11 research outputs found

    Improving mental health in autistic young adults : a qualitative study exploring help-seeking barriers in UK primary care

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    Background Autistic people are at increased risk of developing mental health problems. To reduce the negative impact of living with autism in a non-autistic world, efforts to improve take-up and access to care, and support in early years, which will typically start with a GP appointment, must be grounded in the accounts of autistic young adults. Aim To explore how autistic young adults understand and manage mental health problems; and to consider help seeking as a focus. Design and setting A cross-sectional, qualitative study. Autistic participants were purposively selected to represent a range of mental health conditions including anxiety and depression. A subsample were recruited from a population cohort screened for autism in childhood. The study concerns access to primary care. Method Nineteen autistic young adults without learning disabilities, aged 23 or 24 years, were recruited. In-depth, semi-structured interviews explored how they understood and managed mental health problems. Data were analysed thematically. Results Young adults preferred self-management strategies. Multiple factors contributed to a focus on self-management, including: beliefs about the aetiology of mental health difficulties and increased vulnerability with the context of a diagnosis of autism, knowledge of self-management, and a view that formal support was unavailable or inadequate. Families had limited awareness of professional support. Conclusion Young autistic adults without learning disabilities, and their families, may hold erroneous beliefs about autism and mental health. This may affect help seeking and contribute to an exacerbation of symptoms. GPs need to be alert to the fact that autistic young adults in their care may be experiencing mental health difficulties but may not recognise them as such

    Cognitive bias modification for paranoia (CBM-pa): a randomised controlled feasibility study in patients with distressing paranoid beliefs

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    Background: Cognitive Bias Modification for paranoia (CBM-pa) is a novel, theory-driven psychological intervention targeting the biased interpretation of emotional ambiguity associated with paranoia. Study objectives were (i) test the intervention's feasibility, (ii) provide effect size estimates, (iii) assess dose-response and (iv) select primary outcomes for future trials. Methods: In a double-blind randomised controlled trial, sixty-three outpatients with clinically significant paranoia were randomised to either CBM-pa or an active control (text reading) between April 2016 and September 2017. Patients received one 40 min session per week for 6 weeks. Assessments were given at baseline, after each interim session, post-treatment, and at 1- and 3-months post-treatment. Results: A total of 122 patients were screened and 63 were randomised. The recruitment rate was 51.2%, with few dropouts (four out of 63) and follow-up rates were 90.5% (1-month) and 93.7% (3-months). Each session took 30-40 min to complete. There was no statistical evidence of harmful effects of the intervention. Preliminary data were consistent with efficacy of CBM-pa over text-reading control: patients randomised to the intervention, compared to control patients, reported reduced interpretation bias (d = -0.48 to -0.76), improved symptoms of paranoia (d = -0.19 to -0.38), and lower depressed and anxious mood (d = -0.03 to -0.29). The intervention effect was evident after the third session. Conclusions: CBM-pa is feasible for patients with paranoia. A fully powered randomised control trial is warranted

    Bilingual Comparison of Mandarin and English Cognitive Bias Tasks

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    Most research into cognitive biases has used Western samples, despite potential EastWest socio-cultural differences. One reason is the lack of appropriate measures for nonWesterners. This study is about cross-linguistic equivalence which needs to be established before assessing cross-cultural differences in future research. We developed parallel Mandarin and English measures of interpretation bias and attention bias using backtranslation and decentering procedures. We assessed task equivalence by administering both sets of measures to 47 bilingual Mandarin-English speakers. Interpretation bias measurement was similar and reliable across language versions, confirming suitability of the Mandarin versions for future cross-cultural research. By contrast, scores on attention bias tasks did not intercorrelate reliably, suggesting that nonverbal stimuli such as pictures or facial expressions of emotion might present better prospects for cross-cultural comparison. The development of the first set of equivalent measures of interpretation bias in an Eastern language paves the way for future research investigating East-West differences in biased cognition

    Cognitive Bias Modification for paranoia (CBM-pa): study protocol for a randomised controlled trial

