Sleep quality and paranoia: the role of alexithymia, negative emotions and perceptual anomalies

Recent evidence suggests that sleep problems are associated with psychotic like experiences including paranoia. However, the mechanisms underpinning this association are not well understood and thus studies modelling hypothesised mediating factors are required. Alexithymia, the inability to recognise and describe emotions within the self may be an important candidate. In two separate studies we sought to investigate factors mediating the relationship between sleep quality and paranoia using a cross-sectional design. Healthy volunteers without a mental health diagnosis were recruited (study 1, N= 401, study 2, N= 402). Participants completed a series of measures assessing paranoia, negative emotions, alexithymia and perceptual anomalies in an online survey. In study 1, regression and mediation analyses showed that the relationship between sleep quality and paranoia was partially mediated by alexithymia, perceptual anomalies and negative affect. In contrast, study 2 found that the relationship between sleep quality and paranoia was fully mediated by negative affect, alexithymia and perceptual anomalies. The link between sleep quality and paranoia is unclear and reasons for discrepant results are discussed. Novel findings in this study include the link between alexithymia and paranoia

Psychological aspects of relapse in schizophrenia

Following a review of the relevant literature a Cognitive Behavioural treatment protocol for the prevention of relapse in schizophrenia is presented. This treatment protocol is investigated in a 12-month non-blind randomised controlled trial comparing Cognitive Behavioural Therapy and Treatment as Usual (CBT + TAU) versus Treatment as Usual (TAU) alone. Three studies of treatment outcome are described: relapse and admission, remission and social functioning, and psychological distress. 144 participants with a DSM-IV Schizophrenia spectrum disorder were randomised to receive either CBT + TAU (n = 72) or TAU alone (n = 72). 11 participants dropped out (6 from CBT + TAU, 5 from TAU alone) leaving a completers sample of 133. Participants were assessed at entry, 12-weeks, 26-weeks, and 52 weeks. CBT was delivered over two stages: a 5-session engagement phase which was provided between entry and 12-weeks, and a targeted CBT phase which was delivered on the appearance of early signs of relapse. Over 12-months CBT + TAU was associated with significant reductions in relapse and admission rate. The clinical significance of the reduced relapse and admission rate amongst the CBT + TAU group was investigated. First, receipt of CBT + TAU was associated with improved rates of remission over 12-months. Second, clinically significant improvements in social functioning were investigated. Again, receipt of CBT + TAU was associated with clinically significant improvements in prosocial activities. However, receipt of CBT + TAU was not associated with improvements in psychological distress over 12-months. The theory underpinning the cognitive behavioural treatment protocol predicted that negative appraisals of self and psychosis represent a cognitive vulnerability to relapse. This hypothesis was investigated during the present 2 Abstract study. After controlling for clinical, treatment and demographic variables, negative appraisals of self and entrapment in psychosis were associated with increased vulnerability to relapse, whilst negative appraisals of self were associated with reduced duration to relapse. Finally, an explorative study of changes in negative appraisals of psychosis and self over time, which were associated with relapsers versus non-relapsers from the TAU alone group, was conducted. This study found a strong association between the experience of relapse, increasing negative appraisals of psychosis and self, and the development of psychological co-morbidity in schizophrenia. Results of treatment outcome and theoretical analyses are discussed in terms of their relevance to the further development of psychological models and treatments for psychosis

“It’s like a charge – either fuses you or burns you out”: an interpretative phenomenological analysis of extreme mental states in meditation context

Meditation, an ancient Eastern spiritual practice, is increasingly being practised in the West where its benefits for mental and physical health have been established. Extreme mental states that can be encountered in the context of meditation have also been reported and often have been labelled as psychosis or spiritual emergency. This study aimed for more nuanced understanding of the phenomena. Interpretative phenomenological analysis was employed to explore the meaning-making of three meditation teachers from different philosophical traditions. The teachers described phenomenology of various extreme mental states, explained their nature according to their traditions and discussed ways of helping persons who experience these. Significance was given to having a spiritual teacher to provide guidance and support. The study highlights the importance of acknowledging the diverse understandings of the phenomena and cultivating a non-judgemental attitude towards it, which could help clinicians and meditation teachers work together to support persons experiencing these

Psychosis or spiritual emergency? A Foucauldian discourse analysis of case reports of extreme mental states in the context of meditation

Meditation is becoming increasingly popular in the West and research on its effects is growing. While studies point to various benefits of meditation on mental and physical health, reports of extreme mental states in the context of meditation have also been published. This study employed Foucauldian discourse analysis to examine how the experience of extreme mental states has been constructed in case reports and what kind of practices were employed to address them. The study analyses how extreme mental states associated with meditation are framed within the scientific literature and how such differential framings may affect the meaning making and help-seeking of persons experiencing these states. A systematic scientific literature search identified 22 case studies of extreme mental states experienced by practitioners of various types of meditation. The analysis suggests a discursive divide between two dominant framings: a biomedical discourse which constructs such experiences as psychiatric symptoms and an alternative discursive, which understands them as spiritual emergencies. Both approaches offered distinct therapeutic avenues. This divide maps onto the disciplinary divides within the mental health field more generally, which may obscure a better understanding of these experiences. However, the two discourses are not necessarily mutually exclusive and authors of three articles chose to blend them for their case reports. A supportive environment could help those experiencing extreme state integrate them into their lives. Our findings encourage collaboration between clinicians, therapists and spiritual teachers in order to make a range of approaches available

