efforts in the literature to propose models of auditory hallucination and attempts to verify them. However, many of these studies used survey methods that restrict the person's responses to a set of pre-defined criteria or experiences and do not allow exploration of potential important other symptoms beyond them. This is the first study to explore the correlates of auditory hallucination using a qualitative dataset consisting of unrestricted responses of patients about their lived experiences with mental illness. METHOD The study used a dataset consisting of 10,933 narratives from patients diagnosed with mental illnesses. For analysis, the study used correlation on the text-based data. This approach is an alternative to the knowledge-based approach where experts manually read the narratives and infer the rules and relationships from the dataset. RESULT This study found at least 8 correlates of auditory hallucination (small correlation coefficients), with the unusual ones being "pain." The study also found that auditory hallucinations were independent of obsessive thoughts and compulsive behaviours, and dissociation, in contrast with the literature. CONCLUSION This study presents an innovative approach to explore the possible associations between symptoms without the restrictions of (or outside the confines of) traditional diagnostic categories. The study exemplified this by finding the correlates of auditory hallucination. However, any other symptom or experience of interest can be studied similarly. Potential future directions of these findings are discussed in the context of mental healthcare screening and treatment.
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Affiliation(s)
| | - Duncan McVicar
- Queen's Management School, Queen's University Belfast, Belfast, UK
| | - Gavin Davidson
- School of Social Sciences, Education and Social Work, Queen's University Belfast, Belfast, UK
| | - Ciaran Shannon
- IMPACT Research Centre, Northern Health and Social Care Trust, Antrim, UK
| | - Cherie Armour
- School of Psychology, Queen's University Belfast, Belfast, UK.
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Dudley R, Turkington D, Coulthard N, Pyle M, Gumley A, Schwannauer M, Kingdon D, Morrison AP. Childhood Trauma in Clozapine-Resistant Schizophrenia: Prevalence, and Relationship With Symptoms. SCHIZOPHRENIA BULLETIN OPEN 2023; 4:sgad030. [PMID: 39145330 PMCID: PMC11207680 DOI: 10.1093/schizbullopen/sgad030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
Background and Hypothesis The role of early adversity and trauma is increasingly recognized in psychosis but treatments for trauma and its consequences are lacking. Psychological treatments need to understand the prevalence of these experiences, the relationship with specific symptoms and identify potentially tractable processes that may be targeted in therapy. It was hypothesized that greater adversity, and specifically abuse rather than neglect, would be associated with positive symptoms and specifically hallucinations. In addition, negative beliefs would mediate the relationship with positive symptoms. Study Design 292 Patients with treatment resistant psychosis completed measures of early adversity as well as current symptoms of psychosis. Study Results Early adversity in the form of abuse and neglect were common in one-third of the sample. Adversity was associated with higher levels of psychotic symptoms generally, and more so with positive rather than negative symptoms. Abuse rather than neglect was associated with positive but not with negative symptoms. Abuse rather than neglect was associated with hallucinations but not delusions. Abuse and neglect were related to negative beliefs about the self and negative beliefs about others. Mediation demonstrated a general relationship with adversity, negative-self, and other views and overall psychotic symptoms but not in relation to the specific experience of abuse and hallucinations. Females were more likely to be abused, but not neglected, than males. Conclusions Whilst most relationships were modest, they supported previous work indicating that adversity contributes to people with psychosis experiencing distressing symptoms especially hallucinations. Treatments need to address and target adversity.
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Affiliation(s)
- Robert Dudley
- Early Intervention in Psychosis Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Gosforth, Newcastle Upon Tyne, NE3 3XT, UK
- Department of Psychology, University of York, York, YO10 5DDUK
| | - Douglas Turkington
- Early Intervention in Psychosis Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Gosforth, Newcastle Upon Tyne, NE3 3XT, UK
| | - Naomi Coulthard
- Early Intervention in Psychosis Service, Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Gosforth, Newcastle Upon Tyne, NE3 3XT, UK
| | - Melissa Pyle
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK
| | - Andrew Gumley
- School of Health & Wellbeing, University of, Glasgow Clarice Pears Building, 90 Byres Road, Glasgow G12 8TBUK
| | - Matthias Schwannauer
- Department of Clinical Psychology, School of Health in Social Science, The University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - David Kingdon
- University Department of Psychiatry, University of Southampton, Academic Centre, CollegeKeep 4-12 Terminus Terrace Southampton SO14 3DT, UK
| | - Anthony P Morrison
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Prestwich, M25 3BL, UK
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13
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Černis E, Molodynski A, Ehlers A, Freeman D. Dissociation in patients with non-affective psychosis: Prevalence, symptom associations, and maintenance factors. Schizophr Res 2022; 239:11-18. [PMID: 34800911 PMCID: PMC8765411 DOI: 10.1016/j.schres.2021.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/27/2021] [Accepted: 11/07/2021] [Indexed: 12/30/2022]
Abstract
Dissociation is problematic in its own right for patients with psychosis but may also contribute to the occurrence of psychotic experiences. We therefore set out to estimate in a large cohort of patients with psychosis the prevalence of dissociative experiences, and assess using network models the relationships between dissociation, its potential maintenance mechanisms, and mental health symptoms. 902 patients with non-affective psychosis attending UK mental health services participated. Both an undirected model and a partially directed network model were estimated to identify potential relationships between 'felt sense of anomaly' dissociative experiences, paranoia, hallucinations, psychological wellbeing, sleep, and six potential maintenance mechanisms (affect intolerance, perseverative thinking, general self-efficacy, alexithymia, cognitive appraisals, and cognitive-behavioural responses to dissociation). 617 patients (65.4%) had experienced at least one dissociative symptom regularly over the past fortnight, with the average number experienced being 8.9 (SD = 8.0). Dissociation had direct relationships with paranoia, hallucinations, low psychological wellbeing, cognitive appraisals, cognitive-behavioural responses to dissociation, perseverative thinking, and low alexithymia. Dissociation was a probable cause of hallucinations (94.21% of 50,000 sampled directed acyclic graphs), with a trend towards also being a cause of paranoia (86.25% of 50,000 sampled directed acyclic graphs). Approximately two-thirds of patients with psychosis experience regular dissociative experiences. Dissociation is associated with low psychological wellbeing, and it is likely to have a direct causal influence on psychotic symptoms. Catastrophic cognitive appraisals, cognitive-behavioural responses to dissociation, factors related to affect sensitivity, and perseverative thinking may contribute to the occurrence of dissociation.
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Affiliation(s)
- Emma Černis
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Andrew Molodynski
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
| | - Anke Ehlers
- Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Centre for Anxiety Disorders and Trauma, Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford OX1 1TW, United Kingdom.
| | - Daniel Freeman
- University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford OX3 7JX, United Kingdom.
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14
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Li DJ, Hsieh YC, Chiu CD, Lin CH, Chou LS. The moderation of maternal parenting on the association of trauma, dissociation, and psychosis in depressive inpatients. Eur J Psychotraumatol 2022; 13:2024974. [PMID: 35173910 PMCID: PMC8843245 DOI: 10.1080/20008198.2021.2024974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND The effect of dissociation and parenting style on the relationship between psychological trauma and psychotic symptoms has not previously been investigated. OBJECTIVE The aim of this study was to develop a moderated mediation model to assess whether the association between psychological trauma and psychotic symptoms is mediated by dissociation and moderated by parental maltreatment. METHODS Inpatients with major depressive disorder (MDD) and bipolar depression (BP) were recruited. Self-reported and clinical rating scales were used to measure the level of dissociation, psychotic symptoms, history of psychological trauma and parental maltreatment. The PROCESS macro in SPSS was used to estimate path coefficients and adequacy of the moderated mediation model. High betrayal trauma (HBT), low betrayal trauma (LBT), paternal maltreatment, and maternal maltreatment were alternatively entered into the conceptual model to test the adequacy. RESULTS A total of 91 patients (59 with MDD and 32 with BP) were recruited, with a mean age of 40.59 ± 7.5 years. After testing with different variables, the moderated mediation model showed that the association between LBT and psychotic symptoms was mediated by dissociation and moderated by maternal maltreatment. A higher level of maternal maltreatment enhanced the effect of LBT on dissociation. CONCLUSIONS Healthcare workers should be aware of the risk of developing psychotic symptoms among depressive patients with a history of LBT and maternal maltreatment.
