Michelle H. Lim

Randomized controlled trial of interventions for young people at ultra-high risk of psychosis: study design and baseline characteristics

Objective: Intervention during the pre-psychotic period of illness holds the potential of delaying or even preventing the onset of a full-threshold disorder, or at least of reducing the impact of such a disorder if it does develop. The first step in realizing this aim was achieved more than 10 years ago with the development and validation of criteria for the identification of young people at ultra-high risk (UHR) of psychosis. Results of three clinical trials have been published that provide mixed support for the effectiveness of psychological and pharmacological interventions in preventing the onset of psychotic disorder. Method: The present paper describes a fourth study that has now been undertaken in which young people who met UHR criteria were randomized to one of three treatment groups: cognitive therapy plus risperidone (CogTher + Risp: n = 43); cognitive therapy plus placebo (CogTher + Placebo: n = 44); and supportive counselling + placebo (Supp + Placebo; n = 28). A fourth group of young people who did not agree to randomization were also followed up (monitoring: n = 78). Baseline characteristics of participants are provided. Results and conclusion: The present study improves on the previous studies because treatment was provided for 12 months and the independent contributions of psychological and pharmacological treatments in preventing transition to psychosis in the UHR cohort and on levels of psychopathology and functioning can be directly compared. Issues associated with recruitment and randomization are discussed.

Interpersonal Constraint Conferred by Generalized Social Anxiety Disorder Is Evident on a Behavioral Economics Task

Although social anxiety disorder appears to confer impairment in friendships, evidence beyond self-report is minimal. We used the flexible iterated prisoners dilemma as a simulated interaction with a friend with 27 individuals with the generalized type of social anxiety disorder and 23 demographically equivalent individuals without the disorder. Participants with generalized social anxiety disorder were less giving on the task. Lower giving was also moderately associated with interpersonal variables (e.g., coldness). A trend was also found for participants with generalized social anxiety disorder to show lower assertiveness on the task. The connection between generalized social anxiety disorder and friendship impairment appears likely to be partially explained by interpersonal constraint that is perceived by others as coldness and manifests in a behavioral economics task.

Self and friend's differing views of social anxiety disorder's effects on friendships.

Social anxiety disorder is known to be associated with self-report of global friendship quality. However, information about specific friendships, as well as information beyond self-report, is lacking. Such information is crucial, because known biases in information processing related to social anxiety disorder render global self-ratings particularly difficult to interpret. We examined these issues focusing on diagnosed participants (n = 77) compared with community control participants (n = 63). We examined self-report regarding global (i.e., overall) friendship quality and a specific friendships quality; in addition, we examined friend-report of that friendships quality. Results suggested that social anxiety disorder has a negative impact on self-perception of friendship quality for a specific friendship, but that this effect is less evident as reported by the friends. Specifically, social anxiety disorder was associated with a tendency to report worse friendship quality in comparison to friend-report, particularly in participants who were younger or had less long-lasting friendships. However, friend-report did show clear differences based on diagnostic group, with friends reporting participants with social anxiety disorder to be less dominant in the friendship and less well-adjusted. Overall, the findings are consistent with results of other studies indicating that social anxiety disorder has a strong association with self-ratings of impairment, but that these ratings appear out of proportion with the report of observers (in this case, friends).

Loneliness over time: the crucial role of social anxiety

Loneliness is known to be associated with multiple adverse physical outcomes, including higher mortality and morbidity risk. However, the impact of loneliness on mental health is less well researched, with most studies assessing how loneliness relates to depressive symptoms alone. We hypothesized that 2 mental health symptoms that relate to the fear of others-social anxiety and paranoia-would contribute to loneliness. We examined how loneliness relates to social anxiety, paranoia, and depression symptoms in a general community sample aged 18-87 years old (N = 1,010). We administered online measures over 3 time points across a 6-month period. In a cross-lagged structural equation model controlling for trait levels and prior states, our results indicated that earlier loneliness positively predicted future states of social anxiety, paranoia, and depression. However, in the same model, earlier social anxiety was the only predictor of future loneliness. These results suggest that loneliness may be a potential antecedent to emerging mental health symptoms and that identifying and treating co-occurring social anxiety symptoms may reduce the severity of loneliness. (PsycINFO Database Record

