Vyv Huddy

The Effect of Working Alliance on Adherence and Outcome in Cognitive Remediation Therapy

Abstract Cognitive remediation therapy (CRT) for schizophrenia has been effective in improving cognitive and global functioning outcomes. It is now important to determine what factors maximize benefit. The quality of relationship—or working alliance—between clients and therapists may be one such factor that improves outcome. To investigate this, 49 individuals with schizophrenia were recruited into a naturalistic study of the impact of CRT on work and structured activity outcomes. Participant’s cognitive skills, severity of symptoms, and social skills were assessed at baseline. Both client and therapist working alliance ratings were gathered early in therapy. After controlling for depression, clients who rated the alliance more favorably stayed in therapy longer and were more likely to improve on their main target complaint but notably not on working memory performance or self-esteem. Therapist’s ratings of the alliance were not associated with memory outcome. These findings indicate that working alliance is important for client satisfaction with therapy.

The feasibility and acceptability to service users of CIRCuiTS, a computerized cognitive remediation therapy programme for schizophrenia.

Background: Cognitive remediation (CR) is a psychological therapy, effective in improving cognitive performance and functioning in people with schizophrenia. As the therapy becomes more widely implemented within mental health services its longevity and uptake is likely to depend on its feasibility and acceptability to service users and clinicians. Aims: To assess the feasibility and acceptability of a new strategy-based computerized CR programme (CIRCuiTS) for people with psychosis. Method: Four studies were conducted using mixed methods. Perceptions of attractiveness, comprehensibility, acceptability and usability were assessed using self-report questionnaires in 34 non-clinical participants (study 1), and five people with a schizophrenia diagnosis and three experienced CR therapists (studies 2 and 3). The ease with which pre-specified therapy programmes could be assembled was also assessed by three therapists (Study 2). Finally, the satisfaction of 20 service users with a diagnosis of schizophrenia regarding their experience of using CIRCuiTS in the context of a course of the CR therapy was assessed in a qualitative interview study (study 4). Results: Ratings of perceived attractiveness, comprehensibility, acceptability and usability consistently exceeded pre-set high targets by non-clinical, clinical and therapist participants. Qualitative analysis of satisfaction with CIRCuiTS showed that receiving the therapy was generally seen to be a positive experience, leading to perceptions that cognitive functioning had improved and attempts to incorporate new strategy use into daily activities. Conclusions: CIRCuiTS demonstrates high acceptability and ease of use for both service users with a schizophrenia diagnosis and clinicians.

Measuring community functioning in schizophrenia with the Social Behaviour Schedule

BACKGROUND Current emphasis on community integration requires reliable and valid measures of social behaviour; existing assessments largely overlap with symptoms or provide little detail on functioning. This study aims to re-assess the Social Behaviour Schedule (SBS) to fulfil this measurement role. METHODS Internal consistency, construct validity and test-retest reliability were investigated in 421 community out-patients with schizophrenia. Concurrent validity was assessed against the Life Skill Profile (LSP), in 143 additional patients. RESULTS A 17-item SBS supported the construct validity of four factors: Antisocial Behaviour, Depressed Behaviour, Social Withdrawal and Thought Disturbance. It showed good test-retest reliability and rated significant social behaviour in a community sample. Weak correlations were observed with positive and negative symptoms. With the exception of Depressed Behaviour, the SBS factors showed strong correlations with the LSP. CONCLUSION SBS-17 is a valid measure assessing relevant community social functioning factors with relatively few items. The SBS could be useful both in research and in clinical settings.

Early detection and early intervention in prison: improving outcomes and reducing prison returns

Abstract Our aim was to investigate whether early detection was feasible in prison and whether it could improve mental health outcomes in young prisoners. A secondary aim was to explore whether it can reduce returns to prison. Between 2011 and 2014, a total of 2115 young prisoners were screened, 94 (4.4%) met criteria for ultra-high risk for psychosis and were offered an intervention, 52 actually received it. Return to prison data were sought on the 52 participants, receiving a formal intervention. Of the 52 prisoners who received an intervention, 30.8% returned to custody compared to national average reconviction rates of between 45.4 and 66.5%. Our results suggest that early detection is a feasible option in a prison setting, improving mental health outcomes and reducing returns to prison. Mental health outcomes were recorded for a sub-sample of those receiving the intervention. The results indicated statistically significant improvements on measures of depression, anxiety and psychological distress.

A new generation computerised metacognitive cognitive remediation programme for schizophrenia (CIRCuiTS): A randomised controlled trial

Background Cognitive remediation (CR) is a psychological therapy, which improves cognitive and social functioning in people with schizophrenia. It is now being implemented within routine clinical services and mechanisms of change are being explored. We designed a new generation computerised CR programme, CIRCuiTS (Computerised Interactive Remediation of Cognition – a Training for Schizophrenia), to enhance strategic and metacognitive processing, with an integrated focus on the transfer of cognitive skills to daily living. This large trial tested its feasibility to be delivered in therapist-led and independent sessions, and its efficacy for improved cognitive and social functioning. Methods A two arm single blind randomised superiority trial comparing CIRCuiTS plus treatment-as-usual (TAU) with TAU alone in 93 people with a diagnosis of schizophrenia. Cognitive, social functioning and symptom outcomes were assessed at pre- and post-therapy and 3 months later. Results 85% adhered to CIRCuiTS, completing a median of 28 sessions. There were significant improvements in visual memory at post-treatment (p = 0.009) and follow-up (p = 0.001), and a trend for improvements in executive function at post-treatment (p = 0.056) in favour of the CIRCuiTS group. Community function was also differentially and significantly improved in the CIRCuiTS group at post-treatment (p = 0.003) but not follow-up, and was specifically predicted by improved executive functions. Conclusions CIRCuiTS was beneficial for improving memory and social functioning. Improved executive functioning emerges as a consistent predictor of functional gains and should be considered an important CR target to achieve functional change. A larger-scale effectiveness trial of CIRCuiTS is now indicated.