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Affiliation(s)
- Dian-Jeng Li
- Department of Addiction Science, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Department of Nursing, Meiho University, Pingtung, Taiwan
| | - Yung-Chi Hsieh
- Department of Adult Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
| | - Chui-de Chiu
- Department of Psychology, Clinical and Health Psychology Centre, and Centre for Cognition and Brain Studies, the Chinese University of Hong Kong, Hong Kong
| | - Ching-Hua Lin
- Department of Adult Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan.,Department of Psychiatry, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Li-Shiu Chou
- Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, Taiwan
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15
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Varese F, Douglas M, Dudley R, Bowe S, Christodoulides T, Common S, Grace T, Lumley V, McCartney L, Pace S, Reeves T, Morrison AP, Turkington D. Targeting dissociation using cognitive behavioural therapy in voice hearers with psychosis and a history of interpersonal trauma: A case series. Psychol Psychother 2021; 94:247-265. [PMID: 32914542 DOI: 10.1111/papt.12304] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 07/27/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniques specifically targeting dissociative symptoms could improve both dissociation and auditory hallucination severity in a sample of voice hearers with psychosis and a history of interpersonal trauma (e.g., exposure to sexual, physical, and/or emotional abuse). DESIGN Case series. METHODS A total of 19 service users with psychosis were offered up to 24 therapy sessions over a 6-month intervention window. Participants were assessed four times over a 12-month period using measures of dissociation, psychotic symptoms severity, and additional secondary mental-health and recovery measures. RESULTS Sixteen participants engaged in the intervention and were included in last-observation-carried-forward analyses. Dropout rates were in line with those of other CBT for psychosis trials (26.3%). Repeated measures ANOVAs revealed large and significant improvements in dissociation (drm = 1.23) and hallucination severity (drm = 1.09) by the end of treatment; treatment gains were maintained 6 months following the end of therapy. Large and statistically significant gains were also observed on measures of post-traumatic symptoms, delusion severity, emotional distress, and perceived recovery from psychosis. CONCLUSIONS The findings of this case series suggest that the reduction of dissociation represents a valuable and acceptable treatment target for clients with auditory verbal hallucinations and a trauma history. Future clinical trials might benefit from considering targeting dissociative experiences as part of psychological interventions for distressing voices. PRACTITIONER POINTS Practitioners should consider the role of dissociation when assessing and formulating the difficulties of voice hearers with a history of trauma. Techniques to reduce dissociation can be feasibly integrated within psychological interventions for voices. Voice hearers with histories of trauma can benefit from psychological interventions aimed at reducing dissociation.
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Affiliation(s)
- Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Complex Trauma and Resilience Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Maggie Douglas
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Robert Dudley
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,School of Psychology, Newcastle University, Newcastle upon Tyne, UK
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | | | | | - Tim Grace
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Victoria Lumley
- Tees Esk and Wear Valley, NHS Foundation Trust, Darlington, UK
| | - Laura McCartney
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Sonia Pace
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Thomas Reeves
- Cumbria, Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Anthony P Morrison
- Division of Psychology and Mental Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, UK.,Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester Academic Health Science Centre, UK
| | - Douglas Turkington
- Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
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16
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So SHW, Chung LKH, Tse CY, Chan SSM, Chong GHC, Hung KSY, Sommer IEC. Moment-to-moment dynamics between auditory verbal hallucinations and negative affect and the role of beliefs about voices. Psychol Med 2021; 51:661-667. [PMID: 31907105 DOI: 10.1017/s0033291719003611] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Negative affect (NA) has been suggested to be both an antecedent and a consequence of auditory verbal hallucinations (AVH). Furthermore, negative appraisals of voices have been theorized to contribute to the maintenance of AVH. Using the experience sampling method (ESM), this study examined the bi-directional relationship between NA and AVH, and the moderating effect of negative beliefs about voices. METHODS Forty-seven patients diagnosed with schizophrenia spectrum disorders with frequent AVH completed a clinical interview, followed by ESM for 10 times a day over 6 days on an electronic device. Time-lagged analyses were conducted using multilevel regression modeling. Beliefs about voices were assessed at baseline. RESULTS A total of 1654 data points were obtained. NA predicted an increase in AVH in the subsequent moment, and AVH predicted an increase in NA in the subsequent moment. Baseline beliefs about voices as malevolent and omnipotent significantly strengthened the association between NA and AVH within the same moment. In addition, the belief of omnipotence was associated with more hallucinatory experiences in the moment following NA. However, beliefs about voices were not associated directly with momentary levels of NA or AVH. CONCLUSIONS Experiences of NA and AVH drove each other, forming a feedback loop that maintained the voices. The associations between NA and AVH, either within the same moment or across moments, were exacerbated by negative beliefs about voices. Our results suggest that affect-improving interventions may stop the feedback loop and reduce AVH frequency.
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Affiliation(s)
- Suzanne Ho-Wai So
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Lawrence Kin-Hei Chung
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Chun-Yu Tse
- Department of Psychology, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | - Sandra Sau-Man Chan
- Department of Psychiatry, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, China
| | | | - Karen Shee-Yueng Hung
- Department of Psychiatry, Castle Peak Hospital, New Territories, Hong Kong SAR, China and
| | - Iris E C Sommer
- Department of Neuroscience and Department of Psychiatry, University Medical Center Groningen, The University of Groningen, Groningen, The Netherlands
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17
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Vers une psychologie janétienne des psychoses ? EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2020. [DOI: 10.1016/j.ejtd.2018.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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18
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An Ecological Momentary Assessment Study Investigating the Function of Hoarding. Behav Ther 2020; 51:715-727. [PMID: 32800300 DOI: 10.1016/j.beth.2019.10.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 10/14/2019] [Accepted: 10/16/2019] [Indexed: 11/20/2022]
Abstract
This study examined the function of hoarding behaviors and the relations between hoarding and a series of cognitive and affective processes in the moment using ecological momentary assessment. A matched-groups design was used to compare college students with higher hoarding symptoms (n = 31) and matched controls (n = 29). The two groups did not differ in what function they reported acquiring served, and positive automatic reinforcement was the most commonly reported function in both groups. Engaging in hoarding-relevant behaviors did not predict change in positive or negative affect when controlling for previous affect. Emotional reactivity and experiential avoidance in the moment were both elevated in the higher hoarding group compared to controls, while momentary mindfulness and negative affect differentiation were lower. Overall, these findings support the importance of emotion regulation processes in hoarding. They also suggest individuals may not be successfully regulating affect in the moment with hoarding behaviors, despite efforts to do so. It may be useful to evaluate processes such as striving for positive affect in hoarding disorder in the future.
