Background: The delimitation of the clinical high risk of psychosis (CHRp) is characterized by th... more Background: The delimitation of the clinical high risk of psychosis (CHRp) is characterized by the wide variety of symptoms assessed from different approaches from the onset of psychosis. This study aimed to create a systematic procedure for an effective and accurate earlydetection of CHRp in educational settings. Method: A representative sample of 1,824 adolescents (average age, 15.79; 53.8%, women) was used to develop an online assessment system and a new 3-track, 3-level algorithm that combines symptoms of the main risk approaches: ultra-high risk (UHR), basic symptoms (BS), and anomalies in the subjective self-experience (ASE) with functional deficit. Results: The acceptability and feasibility of the online screening system were confirmed by the data. Of the total participants, 68 (3.7%) were identified as high-risk and 417 (22.9%) were identified as moderate, which also supports the functionality of the proposed algorithm. Conclusions: The system indicates a dynamic model of progression of the different symptoms in the early stages of psychosis, and it may constitute a first line of identification for severe mental disorders in young people in the earliest stages, allowing application of initial preventive measures.
Background: Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and ... more Background: Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and binge eating disorder (BED). Cue exposure therapy (CET) has been proposed as an effective intervention. Objective: To determine which situations and specific cues trigger higher levels of binge craving and to use the results in the development of virtual reality scenarios in which CET could be applied with BN and BED patients. Method: Participants were 101 outpatients, 50 with BED and 51 with BN, according to DSM-5 criteria, and 63 healthy undergraduate students who completed a self-administered questionnaire to assess binge craving. Results: The likelihood of binge craving in the clinical group was greater when alone at home, during the afternoon/early evening and in the late evening/at night, at weekends, and at dinner time or between meals. Higher levels of craving were produced in the kitchen, bedroom, dining room, and bakery situations. With regard to the specific cues reported, the presence of and access to high calorie food and snacks was the most commonly reported cue. Although some gender differences regarding triggering factors were obtained, no statistical differences were observed between ED subtypes. BN and BED patients showed significantly higher levels of binge craving than controls in all the contexts except when feeling positive affect; in this situation, levels of craving were low in both groups. Conclusions: This information regarding trigger contexts and specific cues can be used to create valid and reliable virtual environments for CET. Indeed, the data from this study may serve to develop a wide range of situations with different levels of binge craving, in which the therapeutic aim is to extinguish conditioned responses and facilitate the generalization of craving extinction.
Hintergrund: In aktuellen deutschsprachigen Leitlinien zur Behandlung von Menschen mit Schizophre... more Hintergrund: In aktuellen deutschsprachigen Leitlinien zur Behandlung von Menschen mit Schizophrenie wird für kognitive Verhaltenstherapie (KVT) die höchste Evidenzstufe angegeben. Jedoch weist vergangene Forschung darauf hin, dass nur ein geringer Teil eine entsprechende Behandlung erhält. Methode: Um Zugangsbarrieren für Menschen mit psychotischen Störungen vonseiten der Psychotherapeut_innen zu identifizieren, wurden in der vorliegenden Studie 215 Psychotherapeut_innen in einer Online-Umfrage unter anderem nach ihren Einschätzungen zur Indikation und Schwierigkeiten in der Bewilligung einer Psychotherapie, ihrer Ausbildung hinsichtlich psychotischer Störungen sowie Vorschlägen zur Verbesserung der Zugänglichkeit von Psychotherapie für Menschen mit Psychose befragt. Ergebnisse: Als größtes Hindernis wurde unzureichende Ausbildung hinsichtlich der Behandlung von psychotischen Störungen berichtet. Jedoch wird die Bewilligung einer Psychotherapie von einigen Befragten als erschwert ...
Psychology and Psychotherapy: Theory, Research and Practice
ObjectivesSlowMo is the first blended digital therapy for paranoia, showing significant small‐mod... more ObjectivesSlowMo is the first blended digital therapy for paranoia, showing significant small‐moderate reductions in paranoia in a recent large‐scale randomized controlled trial (RCT). This study explored the subjective service‐user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention.DesignQualitative co‐produced sub‐study of an RCT.MethodsParticipants were 22 adult service users with schizophrenia‐spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24‐week follow‐up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co‐produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were...
AVATAR therapy is a newly developed treatment for auditory verbal hallucinations (AVH) that uses ... more AVATAR therapy is a newly developed treatment for auditory verbal hallucinations (AVH) that uses virtual reality technology to allow a three-way interaction between therapist, participant, and the entity the person believes is the source of their distressing auditory verbal hallucinations with the aim of reducing the perceived power and hostility of the persecutory voices. Two controlled trials, one a preliminary proof of concept and the second a larger powered clinical trial comparing AVATAR therapy with a supportive counseling control intervention, have demonstrated effectiveness in terms of reduced frequency, omnipotence, and associated distress of targeted AVH. This chapter reviews the present evidence and speculates on possible mechanism of action and future developments.
SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related docu... more SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb)
School phobia is characterized by fear to diverse events associated to school such as being beate... more School phobia is characterized by fear to diverse events associated to school such as being beaten by a classmate, bullied or criticised in front of the lass, having to speak in public, doing exams, getting undressed to practice sports, etc. and can frequently cause young children to a chronic school refusal leading to significant social and academic difficulties. In older children and adolescents, the risk of a low school performance and an early school dropout is increased. Diverse techniques of graded and non-graded exposure have been used in the treatment of this problem. In vivo exposure alone or preceded by imagery exposure is the treatment more frequently applied. Clinical practice with children suggests the use of behavioural procedures requires a considerable amount of flexibility and creativity and procedures that warrantee their comprehension and cooperation. techniques based on virtual reality address these requirements and are capable of increasing the motivation of chi...
Paranoid thoughts are common across the psychosis continuum. It is well established that reasonin... more Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically robust and easy-to-use measures of these thinking styles will assist research and clinical practice. Existing assessments include experimental tasks that are complex to administer or self-report measures that have limitations in comprehensively assessing cognitive biases in paranoia. We have developed the first questionnaire to assess fast and slow thinking biases related to paranoid thoughts, and here report on its evaluation. In study 1, we generated, evaluated, and extracted items reflecting reasoning, and assessed their reliability and validity in a non-clinical sample (n = 209). In study 2, we replicated the factor analysis and psych...
AVATAR therapy represents an effective new way of working with distressing voices based on face-t... more AVATAR therapy represents an effective new way of working with distressing voices based on face-to-face dialogue between the person and a digital representation (avatar) of their persecutory voice. To date, there has been no complete account of AVATAR therapy delivery. This article presents, for the first time, the full range of therapeutic targets along with information on acceptability and potential side effects. Interest in the approach is growing rapidly and this report acts as a necessary touchstone for future development.
Background: The delimitation of the clinical high risk of psychosis (CHRp) is characterized by th... more Background: The delimitation of the clinical high risk of psychosis (CHRp) is characterized by the wide variety of symptoms assessed from different approaches from the onset of psychosis. This study aimed to create a systematic procedure for an effective and accurate earlydetection of CHRp in educational settings. Method: A representative sample of 1,824 adolescents (average age, 15.79; 53.8%, women) was used to develop an online assessment system and a new 3-track, 3-level algorithm that combines symptoms of the main risk approaches: ultra-high risk (UHR), basic symptoms (BS), and anomalies in the subjective self-experience (ASE) with functional deficit. Results: The acceptability and feasibility of the online screening system were confirmed by the data. Of the total participants, 68 (3.7%) were identified as high-risk and 417 (22.9%) were identified as moderate, which also supports the functionality of the proposed algorithm. Conclusions: The system indicates a dynamic model of progression of the different symptoms in the early stages of psychosis, and it may constitute a first line of identification for severe mental disorders in young people in the earliest stages, allowing application of initial preventive measures.
Background: Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and ... more Background: Binge eating behavior constitutes a central feature of both bulimia nervosa (BN) and binge eating disorder (BED). Cue exposure therapy (CET) has been proposed as an effective intervention. Objective: To determine which situations and specific cues trigger higher levels of binge craving and to use the results in the development of virtual reality scenarios in which CET could be applied with BN and BED patients. Method: Participants were 101 outpatients, 50 with BED and 51 with BN, according to DSM-5 criteria, and 63 healthy undergraduate students who completed a self-administered questionnaire to assess binge craving. Results: The likelihood of binge craving in the clinical group was greater when alone at home, during the afternoon/early evening and in the late evening/at night, at weekends, and at dinner time or between meals. Higher levels of craving were produced in the kitchen, bedroom, dining room, and bakery situations. With regard to the specific cues reported, the presence of and access to high calorie food and snacks was the most commonly reported cue. Although some gender differences regarding triggering factors were obtained, no statistical differences were observed between ED subtypes. BN and BED patients showed significantly higher levels of binge craving than controls in all the contexts except when feeling positive affect; in this situation, levels of craving were low in both groups. Conclusions: This information regarding trigger contexts and specific cues can be used to create valid and reliable virtual environments for CET. Indeed, the data from this study may serve to develop a wide range of situations with different levels of binge craving, in which the therapeutic aim is to extinguish conditioned responses and facilitate the generalization of craving extinction.
