Authors:Robyn Langdon; Michaela Flynn, Emily Connaughton, Martin Brüne Abstract: ObjectivesEvidence of impairment in explicit mentalizing in people with schizophrenia has inspired interventions to improve awareness of others’ mental states in these individuals. Less is known of implicit mentalizing in schizophrenia, with current findings mixed. We sought to resolve previous inconsistencies using Heider & Simmel's (H&S) classic animation to elicit spontaneous mentalizing and examined relations between spontaneous and deliberative mentalizing.MethodsForty-five schizophrenia outpatients and 27 general-community controls completed two explicit theory-of-mind (TOM) tasks and then described the H&S animation (to elicit spontaneous social attributions about emotionally driven, as well as goal-driven, behaviours), before and after an instruction to think of the shapes as people. Accuracy of basic and social facts and frequencies of personification and different mental-state terms were recorded.ResultsExplicit TOM performance was impaired in patients. Patients also generated fewer social (but not basic) facts than controls to describe the H&S animation, and used less mental-state language, before, and even more so, after the ‘people’ instruction, despite that both groups had used more personification terms after the ‘people’ instruction. Measures of explicit and spontaneous mentalizing contributed independently to discriminating between groups.ConclusionsPatients respond less to the bottom-up signals of agency that ought normally to elicit spontaneous social attributions, even when cued to think of the stimuli as people, and the stimuli depict emotionally driven, as well as goal-driven, behaviour. That impairments of spontaneous and deliberative mentalizing dissociate in schizophrenia suggests that training deliberative mentalizing may not be enough; interventions to improve spontaneous mentalizing are also needed.Practitioner pointsFindingsPeople with schizophrenia were less likely than controls to spontaneously attribute causal mental states when viewing dynamic signals of emotionally driven and goal-driven behaviours.These impairments were even more pronounced when participants were instructed to think of the stimuli as people, suggesting that perceiving others in social roles does not prompt people with schizophrenia to anthropomorphize about others as agents motivated by their own inner worlds.Impairments of spontaneous mentalizing were found to co-occur independently with explicit mentalizing deficits in schizophrenia, consistent with the claim that humans can access two distinct systems for understanding others’ minds.Findings suggest that interventions to improve conscious deliberative mentalizing in schizophrenia may not be enough; we also need to target implicit mentalizing processes.LimitationsThe patient sample was chronic and only mildly symptomatic. As such, findings cannot be generalized to other stages and phases of the illness.All patients were also medicated, allowing for the possibility that automatic responses to socially salient stimuli may have been pharmacologically attenuated. Future research may examine whether unmedicated young people at ultra-high risk of psychosis show a similar profile of mentalizing impairment.Future work may also examine whether impairments of deliberative and spontaneous mentalizing associate differentially with social functioning and different cognitive domains in schizophrenia. PubDate: 2017-06-12T00:45:53.978635-05: DOI: 10.1111/bjc.12144
Authors:Kirsty Miller; Juliet R. H. Wakefield, Fabio Sani Abstract: ObjectivesThe aim of the study was to investigate the link between social group identification and mental health outcomes in a sample of secondary school pupils. Based on previous work, it was predicted that multiple high group identifications would protect against psychological ill health. Furthermore, it was predicted that better mental health would also predict greater number of group identifications, thus creating a ‘virtuous circle’.DesignA longitudinal questionnaire design was used.MethodsA total of 409 Scottish secondary school pupils aged 13–17 completed a questionnaire twice over a year. Pupils’ responses regarding their mental health and the extent of their identification with three groups (the family, school, and friends) were measured.ResultsA path analysis of the data showed that greater number of high group identifications predicted better mental health outcomes amongst participants. However, better mental health also predicted greater number of high group identifications, suggesting that there is a cyclical relationship between both variables.ConclusionsThe findings have both theoretical and practical implications. They highlight the importance of conceptualizing the link between group identification and mental health as cyclical, rather than unidirectional. This reconceptualization has implications for mental health promotion strategies, as it highlights the importance of attempting to turn a potentially ‘vicious cycle’ of social disidentification and mental ill health into a ‘virtuous cycle’ of social identification and mental health.Practitioner pointsResults showed that in a population of 409 high school pupils, the more high group identifications pupils had, the better their mental health outcomes.Better mental health also predicted a greater number of high group identifications over time.The findings suggest that we would benefit from conceptualizing the relationship between group identification and mental outcomes as being cyclical rather than unidirectional.Viewing the relationship between group identification and mental health in this way enables us to consider interventions which help turn a ‘vicious cycle’ into a ‘virtuous cycle’.LimitationsA potential limitation of the work relates to the use of self-report questionnaires which may elicit socially desirable responses.The sample only consists of high school pupils from mainstream public schools within Scotland. PubDate: 2017-06-08T05:10:19.533954-05: DOI: 10.1111/bjc.12143
