Depressive symptoms are common in schizophrenia, often left untreated, and associated with a high... more Depressive symptoms are common in schizophrenia, often left untreated, and associated with a high relapse rate, suicidal ideation, increased mortality, reduced social adjustment and poor quality of life. The neural mechanisms underlying depression in psychosis are poorly understood. Given reports of altered brain response to negative facial affect in depressive disorders, we examined brain response to emotive facial expressions in relation to levels of depression in people with psychosis. Seventy outpatients (final N = 63) and 20 healthy participants underwent functional magnetic resonance imaging during an implicit affect processing task involving presentation of facial expressions of fear, anger, happiness as well as neutral expressions and a (no face) control condition. All patients completed Beck Depression Inventory (BDI-II) and had their symptoms assessed on the Positive and Negative Syndrome Scale (PANSS). In patients, depression (BDI-II) scores associated positively with act...
Psychosis is often characterized by paranoia and poor social functioning. Neurally, there is evid... more Psychosis is often characterized by paranoia and poor social functioning. Neurally, there is evidence of functional dysconnectivity including abnormalities when processing facial affect. We sought to establish whether these abnormalities are resolved by cognitive behavioral therapy for psychosis (CBTp). The study involved 38 outpatients with one or more persistent positive psychotic symptoms, and 20 healthy participants. All participants completed an implicit facial affect processing task during functional magnetic resonance imaging (fMRI). Subsequently, patients either continued to receive standard care only (SCO, n = 16) or received CBTp on top of standard care (+CBTp, n = 22), with fMRI repeated 6-8 months later. To examine the mechanisms underlying CBTp-led changes in threat processing and appraisal, functional connectivity during the social threat (angry faces) condition was assessed separately from left amygdala and right dorsolateral prefrontal cortex (DLPFC) seeds. At baseli...
Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have co... more Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have considered its long-term effectiveness in routine services. This study reports the outcomes of clients seen in a psychological therapies clinic, set up following positive results obtained from an RCT (Peters et al., 2010). The aims were to evaluate the effectiveness of CBTp, using data from the service's routine assessments for consecutive referrals over a 12 years period, and assess whether gains were maintained at a 6+ months' follow-up. Of the 476 consenting referrals, all clients (N = 358) who received ≥5 therapy sessions were offered an assessment at four time points (baseline, pre-, mid-, and end of therapy) on measures assessing current psychosis symptoms, emotional problems, general well-being and life satisfaction. A sub-set (N = 113) was assessed at a median of 12 months after finishing therapy. Following the waiting list (median of 3 months) clients received individualized, formulation-based CBTp for a median number of 19 sessions from 121 therapists with a range of experience receiving regular supervision. Clients showed no meaningful change on any measure while on the waiting list (Cohen's d <= 0.23). In contrast, highly significant improvements following therapy, all of which were significantly greater than changes during the waiting list, were found on all domains assessed (Cohen's d: 0.44-0.75). All gains were maintained at follow-up (Cohen's d: 0.29-0.82), with little change between end of therapy and follow-up (Cohen's d <= 0.18). Drop-out rate from therapy was low (13%). These results demonstrate the positive and potentially enduring impact of psychological therapy on a range of meaningful outcomes for clients with psychosis. The follow-up assessments were conducted on only a sub-set, which may not generalize to the full sample. Nevertheless this study is the largest of its kind in psychosis, and has important implications for the practice of CBTp in clinical services.