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19
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Čolić J, Bassett TR, Latysheva A, Imboden C, Bader K, Hatzinger M, Mikoteit T, Lieb R, Gloster AT, Hoyer J. Depersonalization and derealization in embarrassing social interactions: an experience sampling study in social phobia, major depression and controls. J Anxiety Disord 2020; 70:102189. [PMID: 32070861 DOI: 10.1016/j.janxdis.2020.102189] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 11/14/2019] [Accepted: 01/11/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The study explored the duration and frequency of depersonalization (DP) and derealization (DR) in embarrassing social interactions in the everyday life of individuals with social phobia (SP), major depressive disorder (MDD) and controls. METHODS Experience sampling was used (seven days, five surveys per day). A total of N = 165 patients (n = 47 SP, n = 118 MDD) and n = 119 controls were included. DP/DR were assessed whenever an interaction has been indicated as embarrassing. RESULTS Individuals with SP and MDD experienced more embarrassing social interactions than controls and, accordingly, more DP/DR. The frequency of DP in embarrassing social interactions was, compared to controls, only significantly higher in MDD (no difference between SP and MDD). Regarding DR, there were no between-group differences. The groups also did not differ regarding duration of DP/DR. CONCLUSIONS The study is the first to demonstrate in an ecologically valid manner that DP/DR regularly occur in relation to feelings of embarrassment in controls and in individuals suffering from SP or MDD. DP and DR might be responses to strong emotions, like embarrassment, or might be attempts at coping. The higher emergence of embarrassment itself might be viewed as an indicator of maladaptation. Treatment interventions correcting for these misinterpretations might reduce DP/DR.
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Affiliation(s)
- Jasmin Čolić
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany.
| | - Tyler R Bassett
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Anna Latysheva
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christian Imboden
- Psychiatric Services Solothurn, Solothurn Hospital Group, Solothurn, Switzerland; Private Clinic Wyss, Münchenbuchsee, Switzerland
| | - Klaus Bader
- Center for Psychosomatics and Psychotherapy, University Psychiatric Clinics (UPK), University of Basel, Basel, Switzerland
| | - Martin Hatzinger
- Psychiatric Services Solothurn, Solothurn Hospital Group, Solothurn, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
| | - Thorsten Mikoteit
- Psychiatric Services Solothurn, Solothurn Hospital Group, Solothurn, Switzerland; Medical Faculty, University of Basel, Basel, Switzerland
| | - Roselind Lieb
- Division of Clinical Psychology & Epidemiology, Department of Psychology, University Basel, Basel, Switzerland
| | - Andrew T Gloster
- Division of Clinical Psychology & Intervention Science, Department of Psychology, University Basel, Basel, Switzerland
| | - Jürgen Hoyer
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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20
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Brand RM, Bendall S, Hardy A, Rossell SL, Meyer D, Thomas N. Moment-to-moment associations between posttraumatic stress symptoms and auditory hallucinations in the flow of daily life. Psychiatry Res 2020; 285:112838. [PMID: 32044599 DOI: 10.1016/j.psychres.2020.112838] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 01/28/2020] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
Traumatic events are associated with increased risk of auditory hallucinations (AHs) and posttraumatic stress symptoms have been implicated in this relationship. We aimed to explore the moment-to-moment relationship between posttraumatic stress symptoms and AHs in daily-life. Twenty-eight people with persistent AHs and a history of traumatic events completed six-days of ecological momentary assessment. We assessed AHs, trauma memory intrusions, avoidance, and hyperarousal at ten time points each day. Multi-level modelling showed that the severity of trauma memory intrusions (but not avoidance or hyperarousal) within the preceding hour was associated with the occurrence of AHs. This relationship was significantly stronger for people with a direct link between the content of their AHs and trauma history. In time-lagged analyses, main effects of trauma memory intrusions, avoidance, and hyperarousal on AHs were not significant. Trauma memory intrusions have momentary associations with AHs and this relationship is stronger and more enduring for those with a direct link between their AH and the trauma. Our findings are in keeping with the proposal that intrusive trauma memories are associated with the occurrence of (some) AHs.
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Affiliation(s)
- Rachel M Brand
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia.
| | - Sarah Bendall
- Orygen: The National Centre of Excellence in Youth Mental Health, 35 Poplar Road, Parkville, VIC 3052, Australia; The Centre for Youth Mental Health, The University of Melbourne, VIC 3010, Australia
| | - Amy Hardy
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK; South London & Maudsley NHS Foundation Trust, UK
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia; Psychiatry, St Vincent's Hospital Melbourne, Australia
| | - Denny Meyer
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia
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21
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Jongeneel A, Aalbers G, Bell I, Fried EI, Delespaul P, Riper H, van der Gaag M, van den Berg D. A time-series network approach to auditory verbal hallucinations: Examining dynamic interactions using experience sampling methodology. Schizophr Res 2020; 215:148-156. [PMID: 31780345 DOI: 10.1016/j.schres.2019.10.055] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/23/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Identifying variables that influence daily-life fluctuations in auditory verbal hallucinations (AVHs) provides insight into potential mechanisms and targets for intervention. Network analysis, that uses time-series data collected by Experience Sampling Method (ESM), could be used to examine relations between multiple variables over time. METHODS 95 daily voice-hearing individuals filled in a short questionnaire ten times a day for six consecutive days at pseudo-random moments. Using multilevel vector auto-regression, relations between voice-hearing and negative affect, positive affect, uncontrollable thoughts, dissociation, and paranoia were analysed in three types of networks: between-subjects (between persons, undirected), contemporaneous (within persons, undirected), and temporal (within persons, directed) networks. Strength centrality was measured to identify the most interconnected variables in the models. RESULTS Voice-hearing co-occurred with all variables, while on a 6-day period voice-hearing was only related to uncontrollable thoughts. Voice-hearing was not predicted by any of the factors, but it did predict uncontrollable thoughts and paranoia. All variables showed large autoregressions, i.e. mainly predicted themselves in this severe voice-hearing sample. Uncontrollable thoughts was the most interconnected factor, though relatively uninfluential. DISCUSSION Severe voice-hearing might be mainly related to mental state factors on the short-term. Once activated, voice-hearing appears to maintain itself. It is important to assess possible reactivity of AVH to triggers at the start of therapy; if reactive, therapy should focus on the triggering factor. If not reactive, Cognitive Behavioural interventions could be used first to reduce the negative effects of the voices. Limitations are discussed.
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Affiliation(s)
- Alyssa Jongeneel
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, the Netherlands.
| | - George Aalbers
- Department of Cognitive Science and Artificial Intelligence, Tilburg University, the Netherlands
| | - Imogen Bell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Eiko I Fried
- Department of Clinical Psychology, Leiden University, the Netherlands
| | - Philippe Delespaul
- Maastricht University, PO Box 616, 6226 NB, Maastricht, the Netherlands; Mondriaan, PO Box 4436 6401, CX, Heerlen, the Netherlands
| | - Heleen Riper
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Department of Research and Innovation, GGZ InGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Mark van der Gaag
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, the Netherlands
| | - David van den Berg
- Department of Clinical Psychology, Amsterdam UMC, Amsterdam Public Health Research Institute, Van der Boechorstraat 7, 1081 BT, Amsterdam, the Netherlands; Parnassia Psychiatric Institute, Zoutkeetsingel 40, 2512 HN, Den Haag, the Netherlands
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22
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Perona-Garcelán S, López-Jiménez AM, Bellido-Zanin G, Senín-Calderón C, Ruiz-Veguilla M, Rodríguez-Testal JF. The relationship with the voices as a dialogical experience: The role of self-focused attention and dissociation. J Clin Psychol 2019; 76:549-558. [PMID: 31714615 DOI: 10.1002/jclp.22890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this article was to study the relationship of self-focused attention and dissociation with the dialogical relationship persons diagnosed with psychosis have with their voices. METHOD The DAIMON Scale was applied to 62 persons diagnosed with psychosis to measure the dialogical relationship with their voices, and the Cambridge depersonalization scale, the Tellegen absorption scale, and the self-focused attention scale. RESULTS The results showed that the dialogical relationship with the voices was associated with high levels of self-focused attention (private and public), depersonalization, and absorption. It was also found that absorption mediated significantly between public self-focused attention and the dialogical relationship with the voices. CONCLUSIONS The role of dissociation and self-focused attention in forming the dialogical relationship a person with psychosis has with the voices is discussed and approaches to treatment are suggested.