Authors:Ruth Wadman; David Clarke, Kapil Sayal, Marie Armstrong, Caroline Harroe, Pallab Majumder, Panos Vostanis, Ellen Townsend Abstract: ObjectivesYoung people in the public care system (‘looked-after’ young people) have high levels of self-harm.DesignThis paper reports the first detailed study of factors leading to self-harm over time in looked-after young people in England, using sequence analyses of the Card Sort Task for Self-harm (CaTS).MethodsYoung people in care (looked-after group: n = 24; 14–21 years) and young people who had never been in care (contrast group: n = 21; 13–21 years) completed the CaTS, describing sequences of factors leading to their first and most recent episodes of self-harm. Lag sequential analysis determined patterns of significant transitions between factors (thoughts, feelings, behaviours, events) leading to self-harm across 6 months.ResultsYoung people in care reported feeling better immediately following their first episode of self-harm. However, fearlessness of death, impulsivity, and access to means were reported most proximal to recent self-harm. Although difficult negative emotions were salient to self-harm sequences in both groups, young people with no experience of being in care reported a greater range of negative emotions and transitions between them. For the contrast group, feelings of depression and sadness were a significant starting point of the self-harm sequence 6 months prior to most recent self-harm.ConclusionsSequences of factors leading to self-harm can change and evolve over time, so regular monitoring and assessment of each self-harm episode are needed. Support around easing and dealing with emotional distress is required. Restricting access to means to carry out potentially fatal self-harm attempts, particularly for the young persons with experience of being in care, is recommended.Practitioner pointsSelf-harm (and factors associated with self-harm) can change and evolve over time; assessments need to reflect this.Looked-after young people reported feeling better after first self-harm; fearlessness of death, access to means, and impulsivity were reported as key in recent self-harm.Underlying emotional distress, particularly depression and self-hatred were important in both first and most recent self-harm.Looked-after young people should undergo regular monitoring and assessment of each self-harm episode and access to potentially fatal means should be restricted.The CaTS would have clinical utility as an assessment toolRecruiting participants can be a significant challenge in studies with looked-after children and young people.Future research with larger clinical samples would be valuable. PubDate: 2017-06-08T02:40:25.986411-05: DOI: 10.1111/bjc.12145
Authors:Kirsten V. Smith; Graham R. Thew Abstract: ObjectivesThe combination of clinical psychologists’ therapeutic expertise and research training means that they are in an ideal position to be conducting high-quality research projects. However, despite these skills and the documented benefits of research to services and service users, research activity in practice remains low. This article aims to give an overview of the advantages of, and difficulties in conducting research in clinical practice.MethodWe reviewed the relevant literature on barriers to research and reflected on our clinical and research experiences in a range of contexts to offer practical recommendations.ResultsWe considered factors involved in the planning, sourcing support, implementation, and dissemination phases of research, and outline suggestions to improve the feasibility of research projects in post-qualification roles.ConclusionsWe suggest that research leadership is particularly important within clinical psychology to ensure the profession's continued visibility and influence within health settings.Practitioner pointsClinical implicationsEmerging evidence suggests that clinical settings that foster research are associated with better patient outcomes.Suggestions to increase the feasibility of research projects in clinical settings are detailed.LimitationsThe present recommendations are drawn from the authors’ practical experience and may need adaptation to individual practitioners’ settings.This study does not attempt to assess the efficacy of the strategies suggested. PubDate: 2017-06-01T05:40:28.053123-05: DOI: 10.1111/bjc.12142
Authors:Ena Begovic; Vanessa Panaite, Lauren M. Bylsma, Charles George, Maria Kovacs, Ilya Yaroslavsky, Ildikó Baji, István Benák, Roberta Dochnal, Enikő Kiss, Ágnes Vetró, Krisztina Kapornai, Jonathan Rottenberg Abstract: ObjectivesImpaired positive autobiographical memory (AM) is closely linked to emotional disorders. AM impairments are often found in depressed adults and may be related to the difficulties such persons have in regulating their dysphoric mood. By contrast, less is known about AM disturbances among adolescents, or about the functional relationship of AM disturbances to early-onset depression.DesignA high-risk family design served to compare four groups of youth who differed in depression histories and familial depression risk.MethodsThirty-one currently depressed probands, 185 remitted probands, 204 never-depressed siblings of probands, and 180 healthy control youth were induced into a negative mood prior to recalling positive AMs via a novel memory elicitation procedure. Several positive AM characteristics were assessed.ResultsRelative to control youth, unaffected siblings and probands exhibited consistently impaired positive AMs. Moreover, we also found some evidence that probands were more impaired than siblings, who were in turn more impaired than controls, consistent with a gradient effect.ConclusionsPositive AM disturbances may not only precede the onset of depression in vulnerable youth, but also continue to persist after remission of a depressive episode. Clinical and basic research implications of the findings are discussed.Practitioner pointsPositive AM impairments may be trait-like, persist in the euthymic phase of depression, and may serve as a risk marker for early-onset depression among vulnerable adolescents.Disturbances in positive AM may negatively impact the mood-regulatory functions of positive memory recall and contribute to persistent sadness and anhedonia, which are core features of depression.Our sample of currently depressed youth was relatively small, tempering our conclusions.Although we collected data on some important covariates (e.g., socioeconomic status), we lacked information on other relevant variables such as youths’ executive functioning or IQ. PubDate: 2017-05-23T06:15:24.220233-05: DOI: 10.1111/bjc.12141