Participants Adult inpatients with delusions (scoring ≥ 4 on at least one of the PANSS delusion... more Participants Adult inpatients with delusions (scoring ≥ 4 on at least one of the PANSS delusion items) A casenote diagnosis of schizophrenia spectrum disorder × Drug-induced psychosis or organic psychosis × A primary diagnosis of substance misuse Baseline interview Symptomatology and delusional dimensions • Positive and Negative Syndrome Scale (PANSS) • Schedule for the Assessment of Positive Symptoms (SAPS) • Psychotic Symptom Rating Scales (PSYRATS) Belief flexibility • Maudsley Assessment of Delusions Scale (MADS; Wessely et al, 1993)-Possibility of being Mistaken (PM)-Reaction to Hypothetical Contradiction (RTHC)
Delusional experiences can be considered on a range of dimensions including conviction, distress,... more Delusional experiences can be considered on a range of dimensions including conviction, distress, preoccupation, and disruption, which have been shown to be related to depression and anxiety. This study aimed to test the hypotheses that delusional conviction is less responsive to antipsychotic treatment than delusional distress and preoccupation, and that depression and anxiety reduce alongside improvements in delusional dimensions. Forty acutely ill inpatients with delusions were assessed during their early stage of antipsychotic treatment. Interview data were analysed using mixed models for repeated measures. There was a significant reduction in psychotic symptoms over eight weeks, after controlling for baseline dosage of antipsychotics. We found no differential rate of improvement across delusional dimensions, and all dimensions improved over time. However, conviction ratings remained relatively high throughout the eight weeks. There was no significant improvement in anxiety and depression, and delusional preoccupation covaried with anxiety and depression throughout eight weeks, suggesting a relationship between emotional and delusional processes during the early recovery phase of psychosis.
The study aimed to determine the clinical and neuropsychological predictors of responsiveness to ... more The study aimed to determine the clinical and neuropsychological predictors of responsiveness to cognitive behavioural therapy for psychosis (CBTp). Sixty patients with schizophrenia or schizoaffective disorder and 25 healthy individuals took part in the study. Thirty patients (25 protocol completers) received CBTp in addition to standard care (SC); 30 patients (18 protocol completers) received SC only. All patients were assessed on symptoms using the Positive and Negative Syndrome Scale (PANSS) and clinical and neuropsychological function before and after CBTp. Symptoms and self-esteem improved to a greater extent in the CBTp+SC than SC control group. Greater pre-therapy coping ability and the self-reflectiveness dimension of cognitive insight at baseline predicted improvement in symptoms in the CBTp+SC group, but not the SC control group, explaining up to 21% of the variance in symptom improvement. Pre-therapy neuropsychological function, duration of illness, clinical insight and ...
Prepulse inhibition (PPI) of the startle response refers to the ability of a weak prestimulus to ... more Prepulse inhibition (PPI) of the startle response refers to the ability of a weak prestimulus to transiently inhibit the response to a closely following strong sensory stimulus. PPI provides an operational index of sensorimotor gating and is reduced, on average, in people with schizophrenia, relative to healthy people. Given the variable response to Cognitive Behaviour Therapy for psychosis (CBTp) and positive associations between pre-therapy brain and cognitive functions and CBT outcome across disorders, we examined whether pre-therapy level of PPI is associated with clinical outcome following CBTp. Fifty-six outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their usual treatment were assessed on acoustic PPI. Subsequently, 28 patients received CBTp (CBTp+treatment-as-usual, 23 completers) for 6-8months and 28 continued with their treatment-as-usual (TAU-alone, 17 completers). Symptoms were assessed (b...
There is evidence that people with psychosis display a "jump-to-conclusions" (JTC) reas... more There is evidence that people with psychosis display a "jump-to-conclusions" (JTC) reasoning style, and that this bias may be specific to delusions. A "jump-to-perceptions" (JTP) cognitive bias has also been found and is typically linked to hallucinations. However, there is some evidence for an association between JTP and delusions, and its specificity to hallucinations remains unclear. It has been suggested that these biases are related and products of shared cognitive processes. This study examined the symptom specificity of JTC and JTP, and the relationship between them, in a sample of 98 individuals with delusions divided into 'hallucinators' (n=51) and 'non-hallucinators' (n=47). Biases were assessed using the beads task and visual and auditory perceptual tasks. As predicted, both groups demonstrated a JTC bias, but the 'hallucinators' showed a more pronounced JTP style in both modalities. The presence of JTC and JTP biases did not co...
