Background. Help-seeking is a concept of growing interest in the context of psychosis and the move towards early intervention and community-based service models. Despite a preponderance of first episode studies in this field, help-seeking is also of clinical relevance to adults with more chronic psychosis in the face of spiralling patterns of relapse and diminished recovery. Recent research into attachment theory opens up new avenues for exploring aspects of relating in psychosis, including help-seeking in mental health service contexts. Methods. A systematic review of attachment and psychosis was carried out to critically assess the strength and nature of empirical support for this theory within a clinical context. A social-constructivist based grounded theory study of help-seeking and chronic psychosis was conducted amongst nine individuals in a long term rehabilitation service. This aimed to develop an experiential account and grounded theory of the processes shaping help-seeking for this clinical group. Study findings were reviewed against existing constructs of attachment style, service attachment, recovery style and beliefs about psychosis. Results. A grounded theory emerged from the study emphasising the importance of three domains; ‘beliefs about the self’, ‘beliefs about others’ and ‘service experience’, in dynamically shaping views to help-seeking and receiving, for those with chronic psychosis. Attachment theory and recovery coping style were seen as compatible with this model. Conclusions. Individuals with chronic psychosis may continue to experience difficulties with help-seeking and service engagement, even within supported service settings. An appreciation of the interpersonal significance of service interactions, and improved understanding in this area, may help services better anticipate, respond to and adjust their models of engaging for this important clinical group.

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Background. Previous studies have shown that the use of simulated social environments permits paranoid thinking to be studied. These studies have used a cognitive model of paranoia and suggest that anxiety is an important part of the paranoid experience. Additionally, research addressing the relationship of childhood trauma to psychosis indicates that psychotic symptoms are related to childhood abuse and neglect. The aim of the study was to explore the role of anxiety and childhood trauma in psychotic and anxious participants using a simulated social encounter task. Method. 15 individuals with paranoid delusions (diagnosed with a psychotic disorder), 11 with anxiety disorders and 14 non-clinical controls experienced a simulated social encounter task populated by four filmed characters instructed to behave neutrally (n=40). After the task, the participants completed questionnaires to describe their experience of the situation. 5 questionnaires were used to study paranoid thoughts. The first two were the Details of Threat questionnaire and the VR questionnaire. The other 3 were designed specifically for the study (faces, trust and power questionnaires). Additionally, the Beck Anxiety and Depression Inventories and also a childhood trauma questionnaire were used as indicators of emotional distress. Results. Appraisals from the clinical participants but not from the non-clinical ones were persecutory. The psychological variables from the cognitive model that predicted persecutory ideation were anxiety and neglect. Further, over-sensitivity towards the neutral faces of the characters distinguished again, clinical and non-clinical participants. Conclusions. Paranoid thinking was elicited in clinical participants (anxious and psychotic) by a simulation of a social situation but not in normal controls. Anxiety and two forms of childhood trauma (physical and emotional neglect) were closely associated to persecutory thoughts. The results provide support for the cognitive model of paranoid delusions suggesting that anxiety and neglect underlay paranoid thinking. The study also shows the usefulness of simulations in clinical research.

Background: Empirical evidence suggests a relationship between early trauma and psychosis. However, the underlying mechanisms for this relationship remain unclear. Research into metacognitive functioning in psychosis indicates higher levels of metacognitive dysfunctional beliefs within this patient group. The potential effects of early trauma on metacognitive functioning in psychosis has to date been scarcely researched. Reflective functioning (RF) is believed to be affected by early trauma and leading to psychopathology, particularly borderline personality disorder. However, to date no studies have investigated the effects of early trauma on RF within psychosis. Objectives: The primary aim of this study was to establish core links between the effects of early trauma and metacognitive and reflective functioning in psychosis. A secondary aim was to test the clinical applicability of a brief, newly developed attachment-based measure for RF. Furthermore, the study aimed to explore potential overlaps between the concepts of metacognition and reflective functioning. Method: A quantitative methodology was employed, using a combination of semi-structured interviews and self-report questionnaire, and group comparisons were conducted. Twenty-seven patients with psychosis or bipolar disorder were recruited. Participants were grouped into early trauma versus no early trauma; trauma versus no trauma; and in-patient versus out-patient, and exploratory analyses were completed. Results: No significant effects were found for early trauma but for trauma in general, indicating higher level of dysfunctional beliefs in patients with trauma (early plus adult trauma) history. No significant effect between groups were found for RF. Inpatients, however, showed significantly lower levels of RF when compared with outpatients, and outpatients significantly higher levels of cognitive self-focus(thinking about thoughts). Moreover, a modest positive correlation was found between both measures. Discussion: The findings of the present study suggest core links between the effects of trauma on metacognitive functioning in psychosis. This highlights the importance of routine trauma assessment with psychotic patients. The limitations of the metacognitive model within psychosis are discussed. Further research is implicated to investigate any potential effects of early trauma on RF in psychosis. Low level of RF in in-patients highlights the importance to integrate therapeutic techniques to improve RF functioning in this patient group since high RF is associated with resilience and better therapy outcome. The correlation between metacognition and RF measure indicates construct-validity for the RF measure. The differences between both concepts are considered. Furthermore, the limitations of this study and clinical utility are discussed along with suggestions for future research.