Clinician perceptions of sleep problems, and their treatment, in patients with non-affective psychosis

Aims and method: To assess clinicians’ views about their understanding and treatment of sleep problems in people with non-affective psychosis. An online survey was emailed to adult mental health teams in two NHS trusts. Results: One hundred and eleven clinicians completed the survey. All clinicians reported disrupted sleep in their patients, and endorsed the view that sleep and psychotic experiences each exacerbate the other. However, most clinicians (n = 92, 82%) assessed sleep problems informally, rather than using standard assessment measures. There was infrequent use of the recommended cognitive-behavioural treatments for sleep problems such as persistent insomnia, with the approaches typically used being sleep hygiene and medications instead. Clinical implications: Clinicians recognise the importance of sleep in psychosis, but the use of formal assessments and recommended treatments is limited. Barriers to treatment implementation identified by the clinicians related to services (e.g. lack of time), patients (e.g. their lifestyle) and environmental features of inpatient settings

Safety, play, enablement, and active involvement: Themes from a Grounded Theory study of practitioner and client experiences of change processes in Dramatherapy

Objective: This study aims to investigate how dramatherapists and dramatherapy clients experience change in therapy and whether change processes identified are consistent across dramatherapeutic approaches. Method: Seven dramatherapists and seven dramatherapy clients were interviewed about their experiences of dramatherapy. Using a grounded theory method three core themes were constructed from the data. Results: The resulting core categories – 1. working within a safe distance; 2. the client being allowed and allowing self to play and try out new ways of being and 3. being actively involved in therapy: creating something visible and having physical experiences using the body, capture the experience of change for both dramatherapists and clients in therapy. Key change mechanisms were also proposed, these included: developing new awareness and finding a language to communicate. Main conclusions: A focus on developing new awareness and increased insight into self are important outcomes for therapy and need to be clearly communicated as such. Future research should include further exploration of the key themes identified and the client developing increased reflective functioning as a key change mechanism during dramatherapy

Mental health professionals’ perspectives of family-focused practice across child and adult mental health settings: a qualitative synthesis

The shift towards a family-focused approach to practice has been highly endorsed across child and adult mental health services, with increasing policy development and a growing evidence base. The aim of this review was to synthesize the qualitative evidence of professionals’ perspectives and experiences of implementing family-focused practice across these settings. Electronic databases were searched up to March 2018, with nine articles included. The synthesis produced two overarching challenges relating to the organizational and system issues of family-focused practice and clinicians’ attitudes, knowledge, and practice towards addressing the complexity of families’ needs. The findings point to a limited evidence of professionals viewing the benefits of family-focused practice and a lack of coherence relating to professionals’ investment in family-focused practice. These are discussed within policy and implementation factors

Schizophrenia: An Exploration of an Acceptance, Mindfulness, and Compassion-based Group Intervention

Objective: This study aimed to develop and apply a brief (five-session) group-based intervention called Compassionate, Mindful and Accepting approach to Psychosis (CMAP) for patients diagnosed with paranoid schizophrenia. Methods: The intervention was based on three major approaches: the mindfulness framework adapted for psychosis with the proposed modifications for meditation work, the rationales from Acceptance and Commitment Therapy, and Compassion-Focused Therapy adapted to psychosis. The intervention was in group format, with one therapist (five 1-hr sessions). Five patients (male, single, between 22 and 35 years old, Caucasian) completed the intervention. Participants completed self-report measures at baseline (1 week prior to intervention) and post-treatment (1 week—additionally the Satisfaction with Intervention Questionnaire). Results: The intervention seemed acceptable for all participants. For illustration of potential benefits of this approach, pre-post results are presented and discussed for two patients. Overall, there was improvement in both patients, although in different measures. Both patients’ conviction in paranoid delusions decreased, while an increase in acting with awareness was observed. Conclusions: Although preliminary, the results are in line with previous research in psychosis. Future directions and clinical implications are discussed

An investigation of the factor structure of the Self-Compassion Scale

The Self-Compassion Scale (SCS) is the most widely used measure of self-compassion. The scale is constructed of six factors measuring positive and negative components of compassion. Support for this factor structure has been subject to debate and alternative factor structures have been proposed. We tested the proposed factor structures against existing models of the SCS including one derived from an exploratory factor analysis of our data. Respondents (n = 526) completed the original version of the SCS online at two time points, at baseline (time 1) and 2.5 months later (n = 332, time 2). Exploratory factor analysis (EFA) was carried out on time 1 data and confirmatory factor analyses (CFA) were conducted on time 2 data and retested using time 1 data. The EFA yielded a five-factor model. CFA was used to compare the following models: Neff’s original six-factor correlated and higher-order models; a single-factor, two-factor, five-factor model (as suggested by the EFA) and a bi-factorial model. The bi-factorial model was the best fit to the data followed by the six-factor correlated model. Omega indices were calculated and yielded support for the bi-factorial model of SCS. In conclusion, this study supports the use of the six-factor scoring method of the SCS and the use of an overarching self-compassion score