Lyn Ellett

Paranoia in a nonclinical population of college students.

The present study examined the incidence of paranoid ideation in a nonclinical population. A sample of 324 college students completed a questionnaire assessing their personal experiences of paranoia, with an emphasis on the cognitive, behavioral, and affective components of their experience. They also completed a general measure of paranoia in nonclinical samples, the Fenigstein and Vanable Paranoia Scale, and the Rosenberg Self-Esteem Scale. A total of 153 participants reported an experience of paranoia, which included a clear statement of planned intention to harm. This group scored significantly higher on the Paranoia Scale than those who reported no experience of paranoia. Furthermore, greater levels of paranoid ideation were associated with lower self-esteem. The present findings suggest that paranoia is a common human experience, and are consistent with the idea of continuity between normal and abnormal experience.

The psychological effect of an urban environment on individuals with persecutory delusions: The Camberwell walk study

BACKGROUND Epidemiological studies have found that individuals who live in urban areas are at increased risk of developing psychosis. However it is unknown whether exposure to urban environments exacerbates psychotic symptoms in people who have a diagnosed psychotic disorder. The aim of the study was to examine the psychological and clinical effects of exposure to one specific deprived urban environment on individuals with persecutory delusions. It was predicted that the urban environment would affect emotional and reasoning processes highlighted in a cognitive model of persecutory delusions and would increase paranoia. METHOD Thirty patients with persecutory delusions were randomised to exposure to a deprived urban environment or to a brief mindfulness relaxation task. After exposure, assessments of symptoms, reasoning, and affective processes were taken. Thirty matched non-clinical participants also completed the study measures to enable interpretation of the test scores. RESULTS In individuals with persecutory delusions, exposure to the urban environment, rather than participation in a mindfulness task, increased levels of anxiety, negative beliefs about others and jumping to conclusions. It also increased paranoia. The individuals with persecutory delusions scored significantly differently from the non-clinical group on all measures. CONCLUSIONS For individuals with psychosis, spending time in an urban environment makes them think more negatively about other people and increases anxiety and the jumping to conclusions reasoning bias. Their paranoia is also increased. A number of processes hypothesised in cognitive models to lead to paranoid thoughts are exacerbated by a deprived urban environment. Further research is needed to clarify which aspects of urban environments cause the negative effects. Methodological challenges in the research area are raised.

Paranoid cognitions, failure, and focus of attention in college students

Three experiments examined aspects of the link between focus of attention, manipulated by use of video camera and monitor, and paranoid and depressive cognitions in a sample of college students. In Experiment 1 participants were exposed to either a failure or neutral task, under high (HSA) or low self-awareness (LSA) conditions. HSA triggered paranoid cognitions on neutral and failure tasks; failure alone triggered depressive cognitions. In Experiment 2 the camera switched focus thrice between participant and experimenter using only neutral tasks. Paranoia scores initially were higher in the HSA condition. Paranoia scores increased when participants moved from LSA to HSA. Paranoia scores never fell when moving from HSA to LSA conditions. Experiment 3 used only HSA and failure, and showed how a priming task that increased the accessibility of either positive or negative self-cognitions led to significantly different paranoia and depression scores.

Group mindfulness-based intervention for distressing voices: A pragmatic randomised controlled trial

Group Person-Based Cognitive Therapy (PBCT) integrates cognitive therapy and mindfulness to target distinct sources of distress in psychosis. The present study presents data from the first randomised controlled trial investigating group PBCT in people distressed by hearing voices. One-hundred and eight participants were randomised to receive either group PBCT and Treatment As Usual (TAU) or TAU only. While there was no significant effect on the primary outcome, a measure of general psychological distress, results showed significant between-group post-intervention benefits in voice-related distress, perceived controllability of voices and recovery. Participants in the PBCT group reported significantly lower post-treatment levels of depression, with this effect maintained at six-month follow-up. Findings suggest PBCT delivered over 12 weeks effectively impacts key dimensions of the voice hearing experience, supports meaningful behaviour change, and has lasting effects on mood.

Experience of mindfulness in people with bipolar disorder: A qualitative study

Abstract The aim of the study was to explore experiences of practising mindfulness and how this related to living with, and managing, bipolar disorder. Qualitative methodology was used to explore the experiences of 12 people with bipolar disorder who had been practising mindfulness for at least 18 weeks. Semi-structured interviews exploring how mindfulness practice related to living with bipolar disorder were recorded verbatim, transcribed and analysed using thematic analysis. Seven themes emerged: Focusing on what is present; clearer awareness of mood state/change; acceptance; mindfulness practice in different mood states; reducing/stabilizing negative affect; relating differently to negative thoughts; reducing impact of mood state. All participants reported subjective benefits and challenges of mindfulness practice, and gave insights into processes of change.