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Affiliation(s)
- Salvador Perona-Garcelán
- Mental Health Service, University Hospital Virgen del Rocío, Seville, Spain.,Department of Personality, Evaluation, and Psychological Treatment, University of Seville, Spain
| | | | | | | | | | - Juan F Rodríguez-Testal
- Department of Personality, Evaluation, and Psychological Treatment, University of Seville, Spain
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23
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Bortolon C, Raffard S. Affective and cognitive factors associated with hallucination proneness in the general population: the role of shame and trauma-related intrusions. Cogn Neuropsychiatry 2019; 24:406-420. [PMID: 31549568 DOI: 10.1080/13546805.2019.1670152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Feelings of shame may be an important factor implicated in the onset and maintenance of hallucination (or hearing voices). Shame has been shown to increase trauma-related intrusions and avoidance and may reinforce negative beliefs about the self, which in turn may contribute to hallucinations in clinical and non-clinical populations. To our knowledge, no study has so far explored the role of shame in hallucination-proneness. Therefore, the main goal of the present study is to explore the mediation role of shame, trauma-related intrusions and avoidance in the association between childhood trauma and hallucination-proneness.Methods: Self-report questionnaires were used to assess past traumatic experiences, trauma-related symptoms, shame, and hallucination proneness in 175 participants from the general population.Results: Mediation analyses (joint-significance test and Monte Carlo test) showed that both shame and intrusions mediated the association between childhood trauma and hallucination-proneness.Conclusions: Our results reinforce the importance of considering previous experiences of trauma and trauma-related symptoms, including feelings of shame in individuals experiencing hallucinations. Moreover, this study reinforces previous studies showing some preliminary evidence that compassion-focused therapy, whose primary goal is to reduce shame by increasing self-compassion, could have a significant effect on voices whose content is hostile.
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Affiliation(s)
- Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social, Université Grenoble Alpes, Saint Martin d'Hères, France
| | - Stéphane Raffard
- Service Universitaire de Psychiatrie Adulte, Hôpital La Colombière, Centre Hospitaliere Universitaire de Montpellier, Montpellier, France.,Laboratoire Epsylon, Montpellier, France
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Lynn SJ, Maxwell R, Merckelbach H, Lilienfeld SO, Kloet DVHVD, Miskovic V. Dissociation and its disorders: Competing models, future directions, and a way forward. Clin Psychol Rev 2019; 73:101755. [DOI: 10.1016/j.cpr.2019.101755] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Revised: 06/20/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022]
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Autonomic arousal during psychosis spectrum experiences: Results from a high resolution ambulatory assessment study over the course of symptom on- and offset. Schizophr Res 2019; 212:163-170. [PMID: 31422861 DOI: 10.1016/j.schres.2019.07.046] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/26/2019] [Accepted: 07/28/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Ecological momentary assessment (EMA) studies show that stressors trigger the onset or increase of psychotic symptoms. These studies, however, predominantly rely on large sampling intervals and self-report assessment. This study aims to identify the autonomic stress-response to psychosis-spectrum experiences by using a one-day high-resolution EMA with continuous skin conductance and heart rate monitoring in a sample with attenuated positive symptoms. METHODS Sixty-two participants were equipped with a smartphone and wearable sensors to monitor skin conductance level (SCL) and heart rate variability (HRV) for 24 h. Every 20 min, participants answered questions on current stress, hallucination spectrum experiences (HSE), and paranoia. Sampling intervals were categorized into no event, pre-onset, event, pre-offset, and post-offset phases. We contrasted stress, SCL, and HRV between phases using multilevel regression models of sampling intervals nested in participants. RESULTS For paranoia, we found alterations in the autonomic and self-reported stress response prior to the onset that persisted until the episodes had ended. For HSE, we found no effects. Exploratory separate analyses of the different items aggregated into HSE yielded diverging results for intrusive thoughts, perceptual sensitivity, and hallucinations. CONCLUSION Physiological parameters are sensitive indicators of the onset of paranoia, which holds implications for preventive mobile interventions. To further explore the autonomic stress-response associated with HSE, further studies of the different HSE are needed.
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Lavin R, Bucci S, Varese F, Berry K. The relationship between insecure attachment and paranoia in psychosis: A systematic literature review. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2019; 59:39-65. [PMID: 31390076 PMCID: PMC7028113 DOI: 10.1111/bjc.12231] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/05/2019] [Indexed: 12/15/2022]
Abstract
Objectives Paranoia is a key symptom in psychosis and associated with a range of poor outcomes. Earlier life experiences increase vulnerability to paranoid thinking, and attachment theory has been proposed as a key model in explaining this causal pathway. Previous reviews highlight evidence of associations between insecure attachment styles and overall severity of psychotic symptoms. Studies report on associations between insecure attachment and paranoia, but to date, this literature has not been adequately synthesized. The aim of the current review was to report the strength and consistency of associations between paranoia and insecure attachment across published studies, and provide systematic appraisal of study quality. Method We carried out a systematic review of electronic databases using search terms to capture concepts of adult attachment, paranoia, and psychosis. We pre‐registered the review protocol and followed PRISMA guidelines. Results Significant associations were reported in 11 out of 12 studies between an insecure attachment and paranoia, with associations remaining significant in studies that controlled for comorbid symptoms. The strongest, most commonly reported relationship was between an anxious attachment style and paranoia. Conclusions The findings support the proposed role of attachment insecurity in the development and maintenance of paranoia in psychosis and highlight the need to address insecure attachment representations in the treatment of paranoia. Practitioner points
There is consistent evidence of associations between insecure attachment style and paranoia. Insecure anxious attachment is more consistently associated with paranoia than an insecure avoidant attachment. Associations between attachment and paranoia remain significant when key confounders are controlled for in the analyses. Interventions that address insecure attachment representations and promote a more secure attachment are likely to help reduce paranoia.
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Affiliation(s)
- Rachel Lavin
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Sandra Bucci
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Filippo Varese
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
| | - Katherine Berry
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK.,Complex Trauma and Resilience Research Unit (C-TRU), Greater Manchester Mental Health NHS Foundation Trust, UK
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Akbey ZY, Yildiz M, Gündüz N. Is There Any Association Between Childhood Traumatic Experiences, Dissociation and Psychotic Symptoms in Schziophrenic Patients? Psychiatry Investig 2019; 16:346-354. [PMID: 31132838 PMCID: PMC6539262 DOI: 10.30773/pi.2019.02.10.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Accepted: 02/10/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the rates childhood traumatic experiences (CTEs) of schizophrenia patients and to examine relationship between childhood traumatic experiences, dissociation and psychotic symptoms. METHODS One hundred schizophrenia patients who had 5 or 5 points below in Clinical Global Impression-Severity (CGI-S) and who were not in active psychotic episode and 50 healthy siblings who grew up in the same environment with the patients were included to the study. Structured Clinical Interview for DSM IV, Scale for the Assessment of Positive Symptoms, Scale for the Assessment of Negative Symptoms, Dissociative Experiences Scale (DES), CGI-S, Global Assessment of Functioning Scale and Childhood Trauma Questionnaire (CTQ-28) applied to the patients. RESULTS Childhood abuse subscales and DES scores were statistically higher in the patient group (p<0.001). We determined moderately significant positive correlation between CTQ-28 and DES. We determined moderately significant positive correlation between CTQ total scores and persecutory delusions, delusions of reference, ability to feel intimacy and closeness; relationship with friends and peers. Also, there was a significant positive correlation between persecutory delusions and CTQ-total, DES-total and all subscales of CTQ-28. CONCLUSION Clinicians should inquire about CTEs to develop comprehensive formulations and treatment plans among schizophrenia.
