Angus MacBeth

Exploring compassion : a meta-analysis of the association between self-compassion and psychopathology

Compassion has emerged as an important construct in studies of mental health and psychological therapy. Although an increasing number of studies have explored relationships between compassion and different facets of psychopathology there has as yet been no systematic review or synthesis of the empirical literature. We conducted a systematic search of the literature on compassion and mental health. We identified 20 samples from 14 eligible studies. All studies used the Neff Self Compassion Scale (Neff, 2003b). We employed meta-analysis to explore associations between self-compassion and psychopathology using random effects analyses of Fishers Z correcting for attenuation arising from scale reliability. We found a large effect size for the relationship between compassion and psychopathology of r=-0.54 (95% CI=-0.57 to -0.51; Z=-34.02; p<.0001). Heterogeneity was significant in the analysis. There was no evidence of significant publication bias. Compassion is an important explanatory variable in understanding mental health and resilience. Future work is needed to develop the evidence base for compassion in psychopathology, and explore correlates of compassion and psychopathology.

Attachment states of mind, mentalization, and their correlates in a first-episode psychosis sample

OBJECTIVESnAlthough there has been increased interest in applying attachment theory to the psychological understanding of psychosis, research to date has focused on self-reported attachment and psychotic symptomatology. This study presents evidence for applying attachment and mentalization constructs to understanding engagement and adaptation to first-episode psychosis (FEP), using a narrative based interview.nnnDESIGNnA cross-sectional cohort design was used.nnnMETHODSnThirty-four individuals with a first episode of psychosis were interviewed using the Adult Attachment Interview. Attachment classifications and reflective function scores were derived from the interview. Psychotic symptomatology, premorbid adjustment, duration of untreated psychosis, and psychological variables were also measured.nnnRESULTSnAttachment distribution was heterogeneous in the sample, although the majority of participants were classified dismissing of attachment. Mentalization scores were consistent with previous clinical samples. Attachment and mentalization were unrelated to psychotic symptomatology.nnnCONCLUSIONSnThe current study demonstrates, albeit with a small clinical sample, the importance of assessing attachment and mentalization via narrative methods. The findings also have clinical implications for understanding the process of engagement and adaptation in FEP.

A systematic review of attachment and psychosis: measurement, construct validity and outcomes

This review sought to identify, summarise and critically evaluate studies that investigated attachment amongst individuals with psychosis.

Premorbid adjustment, symptom development and quality of life in first episode psychosis: a systematic review and critical reappraisal

Objective:u2002 To systematically review the relationship of premorbid adjustment to symptomatology in first episode psychosis (FEP), taking into account the influence of duration of untreated psychosis (DUP).

The association between attachment style, social mentalities, and paranoid ideation: an analogue study

OBJECTIVESnThe study was a novel exploration of possible associations between attachment status and psychotic phenomenology, applied within a social mentality framework (Gilbert, 1989, 2001). We hypothesized that attachment avoidance would be associated with higher endorsement of paranoid ideation. Consistent with social mentality theory, we hypothesized that higher levels of interpersonal problems would also be associated with higher paranoia scores and greater attachment avoidance.nnnDESIGNnAn analogue cross-sectional cohort design was used.nnnMETHODSnTwo hundred and thirteen individuals completed self-report measures of current attachment style, interpersonal problems, paranoia, delusions, hallucinations, depression, and anxiety.nnnRESULTSnConfirmatory factor analysis of the attachment measure suggested a two-factor structure: attachment anxiety and avoidance. Covariance modelling suggested both attachment and a strategy of interpersonal distancing predicted paranoia. Hallucinatory phenomena were predicted by latent constructs representing interpersonal dependence and avoidance strategies.nnnCONCLUSIONSnThe findings confirmed a two-factor dimensional model was the optimum model for attachment self-report data. The interaction of attachment theory and social mentalities appears to be a promising framework for exploring developmental aspects of psychotic phenomenology.

Metacognition, symptoms and premorbid functioning in a First Episode Psychosis sample

Significant metacognitive impairments are observed in chronic psychosis samples but metacognition is less understood in first episode psychosis (FEP). The current study explored correlations between metacognition, symptoms and premorbid functioning in an FEP sample. In a cross-sectional cohort study, individuals in the first 12 months of treatment metacognition were assessed with the Metacognition Assessment Scale-Revised version (MAS-R). Psychotic symptomatology, premorbid adjustment, and clinician rated service engagement were also measured. Lower scores for metacognitive understanding of others minds were significantly correlated with greater negative symptoms, poorer early adolescent social adjustment and poorer clinician rated help-seeking. Our findings suggest that FEP individuals with difficulties in understanding others minds have more social deficits and may be less able to make effective use of treatment.

