Biomedical subjects

Philippa A Garety

Publications and source records attributed to Philippa A Garety.

18 recordsLinked to original sources

PubMed2006

Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence.

In a recent theoretical account of persecutory delusions, it is suggested that anxiety and worry are important factors in paranoid experience [Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., & Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41(4), 331-347]. In emotional disorders worry has been understood in terms of catastrophising. In the current study, the concept of catastrophising is applied for the first time with persecutory delusions. Thirty individuals with current persecutory delusions and 30 non-clinical controls participated in a cross-sectional study. The group with persecutory delusions was also followed up at 3 months to assess predictors of delusion persistence. At its most severe, 21% of individuals with persecutory delusions had clinical worry, 68% had levels of worry comparable with treatment seeking GAD patients. Further, high levels of anxiety, worry and catastrophising were associated with high levels of persecutory delusion distress and with the persistence of delusions over 3 months. If future research replicates these findings, worry reduction interventions for individuals with persecutory delusions may be warranted.

Adult↗

PubMed2006

A validation of a new measure of activity in psychosis.

Despite demonstrated relationships between activity and clinical change, we lack effective measures of time use in psychosis. Existing time budget measures of activity are demanding to complete, and thus unsuited to routine clinical use as measures of change. Less burdensome 'check-box' measures are prone to bias and omission in the activities selected. We recently devised a simplified time budget measure of activity in psychosis which was piloted on a small sample [Jolly, S., Garety, P., Dunn, G., White, J., Aitken, M., Challocombe, F., Griggs, M., Wallace, M., Craig, T. 2005. A pilot validation study of a new measure of activity in psychosis. Soc. Psychiatry Psychiatr. Epidemiol. 40, 905-911]. This study is a larger scale validation. 276 participants with a recent relapse of non-affective psychosis completed the new time budget, together with an established measure of global social functioning, measures of positive and negative psychotic symptoms, positive symptom distress and affect. The time budget measure showed a correlation of 0.5 with both the SOFAS and the SANS avolition/apathy subscale. Activity levels were related to psychotic symptomatology, both positive and negative. Positive symptom distress was more strongly associated with activity levels than symptom severity and affective disturbance. We conclude that the time budget measure can be used as an indicator of social functioning, with potential as a measure of therapeutic change. We are currently investigating its sensitivity in this context.

Adult↗

PubMed2006

Acting on persecutory delusions: the importance of safety seeking.

OBJECTIVE: Acting on delusions is a significant clinical issue. The concept of safety behaviours--actions carried out with the intention of reducing perceived threat--provides a new way of understanding acting on delusions. A study was conducted with the aim of examining the prevalence and correlates of safety behaviours related to persecutory delusions. METHOD: One hundred patients with persecutory delusions were assessed for safety behaviours, acting on delusions, anxiety, depression, and psychotic symptoms. Case note data were collected on instances of serious violence or suicide attempts. RESULTS: Ninety-six patients had used safety behaviours in the last month. Greater use of safety behaviours was associated with higher levels of distress. A history of violence or suicide attempts was associated with greater use of safety behaviours. Safety behaviours were significantly associated with acting on delusions, but not with the negative symptoms of psychosis. CONCLUSION: Safety behaviours are a common form of acting on persecutory delusions. These behaviours have the consequence that they are likely to prevent the processing of disconfirmatory evidence and will therefore contribute to delusion persistence.

Adolescent↗

PubMed2006

Specialised care for early psychosis: symptoms, social functioning and patient satisfaction: randomised controlled trial.

BACKGROUND: The provision of early intervention services for people with psychosis is UK government policy, although evidence for benefit of such services is sparse. AIMS: To evaluate the effects of a service providing specialised care for early psychosis (the Lambeth Early Onset Team) on clinical and social outcomes, and on service user satisfaction. METHOD: One hundred and forty-four people with psychosis, presenting to mental health services for the first or second time (if previously failed to engage in treatment), were randomly allocated to care by the early onset team or to standard care. Information was obtained on symptoms, treatment adherence, social and vocational functioning, satisfaction and quality of life. Relapse and rehospitalisation data have been reported separately. RESULTS: Outcomes for the participants treated by the early onset team were significantly better at 18 months for aspects of social and vocational functioning, satisfaction, quality of life and medication adherence. Symptom improvement did not significantly differ between the groups. CONCLUSIONS: The provision of specialised care for early psychosis can achieve better outcomes. The study therefore provides support for current policy.

