Sian Coker

The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples.

BACKGROUND Traditional instruments that measure self-esteem may not relate directly to the schema construct as outlined in recent cognitive models. The Brief Core Schema Scales (BCSS) aim to provide a theoretically coherent self-report assessment of schemata concerning self and others in psychosis. The scales assess four dimensions of self and other evaluation: negative-self, positive-self, negative-other, positive-other. METHOD We analysed the psychometric properties of the BCSS using a sample of 754 students recruited by email and 252 people with psychosis recruited as part of a trial of cognitive therapy. We report the internal consistency, stability and the factor structure of the scale, and the association of the BCSS with measures of self-esteem and with symptoms of paranoia and grandiosity. RESULTS The BCSS have good psychometric properties and have more independence from mood than the Rosenberg Self-Esteem Schedule. People with chronic psychosis reported extreme negative evaluations of both self and others on these scales, but their levels of self-esteem and positive evaluations of self and others were similar to the student sample. CONCLUSIONS Extreme negative evaluations of self and others appear to be characteristic of the appraisals of people with chronic psychosis, and are associated with symptoms of grandiosity and paranoia in the non-clinical population. The BCSS may provide a more useful measure of schemata about self and others than traditional measures of self-esteem.

Are attentional control resources reduced by worry in generalized anxiety disorder

This is the first study to examine attentional control capacities in generalized anxiety disorder (GAD). GAD is characterized by uncontrollable worry. Individuals diagnosed with GAD and healthy participants (HPs) performed a random key-pressing task while thinking about a worrisome or a positive future event, to assess the extent to which attentional control resources are used by worry. Attentional control was also assessed when participants were not instructed to think about a specific topic using the N-back task, which varies in task difficulty, and therefore is sensitive to subtle differences in ability to handle increasing demands on attentional control within the same paradigm. GAD participants (but not HPs) were less random while worrying than thinking about a positive event during the key-pressing task, suggesting that worry consumed more attentional control resources in this population. During the N-Back task, GAD participants performed worse than HPs during the high load conditions only, indicating greater difficulty in sustaining focus on conditions requiring a higher degree of attentional control, even without concurrent task activity. Poor attentional control might underpin the difficulty of GAD individuals to stop worrying and switch to thinking more benign information. Further research could investigate whether worry consumes attentional control resources in other psychological disorders with high rates of worry (e.g., panic disorder, psychosis), as well as the extent to which attentional control is used by other forms of repetitive thinking, such as depressive rumination.

An experimental manipulation of responsibility in children: a test of the inflated responsibility model of obsessive-compulsive disorder.

The objective of this study was to investigate whether Salkovskis (1985) inflated responsibility model of obsessive-compulsive disorder (OCD) applied to children. In an experimental design, 81 children aged 9-12 years were randomly allocated to three conditions: an inflated responsibility group, a moderate responsibility group, and a reduced responsibility group. In all groups children were asked to sort sweets according to whether or not they contained nuts. At baseline the groups did not differ on childrens self reported anxiety, depression, obsessive-compulsive symptoms or on inflated responsibility beliefs. The experimental manipulation successfully changed childrens perceptions of responsibility. During the sorting task time taken to complete the task, checking behaviours, hesitations, and anxiety were recorded. There was a significant effect of responsibility level on the behavioural variables of time taken, hesitations and check; as perceived responsibility increased children took longer to complete the task and checked and hesitated more often. There was no between-group difference in childrens self reported state anxiety. The results offer preliminary support for the link between inflated responsibility and increased checking behaviours in children and add to the small but growing literature suggesting that cognitive models of OCD may apply to children.

The effect of cues on young children’s abilities to discriminate among thoughts, feelings and behaviours

OBJECTIVE To determine if cues help young children discriminate among thoughts, feelings and behaviours. PARTICIPANTS Ninety-six children aged 4-7 years from three schools in Norwich, UK. DESIGN Within each age band (4, 5, 6, 7), children were randomised to the cue or the no cue condition on a stratified basis ensuring that equal numbers of boys and girls from each school were in each of the eight cells (cue condition x age). Cues were glove puppets and post boxes. The effect of IQ was controlled. MEASURES A discrimination task, in which children were asked to identify a thought, a feeling and a behaviour from each of six brief stories, and a brief IQ assessment were administered to children individually. RESULTS There was a significant effect of age and cue condition on performance; older children and those who were presented with the cue performed better. There were no gender differences and no interaction between cue condition and age. CONCLUSION Many young children discriminated among thoughts, feelings and behaviours suggesting that they may be able to engage in this aspect of cognitive behaviour therapy. Simple cues (puppets and posting boxes) improved childrens performance and these may be useful therapeutic tools with young children.