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Affiliation(s)
- Zeynep Yildiz Akbey
- Department of Psychiatry, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
| | - Mustafa Yildiz
- Department of Psychiatry, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Nermin Gündüz
- Department of Psychiatry, Faculty of Medicine, Kutahya Health Sciences University, Kutahya, Turkey
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Wenze SJ, Gaugler TL, Sheets ES, DeCicco JM. Momentary experiential avoidance: Within-person correlates, antecedents, and consequences and between-person moderators. Behav Res Ther 2018; 107:42-52. [PMID: 29859916 DOI: 10.1016/j.brat.2018.05.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 05/22/2018] [Accepted: 05/27/2018] [Indexed: 11/16/2022]
Abstract
We used ecological momentary assessment to investigate momentary correlates, antecedents, and consequences of experiential avoidance (EA), and to explore whether depression and anxiety moderate these within-person relationships. Participants recorded their mood, thoughts, stress, and EA four times daily for one week. Baseline depression and anxiety were associated with EA. EA was lower when participants reported more positive mood and thoughts, and higher when participants reported more negative mood, negative thoughts, and stress. The EA-stress relationship was stronger for participants with higher depression. Lag analyses showed that negative mood, negative thoughts, and stress predicted subsequent EA. In turn, EA predicted subsequent negative mood, negative thoughts, and stress. The relationship between EA and subsequent negative thoughts was stronger for participants with higher anxiety. Participants with higher depression and anxiety had a less negative association between positive thoughts and subsequent EA. This study adds to a growing body of literature on the process of EA as it unfolds in vivo, in real-time. Findings highlight links between momentary negative internal experiences and EA (which may be especially strong for people with depression or anxiety) and suggest that certain positive subjective experiences may buffer against EA. Clinical implications and future research directions are discussed.
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Affiliation(s)
- Susan J Wenze
- Lafayette College, 730 High St., Easton, PA 18042, USA.
| | | | - Erin S Sheets
- Colby College, 4000 Mayflower Hill Dr., Waterville, ME 04901, USA
| | - Jennifer M DeCicco
- Holy Family University, 9801 Frankford Ave., Philadelphia, PA 19114, USA
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Gómez JM, Freyd JJ. High Betrayal Child Sexual Abuse and Hallucinations: A Test of an Indirect Effect of Dissociation. JOURNAL OF CHILD SEXUAL ABUSE 2017; 26:507-518. [PMID: 28569650 DOI: 10.1080/10538712.2017.1310776] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 03/10/2017] [Indexed: 06/07/2023]
Abstract
Though hallucinations traditionally have been conceptualized as a central feature of psychosis, some hallucinations may be dissociative, with dissociation potentially contributing to hallucinations. Childhood trauma has been linked with dissociation and hallucinations. Betrayal trauma theory distinguishes abusive experiences based on closeness to the perpetrator. In the current study, we examined the indirect effect of dissociation on the relationship between high betrayal child sexual abuse (perpetrated by a close other) and hallucinations. Participants (N = 192) from a northwestern university in the United States completed self-report measures online assessing history of high betrayal child sexual abuse and current dissociation and hallucinations. Bootstrapping analyses indicated a significant indirect effect of high betrayal child sexual abuse on hallucinations through dissociation, 95% Confidence Interval (.16, .66). Through betrayal trauma theory, this study provides a non-pathologizing framework for understanding how dissociation and hallucinations may develop as natural reactions to the harm inherent in child sexual abuse perpetrated by a close other. These findings have clinical implications for relational models of healing for trauma survivors who are distressed by dissociation and hallucinations.
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Affiliation(s)
- Jennifer M Gómez
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
| | - Jennifer J Freyd
- a Department of Psychology , University of Oregon , Eugene , Oregon , USA
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McEnteggart C, Barnes-Holmes Y, Dillon J, Egger J, Oliver JE. Hearing voices, dissociation, and the self: A functional-analytic perspective. J Trauma Dissociation 2017; 18:575-594. [PMID: 27689860 DOI: 10.1080/15299732.2016.1241851] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In the current article, we review existing models of the etiology of voice hearing. We summarize the argument and evidence that voice hearing is primarily a dissociative process involving critical aspects of self. We propose a complementary perspective on these phenomena that is based on a modern behavioral account of complex behavior known as relational frame theory. This type of approach to voice hearing concerns itself with the functions served for the individual by this voice hearing; the necessary history, such as trauma, that establishes these functions; and the relevant dissociative processes involving self and others. In short, we propose a trauma-dissociation developmental trajectory in which trauma impacts negatively on the development of self through the process of dissociation. Using the relational frame theory concept of relations of perspective taking, our dissociation model purports that trauma gives rise to more coordination than distinction relations between self and others, thus weakening an individual's sense of a distinct self. Voice hearing experiences, therefore, reflect an individual's perceptions of self and others and may indicate impairments in the natural psychological boundaries between these critical related concepts. One clinical implication suggested by this model is that therapeutic intervention should understand the behaviors associated with a sense of self that is fragile and threatened by others. Relations with self and others should be a key focus of therapy as well as interventions designed to enhance a coherent distinct sense of self.
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Affiliation(s)
- Ciara McEnteggart
- a Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
| | - Yvonne Barnes-Holmes
- a Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
| | - Jacqui Dillon
- a Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
| | - Jos Egger
- a Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
| | - Joseph E Oliver
- a Department of Experimental-Clinical and Health Psychology , Ghent University , Ghent , Belgium
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Brand RM, Rossell SL, Bendall S, Thomas N. Can We Use an Interventionist-Causal Paradigm to Untangle the Relationship between Trauma, PTSD and Psychosis? Front Psychol 2017; 8:306. [PMID: 28316580 PMCID: PMC5334316 DOI: 10.3389/fpsyg.2017.00306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/17/2017] [Indexed: 12/28/2022] Open
Affiliation(s)
- Rachel M Brand
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia; Psychiatry, St. Vincent's HospitalFitzroy, VIC, Australia
| | - Sarah Bendall
- Orygen: The National Centre of Excellence in Youth Mental HealthParkville, VIC, Australia; The Centre for Youth Mental Health, The University of MelbourneParkville, VIC, Australia
| | - Neil Thomas
- Centre for Mental Health, Swinburne UniversityHawthorn, VIC, Australia; The Voices Clinic, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University Central Clinical SchoolMelbourne, VIC, Australia
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Alganami F, Varese F, Wagstaff GF, Bentall RP. Suggestibility and signal detection performance in hallucination-prone students. Cogn Neuropsychiatry 2017; 22:159-174. [PMID: 28253093 DOI: 10.1080/13546805.2017.1294056] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Auditory hallucinations are associated with signal detection biases. We examine the extent to which suggestions influence performance on a signal detection task (SDT) in highly hallucination-prone and low hallucination-prone students. We also explore the relationship between trait suggestibility, dissociation and hallucination proneness. METHOD In two experiments, students completed on-line measures of hallucination proneness (the revised Launay-Slade Hallucination Scale; LSHS-R), trait suggestibility (Inventory of Suggestibility) and dissociation (Dissociative Experiences Scale-II). Students in the upper and lower tertiles of the LSHS-R performed an auditory SDT. Prior to the task, suggestions were made pertaining to the number of expected targets (Experiment 1, N = 60: high vs. low suggestions; Experiment 2, N = 62, no suggestion vs. high suggestion vs. no voice suggestion). RESULTS Correlational and regression analyses indicated that trait suggestibility and dissociation predicted hallucination proneness. Highly hallucination-prone students showed a higher SDT bias in both studies. In Experiment 1, both bias scores were significantly affected by suggestions to the same degree. In Experiment 2, highly hallucination-prone students were more reactive to the high suggestion condition than the controls. CONCLUSION Suggestions may affect source-monitoring judgments, and this effect may be greater in those who have a predisposition towards hallucinatory experiences.