Treating Multiple Incident Post-Traumatic Stress Disorder (PTSD) in an Inner City London Prison: The Need for an Evidence Base

BACKGROUND Mental health problems have been found to be more prevalent in prison populations, and higher rates of post-traumatic stress disorder (PTSD) have been found in sentenced populations compared to the general population. Evidence-based treatment in the general population however has not been transferred and empirically supported into the prison system. AIMS The aim of this manuscript is to illustrate how trauma focused work can be applied in a prison setting. METHOD This report describes a two-phased approach to treating PTSD, starting with stabilization, followed by an integration of culturally appropriate ideas from narrative exposure therapy (NET), given that the traumas were during war and conflict, and trauma-focused cognitive behavioural therapy (TF-CBT). RESULTS PTSD and scores on paranoia scales improved between start and end of treatment; these improvements were maintained at a 6-month follow-up. CONCLUSION This case report 1 illustrates successful treatment of multiple incident PTSD in a prison setting using adaptations to TF-CBT during a window of opportunity when individuals are more likely to be free from substances and live in relative stability. Current service provision and evidence-based practice for PTSD is urgently required in UK prisons to allow individuals to engage in opportunities to reduce re-offending, free from mental health symptoms.

Psychological Therapy for At Risk Mental State for Psychosis in a Prison Setting: A Case Study

There is a very high prevalence of psychosis in U.K. prisons; moreover, a significant number of prisoners meet risk criteria for psychosis. We provide a report of psychological therapy with a client who met risk criteria for psychosis that took place in a prison setting. We applied a self-reflectivity framework when formulating the case, which we believe allowed the flexibility required by the presenting problem and, crucially, the demands of the setting. This approach had two key advantages. First, it enabled the therapist to tailor the work according to the level of self-reflectivity demonstrated by the client. We believe this approach ensured that the client understood the therapists interventions. Second, it helped prepare, and choose a appropriate point, for a move to more traditional interventions for managing the clients main presenting problem. We believe this work represents progress in working with clients in this complex and demanding setting.

Mental simulation and experience as determinants of performance expectancies in people with schizophrenia spectrum disorder

People with schizophrenia demonstrate both impairment in mental time travel and reduced expectancies of performance on future tasks. We aimed to reconcile these findings within the Kahneman and Tversky (1982) simulation heuristic framework by testing a key prediction that impaired future simulation would be associated with reduced performance expectancies in people with schizophrenia spectrum disorder (SZSPEC). A total of 54 individuals (30 people with SZSPEC and 24 healthy controls) generated mental simulations of everyday scenarios; after each response they rated performance expectations, distress and the similarity of the scenario to experience. Independent raters coded the coherence of responses. We found that people with SZSPEC had, compared to healthy controls, lower performance expectations and greater anticipated distress when imaging everyday scenarios. Lower performance expectancies were associated with lower experience of similar scenarios, greater negative symptoms and social withdrawal in the SZSPEC group. The current study confirmed previous findings of both impaired mental simulation and abnormal performance expectations in people with SZSPEC, together with the association of the latter with negative symptoms. Experience with social or occupational activities plays a more important role in determining performance expectancies in people with SS than the ability to mentally simulate scenarios.

The simulation heuristic, paranoia, and social anxiety in a non-clinical sample

BACKGROUND AND OBJECTIVES Quality of reasoning within non-clinical paranoia and mental simulation of future paranoia themed events was investigated by use of a simulation task to determine whether paranoid individuals would be restricted or more adept at reasoning about paranoia relevant material in comparison to a social anxiety group and a group with low paranoia and social anxiety. METHOD Participants (N = 63) were divided into the three groups based on paranoia and social anxiety scores. They were presented with the beginning and end of an imaginary situation and were asked to describe, step-by-step, what they imagined would happen between those two points. They were also administered a beads task to evaluate the jumping to conclusion decision making bias. RESULTS The prediction of more adept reasoning was not supported for paranoia. However, the social anxiety comparison group on average better simulated a scenario with congruent (socially anxious) thematic content compared to ones with non-congruent content. Further, in an exploratory analysis, jumping to conclusions bias was found to be positively related to goodness of simulation for paranoia themed scenarios within the paranoia group. LIMITATIONS Study groups were relatively small and so power was an issue. CONCLUSION The results are discussed in the context of the sometimes paradoxical findings in the area of cognitive biases and paranoia.

The assessment and modeling of perceptual control: A transformation in research methodology to address the replication crisis.

Replication in the behavioral sciences is a matter of considerable debate. We describe a series of fundamental interrelated conceptual and methodological issues with current research that undermine replication and we explain how they could be addressed. Conceptually, we need a shift (a) from verbally described theories to mathematically specified theories, (b) from lineal stimulus-cognition-response theories to closed-loop theories that model behavior as feeding back to sensory input via the environment, and (c) from theories that “chunk” responses to theories that acknowledge the continuous, dynamic nature of behavior. A closely related shift in methodology would involve studies that attempt to model each individuals performance as a continuous and dynamic activity within a closed-loop process. We explain how this shift can be made within a single framework—perceptual control theory (PCT)—that regards behavior as the control of perceptual input. We report evidence of multiple replication using this approach within visual tracking, and go on to demonstrate in practical research terms how the same overarching principle can guide research across diverse domains of psychology and the behavioral sciences, promoting their coherent integration. We describe ways to address current challenges to this approach and provide recommendations for how researchers can manage the transition.