A case series study of compassion-focused therapy for distressing experiences in psychosis

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

Schizophrenia or possession? A reply to Kemal Irmak and Nuray Karanci

A recent paper in this journal argues that some cases of schizophrenia should be seen as cases of demon possession and treated by faith healers. A reply, also published in this journal, responds by raising concerns about the intellectual credibility and potentially harmful practical implications of demon possession beliefs. My paper contributes to the discussion, arguing that a critique of demon possession beliefs in the context of schizophrenia is needed, but suggesting an alternative basis for it. It also reflects on important differences between demonic and other forms of spirit possession and considers the implications of this for mental healthcare providers

Analytic cognitive style, not delusional ideation, predicts data gathering in a large beads task study

It has been proposed that deluded and delusion-prone individuals gather less evidence before forming beliefs than those who are not deluded or delusion-prone. The primary source of evidence for this "jumping to conclusions" (JTC) bias is provided by research that utilises the "beads task" data-gathering paradigm. However, the cognitive mechanisms subserving data gathering in this task are poorly understood.In the largest published beads task study to date (n = 558), we examined data gathering in the context of influential dual-process theories of reasoning.Analytic cognitive style (the willingness or disposition to critically evaluate outputs from intuitive processing and engage in effortful analytic processing) predicted data gathering in a non-clinical sample, but delusional ideation did not.The relationship between data gathering and analytic cognitive style suggests that dual-process theories of reasoning can contribute to our understanding of the beads task. It is not clear why delusional ideation was not found to be associated with data gathering or analytic cognitive style.15 page(s

A systematic review of the implementation of psychological therapies in acute mental health inpatient settings

OBJECTIVES: Research has demonstrated that psychological therapies are not routinely delivered in acute mental health inpatient settings despite being recommended by the National Institute for Health and Care Excellence (NICE) guidelines. This study aimed to identify the barriers and facilitators to implementing psychological therapies in acute mental health inpatient settings. METHODS: A systematic review and narrative synthesis was undertaken. Primary studies were included if they examined the implementation of a NICE recommended psychological therapy in acute psychiatric inpatient settings and were of any study design. Four databases were searched for eligible studies (MEDLINE, CINAHL Plus, PsycINFO and Embase) and Google Scholar. RESULTS: A total of 16 studies (a mixture of both qualitative and quantitative methodologies) were included in the review, and the majority evaluated the implementation of Cognitive Behaviour Therapy. Overall, the literature was deemed to be of poor to moderate quality. The main barriers to the implementation of psychological therapy were the busy nature of the ward, multi-disciplinary professionals not being suitability trained and the acute nature of service users mental health difficulties. Facilitators to implementation included the adaptation of interventions to be specifically delivered in the acute inpatient setting, training of multi-disciplinary professionals, leadership support with the delivery of psychological therapies and prioritising the therapeutic relationship. CONCLUSIONS: There is a requirement for senior management to prioritise the implementation of psychological therapies and update clinical guidelines to describe modifications necessary to implement psychological therapies in acute inpatient settings. Future research should improve their methodological quality and continue to develop the evidence base of brief psychological therapies in acute inpatient settings