Authors:Alyson L. Dodd; Barbara Mezes, Fiona Lobban, Steven H. Jones Abstract: BackgroundPersonal recovery is recognized as an important outcome for individuals with bipolar disorder (BD) and is distinct from symptomatic and functional recovery. Recovery-focused psychological therapies show promise. As with therapies aiming to delay relapse and improve symptoms, research on the psychological mechanisms underlying recovery is crucial to inform effective recovery-focused therapy. However, empirical work is limited. This study investigated whether negative beliefs about mood swings and self-referent appraisals of mood-related experiences were negatively associated with personal recovery.DesignCross-sectional online survey.MethodPeople with a verified research diagnosis of BD (n = 87), recruited via relevant voluntary sector organizations and social media, completed online measures. Pearson's correlations and multiple regression analysed associations between appraisals, beliefs, and recovery.ResultsNormalizing appraisals of mood changes were positively associated with personal recovery. Depression, negative self-appraisals of depression-relevant experiences, extreme positive and negative appraisals of activated states, and negative beliefs about mood swings had negative relationships with recovery. After controlling for current mood symptoms, negative illness models (relating to how controllable, long-term, concerning, and treatable mood swings are; β = −.38), being employed (β = .39), and both current (β = −.53) and recent experience of depression (β = .30) predicted recovery.LimitationsDue to the cross-sectional design, causality cannot be determined. Participants were a convenience sample primarily recruited online. Power was limited by the sample size.ConclusionsInterventions aiming to empower people to feel able to manage mood and catastrophize less about mood swings could facilitate personal recovery in people with BD, which might be achieved in recovery-focused therapy.Practitioner pointsPersonal recovery is an important outcome for people living with bipolar disorderMore positive illness models are associated with better personal recovery in bipolar disorder, over and above mood symptomsRecovery-focused therapy should focus on developing positive illness modelsRecovery-focused therapy should address personally meaningful goals such as gaining employment PubDate: 2017-05-22T05:10:27.215763-05: DOI: 10.1111/bjc.12140
Authors:Lyn Ellett; Olga Luzon, Max Birchwood, Zarina Abbas, Abi Harris, Paul Chadwick Abstract: ObjectivesCommand hallucinations are considered to be one of the most distressing and disturbing symptoms of schizophrenia. Building on earlier studies, we compare key attributes in the symptomatic, affective, and cognitive profiles of people diagnosed with schizophrenia and hearing voices that do (n = 77) or do not (n = 74) give commands.MethodsThe study employed a cross-sectional design, in which we assessed voice severity, distress and control (PSYRATs), anxiety and depression (HADS), beliefs about voices (BAVQ-R), and responsibility beliefs (RIQ). Clinical and demographic variables were also collected.ResultsCommand hallucinations were found to be more distressing and controlling, perceived as more omnipotent and malevolent, linked to higher anxiety and depression, and resisted more than hallucinations without commands. Commanding voices were also associated with higher conviction ratings for being personally responsible for preventing harm.ConclusionsThe findings suggest key differences in the affective and cognitive profiles of people who hear commanding voices, which have important implications for theory and psychological interventions.Practitioner pointsCommand hallucinations are associated with higher distress, malevolence, and omnipotence.Command hallucinations are associated with higher responsibility beliefs for preventing harm.Responsibility beliefs are associated with voice-related distress.Future psychological interventions for command hallucinations might benefit from focussing not only on omnipotence, but also on responsibility beliefs, as is done in psychological therapies for obsessive compulsive disorder.LimitationsThe cross-sectional design does not assess issues of causality.We did not measure the presence or severity of delusions. PubDate: 2017-05-11T07:40:29.061717-05: DOI: 10.1111/bjc.12139
