Carers' attributions about positive events in psychosis relate to expressed emotion

Background

Relapse is increased in people with psychosis who live with carers with high expressed emotion (EE). Attributional style has been used to understand EE at a psychological level. Previous studies have investigated carer appraisals for negative events in the patient's life. We therefore aimed to examine spontaneous carer attributions for both negative and positive events. Further, we distinguished between high EE based on critical comments, and that based on emotional-overinvolvement.

Method

Audiotapes of the Camberwell Family Interview (CFI) (N = 70) were rated using the Leeds Attributional Coding System (LACS). Raters were blind to previous ratings of EE.

Results

In our sample, low EE carers made significantly more attributions about positive events, and less about negative events than high EE carers. This is because criticism, but not overinvolvement, was strongly associated with responsibility attributions for negative events, while overinvolvement, but not criticism, was inversely associated with responsibility attributions for positive events.

Conclusion

Carers' attributions for both positive and negative events may be a useful target for improving family interventions in psychosis.     

Patterns of maternal responding in postpartum mothers with schizophrenia

Little is known about how schizophrenia might affect how a mother responds to her infant, such as whether responding is reduced or impaired. The aim was to identify, from brief videotaped interactions, whether the responses of mothers with schizophrenia were fewer, less positive, more negative, and more ‘abnormal’ than mothers with affective disorder, and whether their infants (mean age: 15 weeks) lacked activity or initiation to which mothers could respond. Mothers with schizophrenia (N = 14) were as responsive as mothers with affective disorder (N = 31), but they showed markedly low positive responsiveness. Only the schizophrenia group exhibited non-responses as a result of being psychologically withdrawn from the interaction, and abnormal behaviors. Inconsistent to our hypothesis, infants in both groups showed similar levels of activity, initiative and negativity. The findings highlight the need for further research to examine the contribution of maternal response impairments to the developmental vulnerability of this genetically high-risk group.     

Environmental control and psychosis-relevant traits modulate the prospective sense of agency in non-clinical individuals

The sense of agency concerns the experience of being the source of one’s own actions and their consequences. An altered sense of agency can occur due to task automation and in psychosis. We tested in a non-clinical sample the hypothesis that reducing voluntary task control diminishes intentional binding as an implicit indicator of the sense of agency, possibly interacting with psychosis-relevant personality traits. Agent-device interactions were manipulated obtaining positive-control (voluntary interaction), no-control (automation), and negative-control (device-commanded interaction) groups. The main results showed reduced prospective intentional binding (predictive coding of action consequences) in the no-control and negative-control groups, compared to the positive-control group. Psychosis-like experiences covaried positively with intentional binding in the no-control group, but negatively in the negative-control group. Moreover, positive-social traits were associated with increased intentional binding in the positive-control group. These findings demonstrate the interplay between environmental and individual differences variables in establishing the implicit sense of agency.     

Imagery and psychotic symptoms: a preliminary investigation

Recent cognitive accounts of psychotic symptoms have suggested that processes involved in the maintenance of emotional disorders may also be implicated in the maintenance of hallucinations and delusions, and particularly emphasise the appraisals of such symptoms as important. Imaginal appraisals have been identified in emotional disorders, and many studies have reported spontaneously occurring images in patients with anxiety disorders. Such images appear to be linked to affect, beliefs and memories. This study examined the occurrence of imagery, using a semi-structured interview, in 35 patients who were experiencing hallucinations and/or delusions and receiving cognitive therapy. The majority of patients (74.3%) reported images, and most of these were recurrent and associated with affect, beliefs and memories. Common themes included images about feared catastrophes associated with paranoia, traumatic memories, and images about the perceived source or content of voices. The theoretical and clinical implications of these findings are discussed and directions for further research considered.     

Three Phases of Treatment with Borderline and Psychotic Patients

Three distinct, yet overlapping, phases of treatment emerge when working with some borderline and psychotic patients. This are patients who test the ordinary limits of psychoanalysis, but can profit from its deep exploration. The first phase is colored by acting out, interpersonally and intrapsychically. An analytic envelope of containment is necessary to sustain the treatment. Interpretive holding and containing help the patient find a psychic receptacle capable of detoxifying violent projections. Many of these patients terminate prematurely. The second phase is centered around the patient's defensive use of the death instinct to extinguish or destroy certain parts of their mental functioning. This difficult standoff between parts of the patient's mind becomes replicated in the transference. The third phase reveals the more fundamental problem of paranoid～schizoid anxieties of loss and primitive experiences of guilt. These include fears of persecution and annihilation. Some patients abort treatment in the first or second phase and never work through the phantasies and feelings of loss. Nevertheless, much intrapsychic and interpersonal progress is possible. Given the instability and chaotic nature of these patient's object relations, the analyst must be cautiously optimistic in their work and realize the potential to help the patient even when presented with less than optimal working conditions.     