Adolescent↗

PubMed2006

Content and affect in persecutory delusions.

OBJECTIVES: The study aimed to explore the content of persecutory delusions and its potential links with levels of affective disturbance. Detailed examinations of the phenomenology of delusional beliefs have been rare, but are important for furthering theoretical and clinical understanding. DESIGN: A cross-sectional investigation of 70 individuals with current persecutory delusions was conducted. METHODS: Taped semi-structured clinical interviews were transcribed for each participant. Using a coding frame devised for the current study, a detailed description of persecutory content was made. Scores on the Beck Depression and Anxiety Inventories, the Rosenberg Self-esteem Scale and the Psychotic Symptom Rating Scales were used as indicators of emotional distress. RESULTS: Data were gathered on the identity and type of persecutor, pervasiveness of threat and the power of the persecutor. Reliability was good. Beliefs involving multiple persecutors, human in nature and identifiable to the individual were common. For the majority threat was severe, ongoing and enduring and coupled with frequent feelings of vulnerability. Specific aspects of delusional content were found to be associated with emotional distress. For example, if participants felt more power in the face of persecution this was coupled with lower depression and higher self-esteem. CONCLUSIONS: Persecutory delusions are beliefs concerning severe threat, particularly of physical harm including death, which is personally significant, frequently involving multiple persecutors known to the individual. Depression is higher in those who felt less powerful than their persecutors. Associations, such as this, with emotional distress support a direct role for emotion in delusion formation and maintenance. It is consistent with cognitive models of delusions which emphasize the importance of considering emotional distress in the context of belief appraisal, although interpretation of the results is limited by the cross-sectional study design. Recognizing these links may in turn aid therapists in identifying aspects of beliefs that might be targeted to facilitate emotional change.

Adolescent↗

PubMed2005

Need for closure and anxiety in delusions: a longitudinal investigation in early psychosis.

This study investigated the role of need for closure (NFC) and anxiety in delusions. The Need For Closure Scale (NFCS) and measures of trait and state anxiety were administered to an early psychosis group with current delusions, a clinical (generalised anxiety disorder--GAD) control group and a non-clinical control group. The battery of questionnaires was repeated at follow-up one year later. The NFCS did not meet criteria for a unidimensional scale and two sub-scales were removed from all further analyses. At baseline the deluded and GAD groups scored significantly higher on the reduced NFCS (NFCS-R) than the control group. Trait anxiety was related to NFCS-R in the GAD and non-clinical control groups, but not in the deluded group. At follow-up all groups scored significantly lower on the NFCS-R, perhaps suggesting a practice effect, although the two clinical groups continued to have higher scores than the non-clinical control group. The recovered and non-recovered deluded groups did not differ on the NFCS-R one year later, unlike in the GAD group where recovered participants had significantly lower scores than the non-recovered. Change scores on the NFCS-R and trait anxiety were correlated at trend level in the GAD and non-clinical control groups, but not in the deluded group. These findings suggest that whilst NFC and trait anxiety are related in non-psychotic groups, NFC may be implicated in the formation of delusions, independently of anxiety, in psychotic individuals.

Adolescent↗

PubMed2005

Reasoning, emotions, and delusional conviction in psychosis.

The aim of the study was to elucidate the factors contributing to the severity and persistence of delusional conviction. One hundred participants with current delusions, recruited for a treatment trial of psychological therapy (PRP trial), were assessed at baseline on measures of reasoning, emotions, and dimensions of delusional experience. Reasoning biases (belief inflexibility, jumping to conclusions, and extreme responding) were found to be present in one half of the sample. The hypothesis was confirmed that reasoning biases would be related to delusional conviction. There was evidence that belief inflexibility mediated the relationship between jumping to conclusions and delusional conviction. Emotional states were not associated with the reasoning processes investigated. Anxiety, but not depression, made an independent contribution to delusional conviction.

