Developments in the theory and practice of cognitive and behavioural therapies

In 1993 Behavioural and Cognitive Psychotherapy published a supplement edited by Ann Hackmann with the title “Behavioural and Cognitive Psychotherapies: Past History, Current Applications and Future Registration Issues”. This was the journal's first ever supplement and it provided an overview of the state of behavioural and cognitive psychotherapies at that time. It was intended to provide a context for discussions concerning the future of the field, and as Paul Salkovskis said in his editorial, “[the supplement]. . .will be an important reference source for years to come.

Psychological interventions for working with trauma and distressing voices: the future is in the past

The relationship between stressful or traumatic life events and the content of experiences associated with a diagnosis of schizophrenia is clinically intriguing but lacks developed theoretical understanding. The high prevalence of traumatic events in this group indicates the need to develop psychosocial interventions. However, antipsychotic medication remains the frontline treatment within most mental health services, frequently prescribed by a doctor implicitly (or explicitly) imposing a simplistic disease model, along with the associated lack of hope for those who do not respond well. The essence of this model being that the distressing experiences associated with the diagnosis, typically paranoia and/or hearing voices, are abnormal and symptoms of a disease. Staying within a diagnostic approach, it is worth noting that recent studies suggest that ~15% of people diagnosed with schizophrenia will also present with experiences consistent with a diagnosis of posttraumatic stress disorder (PTSD; Achim et al., 2011). To date the clinical trials aimed at treating PTSD within this group suggest that exposure and eye movement desensitization and reprocessing (EMDR) are effective (Van den Berg et al., 2015) whilst cognitive restructuring alone may not be (Steel et al., 2017). It is likely that psychological interventions for this group will evolve alongside developments in evidence-based interventions for PTSD. Whilst 85% of people diagnosed with schizophrenia do not fulfill the diagnostic criteria for PTSD, the majority have suffered stressful and traumatic life events (Grubaugh et al., 2011). For many of these people, there appears to be a relationship between their life events and the content of their “psychotic” experiences. For example, Hardy et al. (2005) showed that whilst 12.5% of a sample heard distressing voices which were a direct repetition of a past traumatic event, 45% reported a broader emotional link, e.g., hearing a voice content which made them feel humiliated, replicating the emotional state they experienced during the trauma. There is a need to develop trauma informed approaches for this group, especially when considering the negative relationship between adverse life events and antipsychotic treatment outcome (Hassan and De Luca, 2015)

Schizotypal personality and vulnerability to involuntary autobiographical memories

Background and objectives: Individuals who score high on positive schizotypy personality traits are vulnerable to more frequent trauma-related intrusive memories after a stressful event. This vulnerability may be the product of a low level of contextual integration of non-stressful material combined with a heightened sensitivity to a further reduction in contextual integration during a stressful event. The current study assessed whether high scoring schizotypes are vulnerable to frequent involuntary autobiographical memories (IAMs) of non-stressful material. Methods: A free-association word task was used. Participants completed three recorded trials which were then replayed to allow the identification of any associations where an involuntary autobiographical memory had come to mind. Self-report measures of schizotypy and anxiety were completed. Results: All participants retrieved at least one IAM from the three free-association word trials, with 70% experiencing two or more IAMs. Individuals scoring high in schizotypy reported more IAMs than those who scored low. Over 75% of the memories retrieved were neutral or positive in content. Limitations: The current study is an improvement on previous methodologies used to assess IAMs. However, bias due to retrospective recall remains a possibility. Conclusions: Individuals scoring high in schizotypy are vulnerable to an increased level of neutral intrusive memories which may be associated with a ‘baseline’ level of information-processing which is low in contextual integration

Examining vulnerability to involuntary memories in schizophrenia comorbid with post-traumatic stress disorder

The current study explored whether individuals diagnosed with schizophrenia and a high level of PTSD symptoms experience more frequent neutral intrusive memories than individuals diagnosed with schizophrenia with low level PTSD symptoms. Results supported a vulnerability to neutral intrusive memories within the comorbid group, which did not seem to be related to psychotic symptom severity. It is possible that a subgroup of psychotic individuals’ process information in a manner that make them susceptible to frequent intrusive memories, characteristic of a PTSD presentation. A longitudinal study is required to specify the development of this vulnerability so as to inform future interventions

The PCL as a brief screen for posttraumatic stress disorder within schizophrenia

Objectives: To assess the utility of using the Posttraumatic Checklist (PCL) as a screening measure for identifying posttraumatic stress disorder (PTSD) in individuals diagnosed with a psychotic disorder. Methods: The PCL was administered to 165 participants as part of a clinical trial. Those scoring 44 or above on the PCL underwent further assessment using the Clinician Administered PTSD Scale (CAPS-S). Results: Overall 18.2% of the sample exhibited a diagnostic level of PTSD symptoms, as indicated by the CAP-S assessment. Only 29.7% of those who scored above the PCL threshold were diagnostic of PTSD. Conclusions: The use of PCL for identifying PTSD within this population is not recommended