The jumping-to-conclusions bias in new religious movements

Abstract The jumping-to-conclusions bias has not been examined in a new religious movement (NRM) group. Twenty-seven delusion-prone NRM individuals were compared with 25 individuals with psychotic disorders and 63 non–delusion-prone individuals on four probabilistic inference tasks, together with measures of psychotic symptoms and delusion proneness. The NRM individuals requested significantly less evidence when compared with the control individuals on both meaningful and nonmeaningful tasks. The NRM individuals requested significantly more evidence on a difficult meaningful task when compared with the individuals with psychotic disorders. A specific reasoning style but not a general reasoning style differentiates the NRM individuals from the individuals with psychotic disorders. These findings may be specific to NRM individuals and may not be generalized to other delusion-prone groups.

Social connectedness across the psychosis spectrum: Current issues and future directions for interventions in loneliness

Loneliness, sometimes referred to as “perceived social isolation,” is defined as a subjective experience of social isolation. Loneliness has been shown to be related more to the quality of social relationships than to the quantity, and is typically characterized by feelings of social disconnection (e.g., being misunderstood by others). It occurs when there is a discrepancy between desired and actual amounts of social interaction. Humans are a social species and have a fundamental need to belong. Feelings of loneliness have been perceived to be early warning signals of potential threats to psychological health (akin to physical pain in physical health problems). Loneliness is associated with an increased risk of various health conditions (e.g., increased inflammation, decreased immunity) and can occur in transient and chronic forms across the lifespan. In the last few decades, there has been an increase in scientific studies in loneliness and much of this research stemmed from a social neuroscience approach (see work by Cacioppo). The onset of loneliness is thought to motivate an individual to seek connectedness with others; however, symptoms of mental illness often involve withdrawal from the social world. A growing interest in the relationship between loneliness and mental health disorders is therefore not surprising and was first identified as an important relationship in the late 1950s. Psychoanalyst Frieda Fromm-Reichmann highlighted the devastating impact of loneliness on patients with schizophrenia. In more recent times, researchers have used a neuroscience approach to further clarify the relationship between social withdrawal/isolation and positive symptoms of psychosis (see Hoffman’s social deafferentation hypothesis). The psychological consequences of loneliness, however, remain under examined by researchers. It is plausible, but remains unclear, that loneliness is a transdiagnostic factor across different mental disorders that raises the risk of mental health problems, increases the severity of symptoms, maintains diagnostic status, or all of the above. Loneliness is associated with various mental disorders, including depression, social anxiety disorder, and obsessive–compulsive disorder (1), and most of the research on loneliness and mental health has focused on its relationship with depression (2). To date, there has been no published study that has developed an evidence-based loneliness intervention in individuals with psychosis. A meta-analytic review of interventions aimed at reducing loneliness in a range of different populations surprisingly included only five studies with individuals with mental health symptoms, and none of the studies were specific to psychosis (3). There is, however, emerging research that highlights the deleterious effects of loneliness in individuals with psychotic disorders. In the second Australian national survey of psychosis (N = 1825), 80.1% of adults aged between 18 and 34 years, diagnosed with a psychotic disorder endorsed perceived loneliness; 37.2% of these adults identified loneliness as a barrier to recovery (4). While many psychosocial interventions are aimed at introducing new social supports (e.g., befriending) or providing social skills training (SST) for people with psychotic disorders, there has been no known study that specifically targets loneliness.

Selective attention to threat bias in delusion-prone individuals.

The study examined the selective attention to threat bias in delusion-prone individuals recruited from New Religious Movements (NRMs). Twenty-seven delusion-prone NRM individuals were compared with 25 individuals with psychotic disorders and 63 non-delusion-prone individuals on a Stroop task, together with psychotic and delusion proneness measures. NRM individuals showed significantly lower levels of selective attention to threat bias compared with individuals with psychotic disorders but not with non-delusion-prone individuals. Selective attention to threat bias was also not correlated with distress associated with delusional ideation. These findings may be specific to delusion-prone NRM individuals. The absence of the selective attention to threat bias may be related to levels of safety and security among members of NRMs.