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    Persecutory delusions are the most common type of delusions in psychosis and present in around 10-15% of the general population. Persecutory delusions are thought to be sustained by biased cognitive and emotional processes. Recent advances favour targeted interventions, focussing on specific symptoms or mechanisms. Our aim is to test the clinical feasibility of a novel psychological intervention, which manipulates biased interpretations toward more adaptive processing, in order to reduce paranoia in patients.The 'Cognitive Bias Modification for paranoia' (CBM-pa) study is a feasibility, double-blind, randomised controlled trial (RCT) for 60 stabilised outpatients with persistent, distressing paranoid symptoms. Patients will be randomised at a 50:50 ratio, to computerised CBM-pa or a text-reading control intervention, receiving one 40-min session per week, for 6\ua0weeks. CBM-pa involves participants reading stories on a computer screen, completing missing words and answering questions about each story in a way that encourages more helpful beliefs about themselves and others. Treatment as Usual will continue for patients in both groups. Patients will be assessed by a researcher blind to allocation, at baseline, each interim session, post treatment and 1- and 3-month follow-up post treatment. The primary outcome is the feasibility parameters (trial design, recruitment rate and acceptability) of the intervention. The secondary outcomes are clinical symptoms (including severity of paranoia) as assessed by a clinical psychologist, and 'on-line' measurement of interpretation bias and stress/distress. The trial is funded by the NHS National Institute for Health Research.This pilot study will test whether CBM-pa has the potential to be a cost-effective, accessible and flexible treatment. If the trial proves feasible and demonstrates preliminary evidence of efficacy, a fully powered RCT will be warranted.Current Controlled Trials ISRCTN: 90749868 . Retrospectively registered on 12 May 2016

    Cognitive bias modification for paranoia (CBM-pa): a randomised controlled feasibility study in patients with distressing paranoid beliefs.

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    Cognitive Bias Modification for paranoia (CBM-pa) is a novel, theory-driven psychological intervention targeting the biased interpretation of emotional ambiguity associated with paranoia. Study objectives were (i) test the intervention's feasibility, (ii) provide effect size estimates, (iii) assess dose-response and (iv) select primary outcomes for future trials. In a double-blind randomised controlled trial, sixty-three outpatients with clinically significant paranoia were randomised to either CBM-pa or an active control (text reading) between April 2016 and September 2017. Patients received one 40 min session per week for 6 weeks. Assessments were given at baseline, after each interim session, post-treatment, and at 1- and 3-months post-treatment. A total of 122 patients were screened and 63 were randomised. The recruitment rate was 51.2%, with few dropouts (four out of 63) and follow-up rates were 90.5% (1-month) and 93.7% (3-months). Each session took 30-40 min to complete. There was no statistical evidence of harmful effects of the intervention. Preliminary data were consistent with efficacy of CBM-pa over text-reading control: patients randomised to the intervention, compared to control patients, reported reduced interpretation bias ( = -0.48 to -0.76), improved symptoms of paranoia ( = -0.19 to -0.38), and lower depressed and anxious mood ( = -0.03 to -0.29). The intervention effect was evident after the third session. CBM-pa is feasible for patients with paranoia. A fully powered randomised control trial is warranted

    Additional file 1: of Cognitive Bias Modification for paranoia (CBM-pa): study protocol for a randomised controlled trial

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    Examples of CBM-pa and control conditions. Figure S1a. Instructions for the task are included within the programme and displayed before the participant begins. There is no time limit on the instructions. Figure S1b. A CBM-pa intervention passage. The passage is initially ambiguous, but the final word solution requires the participant to interpret in a non-paranoid way. Participants are initially given 20 s to read the passage, and 20 s to complete the word solution. Figure S1c. The participant is required to enter the first missing letter of the word, and is given positive feedback if they do so. Figure S1d. An incorrect response prompts the participant to try again, and more letters are given to help. Participants are given 23 s to respond. Figure S1e. The solution is then shown for 5 s regardless of whether a participant types the letter correctly or not. Figure S1f. A comprehension question is asked to encourage the participant to engage with the meaning of the passage. Participants are given 20 s to answer. Figure S1g. The figure above is shown when a participant responds in a non-paranoid way, for a maximum of 20 s. Figure S1h The figure above is shown when a participant responds in a paranoid way, for a maximum of 20 s. Figure S1i. A text-reading control passage. The text reading control programme is presented in an identical fashion to the CBM-pa. (DOCX 158 kb
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