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Affiliation(s)
- Fatimah Alganami
- a Department of Psychological Sciences , Liverpool University , Liverpool , UK
| | - Filippo Varese
- b Section of Clinical and Health Psychology , School of Psychological Sciences, University of Manchester , Manchester , UK
| | - Graham F Wagstaff
- a Department of Psychological Sciences , Liverpool University , Liverpool , UK
| | - Richard P Bentall
- a Department of Psychological Sciences , Liverpool University , Liverpool , UK
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Castilho P, Martins MJ, Pinto AM, Viegas R, Carvalho S, Madeira N. Understanding the effect of attachment styles in paranoid ideation: The mediator role of experiential avoidance. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2017. [DOI: 10.1016/j.jcbs.2016.11.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sitko K, Varese F, Sellwood W, Hammond A, Bentall R. The dynamics of attachment insecurity and paranoid thoughts: An experience sampling study. Psychiatry Res 2016; 246:32-38. [PMID: 27649527 DOI: 10.1016/j.psychres.2016.08.057] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 08/20/2016] [Accepted: 08/21/2016] [Indexed: 11/24/2022]
Abstract
It has been proposed that insecure attachment can have adverse effects on the course of psychosis once symptoms have emerged. There is longitudinal evidence that increased insecure attachment is associated with increased severity of psychotic symptoms. The present study examined whether in the flow of daily life attachment insecurity fluctuates, whether elevated stress precedes the occurrence of attachment insecurity, and whether elevated attachment insecurity precedes the occurrence of paranoia. Twenty clinical participants with a psychosis-spectrum diagnosis and twenty controls were studied over six consecutive days using the experience sampling method (ESM). The findings revealed that fluctuations in attachment insecurity were significantly higher in the clinical group, that elevated stress predicted a subsequent increase in attachment insecurity, and that elevated attachment insecurity predicted a subsequent increase in paranoia; this effect was not observed in auditory hallucinations once co-occurring symptoms were controlled for. Finally, although previous ESM studies have shown that low self-esteem precedes the occurrence of paranoia, attachment insecurity continued to predict paranoia even when self-esteem was controlled for. The findings suggest that attachment security may be associated with a lower risk of paranoia, and that psychological interventions should address attachment beliefs and work towards establishing a sense of attachment security.
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Affiliation(s)
- Katarzyna Sitko
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK.
| | - Filippo Varese
- Section of Clinical and Health Psychology, School of Psychological Sciences, University of Manchester, M13 9PL, UK
| | - William Sellwood
- Division of Health Research, Faculty of Health and Medicine, Furness Building, Lancaster University, Lancaster LA14YG, UK
| | - Amy Hammond
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK
| | - Richard Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GL, UK
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Perona-Garcelán S, Bellido-Zanin G, Rodríguez-Testal JF, López-Jiménez AM, García-Montes JM, Ruiz-Veguilla M. The relationship of depersonalization and absorption to hallucinations in psychotic and non-clinical participants. Psychiatry Res 2016; 244:357-62. [PMID: 27525824 DOI: 10.1016/j.psychres.2016.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 07/22/2016] [Accepted: 08/05/2016] [Indexed: 12/20/2022]
Abstract
The purpose of this study was to examine the relationship between dissociative variables and hallucinations, or predisposition to hallucinations, respectively, in patients with psychoses and non-clinical participants, controlling for any possible effect of emotional variables and age. Three groups were formed for this purpose: patients diagnosed with schizophrenia with auditory hallucinations at the time of study, healthy participants prone to hallucinations, and healthy participants not prone to hallucinations. The final sample was 318 participants with a mean age of 21.41 years (SD: 5.78) and a male-to-female ratio of 67:251. All participants were given the Tellegen Absorption Scale, the Cambridge Depersonalization Scale and the Metacognitions Questionnaire. The results showed that patients with psychosis had higher levels of depersonalization than participants prone and not prone to hallucinations. Prone participants showed higher levels of absorption than patients with psychosis and healthy participants with no proneness to hallucinations. Finally, a multinomial logistic regression analysis showed that depersonalization increased the probability of belonging to the group of patients with psychosis and auditory hallucinations, and absorption in the group prone to hallucinations. The conclusions discuss the importance of dissociative variables in understanding the etiology of hallucinations and consider the possibility that different psychological processes may occur in healthy participants prone to hallucinations and in hallucinations in persons with psychoses.
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Affiliation(s)
- Salvador Perona-Garcelán
- Institute of Biomedicine, Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Spain; University of Seville Personality, Evaluation and Psychological Treatment Department, Spain.
| | - Gloria Bellido-Zanin
- Institute of Biomedicine, Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Spain
| | - Juan Francisco Rodríguez-Testal
- Institute of Biomedicine, Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Spain; University of Seville Personality, Evaluation and Psychological Treatment Department, Spain
| | | | - José M García-Montes
- University of Almería Personality, Evaluation and Psychological Treatment Department, Spain
| | - Miguel Ruiz-Veguilla
- Institute of Biomedicine, Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Spain
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Yamasaki S, Ando S, Koike S, Usami S, Endo K, French P, Sasaki T, Furukawa TA, Hasegawa-Hiraiwa M, Kasai K, Nishida A. Dissociation mediates the relationship between peer victimization and hallucinatory experiences among early adolescents. Schizophr Res Cogn 2016; 4:18-23. [PMID: 28740809 PMCID: PMC5506722 DOI: 10.1016/j.scog.2016.04.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/21/2016] [Accepted: 04/23/2016] [Indexed: 11/23/2022]
Abstract
Peer victimization increases the risk of experiencing psychotic symptoms among clinical and general populations, but the mechanism underlying this association remains unclear. Dissociation, which is related to peer victimization and hallucinatory experiences, has been demonstrated as a significant mediator in the relation between childhood victimization and hallucinatory experience among adult patients with psychosis. However, no studies have examined the mediating effect of dissociation in a general early adolescent population. We examined whether dissociation mediates the relationship between peer victimization and hallucinatory experiences among 10-year-old adolescents using a population-based cross-sectional survey of early adolescents and their main parent (Tokyo Early Adolescence Survey; N = 4478). We examined the mediating effect of dissociation, as well as external locus of control and depressive symptoms, on the relationship between peer victimization and hallucinatory experiences using path analysis. The model assuming mediation effects indicated good model fit (comparative fit index = .999; root mean square error of approximation = .015). The mediation effect between peer victimization and hallucination via dissociation (standardized indirect effect = .038, p < .001) was statistically significant, whereas the mediation effects of depressive symptoms (standardized indirect effect = -.0066, p = 0.318) and external locus of control (standardized indirect effect = .0024, p = 0.321) were not significant. These results suggest that dissociation is a mediator in the relation between peer victimization and hallucinatory experiences in early adolescence. For appropriate intervention strategies, assessing dissociation and peer victimization as they affect hallucinatory experiences is necessary.