Depressive symptoms are common in schizophrenia, often left untreated, and associated with a high... more Depressive symptoms are common in schizophrenia, often left untreated, and associated with a high relapse rate, suicidal ideation, increased mortality, reduced social adjustment and poor quality of life. The neural mechanisms underlying depression in psychosis are poorly understood. Given reports of altered brain response to negative facial affect in depressive disorders, we examined brain response to emotive facial expressions in relation to levels of depression in people with psychosis. Seventy outpatients (final N = 63) and 20 healthy participants underwent functional magnetic resonance imaging during an implicit affect processing task involving presentation of facial expressions of fear, anger, happiness as well as neutral expressions and a (no face) control condition. All patients completed Beck Depression Inventory (BDI-II) and had their symptoms assessed on the Positive and Negative Syndrome Scale (PANSS). In patients, depression (BDI-II) scores associated positively with act...
Psychosis is often characterized by paranoia and poor social functioning. Neurally, there is evid... more Psychosis is often characterized by paranoia and poor social functioning. Neurally, there is evidence of functional dysconnectivity including abnormalities when processing facial affect. We sought to establish whether these abnormalities are resolved by cognitive behavioral therapy for psychosis (CBTp). The study involved 38 outpatients with one or more persistent positive psychotic symptoms, and 20 healthy participants. All participants completed an implicit facial affect processing task during functional magnetic resonance imaging (fMRI). Subsequently, patients either continued to receive standard care only (SCO, n = 16) or received CBTp on top of standard care (+CBTp, n = 22), with fMRI repeated 6-8 months later. To examine the mechanisms underlying CBTp-led changes in threat processing and appraisal, functional connectivity during the social threat (angry faces) condition was assessed separately from left amygdala and right dorsolateral prefrontal cortex (DLPFC) seeds. At baseli...
Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have co... more Randomised controlled trials (RCTs) have shown the efficacy of CBTp, however, few studies have considered its long-term effectiveness in routine services. This study reports the outcomes of clients seen in a psychological therapies clinic, set up following positive results obtained from an RCT (Peters et al., 2010). The aims were to evaluate the effectiveness of CBTp, using data from the service's routine assessments for consecutive referrals over a 12 years period, and assess whether gains were maintained at a 6+ months' follow-up. Of the 476 consenting referrals, all clients (N = 358) who received ≥5 therapy sessions were offered an assessment at four time points (baseline, pre-, mid-, and end of therapy) on measures assessing current psychosis symptoms, emotional problems, general well-being and life satisfaction. A sub-set (N = 113) was assessed at a median of 12 months after finishing therapy. Following the waiting list (median of 3 months) clients received individualized, formulation-based CBTp for a median number of 19 sessions from 121 therapists with a range of experience receiving regular supervision. Clients showed no meaningful change on any measure while on the waiting list (Cohen's d <= 0.23). In contrast, highly significant improvements following therapy, all of which were significantly greater than changes during the waiting list, were found on all domains assessed (Cohen's d: 0.44-0.75). All gains were maintained at follow-up (Cohen's d: 0.29-0.82), with little change between end of therapy and follow-up (Cohen's d <= 0.18). Drop-out rate from therapy was low (13%). These results demonstrate the positive and potentially enduring impact of psychological therapy on a range of meaningful outcomes for clients with psychosis. The follow-up assessments were conducted on only a sub-set, which may not generalize to the full sample. Nevertheless this study is the largest of its kind in psychosis, and has important implications for the practice of CBTp in clinical services.
