Increasing access to psychological therapies for people with psychosis: predictors of successful training

BackgroundCognitive behavioural therapy for psychosis (CBTp) is recommended for people with schizophrenia, but routine delivery remains limited. Obstacles to increasing access include inadequate training, organisational support and supervision, resulting in low levels of staff competence and confidence. This study is a preliminary evaluation of a CBTp training programme, designed to overcome these obstacles and to increase routine delivery of competent CBTp.MethodTraining outcomes for a pilot group and for the first three cohorts to complete training were analysed to identify predictors of successful completion and of therapy delivery after training.ResultsObjective competence was attained by 37 students (out of 58), who delivered therapy to over 160 service users. Successful completion was associated with previous CBT therapy experience. Delivery after one year was associated with working in a therapy rather than a care co-ordination role.ConclusionsThe programme succeeded in training therapists to deliver competent therapy. Our results suggest that preliminary training in CBT for other disorders may improve success rates in CBTp. Despite extensive service liaison, delivery remained problematic for care co-ordinators without role change and provision of dedicated time. The findings should inform future implementation strategies.     

Dissociation, trauma, and the role of lived experience: toward a new conceptualization of voice hearing

Voice hearing (VH) is often regarded as pathognomic for schizophrenia. The purpose of this article is to review and integrate historical, clinical, epidemiological, and phenomenological evidence in order to suggest that VH may be more appropriately understood as a dissociative rather than a psychotic phenomenon. First, we discuss the lifetime prevalence of VH in the general population, which is estimated to range between 1% and 16% for adult nonclinical populations and 2% and 41% in healthy adolescent samples. Second, we demonstrate how the ubiquity of VH phenomenology, including variables like voice location, content, and frequency, limits its diagnostic and prognostic utility for differentiating psychotic from trauma-spectrum and nonclinical populations. Finally, we report on the empirical associations between VH, measures of dissociation, and trauma particularly (though not exclusively) childhood sexual abuse. There are 2 main conclusions from this review. First, we argue that available evidence suggests that VH experiences, including those in the context of psychotic disorders, can be most appropriately understood as dissociated or disowned components of the self (or self-other relationships) that result from trauma, loss, or other interpersonal stressors. Second, we provide a rationale for clinicians to use psychotherapeutic methods for integrating life events as precipitating and/or maintaining factors for distressing voices. Potential mechanisms for the relationship between trauma, dissociation, VH, and clinical diagnosis are described, including the relevance of literature from the field of attachment in providing a diathesis for dissociation. Suggestions for future research are also discussed.     

A reconsideration of Freud's essays on sexuality and their clinical implications

This paper considers some of the concisely presented material of the second of Freud's Three Essays on the Theory of Sexuality (1905a), on "Infantile Sexuality." The author puts forward the view that infantile sexuality may be thought of not simply as an immature stage that must be passed through, but also as a pool of psychic experiences upon which mature personality organization can continually draw, in dynamic oscillation among different mental positions. The link between infantile sexuality and the structuring of the psychic apparatus, discussed in the first and third of the Three Essays ("The Sexual Aberrations" and "The Transformations of Puberty"), raises questions that are still open to further research.     

When different means bad or merely worse. How minimal and maximal goals affect ingroup projection and outgroup attitudes

Group members tend to perceive their ingroup relative to an outgroup as more prototypical for a common superordinate group because they project features of their ingroup onto the superordinate group. As a consequence, the ingroup is perceived as more positive than the outgroup (Mummendey & Wenzel, 1999). We extend the ingroup projection model by examining different types of ingroup goals: minimal and maximal goals as well as actual and ideal goals. Minimal goals should engender either‐or thinking and lead to more ingroup projection compared with maximal goals that should involve more nuanced thinking. Ingroup prototypicality in terms of ideal goals (e.g., what we ideally should strive for) was expected to show a stronger relation to outgroup attitudes than ingroup prototypicality in terms of actual goals (e.g., what we are actually striving for). We manipulated minimal and maximal goal orientation and assessed actual and ideal goals. Across two studies, relative ingroup prototypicality was higher in the minimal compared with the maximal goal condition. Moreover, ingroup prototypicality referring to ideal goals showed a stronger relation to outgroup evaluation than ingroup prototypicality referring to actual goals. Copyright © 2012 John Wiley & Sons, Ltd.     