Imagery rescripting for the treatment of trauma in voice hearers: a case series

Background: High rates of trauma and post-traumatic stress disorder (PTSD) are reported in people who hear voices (auditory hallucinations). A recent metanalysis of trauma interventions in psychosis showed only small improvements in PSTD symptoms and voices. Imagery Rescripting (ImRs) may be a therapy that is more effective in this population because it generalizes over memories, which is ideal in this population with typically repeated traumas. The primary aims of this study were to investigate whether ImR reduces (1) PTSD symptoms and (2) voice frequency and distress in voice hearers. Methods: A single arm open trial study, case-series design. Twelve voice hearers with previous traumas that were thematically related to their voices participated. Brief weekly assessments (administered sessions 1-8, post-intervention, and 3-month follow-up) and longer measures (administered pre-, mid-, and post-intervention) were administered. Mixed regression analysis was used to analyze the results. Results: There was one treatment dropout. Results of the weekly measure showed significant linear reductions over time in all three primary variables - Voice Distress, Voice Frequency, and Trauma Intrusions - all with large effect sizes. These effects were maintained (and continued to improve for Trauma Intrusions) at 3-month follow-up. On the full assessment tools, all measures showed improvement over time, with five outcomes showing significant time effects: trauma, voice frequency, voice distress, voice malevolence and stress. Conclusion: The findings of the current study suggest that ImRs for PTSD symptoms is generally well tolerated and can be therapeutically beneficial among individuals who hear voices

The Role of National Culture in the Strategic Use of and Investment in ICT: A Comparative Study of Japanese and Australian Organisations

The recent desire to apply virtual reality for e-commerce implies the need for a better understanding of this emerging medium as an approach for digitisation and marketing of product and brand. Though two-dimensional presentation media (e.g. text, images and videos) are frequently investigated in information systems research, few studies address how virtual reality can be utilised in presenting and selling products, as it only recently became affordable and accessible to consumers. Virtual reality is much more capable of enabling “presence”, the perceptual illusion of nonmediation or the feeling of being in the virtual environment instead of in the real world. This explorative study will investigate what characteristics of immersive virtual reality and its associated virtual space to digitally stimulate “presence”, and whether and how “presence” can affect online consumers’ impression of the e-retailer, interest generation and actual purchasing behaviour of products

The role of national culture in the strategic use of and investment in ICT: a comparative study of Japanese and Australian organisations

Japanese ICT investment trailed the developed world for many decades, contributing to low productivity growth. A potential root cause is the influence of Japanese culture over the strategic use of and investment in ICT (SUIICT). Empirical research on cultural aspects of SUIICT in Japan is lacking. This study will examine national culture and its association with SUIICT in organisations in Japan compared to Australia. A quantitative survey of ICT decision makers in Japanese and Australian organisations will be fielded based on questions synthesized from McFarlan, McKenney and Pyburn (The Strategic Grid), and Hofstede and Minkov (Cultural Dimensions Model). A contribution to theory will be the development and testing of an empirical model and practical instrument for determining the association between national culture and SUIICT. A practical contribution will be an increase in understanding of both markets allowing for more effective market segmentation and development of ICT offerings for both countries

Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behaviour therapy in addition to standard care for patients with psychosis and a co-morbid substance use problem. Design Two-centre, open, rater-blind randomised controlled trial Setting UK Secondary Care Participants 327 patients with clinical diagnoses of schizophrenia, schizophreniform or schizoaffective disorder and DSM-IV diagnoses of drug and/or alcohol dependence or abuse Interventions Participants were randomly allocated to integrated motivational interviewing and cognitive behaviour therapy or standard care. Therapy has two phases. Phase one – “motivation building” – concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two –“Action” – supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcomes The primary outcome was death from any cause or admission to hospital in the 12 months after therapy. Secondary outcomes were frequency and amount of substance use (Timeline Followback), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, global assessment of functioning and deliberate self harm, at 12 and 24 months, with additional Timeline Followback assessments at 6 and 18 months. Analysis was by intention-to-treat with robust treatment effect estimates. Results 327 participants were randomised. 326 (99.7%) were assessed on the primary outcome, 246 (75.2%) on main secondary outcomes at 24 months. Regarding the primary outcome, there was no beneficial treatment effect on hospital admissions/ death during follow-up, with 20.2% (33/163) of controls and 23.3% (38/163) of the therapy group deceased or admitted (adjusted odds-ratio 1.16; P= 0.579; 95% confidence interval 0.68 to 1.99). For secondary outcomes there was no treatment effect on frequency of substance use or perceived negative consequences, but a statistically significant effect of therapy on amount used per substance-using day (adjusted odds-ratios: (a) for main substance 1.50; P=0.016; 1.08 to 2.09, (b) all substances 1.48; P=0.017; 1.07 to 2.05). There was a statistically significant treatment effect on readiness to change use at 12 months (adjusted odds-ratio 2.05; P=0.004; 1.26 to 3.31), not maintained at 24 months. There were no treatment effects on assessed clinical outcomes. Conclusions Integrated motivational interviewing and cognitive behaviour therapy for people with psychosis and substance misuse does not improve outcome in terms of hospitalisation, symptom outcomes or functioning. It does result in a reduction in amount of substance use which is maintained over the year’s follow up. Trial registration Current Controlled Trials: ISRCTN1440448