Authors:Miriam Fornells-Ambrojo; Louise Johns, Juliana Onwumere, Philippa Garety, Craig Milosh, Catherine Iredale, Emmanuelle Peters, Adrian Webster, Suzanne Jolley Abstract: ObjectivesPsychological therapy services are increasingly required to instate routine outcome monitoring (ROM), to demonstrate the clinical and economic impact of interventions. Professionals’ views of ROM are an acknowledged barrier to implementation. Service user perspectives have rarely been examined, but acceptability and perceptions of ROM are critical to successful implementation. We investigated service users’ experiences of ROM in an Improving Access to Psychological Therapies for people with Severe Mental Illness psychosis demonstration site.DesignROM comprised a periodic assessment battery completed at baseline, mid-therapy, and end-of-therapy and a single measure completed session-by-session. Qualitative and quantitative feedback were sought at each periodic ROM administration, and, for sessional ROM, at mid-therapy and end-of-therapy. Demographic and clinical correlates of satisfaction were examined cross-sectionally at baseline. Consistency of satisfaction over time and associations of satisfaction with engagement were examined longitudinally.MethodsService users rated baseline (n = 281/289), mid-therapy (n = 114/121), end-of-therapy (n = 124/154), and session-by-session (mid-therapy n = 63/87 and end-of-therapy n = 90/123) ROM from 0 (‘extremely unhelpful’) to 10 (‘extremely helpful’) and gave qualitative feedback.ResultsService users predominantly found ROM helpful (score 6–10; 64–72%) or neutral (score 5; 19–29%). Finding ROM less helpful was associated with younger age and poorer general outcomes, but not with psychotic symptoms or therapy dropout. Emerging qualitative themes included feeling understood, valuing opportunities to reflect, expressing feelings, and tracking progress towards goals. Shorter batteries would be preferable, particularly for younger respondents, and those with poorer outcomes.ConclusionsROM is acceptable for people with psychosis. Tailoring assessments to specific subgroups should be considered.Practitioner pointsRoutine outcome monitoring for psychological therapy is acceptable to people with psychosis.Most respondents experienced outcome monitoring as an opportunity to feel understood.Younger people and those with poorer functioning and well-being might be at higher risk of dissatisfaction.Short assessment batteries and less frequent outcome monitoring might be preferable for some service users.Limitations of the studyFeedback about session-by-session outcome monitoring was not contemporaneous with completion and may be subject to memory or other biases.Only two-thirds of service users provided feedback about session-by-session ROM (compared to >94% for periodic ROM) so findings may not be fully representative.Feedback about measures was not provided anonymously, and it is possible that service users were reluctant to express criticism about ROM to the assessor. PubDate: 2017-05-11T07:35:32.030953-05: DOI: 10.1111/bjc.12136
Authors:Sheri L. Johnson; Jordan A. Tharp, Andrew D. Peckham, Charles S. Carver, Claudia M. Haase Abstract: ObjectivesA growing empirical literature indicates that emotion-related impulsivity (compared to impulsivity that is unrelated to emotion) is particularly relevant for understanding a broad range of psychopathologies. Recent work, however, has differentiated two forms of emotion-related impulsivity: A factor termed Pervasive Influence of Feelings captures tendencies for emotions (mostly negative emotions) to quickly shape thoughts, and a factor termed Feelings Trigger Action captures tendencies for positive and negative emotions to quickly and reflexively shape behaviour and speech. This study used path modelling to consider links from emotion-related and non-emotion-related impulsivity to a broad range of psychopathologies.Design and methodsUndergraduates completed self-report measures of impulsivity, depression, anxiety, aggression, and substance use symptoms.ResultsA path model (N = 261) indicated specificity of these forms of impulsivity. Pervasive Influence of Feelings was related to anxiety and depression, whereas Feelings Trigger Action and non-emotion-related impulsivity were related to aggression and substance use.ConclusionsThe findings of this study suggest that emotion-relevant impulsivity could be a potentially important treatment target for a set of psychopathologies.Practitioner pointsRecent work has differentiated two forms of emotion-related impulsivity.This study tests a multivariate path model linking emotion-related and non-emotion-related impulsivity with multiple forms of psychopathology.Impulsive thoughts in response to negative emotions were related to anxiety and depression.Impulsive actions in response to emotions were related to aggression and substance use, as did non-emotion-related impulsivity.The study was limited by the reliance on self-report measures of impulsivity and psychopathology.There is a need for longitudinal work on how these forms of impulsivity predict the onset and course of psychopathology. PubDate: 2017-05-11T07:26:02.458207-05: DOI: 10.1111/bjc.12135
Authors:Zorry Belchev; Neta Levy, Itamar Berman, Hila Levinzon, Dan Hoofien, Asaf Gilboa Abstract: ObjectivesTo dissociate injury-related factors from psychological contributions to impaired awareness of deficits following traumatic brain injury (TBI); impaired awareness is theorized to partly reflect psychological factors (e.g., denial), but empirical evidence for this theory is scarce.DesignWe examined how different factors predict awareness in patients undergoing rehabilitation (N = 43). Factors included (1) neurological (injury severity), (2) neuropsychological loss, (3) psychological (denial, projection, identification), and (4) personality (narcissism).Methods/Main measuresThe Patient Competency Rating Scale, comparing patient with clinician reports on different functional domains; the Thematic Apperception Test, an injury-independent measure of the propensity to mobilize specific defence mechanisms; and the Narcissism Personality Inventory.ResultsImpaired awareness was not predicted by injury-related and neuropsychological scores but was significantly predicted by use of primitive defence mechanisms (denial and projection). Patients who underestimate their abilities also demonstrated high denial levels, but contrary to underestimators, this was positively related to depression and negatively to awareness.ConclusionsPrimitive defence mechanism