• Components of therapy as mechanisms of change in cognitive therapy for people at risk of psychosis: An analysis of the EDIE-2 trial

      Flach, Clare; French, Paul; Dunn, Graham; Fowler, David; Gumley, Andrew I.; Birchwood, Max; Stewart, Suzanne L. K.; Morrison, Anthony P.; University of Manchester ; Greater Manchester West NHS Foundation Trust/Liverpool University ; University of Manchester ; University of Sussex ; University of Glasgow ; University of Warwick ; University of Chester ; Greater Manchester West NHS Foundation Trust/University of Manchester (2015-05-21)
      Background: Research suggests that the way in which cognitive therapy is delivered is an important factor in determining outcomes. We test the hypotheses that the development of a shared problem list, use of case formulation, homework tasks and active intervention strategies will act as process variables. Methods: Presence of these components during therapy is taken from therapist notes. The direct and indirect effect of the intervention is estimated by an instrumental variable analysis. Results: A significant decrease in symptom score for case formulation (coefficient=-23, 95%CI -44 to -1.7, p=0.036) and homework (coefficient=-0.26, 95%CI -0.51 to -0.001, p=0.049) is found. Improvement with the inclusion of active change strategies is of borderline significance (coefficient= -0.23, 95%CI -0.47 to 0.005, p=0.056). Conclusions: There is a greater treatment effect if formulation and homework are involved in therapy. However, high correlation between components means that these may be indicators of overall treatment fidelity.
    • Core Schemas across the Continuum of Psychosis: A Comparison of Clinical and Non-Clinical Groups

      Taylor, Hannah E.; Stewart, Suzanne L. K.; Dunn, Graham; Parker, Sophie; Fowler, David; Morrison, Anthony P.; University of Manchester; Greater Manchester West Mental Health NHS Foundation; University of East Anglia (Cambridge University Press, 2013-08-07)
      Background: Research suggests that core schemas are important in both the development and maintenance of psychosis. Aims: The aim of the study was to investigate and compare core schemas in four groups along the continuum of psychosis and examine the relationships between schemas and positive psychotic symptomatology. Method: A measure of core schemas was distributed to 20 individuals experiencing first-episode psychosis (FEP), 113 individuals with “at risk mental states” (ARMS), 28 participants forming a help-seeking clinical group (HSC), and 30 non-help-seeking individuals who endorse some psychotic-like experiences (NH). Results: The clinical groups scored significantly higher than the NH group for negative beliefs about self and about others. No significant effects of group on positive beliefs about others were found. For positive beliefs about the self, the NH group scored significantly higher than the clinical groups. Furthermore, negative beliefs about self and others were related to positive psychotic symptomatology and to distress related to those experiences. Conclusions: Negative evaluations of the self and others appear to be characteristic of the appraisals of people seeking help for psychosis and psychosis-like experiences. The results support the literature that suggests that self-esteem should be a target for intervention. Future research would benefit from including comparison groups of people experiencing chronic psychosis and people who do not have any psychotic-like experiences.
    • Psychopathology and affect dysregulation across the continuum of psychosis: A multiple comparison group study

      Taylor, Hannah E.; Stewart, Suzanne L. K.; Dunn, Graham; Parker, Sophie; Bentall, Richard P.; Birchwood, Max; Morrison, Anthony P.; University of Manchester; Greater Manchester West Mental Health NHS Foundation Trust; Bangor University; University of Birmingham (Wiley, 2013-06-17)
      Aim: There is evidence that psychotic-like phenomena can be detected within the general population and that psychotic experiences lie on a continuum which also spans affective states. We aimed to investigate comparisons of a first episode psychosis group, an ‘at-risk mental state group’ and a help-seeking control group with non-patients to explore whether affective states lie on a continuum of psychosis. Method: Measures of psychotic-like experiences, social anxiety and depression were administered to 20 patients experiencing first episode psychosis (FEP), 113 patients experiencing an ‘at-risk’ mental state (ARMS), 28 patients who were help-seeking but not experiencing a FEP or ARMS (HSC) and 30 non-clinical participants (NC). Results: For distress in relation to psychotic-like experiences, the FEP, ARMS and HSC groups scored significantly higher than the NC group for the perceptual abnormalities and non-bizarre ideas. In terms of severity of psychotic experiences, the FEP scored the highest, followed by the ARMS group, followed by the HSC and NC group. The clinical groups scored significantly higher for depression than the non-clinical group. Interestingly, only the FEP and the ARMS group scored significantly higher than non-patients for social anxiety. Conclusions: These findings suggest that a psychosis continuum exists, however this does not suggest that both psychosis and affective symptoms lie on the same continuum, rather it would appear that the presence of such affective states that may affect help-seeking behavior and clinical status. The implications of these findings for clinical practice are discussed.