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Affiliation(s)
- Syudo Yamasaki
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan
| | - Shuntaro Ando
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Shinsuke Koike
- Office for Mental Health Support, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Satoshi Usami
- Department of Psychology, University of Tsukuba, Tennodai, Tsukuba, Ibaraki, 305-8572, Japan
| | - Kaori Endo
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan
| | - Paul French
- Greater Manchester West Mental Health NHS Foundation Trust, Bury New Road, Prestwich, Manchester, M25 3BL, United Kingdom
| | - Tsukasa Sasaki
- Department of Physical and Health Education, Graduate School of Education, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Toshi A. Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine/School of Public Health, Kyoto University, Yoshida Konoe-cho, Sakyo-ku, Kyoto, 606-8501, Japan
| | - Mariko Hasegawa-Hiraiwa
- School of Advanced Science, SOKENDAI (The Graduate University for Advanced Studies), Shonan Village, Hayama, Kanagawa, 240-0193, Japan
| | - Kiyoto Kasai
- Department of Neuropsychiatry, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Atsushi Nishida
- Department of Psychiatry and Behavioral Science, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan
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Varese F, Morrison AP, Beck R, Heffernan S, Law H, Bentall RP. Experiential avoidance and appraisals of voices as predictors of voice-related distress. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2016; 55:320-31. [PMID: 26752336 DOI: 10.1111/bjc.12102] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Revised: 11/11/2015] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Filippo Varese
- Division of Health Research, Lancaster University, UK.,School of Psychological Sciences, University of Manchester, UK
| | - Anthony P Morrison
- School of Psychological Sciences, University of Manchester, UK.,Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Rosie Beck
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | | | - Heather Law
- Greater Manchester West Mental Health NHS Foundation Trust, Manchester, UK
| | - Richard P Bentall
- Institute of Psychology Health and Society, University of Liverpool, UK
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Fielding-Smith SF, Hayward M, Strauss C, Fowler D, Paulik G, Thomas N. Bringing the "self" into focus: conceptualising the role of self-experience for understanding and working with distressing voices. Front Psychol 2015; 6:1129. [PMID: 26300821 PMCID: PMC4528282 DOI: 10.3389/fpsyg.2015.01129] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 07/20/2015] [Indexed: 01/22/2023] Open
Abstract
A primary goal of cognitive behavior therapy for psychosis (CBTp) is to reduce distress and disability, not to change the positive symptoms of psychosis, such as hearing voices. Despite demonstrated associations between beliefs about voices and distress, the effects of CBTp on reducing voice distress are disappointing. Research has begun to explore the role that the psychological construct of "self" (which includes numerous facets such as self-reflection, self-schema and self-concept) might play in causing and maintaining distress and disability in voice hearers. However, attempts to clarify and integrate these different perspectives within the voice hearing literature, or to explore their clinical implications, are still in their infancy. This paper outlines how the self has been conceptualised in the psychosis and CBT literatures, followed by a review of the evidence regarding the proposed role of this construct in the etiology of and adaptation to voice hearing experiences. We go on to discuss some of the specific intervention methods that aim to target these aspects of self-experience and end by identifying key research questions in this area. Notably, we suggest that interventions specifically targeting aspects of self-experience, including self-affection, self-reflection, self-schema and self-concept, may be sufficient to reduce distress and disruption in the context of hearing voices, a suggestion that now requires further empirical investigation.
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Affiliation(s)
| | - Mark Hayward
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - Clara Strauss
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - David Fowler
- School of Psychology, University of Sussex , Brighton, UK ; Sussex Partnership NHS Foundation Trust , Hove, UK
| | - Georgie Paulik
- School of Psychology, University of Western Australia , Perth, WA, Australia ; Schizophrenia Research Institute, Darlinghurst , NSW, Australia
| | - Neil Thomas
- Brain and Psychological Sciences Research Centre, Swinburne University, Melbourne , VIC, Australia ; Monash Alfred Psychiatry Research Centre, The Alfred, Melbourne , VIC, Australia
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Pilton M, Varese F, Berry K, Bucci S. The relationship between dissociation and voices: A systematic literature review and meta-analysis. Clin Psychol Rev 2015; 40:138-55. [DOI: 10.1016/j.cpr.2015.06.004] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 03/12/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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Perona-Garcelán S, Pérez-Álvarez M, García-Montes JM, Cangas AJ. Auditory Verbal Hallucinations as Dialogical Experiences. JOURNAL OF CONSTRUCTIVIST PSYCHOLOGY 2015. [DOI: 10.1080/10720537.2014.938847] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bentall RP, de Sousa P, Varese F, Wickham S, Sitko K, Haarmans M, Read J. From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Soc Psychiatry Psychiatr Epidemiol 2014; 49:1011-22. [PMID: 24919446 DOI: 10.1007/s00127-014-0914-0] [Citation(s) in RCA: 199] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 05/30/2014] [Indexed: 02/07/2023]
Abstract
PURPOSE Although there is considerable evidence that adversities in childhood such as social deprivation, sexual abuse, separation from parents, neglect and exposure to deviant parental communication are associated with psychosis in later life, most studies have considered broad diagnoses as outcomes. In this review we consider evidence for pathways between specific types of adversity and specific symptoms of psychosis. METHODS We present theoretical arguments for expecting some degree of specificity (although by no means perfect specificity) between different kinds of adversity and different symptoms of psychosis. We review studies that have investigated social-environmental risk factors for thought disorder, auditory-verbal hallucinations and paranoid delusions, and consider how these risk factors may impact on specific psychological and biological mechanisms. RESULTS Communication deviance in parents has been implicated in the development of thought disorder in offspring, childhood sexual abuse has been particularly implicated in auditory-verbal hallucinations, and attachment-disrupting events (e.g. neglect, being brought up in an institution) may have particular potency for the development of paranoid symptoms. Current research on psychological mechanisms underlying these symptoms suggests a number of symptom-specific mechanisms that may explain these associations. CONCLUSIONS Few studies have considered symptoms, underlying mechanisms and different kinds of adversity at the same time. Future research along these lines will have the potential to elucidate the mechanisms that lead to severe mental illness, and may have considerable clinical implications.
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Perona-Garcelán S, García-Montes JM, Rodríguez-Testal JF, Ruiz-Veguilla M, Benítez-Hernández MDM, López-Jiménez AM, Arias-Velarde MÁ, Ductor-Recuerda MJ, Gómez-Gómez MT, Pérez-Álvarez M. Relationship of absorption, depersonalisation, and self-focused attention in subjects with and without hallucination proneness. Cogn Neuropsychiatry 2014; 18:422-36. [PMID: 23082781 DOI: 10.1080/13546805.2012.728133] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION The purpose of this work was to study the relationship of absorption, depersonalisation, and self-focused attention in subjects prone to hallucination. METHODS A sample of 218 healthy subjects was given the LSHS-R Hallucination Scale (Bentall & Slade, 1985). Three groups, subjects with high, medium, and low hallucination proneness, were formed from this sample. The Tellegen Absorption Scale (TAS; Tellegen & Atkinson, 1974), Cambridge Depersonalisation Scale (CDS; Sierra & Berrios, 2000), and Self-Absorption Scale (SAS; McKenzie & Hoyle, 2008) were also given to all the participants. The Metacognitions Questionnaire (MCQ-30; Wells & Cartwright-Hatton, 2004) was used as a covariant to control for the effects of emotional vulnerability on the dependent variables studied. RESULTS The results showed that subjects highly prone to hallucinations had significantly higher absorption, depersonalisation, and self-focused attention than the subjects in the other two groups. A hierarchical regression analysis showed that absorption and depersonalisation predict hallucination proneness. CONCLUSIONS The importance of the absorption, depersonalisation, and self-focused attention variables for understanding the aetiology of hallucinations is discussed in the Conclusions, where some approaches to its treatment are also suggested.
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Affiliation(s)
- Salvador Perona-Garcelán
- a Instituto de Biomedicina de Sevilla (IBiS) , University Hospital Virgen del Rocío/CSIC/University of Seville , Seville , Spain
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McCarthy-Jones S, Trauer T, Mackinnon A, Sims E, Thomas N, Copolov DL. A new phenomenological survey of auditory hallucinations: evidence for subtypes and implications for theory and practice. Schizophr Bull 2014; 40:231-5. [PMID: 23267192 PMCID: PMC3885292 DOI: 10.1093/schbul/sbs156] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A comprehensive understanding of the phenomenology of auditory hallucinations (AHs) is essential for developing accurate models of their causes. Yet, only 1 detailed study of the phenomenology of AHs with a sample size of N ≥ 100 has been published. The potential for overreliance on these findings, coupled with a lack of phenomenological research into many aspects of AHs relevant to contemporary neurocognitive models and the proposed (but largely untested) existence of AH subtypes, necessitates further research in this area. We undertook the most comprehensive phenomenological study of AHs to date in a psychiatric population (N = 199; 81% people diagnosed with schizophrenia), using a structured interview schedule. Previous phenomenological findings were only partially replicated. New findings included that 39% of participants reported that their voices seemed in some way to be replays of memories of previous conversations they had experienced; 45% reported that the general theme or content of what the voices said was always the same; and 55% said new voices had the same content/theme as previous voices. Cluster analysis, by variable, suggested the existence of 4 AH subtypes. We propose that there are likely to be different neurocognitive processes underpinning these experiences, necessitating revised AH models.