use significantly contributes to impaired awareness independent of injury-related factors, particularly in domains associated with self-identity. Well-validated tests of defence mechanism mobilization are needed to support clinical interpretation of and intervention with impaired awareness. More research is needed to understand the psychology of hypersensitivity to deficits.Practitioner pointsThis study provides an empirical demonstration of dissociable contributions of neurological and psychological factors to awareness of deficits in TBI.Trait proclivity to mobilize defence mechanisms in response to anxiety-provoking situations can be measured, and strongly predicts impaired awareness. Importantly, measures of psychological reactions were independent of responses to the neurological deficits themselves, discriminating between psychological and neurological contributions to impaired awareness.The importance of identifying psychological reactions to impaired awareness and hindering rehabilitation success is highlighted, and vital for clinicians to consider during the rehabilitation process.Psychological reactions to TBI can be identified using well-validated, quantitative measures of the use of psychological defences (e.g., Cramer's Thematic Apperception Test scoring system), and the authors suggest this is a critical step to properly characterize and manage awareness in patients during treatment.Although only TBI patients were examined, the results may inform impaired awareness that occur as a result of other disorders and illnesses.The patients in this study were in the chronic stages of the injury, and therefore, the results may not generalize to patients in more acute stages. PubDate: 2017-05-03T08:21:00.528553-05: DOI: 10.1111/bjc.12134
Authors:Matthew Brooks; Nicola Graham-Kevan, Michelle Lowe, Sarita Robinson Abstract: ObjectivesThe Cognitive Growth and Stress (CGAS) model draws together cognitive processing factors previously untested into a single model. Intrusive rumination, deliberate rumination, present and future perceptions of control, and event centrality were assessed as predictors of post-traumatic growth (PTG) and post-traumatic stress (PTS).MethodThe CGAS model is tested on a sample of survivors (N = 250) of a diverse range of adverse events using structural equation modelling techniques.ResultsOverall, the best fitting model was supportive of the theorized relations between cognitive constructs and accounted for 30% of the variance in PTG and 68% of the variance in PTS across the sample.ConclusionsRumination, centrality, and perceived control factors are significant determinants of positive and negative psychological change across the wide spectrum of adversarial events. In its first phase of development, the CGAS model also provides further evidence of the distinct processes of growth and distress following adversity.Practitioner pointsClinical implicationsPeople can experience positive change after adversity, regardless of life background or types of events experienced.While growth and distress are possible outcomes after adversity, they occur through distinct processes.Support or intervention should consider rumination, event centrality, and perceived control factors to enhance psychological well-being.Cautions/limitationsLongitudinal research would further clarify the findings found in this study.Further extension of the model is recommended to include other viable cognitive processes implicated in the development of positive and negative changes after adversity. PubDate: 2017-05-02T11:01:07.326461-05: DOI: 10.1111/bjc.12138
Authors:Bianca T. Villalobos; Jodie Ullman, Tracy Wang Krick, Darcy Alcántara, Alex Kopelowicz, Steven R. López Abstract: ObjectivesThis study tested an attribution model of help-giving in family caregivers of persons with schizophrenia as it relates to caregivers’ reported burden. We hypothesized (a) that caregivers’ attributions of their ill relatives’ responsibility for their symptoms would be associated with more negative and less positive affective reactions, (b) that affective reactions would be related to perceptions of administered support, and (c) that support would in turn predict greater burden.MethodsWe examined 60 family caregivers of Mexican origin living in Southern California. Mexican Americans were chosen because of their high degree of contact with their ill relative, thereby facilitating the examination of help-giving and burden. Contrary to past studies, caregivers’ attributions and affective stance were assessed independently, the former based on self-report and the latter based on codes drawn from the Camberwell Family Interview. Caregiver burden was assessed at baseline and one year later.ResultsPath analyses showed partial support for the attribution model of help-giving. Specifically, attributions of responsibility negatively predicted caregiver's warmth, which in turn predicted more administered support. Contrary to hypotheses, attributions were not associated with caregiver criticism, and criticism was positively related to administered support. In addition, caregiver support was not related to burden at either baseline or a year later. Criticism was a significant predictor of burden at follow-up through burden at baseline.ConclusionThe emotional stance of caregivers predicts burden independent of the help they provide. Caregiver criticism not only predicts negative patient outcomes but can predict negative caregiver outcomes as well.Practitioner pointsPositive clinical implicationsIn family treatment, it is important to address caregiver criticism not only because of its relationship to poor clinical outcomes of ill relatives but also because of its relationship to greater caregiver burden.Integrating a balanced rationale for family interventions – to improve ill relatives’ and caregivers’ outcomes – may promote further engagement of both parties as some caregivers may be additionally motivated to improve their own well-being, and some ill relatives may appreciate more equitably distributing the treatment focus.LimitationsThe caregiver sample was in general low in criticism; therefore, the findings may not be generalizable to families with a higher degree of criticism.There was a 35% sample attrition at the one-year follow-up. PubDate: 2017-05-02T10:34:48.358227-05: DOI: 10.1111/bjc.12137