Adolescent↗

PubMed2005

The psychology of persecutory ideation II: a virtual reality experimental study.

A cognitive model of persecutory delusions is used to predict the occurrence of nonclinical paranoid thoughts in a virtual reality environment. Scorers across the range of paranoia entered a virtual reality scene populated by five computer characters programmed to behave neutrally (N = 30). Many appraisals of the computer characters were positive or neutral. However, there were also persecutory thoughts about the characters. Providing evidence of the validity of the experimental method, persecutory ideation was predicted by higher trait paranoia and a greater sense of presence in the environment. The psychological variables from the cognitive model that predicted persecutory ideation were anxiety, timidity, and hallucinatory predisposition. Further, hallucinatory predisposition distinguished the prediction of paranoid thoughts from social anxiety in virtual reality. It is concluded that nonclinical paranoid thoughts are most closely associated with emotional disturbances and anomalous experiences. Extreme reasoning bias may particularly contribute to the development of clinical phenomena.

Adult↗

PubMed2005

The psychology of persecutory ideation I: a questionnaire survey.

Paranoia is a complex phenomenon that is likely to arise from a number of factors. In a recent cognitive model of persecutory delusions, three key factors are highlighted: anomalous experiences, emotion, and reasoning. In the first of two linked studies, we report a questionnaire survey of nonclinical paranoia designed to assess the theoretical model. A nonclinical population (N = 327) completed measures of paranoia, anomalous experiences (hallucinatory predisposition, perceptual anomalies), emotion (depression, anxiety, self-focus, stress, interpersonal sensitivity), and reasoning (need for closure). Paranoia was best explained by separation anxiety, depression, fragile inner self, hallucinatory experiences, discomfort with ambiguity, stress, self-focus, perceptual anomalies, and anxiety. The findings are consistent with the central predictions within the model of paranoia.

Adult↗

PubMed2005

Psychological investigation of the structure of paranoia in a non-clinical population.

BACKGROUND: Previous studies of paranoia have assessed only limited numbers of paranoid thoughts, and have not considered the experience from a multidimensional perspective or examined the relationship between different suspicious thoughts. AIMS: To assess a wide range of paranoid thoughts multidimensionally and examine their distribution, to identify the associated coping strategies and to examine social-cognitive processes and paranoia. METHOD: Six questionnaire assessments were completed by 1202 individuals using the internet. RESULTS: Paranoid thoughts occurred regularly in approximately a third of the group. Increasing endorsement of paranoid thoughts was characterised by the recruitment of rarer and odder ideas. Higher levels of paranoia were associated with emotional and avoidant coping, less use of rational and detached coping, negative attitudes to emotional expression, submissive behaviours and lower social rank. CONCLUSIONS: Suspiciousness is common and there may be a hierarchical arrangement of such thoughts that builds on common emotional concerns.

Adaptation, Psychological↗

PubMed2005

Developing a theoretical understanding of therapy techniques: an illustrative analogue study.