Background: Attachment literature indicates attachment status is related to trauma with associations between early trauma and insecure attachment. Links between psychosis and trauma have been established within the literature; however the precise nature of this relationship is still not fully understood. A systematic review was carried out to assess the state of the evidence pertaining to psychosis and attachment. Associations between insecure attachment and psychotic symptoms were identified. Other psychological correlates such as perceived parental care, attachment to services and interpersonal problems were found to relate to insecure attachment status. However due to the early stage of this area of research, small clinical sample sizes and heterogeneity of correlates investigated, firm conclusions cannot currently be drawn. Aim: The aim of this study was to investigate the relationship between trauma, attachment, reflective functioning (RF) and distress for people with psychosis with a view to further understanding these links and the clinical implications. Method: Participants with a diagnosis of psychosis were recruited and measures were completed with the principle investigator pertaining to trauma, attachment and distress in psychosis. Results: The majority of the sample reported insecure attachment and low RF and there were high levels of general, and more specifically, interpersonal trauma within the sample. Results indicated that early interpersonal trauma was associated with higher levels of emotional distress. Exploratory mediation analyses implicated anxious attachment in mediating the relationship between interpersonal trauma and distress. Discussion: The results indicate the need to consider early trauma histories and specifically interpersonal trauma and attachment in the context of emotional distress for people experiencing psychosis. Incorporating trauma and attachment based therapeutic approaches for people with psychosis is as relevant as it is for other trauma populations, where these approaches may be more routinely drawn on for formulation and treatment. Limitations of the methodological approach are considered along with suggestions for future research.

Background: High levels of dissociation have been found in recent studies involving psychiatric inpatients. Proponents of the ‘dissociative psychoses’ have found that trauma-focused intervention strategies can improve outcomes of patients with major mental illness. Despite this, levels of dissociation have not been measured in forensic inpatients in Scotland. This study investigates levels of dissociative symptoms (DES-II) within a sample of male patients in secure forensic psychiatry settings in Scotland. It explores levels of psychosis (PANSS) and self-reported childhood trauma (CTQ), current PTSD symptoms (IES-R), levels of depression (BDI-II) and broad attachment style (RQ). Four groups were arbitrarily defined based on presence or absence of psychosis and childhood trauma. It was hypothesised that levels of dissociation would be predicted by presence of childhood trauma. Methods: A quantitative cross-sectional design was used in which 56 mentally disordered offenders were interviewed across three different secure hospitals in Scotland: The State Hospital – a maximum security psychiatric hospital, and two medium secure facilities. Attempts are made to clarify the relationship of dissociation with different types of childhood trauma and psychosis symptom clusters. By splitting the data into groups the study seeks to discern whether the groups differ significantly on dissociation scores in relation to the childhood experiences they reported and presence of psychosis they are experiencing. Results: Childhood traumatic experiences were frequent where median CTQ total score = 47.0 (IQR: 42-70.5). Physical neglect was reported by 58.9% of the sample closely followed by emotional neglect (55.4%). 46.4% of the sample reported physical abuse of significant levels, 44.6% reported being emotionally abused and almost a third reported being sexually abused (28.6%). DES-II (dissociation) scores were significantly associated with delusions and hallucinatory behaviour from PANSS. Emotional abuse and sexual abuse were significantly associated with dissociation scores. Mann Whitney tests revealed that dissociation was significantly higher in the groups which reported childhood trauma. Kruskal-Wallis results indicated no significant differences between groups within the data and dissociation scores. Conclusion: Patients with clinically significant levels of dissociative symptoms were identified. This indicates that dissociation is a key characteristic, warranting further consideration in this sample. Levels and severity of reported childhood trauma were higher than expected. The findings add weight and support to the importance of dissociation and trauma in formulations of male, mentally disordered offenders. Clinical implications of these findings are considered and further directions are discussed.