Authors:Anastasia Hronis; Lynette Roberts, Ian I. Kneebone Abstract: ObjectiveNearly half of children with intellectual disability (ID) have comorbid affective disorders. These problems are chronic if left untreated and can significantly impact upon future vocational, educational, and social opportunities. Despite this, there is a paucity of research into effective treatments for this population. Notably, one of the most supported of psychological therapies, cognitive behaviour therapy (CBT), remains largely uninvestigated in children with ID. The current review considers the neuropsychological profile of children and adolescents with mild to moderate ID, with a view to informing how CBT might best be adapted for children and adolescents with ID.MethodNarrative review of literature considering the neuropsychological profiles of children and adolescents with ID, with specific focus upon attention, memory, learning, executive functioning, and communication. Studies were identified through SCOPUS, PsycINFO, and PubMed databases, using combinations of the key words ‘intellectual disability’, ‘learning disability’, ‘neuropsychology’, ‘attention’, ‘learning’, ‘memory’, ‘executive function’, ‘language’, and ‘reading’.ResultsChildren with ID have significant deficits in attention, learning, memory, executive functions, and language. These deficits are likely to have a negative impact upon engagement in CBT. Suggestions for adapting therapy to accommodate these wide ranging deficits are proposed.ConclusionsThere are multiple cognitive factors which need to be considered when modifying CBT for children who have ID. Furthermore, research is required to test whether CBT so modified is effective in this population.Practitioner pointsClinical implicationsEffective ways of providing cognitive behavioural therapy (CBT) to children with intellectual disability (ID) is unclear. This study provides a framework of potential adaptations for clinical practiceAs rates of mental illness for children with intellectual disability are high, and rates of treatment provision low, it is hoped that the recommendations provided in this study will encourage more mental health practitioners to provide CBT to children with ID.LimitationsThese recommendations are based only upon neuropsychological literature. Trialling the effectiveness of an adapted form of CBT for children and adolescents with ID is required.There are varying causes of intellectual disability, with differences in cognitive profiles. The utility of the recommendations made here may vary according to specific aetiologies. PubDate: 2017-04-11T02:11:14.046338-05: DOI: 10.1111/bjc.12133
Authors:Debora Vasconcelos e Sa; Christine Barrowclough, Samantha Hartley, Alison Wearden Abstract: ObjectivesThere is evidence that self-blame is an important predictor of distress and depression in relatives of people with long-term psychosis, but there is limited research investigating the nature and correlates of self-blame in relatives of people with recent-onset psychosis. Self-blame motivates a tendency to engage with others and to repair wrongdoings; it might be that such cognitions also impact on relatives’ behaviours towards the patient. This study examined the association between self-blame and psychological distress, and tested the prediction that greater self-blame would be associated with more behavioural control attempts to patients in a sample of relatives of people with recent-onset psychosis.MethodsStatements pertaining to self-blame and behavioural control were extracted and rated from 80 interviews with relatives, who also completed the General Health Questionnaire–28. Content analysis was used to examine the nature of self-blame attributions. Regression analyses were used to explore the links between self-blame attributions and distress, and between self-blame and behavioural control in this recent-onset population.ResultsHigher levels of self-blame were associated with more behavioural control attempts, and self-blame predicted relatives’ behavioural responses when adjusting for the contribution of control attributions. Self-blame was also linked with distress, but did not emerge as an independent predictor in multivariate analysis. Most relatives who blamed themselves did so for not overseeing their family member's mental health problems properly or for perceiving themselves generally as poor carers.ConclusionsThis study extends findings related to self-blame to a population of relatives of people with recent-onset psychosis and highlights the possible role of blaming cognitions in promoting interpersonal engagement through behavioural control.Practitioner PointsSelf-blaming beliefs were linked with increased distress in relatives of people with recent-onset psychosis;Increased self-blame was associated with more behavioural control attempts;Most relatives blamed themselves for not overseeing their family member's mental health problems properly, and for perceiving themselves generally as poor carers.The cross-sectional study design limits inferences about causality. PubDate: 2017-04-11T01:25:36.919486-05: DOI: 10.1111/bjc.12132