Quality of life and illness beliefs in individuals with early psychosis.

PurposeQuality of life (QoL) has become an important outcome measure in early psychosis. This study examined associations between illness beliefs (how individuals perceive their mental health problems), symptom factors and QoL in an early psychosis population.MethodsEighty-one individuals with early psychosis completed a battery of questionnaires measuring QoL, illness perceptions, psychotic and affective symptoms.ResultsQoL was significantly associated with certain illness beliefs, namely treatment control and consequences of psychosis. Lower levels of QoL were associated with higher depression, anxiety and general psychopathology. QoL was found to be predicted by key illness beliefs.ConclusionsCausality has not been fully established, but these results suggest that beliefs about mental health problems may have a direct impact on outcome, and point towards possible targets for intervention, such as challenging illness-related appraisals. This is consistent with both general cognitive models of psychosis, and Cognitive Behaviour Therapy for this client group.

Perception of peer group rank of individuals with early psychosis

OBJECTIVES Social rank theory has been applied to psychosis, in particular the relationship between an individual and their voices. However, perceived peer group rank has not been empirically tested in an early psychosis group. The purpose of the study was to test the prediction that individuals with early psychosis will have lower perceived social status, engage in submissive behaviours more frequently, and will feel more entrapped by external events compared to a healthy control group. DESIGN The study employed a cross-sectional design, comparing individuals with early psychosis and healthy controls. METHODS A total of 24 participants with early psychosis and 24 matched controls completed self-report measures of social rank, including social comparison, submissive behaviours and entrapment, measures of depression, anxiety and psychotic symptoms, and measures of peer network size and peer relationship quality. RESULTS Individuals with early psychosis viewed themselves as being of lower social rank and inferior in relation to matched controls, and also reported engaging in submissive behaviours more frequently and felt more entrapped by external events. CONCLUSIONS Perception of lower social rank and inferiority amongst individuals with early psychosis may impact on engagement in peer relationships and impact on the social decline in early psychosis, which could have significant implications for interventions and recovery.

What is it like to be friends with a young person with psychosis? A qualitative study

Psychosis has a concerning social impact and can lead to significant reductions in social networks early in its course. There are serious developmental and illness-related implications of reduced social networks which make it important to understand why this occurs. This study aimed to explore the often neglected perspective of friends in order to advance our understanding of the reasons for breakdowns in relationships following the onset of psychosis. Seven friends were interviewed about their experience of being friends with a young person with psychosis. Constructivist Grounded Theory was used to analyse the transcripts and develop a theoretical model. The central category that emerged was “persisting with the friendship”, a chronological process that unfolded over time, from the point at which friends began to notice initial psychotic symptoms, through to thinking about what the future might hold for the young person with psychosis. A number of factors impacted on friends’ ability to persist with the friendship, five that hindered and six that helped. Future research might usefully examine the feasibility and desirability of working with friends within the context of peer interventions.

Perceived ethnic discrimination and persecutory paranoia in individuals at ultra-high risk for psychosis

Despite a consensus that psychosocial adversity plays a role in the onset of psychosis, the nature of this role in relation to persecutory paranoia remains unclear. This study examined the complex relationship between perceived ethnic discrimination and paranoid ideation in individuals at Ultra High Risk (UHR) for psychosis using a virtual reality paradigm to objectively measure paranoia. Data from 64 UHR participants and 43 healthy volunteers were analysed to investigate the relationship between perceived ethnic discrimination and persecutory ideation in a virtual reality environment. Perceived ethnic discrimination was higher in young adults at UHR in comparison to healthy controls. A positive correlation was observed between perceived ethnic discrimination and paranoid persecutory ideation in the whole sample. Perceived ethnic discrimination was not a significant predictor of paranoid persecutory ideation in the VR environment. Elevated levels of perceived ethnic discrimination are present in individuals at UHR and are consistent with current biopsychosocial models in which psychosocial adversity plays a key role in the development of psychosis and attenuated symptomatology.

Friends interventions in psychosis: a narrative review and call to action

To highlight the importance of friendships to young people with psychosis, and the need for clinical interventions to help maintain peer relationships during illness. To structure a research agenda for developing evidence‐based interventions with friends.