Integrating multiple perspectives on error-related brain activity: The ERN as a neural indicator of trait defensive reactivity

In the past 20 years, research concerning the error-related negativity (ERN), a negative-going deflection in the event-related brain potential (ERP) following an erroneous response, has flourished. Despite a substantial body of research, debate regarding its functional significance persists. In what follows, we selectively review literature on the ERN, and outline several prominent cognitive theories related to the generation and significance of the ERN. Cognitive theories predict that the size of the ERN should relate to variation in behavior, although there is substantial evidence that the ERN and behavioral measures are at least partially dissociable. Moreover, individual difference measures, psychopathology, and motivational factors all appear to impact basic mechanisms that generate the ERN to moderate the magnitude of the ERN, suggesting a need to integrate alternative perspectives into models of ERN amplitude. Insofar as errors prompt the mobilization of defensive responses, we view variation in the ERN in terms of error detection in the service of protecting the organism. Based on data indicating that the ERN is highly stable over time, heritable, and related to broad dimensions of personality, we propose that the ERN is a neural index of a neurobehavioral trait and variation in its amplitude is related in part to individual differences in defensive reactivity. Implications and future directions are considered.     

Retaliation and antisocial punishment are overlooked in many theoretical models as well as behavioral experiments

Guala argues that there is a mismatch between most laboratory experiments on costly punishment and behavior in the field. In the lab, experimental designs typically suppress retaliation. The same is true for most theoretical models of the co-evolution of costly punishment and cooperation, which a priori exclude the possibility of defectors punishing cooperators.     

Who we were and who we will be: the temporal context of women's in-group stereotype content

Research has elaborated considerably on the dimensions of out-group stereotype content and on the origins and functions of different content combinations. Less attention has been given to the origins and functions of in-group stereotype content. We argue that in-group stereotypes are likely to serve different social identity functions, and thus attract different content, dependent on individual differences in in-group identification and on the temporal perspective of the perceiver. Two studies (Ns = 43 and 93) found that women's in-group stereotype content varied as a function of gender group identification and temporal perspective. When the past was primed, highly identified women generated stereotypes that emphasized the warmth (but not competence) of their group. When the future was primed, highly identified women generated stereotypes that emphasized the competence (as well as warmth) of their group. These results are discussed in terms of the use of stereotypes for social creativity versus social change.     

Hypnotic ingroup-outgroup suggestion influences economic decision-making in an Ultimatum Game

Studies in economic decision-making have demonstrated that individuals appreciate social values supporting equity and disapprove unfairness when distributing goods between two or more parties. However, this seems to critically depend on psychological mechanisms partly pertaining to the ingroup-outgroup distinction. Little is known as to what extent economic bargaining can be manipulated by means of psychological interventions such has hypnosis. Here we show that a hypnotic ingroup versus outgroup suggestion impacts the tolerance of unfairness in an Ultimatum Game. Specifically, the ingroup suggestion was associated with significantly greater acceptance rates of unfair offers than the outgroup suggestion, whereas hypnosis alone exerted only small effects on unfairness tolerance. These findings indicate that psychological interventions such as hypnotic suggestion can contribute to ingroup favoritism and outgroup rejection.     

Differential involvement of mGluR1 and mGluR5 in memory reconsolidation and retrieval in a passive avoidance task in 1-day old chicks

Group I metabotropic glutamate receptors (mGluRs) are involved in memory formation. The Ca2+ signal derived from stimulation of IP3 receptors (IP3Rs) via mGluRs, initiates protein synthesis that is required for memory consolidation and reconsolidation. However it has been suggested that different mechanisms are triggered by mGluR1/5 activation in these two processes. It is also not clear whether the transient amnesia observed after blockade of group I mGluRs after a reminder, results from disturbance of memory reconsolidation or temporal impairment of recall. The aim of this study was to examine more closely the role of mGluR1 in memory consolidation and reconsolidation and to detect differences in the participation of mGluR1 and mGluR5 in memory retrieval after initial training and after the remainder of the task. Our results demonstrate, that in chicks performing a one-trial passive avoidance task, antagonists of mGluR1, mGluR5 and IP3R significantly disturb memory consolidation and reconsolidation. Inhibition of mGluR5 and IP3R also impairs memory recall, whereas mGluR1 do not seem to participate in this process. The presented data suggest that activation of mGluR1 and mGluR5 is necessary for the correct course of memory consolidation and reconsolidation, whereas mGluR5 are additionally involved in retrieval processes dependent on Ca2+ release from IP3 activated intracellular stores.