Introduction: Young people recovering from first episode psychosis experience a high degree of emotional distress and co-morbidity. Depression and social anxiety are highly prevalent following first episode psychosis and have been associated with poorer outcome, increased risk of suicide and lower quality of life. However, there is little research examining how these emotional difficulties relate to the course of psychotic symptoms and subsequent adaptation and recovery. The primary aim of this research was to establish a grounded theory of the experience of mood and anxiety related difficulties in young people who experience a first episode psychosis. Secondly, the research aimed to establish the underlying psychological factors contributing to the relationship between psychosis and affective dysfunction. Method: The study used a mixed-methods design with primacy given to the qualitative component (QUAL+quan). Young people (n=10) who had experienced a first-episode of psychosis were interviewed and completed measures of depression, social anxiety and recovery. Interviews were transcribed and analysed using a social constructivist version of grounded theory. Quantitative measures were integrated with the qualitative data, providing a framework for re-examining inferences made in the qualitative analysis. Results: The overarching theme to emerge was the experience of a developmental trajectory of psychosis. Seven key categories were identified: The build up; coping; breaking point; facing diagnosis; impact of illness; getting stuck and; moving on. Isolation, low mood and anxiety were universal outcomes and appeared to be mediated by maladaptive forms of coping and mood regulation in addition to psychological appraisals and negative illnessrelated experiences. Conclusions: The findings suggest that depression and social anxiety are not co-morbid features of psychosis but are intrinsically linked to the underlying processes involved in coping with and adapting to psychosis. Strengths and limitations of the research are discussed and implications for clinical practice and further research are reviewed.

Family Interventions (FI) are recommended in the treatment of psychosis. This is based on the robust finding that a high rating of Expressed Emotion (EE) is predictive of poor outcome. Research has looked to attachment and attribution theories to further develop our understanding of EE. This study sought to understand how the experience of FI helped family members to develop their thinking about their attachment experiences and the appraisals made about a relative, and how these discussions helped to inform their understanding about the interactional way in which difficulties could be maintained. Six master themes were identified: ‘the significance of the therapeutic relationship’, ‘understanding relationships with significant others’, ‘developing a sense of agency’, ‘making sense of psychosis/difficulties’, ‘exploring and understanding unhelpful patterns of interaction in the family’, and the ‘mechanisms of therapy that were helpful’. The FI was experienced as helpful in bringing about changes in the way family members construed each other and psychosis. This influenced patterns of relating which allowed for an emotional climate within the family that promoted a sense of agency and was experienced as healing.

The Schedule for Affective Disorders and Schizophrenia-Change Version (SADS-C), the Social Adjustment Scale-Patient Version II (SAS-PATII) and the Command Hallucination Questionnaire (CAQ) were administered to 86 psychotic inpatients to investigate the relationship between command hallucinations, aggressive behavior, and compliance. Two SADS-C items ("severity of hallucinations" and "depersonalization") were useful as indicators of command hallucinations. Ninety-two percent had complied with their command at least once in the past month. Three SADS-C variables related to compliance with command hallucinations were identified: middle insomnia, the belief that the voice was acting in your best interest, and overt irritability. The patients' level of distortion of reality did not appear to influence compliance rates. Results also indicated that patients who experience command hallucinations were not significantly more or less dangerous than other psychotic inpatients.

In this study I try to survey experiences of psychotherapists who work with people that are diagnosed with schizophrenia disorder. The goal of this study is to find out what therapeutic factors contribute to effectiveness of such psychotherapy. The study is a detailed description of work experience of four clinical psychologists - therapists. The therapists were chosen in a way to represent variety of psychotherapeutic schools. Data were collected with the use of semistructured interview and then analyzed with the use of Grounded Theory Method. The study shows particular psychotherapeutic factors that are used by individual psychotherapists and how are these factors combined so such combination contributes to the effectiveness of psychotherapy. Powered by TCPDF (www.tcpdf.org)