Abstract: ‘A meta-analysis and theoretical critique of oxytocin and psychosis: Prospects for attachment and compassion in promoting recovery’ by Andrew Gumley, Christine Braehler, and Angus Macbeth (2014).The above article, published online on 21 February 2014 in Wiley Online Library (wileyonlinelibrary.com), and in Volume 53, pp. 42–61, has been retracted by agreement between the authors, the journal Editor-in-Chief, Julie Henry, and John Wiley & Sons Limited.The retraction has been agreed due to errors in the coding of effects and in the random effects components of the meta-analysis. In particular, confidence intervals for the random effects estimates were reported as significant, whereas they should have crossed zero, rendering them non-significant.ReferencesGumley, A., Braehler, C., & Macbeth, A. (2014). A meta-analysis and theoretical critique of oxytocin and psychosis: Prospects for attachment and compassion in promoting recovery. British Journal of Clinical Psychology, 53, 42–61. doi:10.1111/bjc.12041 PubDate: 2017-04-10T00:50:41.675136-05: DOI: 10.1111/bjc.12131
Authors:Donald R. Williams; Paul-Christian Bürkner Abstract: ObjectiveWhile oxytocin has been identified as having therapeutic properties for schizophrenia, the emerging evidence has been mixed which has resulted in meta-analytic reviews. We identified several errors in one such meta-analysis. Here, we highlight these errors, demonstrate the conclusions were incorrect, and state the importance of this report.MethodsWe reproduced the methods of Gumley, Braehler, and Macbeth (), including: outcomes (positive, negative, and total symptoms, as well as general psychopathology) and meta-analytic estimates for fixed and random effect models.ResultsWhereas (Gumley, Braehler, and Macbeth ) they reported oxytocin had significant effects on three of four outcomes, we show that all effects were non-significant.ConclusionsBased on these null results, we hope this report encourages a re-evaluation of intranasal oxytocin as a treatment for schizophrenia. PubDate: 2017-02-20T02:20:21.642706-05: DOI: 10.1111/bjc.12130
Authors:Nadine Keen; Darren George, Peter Scragg, Emmanuelle Peters Abstract: ObjectivesTo examine the role of shame and its relationship to depression in schizophrenia. It was predicted that individuals with a diagnosis of schizophrenia would exhibit higher levels of shame due to the stigma associated with their diagnosis, independently of depression levels, compared with psychiatric and medical control groups.DesignCross-sectional design with three groups: individuals with a diagnosis of (1) schizophrenia, (2) depression, and (3) rheumatoid arthritis.MethodsSixty individuals participated in the study (20 per group). Groups were compared on questionnaires assessing external shame, trait shame and guilt, and depression.ResultsThe pattern of group differences depended on the type of shame measure used. Both the schizophrenia and depression groups exhibited higher levels of external shame, or seeing others as shaming, than the medical group. For individuals with schizophrenia, seeing others as shaming was associated with higher levels of depression, a relationship not found in either control group. They also showed lower levels of trait guilt and shame (at trend level), compared with both control groups. No difference was found between the groups on depression, suggesting that the observed differences were not attributable to differences in levels of depression.ConclusionsThe findings highlight the importance of shame in schizophrenia, especially the link between seeing other people as shaming and depression, which was unique to this group. These results suggest that stigma associated with a diagnosis of mental illness, and schizophrenia in particular, has negative emotional consequences that may impede recovery, and should be addressed by psychological and social interventions.Practitioner pointsClinical implicationsIndividuals with a diagnosis of mental illness (schizophrenia or depression) are more likely to experience others as shaming than those diagnosed with a physical illness, irrespective of current levels of depression and proneness to shame.There is a specific association between external shame and depression in individuals diagnosed with schizophrenia, suggesting the need for interventions levelled both at the individual's illness appraisals, and at social stigma relating to schizophrenia.Limitations of the studyThe participant numbers were low in each group.The three groups could not be matched on all variables.No additional internalized-stigma measure was used. PubDate: 2017-01-19T04:45:58.798925-05: DOI: 10.1111/bjc.12125
Authors:Giovanna Mioni; Erica Bertucci, Antonella Rosato, Gill Terrett, Peter G. Rendell, Massimo Zamuner, Franca Stablum Abstract: ObjectivePrevious studies have shown that traumatic brain injury (TBI) patients have difficulties with prospective memory (PM). Considering that PM is closely linked to independent living it is of primary interest to develop strategies that can improve PM performance in TBI patients.MethodThis study employed Virtual Week task as a measure of PM, and we included future event simulation to boost PM performance. Study 1 evaluated the efficacy of the strategy and investigated possible practice effects. Twenty-four healthy participants performed Virtual Week in a no strategy condition, and 24 healthy participants performed it in a mixed condition (no strategy – future event simulation). In Study 2, 18 TBI patients completed the mixed condition of Virtual Week and were compared with the 24 healthy controls who undertook the mixed condition of Virtual Week in Study 1. All participants also completed a neuropsychological evaluation to characterize the groups on level of cognitive functioning.ResultsStudy 1 showed that participants in the future event simulation condition outperformed participants in the no strategy condition, and these results were not attributable to practice effects. Results of Study 2 showed that TBI patients performed PM tasks less accurately than controls, but that future event simulation can substantially reduce TBI-related deficits in PM performance. The future event simulation strategy also improved the controls’ PM performance.ConclusionsThese studies showed the value of future event simulation strategy in improving PM performance in healthy participants as well as in TBI patients.Practitioner pointsTBI patients performed PM tasks less accurately than controls, confirming prospective memory impairment in these patients.Participants in the future event simulation condition out-performed participants in the no strategy condition.Future event simulation can substantially reduce TBI-related deficits in PM performance.Future event simulation strategy also improved the controls’ PM performance. PubDate: 2017-01-17T02:43:12.777973-05: DOI: 10.1111/bjc.12126