Social Anxiety and Friendship Quality over Time

Abstract High social anxiety in adults is associated with self-report of impaired friendship quality, but not necessarily with impairment reported by friends. Further, prospective prediction of social anxiety and friendship quality over time has not been tested among adults. We therefore examined friendship quality and social anxiety prospectively in 126 young adults (67 primary participants and 59 friends, aged 17–22 years); the primary participants were screened to be extreme groups to increase power and relevance to clinical samples (i.e., they were recruited based on having very high or very low social interaction anxiety). The prospective relationships between friendship quality and social anxiety were then tested using an Actor–Partner Interdependence Model. Friendship quality prospectively predicted social anxiety over time within each individual in the friendship, such that higher friendship quality at Time 1 predicted lower social anxiety approximately 6 months later at Time 2. Social anxiety did not predict friendship quality. Although the results support the view that social anxiety and friendship quality have an important causal relationship, the results run counter to the assumption that high social anxiety causes poor friendship quality. Interventions to increase friendship quality merit further consideration.

Loneliness in psychosis: a systematic review

PurposeThe aim of the review is to understand the relationships between loneliness and related psychological and social factors in individuals with psychosis. Loneliness is poorly understood in people with psychosis. Given the myriad of social challenges facing individuals with psychosis, these findings can inform psychosocial interventions that specifically target loneliness in this vulnerable group.MethodsWe adhered to the PRISMA guidelines and systematically reviewed empirical studies that measured loneliness either as a main outcome or as an associated variable in individuals with psychosis.ResultsA total of ten studies examining loneliness in people diagnosed with a psychotic disorder were examined. Heterogeneity in the assessment of loneliness was found, and there were contradictory findings on the relationship between loneliness and psychotic symptomatology. In individuals with psychosis, loneliness may be influenced by psychological and social factors such as increased depression, psychosis, and anxiety, poor social support, poor quality of life, more severe internalised stigma and perceived discrimination, and low self-esteem.ConclusionsThe relationship between loneliness and psychosis remains poorly understood due to a lack of rigorous studies. Although having strong social relationships is crucial to facilitate recovery from serious mental illness, psychosocial interventions that specifically target loneliness in individuals with psychosis are lacking and sorely needed. Interventions targeting loneliness in those with psychosis will also need to account for additional barriers associated with psychosis (e.g., social skill deficits, impoverished social networks, and negative symptoms).

Ecological Momentary Assessment and Intervention in the Treatment of Psychotic Disorders: A Systematic Review

OBJECTIVE Ecological momentary assessment (EMA) and ecological momentary intervention (EMI) are technologies used to track fluctuations in experiences and prompt behavioral responses within the context of a persons daily life. Most commonly delivered via smartphone, EMA and EMI have potential to provide simple, cost-effective, and user-led treatment for psychotic disorders. This systematic review aimed to synthesize current research exploring the feasibility, acceptability, and clinical outcomes of EMA and EMI in the treatment of psychotic disorders. METHODS A systematic search was conducted identifying studies published between 1980 and July 7, 2016, by searching PubMed, PsycINFO, PsycARTICLES, and the Cochrane Central Register of Controlled Trials with combinations of search terms related to mobile devices, EMA and EMI, and psychotic disorders. RESULTS Of 1,623 studies identified, nine met inclusion criteria for the review. These studies found satisfactory feasibility and acceptability and preliminary evidence of improved clinical outcomes. The interventions, which had a broad array of features, targeted remote monitoring of illness and symptoms, and they also targeted illness self-management by using momentary reminders or instructions for behaviors, including medication adherence, management of symptoms and psychosocial impairments, daily living skills, and goal achievement. CONCLUSIONS The findings of this review provide preliminary support for the clinical utility of EMA and EMI in the treatment of psychotic disorders. Future research should explore further applications of these technologies with larger sample sizes and controlled designs.