The effects of improving sleep on mental health (OASIS): a randomised controlled trial with mediation analysis

Summary Background Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. Methods We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. Findings Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice (n=1864). Compared with usual practice, the sleep intervention at 10 weeks reduced insomnia (adjusted difference 4·78, 95% CI 4·29 to 5·26, Cohens d=1·11; p<0·0001), paranoia (−2·22, −2·98 to −1·45, Cohens d=0·19; p<0·0001), and hallucinations (−1·58, −1·98 to −1·18, Cohens d=0·24; p<0·0001). Insomnia was a mediator of change in paranoia and hallucinations. No adverse events were reported. Interpretation To our knowledge, this is the largest randomised controlled trial of a psychological intervention for a mental health problem. It provides strong evidence that insomnia is a causal factor in the occurrence of psychotic experiences and other mental health problems. Whether the results generalise beyond a student population requires testing. The treatment of disrupted sleep might require a higher priority in mental health provision. Funding Wellcome Trust.

CAN CHILDREN DISTINGUISH BETWEEN THOUGHTS AND BEHAVIOURS

Abstract. The extent to which cognitive behaviour therapy can be used with children is unclear. In meta analyses older children and teenagers seem to derive greater benefit than young children. This may be because the cognitive immaturity of young children means that they cannot manage the cognitive demands of cognitive behaviour therapy. This paper seeks to establish how well children aged 7–8 and aged 10–11 can complete a task requiring them to distinguish between thoughts and behaviours (based on Greenberger & Padesky, 1995). Half of the children were provided with a visual cue and half were not. The effects of age, the visual cue, and verbal IQ on performance were examined. Seventy-two children were randomized to the cue and no-cue condition and individually tested during school time. Both age groups performed well and there was a significant difference between older and younger children, with the older children performing better. Visual cues did not aid performance. Verbal IQ was significantly associated with performance in the younger but not the older children. The implications of these results for the delivery of cognitive behaviour therapy with children and future research are discussed. Keywords: Children, thoughts, behaviours, cognitive, development

Investigating trajectories of social recovery in individuals with first-episode psychosis: a latent class growth analysis

Background Social disability is a hallmark of severe mental illness yet individual differences and factors predicting outcome are largely unknown. Aim To explore trajectories and predictors of social recovery following a first episode of psychosis (FEP). Method A sample of 764 individuals with FEP were assessed on entry into early intervention in psychosis (EIP) services and followed up over 12 months. Social recovery profiles were examined using latent class growth analysis. Results Three types of social recovery profile were identified: Low Stable (66%), Moderate-Increasing (27%), and High-Decreasing (7%). Poor social recovery was predicted by male gender, ethnic minority status, younger age at onset of psychosis, increased negative symptoms, and poor premorbid adjustment. Conclusions Social disability is prevalent in FEP, although distinct recovery profiles are evident. Where social disability is present on entry into EIP services it can remain stable, highlighting a need for targeted intervention.

Assessing Levels of Subthreshold Psychotic Symptoms in the Recovery Phase: the Schizotypal Symptoms Inventory (SSI)

Objective Subthreshold psychotic symptoms occurring during the recovery stages of psychosis may impede social functioning and precipitate relapse. Traditional assessment tools lack adequate sensitivity to assess such phenomena. The study aim was to develop a comprehensive self-report measure of residual psychotic symptoms. Method The psychometric properties of the Schizotypal Symptoms Inventory (SSI) were analysed in a sample of 808 students and a sample of 126 clinical cases recovering from psychosis. Levels of schizotypal symptoms were compared between the two groups. Results The SSI was shown to have good psychometric properties. The clinical sample had higher scores on all dimensions of the SSI than the non-clinical sample. Social anxiety symptoms were particularly prevalent in the recovery phase. Conclusions Individuals recovering from acute psychosis experience high levels of subthreshold psychotic symptoms which may impede long-term recovery. The SSI has robust psychometric properties and could be used to assess these phenomena.

Testing an integrated model of eating disorders in paediatric type 1 diabetes mellitus

Eating disorders in young people with type 1 diabetes mellitus confer additional health risks beyond those conferred by the disease itself. Risk factors for developing eating disorders are poorly understood.

Cross-Cultural Differences in Desirable and Undesirable Forms of Self-Consistency and Influence on Symptoms of Depression and Anxiety

This study investigated how cross-cultural differences in desirable and undesirable forms of self-consistency influence symptoms of anxiety and depression. British (n = 172) and East Asian (n = 122) participants completed measures of self-consistency (situation-specific self-description task) and depression and anxiety (Hopkins Symptom Checklist–25). British participants had significantly higher overall self-consistency when compared with East Asian participants. British participants also scored significantly higher than East Asian participants in relation to consistently endorsing desirable self-characteristics. In contrast, East Asian participants scored significantly higher in terms of consistently endorsing undesirable self-characteristics than British participants. Finally, in both cultural groups, consistently denying undesirable characteristics was significantly associated with fewer symptoms of depression and anxiety, while consistently endorsing undesirable characteristics was significantly associated with greater symptoms of depression and anxiety. The findings highlight the importance of self-concept content as well as structure when exploring relationships between self-concept and psychological adjustment.