OBJECTIVES: In psychological interventions, clients are often asked to review unhelpful beliefs. Surprisingly, there is no theoretical understanding of how beliefs are reviewed in therapy. Moreover, by understanding a therapeutic technique, potential interactions with symptom processes can be considered. An analogue study assessing the feasibility of researching therapy techniques is described, in which links between symptoms, reasoning style, and an experimental version of the cognitive therapy technique of belief evaluation are examined. DESIGN: Individuals without psychiatric illness (N = 30) completed (i) dimensional measures of depression, anxiety, and delusions, (ii) a measure of confirmatory reasoning (Wason's 2-4-6 task) both before and after instruction in disconfirmatory reasoning, and (iii) a belief evaluation task. RESULTS: Compared with individuals with a confirmatory reasoning style, individuals with a disconfirmatory reasoning style in Wason's task were less hasty in their data gathering, considered a greater number of hypotheses during the task, had higher intellectual functioning, and had lower levels of depressive symptoms. Conversely, the individuals with the strongest confirmatory reasoning had higher levels of depression and preoccupation with delusional ideation. Successful adoption of disconfirmatory reasoning was associated with less hasty decision-making and lower levels of preoccupation and distress by delusional ideation. Individuals with a disconfirmatory reasoning style reported more evidence both for and against their beliefs in the belief evaluation task. CONCLUSION: The preliminary evidence, from this small non-clinical group, indicates that evaluating beliefs may partially involve the use of confirmatory and disconfirmatory reasoning processes. Disconfirmatory reasoning, associated with less hasty data gathering and consideration of alternatives, may lead to better belief evaluation. In the context of clinical research indicating that individuals with delusions are hasty in their data gathering and have difficulty considering alternatives, a potential implication of the findings is that individuals with delusions may find belief evaluation in therapy.

Adult↗

PubMed2005

Bad me paranoia in early psychosis: a relatively rare phenomenon.

PURPOSE: The aim of this study was to follow up Trower and Chadwick's (1995) proposal that there are two types of paranoia: poor me paranoia, in which the persecution is believed to be undeserved, and bad me paranoia, in which the persecution is seen as a deserved punishment. METHOD: A cross-sectional design was used. A group of 40 participants with early psychosis, who were experiencing persecutory delusions, were assessed using a semi-structured interview on the content of their beliefs. RESULTS: An extremely low rate of bad me paranoia was found in the sample of participants with early psychosis. CONCLUSIONS: People with persecutory delusions who are in the initial stages of their illness do not tend to believe that they are being justifiably punished. Stigma and depression are put forward as tentative explanations of the development of this evaluative belief with time.

Acute Disease↗

PubMed2005

Factors in outcome of cognitive-behavioural therapy for psychosis: users' and clinicians' views.

OBJECTIVES: Despite increasing evidence to suggest that cognitive-behavioural therapy (CBT) is helpful for a significant proportion of people with psychosis, only limited information is available regarding factors implicated in outcome. The present study investigated factors differentiating outcomes on the basis of accounts from participants in the therapeutic process. METHOD: Four therapists and eight of their clients were interviewed about their experiences of CBT. Clients were defined as having progressed or not progressed during therapy. Interview data were analysed using a qualitative 'grounded theory' methodology. RESULTS: A number of major categories differentiated the two client groups, including ability to let go of distressing beliefs, logical thought, holding therapy, and presence of a shared goal. Overall, clients who progressed were better able to move into the therapist's frame of reference. Therapists and clients also felt that non-specific benefits accrued from the therapy for both groups. CONCLUSION: The results were consistent with previous studies suggesting that ability to disengage from distressing beliefs is important in therapeutic progression. Reasons considered for the inability to progress include emotional investment in psychotic beliefs and cognitive processing. Further research is required to clarify the role of logical thought and therapeutic alliance in progress and in predicting outcome.

Adult↗

PubMed2004

Why do people with delusions fail to choose more realistic explanations for their experiences? An empirical investigation.

Delusions can be viewed as explanations of experiences,. By definition, the experiences are insufficient to merit the delusional explanations. So why have delusions been accepted rather than more realistic explanations? The authors report a study of alternative explanations in 100 individuals with delusions. Patients were assessed on the following criteria: symptom measures, the evidence for the delusions, the availability of alternative explanations, reasoning, and self-esteem. Three quarters of the patients did not report any alternative explanation for the experiences on which the delusions were based. These patients reported significantly more internal anomalous experiences and had a more hasty reasoning style than patients who did have alternative explanations available. Having doubt in a delusion, without an alternative explanation, was associated with lower self-esteem. Clinicians will need to develop plausible and compelling alternative accounts of experience in interventions rather than merely challenge patients' delusional beliefs.

Adult↗

PubMed2003

Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations.