How to integrate dreaming into a general theory of consciousness--a critical review of existing positions and suggestions for future research

In this paper, we address the different ways in which dream research can contribute to interdisciplinary consciousness research. As a second global state of consciousness aside from wakefulness, dreaming is an important contrast condition for theories of waking consciousness. However, programmatic suggestions for integrating dreaming into broader theories of consciousness, for instance by regarding dreams as a model system of standard or pathological wake states, have not yielded straightforward results. We review existing proposals for using dreaming as a model system, taking into account concerns about the concept of modeling and the adequacy and practical feasibility of dreaming as a model system. We conclude that existing modeling approaches are premature and rely on controversial background assumptions. Instead, we suggest that contrastive analysis of dreaming and wakefulness presents a more promising strategy for integrating dreaming into a broader research context and solving many of the problems involved in the modeling approach.     

The relationship between different types of dissociation and psychosis-like experiences in a non-clinical sample

This study investigated whether detachment-type dissociation, compartmentalisation-type dissociation or absorption was most strongly associated with psychosis-like experiences in the general population. Healthy participants (N = 215) were tested with the Dissociative Experiences Scale (DES, for detachment-related dissociative experiences); the Harvard Group Scale of Hypnotic Susceptibility (HGSHS: A, for dissociative compartmentalisation); the Tellegen Absorption Scale (TAS, for non-clinical ‘functional’ dissociative experience); and two measures of psychotic-like experiences, the 21-item Peters et al. Delusions Inventory (PDI-21) and the Cardiff Anomalous Perceptions Scale (CAPS). In multiple regression analyses, DES and TAS but not HGSHS: A scores were found to be significantly associated with PDI-21 and CAPS overall scores. A post hoc hierarchical cluster analysis checking for cluster overlap between DES and CAPS items, and the TAS and CAPS items showed no overlap between items on the DES and CAPS and minimal overlap between TAS and CAPS items, suggesting the scales measure statistically distinct phenomena. These results show that detachment-type dissociation and absorption, but not compartmentalisation-type dissociation are significantly associated with psychosis-like experiences in a non-clinical population.     

What do We Know about Family Interventions for Psychosis at the Process Level? A Systematic Review

The evidence regarding effectiveness of family interventions for psychosis (FIP) is strong and consistent. However, there is a gap in the research on the process of these interventions, and little is known about their active ingredients. This review aims to identify the active ingredients of FIP. We conducted a systematic literature review, focusing on qualitative research, and analyzed 22 papers in total. We found a single study comprehensively exploring the process of FIP. All other studies focused on particular aspects of process‐related variables. The key elements of FIP seem to be the so‐called “common therapeutic factors”, followed by education about the illness and coping skills training. This review supports the value of a stepped model of intervention according to the needs of the families. However, the evidence reviewed also reveals a gap in the research findings based on the limited research available. FIP are complex, psychosocial interventions with multiple components, and more intensive, qualitative research is needed to establish linkages between process and outcome.     

Accounting for the phenomenology and varieties of auditory verbal hallucination within a predictive processing framework

Two challenges that face popular self-monitoring theories (SMTs) of auditory verbal hallucination (AVH) are that they cannot account for the auditory phenomenology of AVHs and that they cannot account for their variety. In this paper I show that both challenges can be met by adopting a predictive processing framework (PPF), and by viewing AVHs as arising from abnormalities in predictive processing. I show how, within the PPF, both the auditory phenomenology of AVHs, and three subtypes of AVH, can be accounted for.     

The dreaming brain/mind, consciousness and psychosis

Several independent lines of research in neurobiology seem to support the phenomenologically-grounded view of the dreaming brain/mind as a useful model for psychosis. Hallucinatory phenomena and thought disorders found in psychosis share several peculiarities with dreaming, where internally generated, vivid sensorimotor imagery along with often heightened and incongruous emotion are paired with a decrease in ego functions which ultimately leads to a severe impairment in reality testing. Contemporary conceptualizations of severe mental disorders view psychosis as one psychopathological dimension that may be found across several diagnostic categories. Some experimental data have shown cognitive bizarreness to be equally elevated in dreams and in the waking cognition of acutely psychotic subjects and in patients treated with pro-dopaminergic drugs, independent of the underlying disorder. Further studies into the neurofunctional underpinnings of both conditions will help to clarify the use and validity of this model.