Participants Adult inpatients with delusions (scoring ≥ 4 on at least one of the PANSS delusion... more Participants Adult inpatients with delusions (scoring ≥ 4 on at least one of the PANSS delusion items) A casenote diagnosis of schizophrenia spectrum disorder × Drug-induced psychosis or organic psychosis × A primary diagnosis of substance misuse Baseline interview Symptomatology and delusional dimensions • Positive and Negative Syndrome Scale (PANSS) • Schedule for the Assessment of Positive Symptoms (SAPS) • Psychotic Symptom Rating Scales (PSYRATS) Belief flexibility • Maudsley Assessment of Delusions Scale (MADS; Wessely et al, 1993)-Possibility of being Mistaken (PM)-Reaction to Hypothetical Contradiction (RTHC)
Delusional experiences can be considered on a range of dimensions including conviction, distress,... more Delusional experiences can be considered on a range of dimensions including conviction, distress, preoccupation, and disruption, which have been shown to be related to depression and anxiety. This study aimed to test the hypotheses that delusional conviction is less responsive to antipsychotic treatment than delusional distress and preoccupation, and that depression and anxiety reduce alongside improvements in delusional dimensions. Forty acutely ill inpatients with delusions were assessed during their early stage of antipsychotic treatment. Interview data were analysed using mixed models for repeated measures. There was a significant reduction in psychotic symptoms over eight weeks, after controlling for baseline dosage of antipsychotics. We found no differential rate of improvement across delusional dimensions, and all dimensions improved over time. However, conviction ratings remained relatively high throughout the eight weeks. There was no significant improvement in anxiety and depression, and delusional preoccupation covaried with anxiety and depression throughout eight weeks, suggesting a relationship between emotional and delusional processes during the early recovery phase of psychosis.
The study aimed to determine the clinical and neuropsychological predictors of responsiveness to ... more The study aimed to determine the clinical and neuropsychological predictors of responsiveness to cognitive behavioural therapy for psychosis (CBTp). Sixty patients with schizophrenia or schizoaffective disorder and 25 healthy individuals took part in the study. Thirty patients (25 protocol completers) received CBTp in addition to standard care (SC); 30 patients (18 protocol completers) received SC only. All patients were assessed on symptoms using the Positive and Negative Syndrome Scale (PANSS) and clinical and neuropsychological function before and after CBTp. Symptoms and self-esteem improved to a greater extent in the CBTp+SC than SC control group. Greater pre-therapy coping ability and the self-reflectiveness dimension of cognitive insight at baseline predicted improvement in symptoms in the CBTp+SC group, but not the SC control group, explaining up to 21% of the variance in symptom improvement. Pre-therapy neuropsychological function, duration of illness, clinical insight and ...
Prepulse inhibition (PPI) of the startle response refers to the ability of a weak prestimulus to ... more Prepulse inhibition (PPI) of the startle response refers to the ability of a weak prestimulus to transiently inhibit the response to a closely following strong sensory stimulus. PPI provides an operational index of sensorimotor gating and is reduced, on average, in people with schizophrenia, relative to healthy people. Given the variable response to Cognitive Behaviour Therapy for psychosis (CBTp) and positive associations between pre-therapy brain and cognitive functions and CBT outcome across disorders, we examined whether pre-therapy level of PPI is associated with clinical outcome following CBTp. Fifty-six outpatients stable on medication with at least one distressing symptom of schizophrenia and willing to receive CBTp in addition to their usual treatment were assessed on acoustic PPI. Subsequently, 28 patients received CBTp (CBTp+treatment-as-usual, 23 completers) for 6-8months and 28 continued with their treatment-as-usual (TAU-alone, 17 completers). Symptoms were assessed (b...
There is evidence that people with psychosis display a "jump-to-conclusions" (JTC) reas... more There is evidence that people with psychosis display a "jump-to-conclusions" (JTC) reasoning style, and that this bias may be specific to delusions. A "jump-to-perceptions" (JTP) cognitive bias has also been found and is typically linked to hallucinations. However, there is some evidence for an association between JTP and delusions, and its specificity to hallucinations remains unclear. It has been suggested that these biases are related and products of shared cognitive processes. This study examined the symptom specificity of JTC and JTP, and the relationship between them, in a sample of 98 individuals with delusions divided into 'hallucinators' (n=51) and 'non-hallucinators' (n=47). Biases were assessed using the beads task and visual and auditory perceptual tasks. As predicted, both groups demonstrated a JTC bias, but the 'hallucinators' showed a more pronounced JTP style in both modalities. The presence of JTC and JTP biases did not co...
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