Metacognitive functioning predicts positive and negative symptoms over 12 months in first episode psychosis

The negative symptoms of schizophrenia are a major source of impairment and distress but both pharmacological and psychological treatment options provide only modest benefit. Developing more effective psychological treatments for negative symptoms will require a more sophisticated understanding of the psychological processes that are implicated in their development and maintenance. We extended previous work by demonstrating that metacognitive functioning is related to negative symptom expression across the first 12 months of first episode psychosis (FEP). Previous studies in this area have either been cross-sectional or have used much older participants with long-standing symptoms. In this study, forty-five FEP participants were assessed three times over 12 months and provided data on PANSS rated symptoms, premorbid adjustment, metacognitive functioning, and DUP. Step-wise linear regression showed that adding metacognition scores to known predictors of negative symptoms (baseline symptom severity, gender, DUP, and premorbid academic and social adjustment) accounted for 62% of the variance in PANSS negative symptom scores at six months and 38% at 12 months. The same predictors also explained 47% of the variance in positive symptoms at both six and 12 months. However, exploration of the simple correlations between PANSS symptom scores and metacognition suggests a stronger univariate relationship between metacognition and negative symptoms. Overall, the results indicate that problems with mental state processing may be important determinants of negative symptom expression from the very early stages of psychosis. These results provide further evidence that metacognitive functioning is a potentially relevant target for psychological interventions.

A meta-analysis and theoretical critique of oxytocin and psychosis: Prospects for attachment and compassion in promoting recovery

OBJECTIVESnThere is now considerable evidence that affiliative processes are linked to oxytocin (OXT), which is linked to a range of social-cognition competences underpinning interpersonal functioning. There is evidence that OXT circuitry is involved in psychosis and emerging evidence for OXT in treatment. Therefore, this study explored studies investigating OXT and improvements in symptoms and social cognition among individuals diagnosed with psychosis.nnnMETHODnWe conducted a systematic review of randomized controlled trials investigating OXT and psychosis. Specifically we asked, (1) what is the evidence that OXT is associated with improved overall, positive, negative and general symptoms and (2) what is the evidence that OXT is associated with improved social cognition?nnnRESULTSnThere were seven randomized controlled trials that met the inclusion criteria for this review. We conducted an exploratory meta-analysis of data from four of these studies on a total sample size of n = 105. For overall symptoms, using a random-effects model OXT versus placebo was associated with an effect size of d = 0.52 (95% CI = 0.34-0.70; z = 5.66; p < .01). There was evidence of significant heterogeneity (Q = 96.4, p < .001; I(2) = 96.5%). Similar patterns of findings were observed for positive, negative, and general symptoms. We found significant evidence of high risk of bias across all studies. We also identified that one particular study had an undue effect on overall effect size estimates. Finally, evidence regarding OXT was linked to improved social cognition was inconsistent.nnnCONCLUSIONSnThere are significant problems in interpreting the current evidence base for OXT in psychosis. However, OXT may provide a useful biomarker for exploring mechanisms of change occurring in psychological therapies including compassion-focused therapy (CFT), which through its engagement of the attachment system may directly influence OXT.

Self-reported quality of life in a Scottish first-episode psychosis cohort: associations with symptomatology and premorbid adjustment

There is increased interest in quality of life (QoL) as a clinically relevant factor in adjustment to, and recovery from, first‐episode psychosis (FEP). Given the subjective nature of QoL, it is proposed that this variable may be associated with compromised functioning prior to the onset of psychosis, and may also have an impact on an individuals adjustment to psychosis after treatment is initiated.

Plasma Cortisol Levels and Illness Appraisal in Deficit Syndrome Schizophrenia

Research investigating the association between negative symptoms and plasma cortisol levels in individuals with schizophrenia has produced inconsistent findings. This study investigated whether deficit syndrome schizophrenia (characterized by high levels of primary negative symptoms) is associated with comparatively high morning plasma cortisol levels, more negative appraisals about illness and higher levels of depression. Participants were 85 individuals diagnosed with schizophrenia and 85 individuals with no history of contact with psychiatric services matched for age and gender. All participants provided fasting 9.00a.m. plasma cortisol samples. There were no significant differences between the schizophrenia and control participants in plasma cortisol levels. The Proximal Deficit Syndrome method was used to identify individuals with deficit syndrome schizophrenia. Contrary to what had been hypothesized, participants with deficit syndrome schizophrenia had significantly lower plasma cortisol levels than both non-deficit syndrome participants and control participants. Participants with the deficit syndrome reported significantly less negative appraisals about illness (assessed by PBIQ) and lower levels of depression (assessed by BDI-II). Differences in cortisol levels continued to trend toward significance when levels of depression were controlled for. The patterns of illness-related appraisals and plasma cortisol levels raise the possibility that the deficit syndrome could be a form of adaptation syndrome.