Authors:Courtney Hippel; Julie D. Henry, Gill Terrett, Kimberly Mercuri, Karen McAlear, Peter G. Rendell Abstract: ObjectivesPeople with a history of substance abuse are subject to widespread stigmatization. It seems likely that this societal disapproval will result in feelings of stereotype threat, or the belief that one is the target of demeaning stereotypes. If so, stereotype threat has the potential to contribute to functional difficulties including poor social outcomes.MethodsEighty drug users on opioid substitution therapy and 84 demographically matched controls completed measures of mental health and social function. The opioid substitution therapy group were additionally asked to complete a measure that focused on their feelings of stereotype threat in relation to their drug use history. Bivariate correlations and hierarchical regression analyses were conducted to establish the magnitude and specificity of the relationship between stereotype threat and social functioning.ResultsRelative to controls, the opioid substitution therapy group reported higher levels of negative affect and schizotypy, and poorer social functioning, with all three of these indices significantly correlated with their feelings of stereotype threat. The results also showed that stereotype threat contributed significant unique variance to social functioning in the opioid substitution therapy group, even after taking into account other background, clinical, and mental health variables.ConclusionsSocial functioning is an important aspect of recovery, yet these data indicate that people with a history of drug abuse who believe they are the target of stereotypical attitudes have poorer social functioning. This relationship holds after controlling for the impact of other variables on social functioning, including mental health. The theoretical and practical implications of these findings are discussed.Practitioner pointsConcerns about being stereotyped can shape the social experiences of opioid substitution therapy patients.Opioid substitution therapy patients who feel negatively stereotyped experience greater social function deficits, and this relationship emerges after controlling for important clinical and mental health variables.Understanding the relationship between feeling stereotyped and social function may assist practitioners in their treatment.The study is cross-sectional, and thus, experimental or longitudinal research is required to determine the causal direction between stereotype threat and social function. PubDate: 2017-01-10T04:50:28.322318-05: DOI: 10.1111/bjc.12128
Authors:Alexandra Brown; Cathy Creswell, Chris Barker, Stephen Butler, Peter Cooper, Catherine Hobbs, Kerstin Thirlwall Abstract: ObjectivesBrief guided parent-delivered cognitive behaviour therapy (CBT) has been developed to meet the demand for non-intensive interventions for children with anxiety disorders, and initial trials have shown it to be effective for children with a range of anxiety disorders. This study examined outcomes 3–5 years post-treatment.DesignA long-term follow-up (LTFU) cohort study.MethodsFamilies who (1) completed at least 50% of allocated treatment sessions of guided parent-delivered CBT for childhood anxiety as part of a randomized control trial (RCT), (2) provided consent to be recontacted, (3) had not received further mental health interventions, and (4) were contactable were invited to take part. Fifty-seven families (29% of the original sample) completed structured diagnostic interviews on average 50 months after treatment (39–61 months).ResultsAt LTFU, 79% of the assessed children who had received the treatment no longer met criteria for their primary diagnosis, 63% did not meet criteria for any anxiety disorder, and 61% did not meet criteria for any DSM-IV disorder. Treatment gains were mostly maintained (60%), and some children went on to recover during the follow-up period without additional input from mental health services (19%). Few young people had relapsed since their last assessment (12%). Mean scores on standardized symptom questionnaires were within the normal range.ConclusionsChildren who recovered from anxiety disorders following brief guided parent-delivered CBT typically maintained good outcomes and few relapsed. These findings suggest that this is a viable first-line, low-intensity treatment approach. This study only included a small subsample of those in the original RCT (29%), and more information is required about those who dropped out of treatment and those who required further intervention immediately after treatment.Practitioner pointsTreatment gains from brief guided parent-delivered cognitive behaviour therapy for children with anxiety are maintained for most children 3–5 years later.The majority of children who completed at least 50% of the intervention required no further mental health intervention in that time.Some children make continued improvement after completing the intervention.Data are based on a sample of families from southern England where the primary caregiving parent was free of mental health difficulties.Further research is needed to explore the mental health needs of those who do not benefit from this intervention. PubDate: 2017-01-09T23:50:26.151412-05: DOI: 10.1111/bjc.12127
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