Christine Braehler

Exploring change processes in compassion focused therapy in psychosis: results of a feasibility randomized controlled trial.

OBJECTIVES Compassion focused therapy (CFT) was developed to stimulate capacities for soothing and affiliation to self and others as a way to regulate the threat system. This feasibility study aimed to assess the safety, the acceptability, the potential benefits, and associated change processes of using group CFT with people recovering from psychosis. DESIGN A prospective, randomized, open-label, blinded end point evaluation design was used. METHOD Forty adult patients with a schizophrenia-spectrum disorder were randomized to CFT plus treatment as usual (TAU; n = 22) or to TAU alone (n = 18). Group CFT comprised 16 sessions (2 hr each, 1 x week). Participants were assessed prior to randomization and at the end of treatment. Assessments included semi-structured interviews to elicit narratives of recovery from psychosis and self-report measures. At the end of treatment, participants were rated on the Clinical Global Impression Scale. Narratives were coded using the Narrative Recovery Style Scale to provide measures of change in compassion and avoidance. Change processes were correlated with changes in depression, personal beliefs about illness, fear of recurrence, and positive and negative affect. RESULTS Group CFT was associated with no adverse events, low attrition (18%), and high acceptability. Relative to TAU, CFT was associated with greater observed clinical improvement (p < 0.001) and significant increases in compassion (p = 0.015) of large magnitude. Relative to TAU, increases in compassion in the CFT group were significantly associated with reductions in depression (p = 0.001) and in perceived social marginalization (p = 0.002). DISCUSSION Findings support the feasibility of group CFT in psychosis and suggest that changes in compassion can be achieved, which appear to reduce depression in particular. This is the first randomized controlled evaluation of CFT. CONCLUSION Compassion focused therapy appears as a safe, acceptable, promising, and evolving intervention for promoting emotional recovery from psychosis.

Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls

Increasing evidence supports the role of childhood trauma in the etiology of psychosis but underlying mechanisms are poorly understood. Early maltreatment has been linked to dissociative symptoms in psychosis patients. We explored associations between childhood trauma (Childhood Trauma Questionnaire) and dissociation (Dissociative Experiences Scale) in first-episode psychotic patients (n=62), chronic psychotic patients (n=43), and non-psychotic community controls (n=66). Multivariate analyses of covariance were used to test associations between childhood trauma and dissociation by group while controlling for sex. Chronic patients reported the highest level of dissociation. More severe childhood trauma was associated with greater dissociative symptoms in all groups although most strongly in chronic patients. Emotional abuse showed the strongest associations with dissociation, with these being strongest for chronic patients, followed by first-episode patients--and least for controls. Men showed a stronger association between physical neglect and dissociation than women, irrespective of group. There were no significant group by sex interactions. Our findings replicate the strong association between childhood trauma and dissociative symptoms in chronic and first-episode psychotic patients relative to non-psychotic control subjects. We also demonstrate the salience of emotional abuse in explaining variance in dissociation, especially in chronic patients.

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

OBJECTIVES There 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. METHOD We 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? RESULTS There 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. CONCLUSIONS There 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.

Recovering an emerging self: Exploring reflective function in recovery from adolescent-onset psychosis

OBJECTIVES This paper investigates (1) the processes involved in how young people with adolescent-onset psychosis adapt to psychosis and (2) how processes of reflective function (RF) influence the adaptation process. DESIGN This study used a qualitative design to inductively construct hypotheses about processes of adaptation and to deductively explore the influence of RF on adaptation. METHODS Eight young people (aged 18-21) who had experienced clinically significant psychosis and attended a Child and Adolescent Mental Health Services (CAMHS) first-episode psychosis service participated in two interviews: (1) grounded theory open interview; (2) Adult Attachment Interview (AAI). Grounded theory methodology was used to investigate young peoples experiences of adaptation to psychosis. Fonagys manual of RF was used to identify passages with different levels of RF in the adaptation narratives and to assign an overall rating of RF with regard to attachment states of mind to AAI transcripts. Links between adaptation themes and RF were examined qualitatively across participants. RESULTS Two main themes relating to adaptation and adolescent individuation emerged. Moderate RF was linked to primarily positive adjustment and successful individuation following psychosis. Impaired RF was associated with unresolved adaptation and blocked individuation post-psychosis. CONCLUSION Level of RF appeared to moderate adaptation and individuation processes post-psychosis and should be considered in the delivery of psychological therapies.