Hintergrund: In aktuellen deutschsprachigen Leitlinien zur Behandlung von Menschen mit Schizophre... more Hintergrund: In aktuellen deutschsprachigen Leitlinien zur Behandlung von Menschen mit Schizophrenie wird für kognitive Verhaltenstherapie (KVT) die höchste Evidenzstufe angegeben. Jedoch weist vergangene Forschung darauf hin, dass nur ein geringer Teil eine entsprechende Behandlung erhält. Methode: Um Zugangsbarrieren für Menschen mit psychotischen Störungen vonseiten der Psychotherapeut_innen zu identifizieren, wurden in der vorliegenden Studie 215 Psychotherapeut_innen in einer Online-Umfrage unter anderem nach ihren Einschätzungen zur Indikation und Schwierigkeiten in der Bewilligung einer Psychotherapie, ihrer Ausbildung hinsichtlich psychotischer Störungen sowie Vorschlägen zur Verbesserung der Zugänglichkeit von Psychotherapie für Menschen mit Psychose befragt. Ergebnisse: Als größtes Hindernis wurde unzureichende Ausbildung hinsichtlich der Behandlung von psychotischen Störungen berichtet. Jedoch wird die Bewilligung einer Psychotherapie von einigen Befragten als erschwert ...
Psychology and Psychotherapy: Theory, Research and Practice
ObjectivesSlowMo is the first blended digital therapy for paranoia, showing significant small‐mod... more ObjectivesSlowMo is the first blended digital therapy for paranoia, showing significant small‐moderate reductions in paranoia in a recent large‐scale randomized controlled trial (RCT). This study explored the subjective service‐user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the triangle of the therapeutic alliance; and the experience of the digital aspects of the intervention.DesignQualitative co‐produced sub‐study of an RCT.MethodsParticipants were 22 adult service users with schizophrenia‐spectrum psychosis and persistent distressing paranoia, who completed at least one SlowMo therapy session and a 24‐week follow‐up, at one of 3 sites in Oxford, London, and Sussex, UK. They were interviewed by peer researchers, using a topic guide co‐produced by the Patient and Public Involvement (PPI) team. The transcribed data were analysed thematically. Multiple coding and triangulation, and lay peer researcher validation were...
AVATAR therapy is a newly developed treatment for auditory verbal hallucinations (AVH) that uses ... more AVATAR therapy is a newly developed treatment for auditory verbal hallucinations (AVH) that uses virtual reality technology to allow a three-way interaction between therapist, participant, and the entity the person believes is the source of their distressing auditory verbal hallucinations with the aim of reducing the perceived power and hostility of the persecutory voices. Two controlled trials, one a preliminary proof of concept and the second a larger powered clinical trial comparing AVATAR therapy with a supportive counseling control intervention, have demonstrated effectiveness in terms of reduced frequency, omnipotence, and associated distress of targeted AVH. This chapter reviews the present evidence and speculates on possible mechanism of action and future developments.
SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related docu... more SPIRIT 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 122 kb)
School phobia is characterized by fear to diverse events associated to school such as being beate... more School phobia is characterized by fear to diverse events associated to school such as being beaten by a classmate, bullied or criticised in front of the lass, having to speak in public, doing exams, getting undressed to practice sports, etc. and can frequently cause young children to a chronic school refusal leading to significant social and academic difficulties. In older children and adolescents, the risk of a low school performance and an early school dropout is increased. Diverse techniques of graded and non-graded exposure have been used in the treatment of this problem. In vivo exposure alone or preceded by imagery exposure is the treatment more frequently applied. Clinical practice with children suggests the use of behavioural procedures requires a considerable amount of flexibility and creativity and procedures that warrantee their comprehension and cooperation. techniques based on virtual reality address these requirements and are capable of increasing the motivation of chi...
Paranoid thoughts are common across the psychosis continuum. It is well established that reasonin... more Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically robust and easy-to-use measures of these thinking styles will assist research and clinical practice. Existing assessments include experimental tasks that are complex to administer or self-report measures that have limitations in comprehensively assessing cognitive biases in paranoia. We have developed the first questionnaire to assess fast and slow thinking biases related to paranoid thoughts, and here report on its evaluation. In study 1, we generated, evaluated, and extracted items reflecting reasoning, and assessed their reliability and validity in a non-clinical sample (n = 209). In study 2, we replicated the factor analysis and psych...
AVATAR therapy represents an effective new way of working with distressing voices based on face-t... more AVATAR therapy represents an effective new way of working with distressing voices based on face-to-face dialogue between the person and a digital representation (avatar) of their persecutory voice. To date, there has been no complete account of AVATAR therapy delivery. This article presents, for the first time, the full range of therapeutic targets along with information on acceptability and potential side effects. Interest in the approach is growing rapidly and this report acts as a necessary touchstone for future development.
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