Diagnostic classification systems contain a core divide between neurosis and psychosis, leading to their separate study and treatment. The basis for the separation of the disorders is outlined and reassessed. It is argued that the empirical evidence does not support such a sharp distinction between neurosis and psychosis. The frequent occurrence of emotional disorder prior to and accompanying psychosis indicates that neurosis contributes to the development of the positive symptoms of psychosis. Psychological theories and experimental evidence concerning the influence of emotion on the content and form of delusions and hallucinations are therefore reviewed. It is argued that in many cases delusions are a direct representation of emotional concerns, and that emotion contributes to delusion formation and maintenance. The content of hallucinations less often directly expresses the emotional concerns of the individual, but emotion can trigger and contribute to the maintenance of hallucinatory phenomena, although how this occurs is not well understood. It is concluded that study needs to be made of the interaction between psychotic and neurotic processes in the development of delusions and hallucinations, and that neurotic and psychotic disorders may have common maintenance processes.

Delusions↗

PubMed2003

Can virtual reality be used to investigate persecutory ideation?

The use of virtual reality permits individuals' reactions to standard controlled environments to be studied. It may therefore provide a means for understanding the interpretations of experience relevant to clinical disorders. The use of this technology for understanding persecutory ideation has not been investigated. A pilot study was undertaken to examine whether individuals have persecutory thoughts about virtual reality characters under controlled conditions and if there are factors that predict the occurrence of such thoughts.Twenty-four nonclinical participants entered a neutral virtual environment that contained computer-generated people. The participants completed dimensional assessments of items related to psychiatric symptoms and their thoughts about the virtual characters. Positive views about the virtual characters were common. However, a number of participants had ideas of reference and ideas of persecution about the virtual characters. Individuals who had persecutory thoughts about the virtual characters had significantly higher levels of interpersonal sensitivity and anxiety. The study provides direct evidence that individuals attribute mental states to virtual reality characters. Important for the study of clinical phenomena, some individuals have thoughts of a persecutory nature about virtual characters. Additionally, the findings indicate that feelings of interpersonal vulnerability and anxiety may directly contribute to the development of persecutory ideation in response to essentially neutral contexts. Virtual reality may prove to be a valuable methodology for developing an understanding of persecutory ideation.

Adult↗

PubMed2003

The future of psychological therapies for psychosis.

The need for psychological therapies for psychosis is increasingly recognised. In recent years, two psychological approaches, cognitive behavioural therapy (CBT) and family interventions (FI), have emerged from among a range of psychological approaches as effective therapies with the strongest evidence base. The theoretical basis of these approaches, within a broader biopsychosocial stress-vulnerability framework, is described. The evidence of effectiveness, drawn from the results of recent systematic reviews of CBT and FI, is summarised. CBT is found to reduce symptoms and FI to reduce relapse, with some evidence of improvement in other outcomes for both approaches. Future directions for these therapies are considered, with particular emphasis on their role in early intervention services and relapse prevention. Promising newer applications of these approaches are also discussed, for example in work with people with a dual diagnosis of psychosis and substance misuse disorder. Finally, training and dissemination issues are addressed. It is emphasised that the integration of psychological therapies within comprehensive service provision is important.

Journal Article↗

PubMed2002

A cognitive model of persecutory delusions.

A multifactorial model of the formation and maintenance of persecutory delusions is presented. Persecutory delusions are conceptualized as threat beliefs. The beliefs are hypothesized to arise from a search for meaning for internal or external experiences that are unusual, anomalous, or emotionally significant for the individual. The persecutory explanations formed reflect an interaction between psychotic processes, pre-existing beliefs and personality (particularly emotion), and the environment. It is proposed that the delusions are maintained by processes that lead to the receipt of confirmatory evidence and processes that prevent the processing of disconfirmatory evidence. Novel features of the model include the (non-defended) direct roles given to emotion in delusion formation, the detailed consideration of both the content and form of delusions, and the hypotheses concerning the associated emotional distress. The clinical and research implications of the model are outlined.

Cognition Disorders↗