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Affiliation(s)
- Simon McCarthy-Jones
- To whom correspondence should be addressed; ARC Centre of Excellence in Cognition and Its Disorders, Department of Cognitive Science, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia; tel: +61 2 9850 8669, fax: +61 2 9850 6059, e-mail:
| | - Tom Trauer
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia;,Department of Psychiatry, The University of Melbourne, Melbourne, Australia;,St Vincent’s Hospital, Mental Health Service, Melbourne, Australia
| | - Andrew Mackinnon
- Centre for Youth Mental Health, The University of Melbourne, Melbourne, Australia
| | - Eliza Sims
- Victoria Harbour Medical Centre, Docklands, Victoria 3008, Australia
| | - Neil Thomas
- Monash Alfred Psychiatry Research Centre, The Alfred, Melbourne, Australia;,Faculty of Life and Social Sciences, Swinburne University, Melbourne, Australia
| | - David L. Copolov
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
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Mackie CJ, O'Leary-Barrett M, Al-Khudhairy N, Castellanos-Ryan N, Struve M, Topper L, Conrod P. Adolescent bullying, cannabis use and emerging psychotic experiences: a longitudinal general population study. Psychol Med 2013; 43:1033-1044. [PMID: 23171473 DOI: 10.1017/s003329171200205x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Using longitudinal and prospective measures of psychotic experiences during adolescence, we assessed the risk of developing psychosis in three groups showing low, increasing and elevated psychotic experiences associated with bullying by peers and cannabis use in a UK sample of adolescents. Method Data were collected by self-report from 1098 adolescents (mean age 13.6 years; 60.9% boys) at five separate time points, equally separated by 6 months, across a 24-month period. General growth mixture modelling identified three distinct trajectories of adolescents reporting psychotic experiences: elevated, increasing and low. RESULTS Controlling for cannabis use, bullying by peers significantly predicted change in psychotic experiences between Time 2 and Time 5 in adolescents belonging to the increasing group. No effect was found for the elevated or low groups. Controlling for bullying, an earlier age of cannabis use and cannabis use more than twice significantly predicted change in psychotic experiences in adolescents belonging to the increasing group. Cannabis use at any age was significantly associated with subsequent change in psychotic experiences in the low group. Reverse causal associations were examined and there was no evidence for psychotic experiences at Time 1 predicting a subsequent change in cannabis use between Times 2 and 5 in any trajectory group. CONCLUSIONS Bullying by peers and cannabis use are associated with adolescents' reports of increasing psychotic experiences over time. Further research into the longitudinal development of psychosis in adolescence and the associated risk factors would allow for early intervention programmes to be targeted more precisely.
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Affiliation(s)
- C J Mackie
- Addictions Department, Institute of Psychiatry, King's College London, UK.
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Hartley S, Varese F, Vasconcelos e Sa D, Udachina A, Barrowclough C, Bentall RP, Lewis SW, Dunn G, Haddock G, Palmier-Claus J. Compliance in experience sampling methodology: the role of demographic and clinical characteristics. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2013. [DOI: 10.1080/17522439.2012.752520] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Samantha Hartley
- Division of Clinical Psychology, University of Manchester, Manchester, UK
| | - Filippo Varese
- Division of Clinical Psychology, University of Manchester, Manchester, UK
| | | | - Alisa Udachina
- Clinical Psychology Unit, University of Sheffield, Sheffield, UK
| | - Christine Barrowclough
- Division of Clinical Psychology, University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care Trust, Manchester, UK
| | - Richard P. Bentall
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Shôn W. Lewis
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Graham Dunn
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Gillian Haddock
- Division of Clinical Psychology, University of Manchester, Manchester, UK
- Manchester Mental Health and Social Care Trust, Manchester, UK
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Varese F, Barkus E, Bentall RP. Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychol Med 2012; 42:1025-1036. [PMID: 21896238 DOI: 10.1017/s0033291711001826] [Citation(s) in RCA: 179] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND It has been proposed that the relationship between childhood trauma and hallucinations can be explained by dissociative processes. The present study examined whether the effect of childhood trauma on hallucination-proneness is mediated by dissociative tendencies. In addition, the influence of dissociative symptoms on a cognitive process believed to underlie hallucinatory experiences (i.e. reality discrimination; the capacity to discriminate between internal and external cognitive events) was also investigated. METHOD Patients with schizophrenia spectrum disorders (n=45) and healthy controls (with no history of hallucinations; n=20) completed questionnaire measures of hallucination-proneness, dissociative tendencies and childhood trauma, as well as performing an auditory signal detection task. RESULTS Compared to both healthy and non-hallucinating clinical controls, hallucinating patients reported both significantly higher dissociative tendencies and childhood sexual abuse. Dissociation positively mediated the effect of childhood trauma on hallucination-proneness. This mediational role was particularly robust for sexual abuse over other types of trauma. Signal detection abnormalities were evident in hallucinating patients and patients with a history of hallucinations, but were not associated with pathological dissociative symptoms. CONCLUSIONS These results are consistent with dissociative accounts of the trauma-hallucinations link. Dissociation, however, does not affect reality discrimination. Future research should examine whether other cognitive processes associated with both dissociative states and hallucinations (e.g. deficits in cognitive inhibition) may explain the relationship between dissociation and hallucinatory experiences.
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Affiliation(s)
- F Varese
- School of Psychology, Bangor University, Bangor, Gwynedd, UK.
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Palmier-Claus JE, Dunn G, Lewis SW. Emotional and symptomatic reactivity to stress in individuals at ultra-high risk of developing psychosis. Psychol Med 2012; 42:1003-1012. [PMID: 22067414 DOI: 10.1017/s0033291711001929] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The stress-vulnerability model of psychosis continues to be influential. The aim of this study was to compare emotional and symptomatic responses to stress in individuals at ultra-high risk (UHR) of developing psychosis, in age- and gender-matched healthy controls, and in patients with non-affective psychosis. METHOD A total of 27 UHR, 27 psychotic and 27 healthy individuals completed the experience sampling method, an ambulant diary technique, where they were required to fill in self-assessment questions about their emotions, symptoms and perceived stress at semi-random times of the day for 6 days. Quesionnaire and interview assessments were also completed. RESULTS Multilevel regression analyses showed that individuals at UHR of developing psychosis reported greater negative emotions in response to stress than the healthy individuals. Against the initial hypotheses, the UHR individuals also experienced greater emotional reactivity to stress when compared with the patient group. No significant differences were observed between the patients and the non-clinical sample. Stress measures significantly predicted the intensity of psychotic symptoms in UHR individuals and patients, but the extent of this did not significantly differ between the groups. CONCLUSIONS Individuals at UHR of developing psychosis may be particularly sensitive to everyday stressors. This effect may diminish after transition to psychosis is made and in periods of stability. Subtle increases in psychotic phenomena occur in response to stressful events across the continuum of psychosis.
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Affiliation(s)
- J E Palmier-Claus
- School of Community Based Medicine and Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
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Beavan V, Read J, Cartwright C. The prevalence of voice-hearers in the general population: A literature review. J Ment Health 2011; 20:281-92. [DOI: 10.3109/09638237.2011.562262] [Citation(s) in RCA: 173] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Vanessa Beavan
- First Episode Psychosis Team, St Lukes Community Mental Health Centre, Auckland District Health Board,
Auckland, New Zealand
| | - John Read
- Department of Psychology, University of Auckland,
Auckland, 1142, New Zealand
| | - Claire Cartwright
- Department of Psychology, University of Auckland,
Auckland, 1142, New Zealand
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