• Assessment of metacognitive beliefs in an at risk mental state for psychosis: A validation study of the Metacognitions Questionnaire-30

      Bright, Measha; Parker, Sophie; French, Paul; Morrison, Anthony P.; Tully, Sarah; Stewart, Suzanne L. K.; Wells, Adrian; University of Manchester; Greater Manchester Mental Health NHS Foundation Trust; University of Chester (Wiley, 2018-06-07)
      Aim: The Metacognitions Questionnaire-30 (MCQ-30) has been used to assess metacognitive beliefs in a range of mental health problems. The aim of this study is to assess the validity of the MCQ-30 in people at risk for psychosis. Methods: One hundred and eighty-five participants meeting criteria for an at risk mental state (ARMS) completed the MCQ-30 as part of their involvement in a randomised controlled trial. Confirmatory and exploratory factor analyses were conducted to assess factor structure and construct validity. Results: Confirmatory factor analyses confirmed the original 5-factor structure of the MCQ-30. Examination of principal component analysis and parallel analysis outputs also suggested a 5-factor structure. Correlation analyses including measures of depression, social anxiety and beliefs about paranoia showed evidence of convergent validity. Discriminant validity was supported using the normalising subscale of the beliefs about paranoia tool. Conclusions: The MCQ-30 demonstrated good fit using the original 5-factor model, acceptable to very good internal consistency of items was evident and clinical usefulness in those at risk for psychosis was demonstrated.
    • 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.
    • Metacognitive beliefs as psychological predictors of social functioning: an investigation with young people at risk of psychosis

      Bright, Measha; Parker, Sophie; French, Paul; Fowler, David; Gumley, Andrew I.; Morrison, Anthony P.; Birchwood, Max; Jones, Peter B.; Stewart, Suzanne L. K.; Wells, Adrian; et al. (Elsevier, 2017-09-14)
      Poor social functioning has been found to be present in those at risk for psychosis. This study aimed to examine metacognitive beliefs as potential predictors of structured activity (measure of social functioning) in those with an At Risk Mental State (ARMS). Regression and correlation analyses were conducted. The sample included 109 young people. Age was found to be positively correlated to structured activity. Metacognitive beliefs concerning uncontrollability and danger of worry were found to negatively predict structured activity. This was after controlling for age, gender, treatment allocation, cognitive schemas, positive symptom severity, social anxiety, and depression. Metacognitive danger items were most important. Age was the only control variable found to be an independent predictor of structured activity in the regression model, despite negative bi-variate relationships with structured activity found across three cognitive schema subscales and social anxiety. This is the first study to find that higher negative metacognitive beliefs about uncontrollability and danger predict lower social functioning in an ARMS sample, and that the perception of thoughts being dangerous was of particular importance. Psychological interventions should consider targeting this metacognitive dimension to increase social functioning. Future longitudinal research is required to strengthen findings in this area.
    • Negative cognition, affect, metacognition and dimensions of paranoia in people at ultra-high risk of psychosis: A multi-level modelling analysis

      Morrison, Anthony P.; Shryane, Nick; Fowler, David; Birchwood, Max; Gumley, Andrew I.; Taylor, Hannah E.; French, Paul; Stewart, Suzanne L. K.; Jones, Peter B.; Lewis, Shôn W.; et al. (Cambridge University Press, 2015-04-08)
      Background: Paranoia is one of the commonest symptoms of psychosis but has rarely been studied in a population at risk of developing psychosis. Based on existing theoretical models, including the proposed distinction between ‘poor me’ and ‘bad me’ paranoia, we test specific predictions about associations between negative cognition, metacognitive beliefs and negative emotions and paranoid ideation and the belief that persecution is deserved (deservedness). Methods: We used data from 117 participants from the EDIE-2 trial of cognitive behaviour therapy for people at high risk of developing psychosis, comparing them with samples of psychiatric inpatients and healthy students from a previous study. Multi-level modelling was utilised to examine predictors of both paranoia and deservedness, with post-hoc planned comparisons conducted to test whether person-level predictor variables were associated differentially with paranoia or with deservedness. Results: Our sample of ARMS participants was not as paranoid, but reported higher levels of “bad-me” deservedness, compared to psychiatric inpatients. We found several predictors of paranoia and deservedness. Negative beliefs about self were related to deservedness but not paranoia, whereas negative beliefs about others were positively related to paranoia but negatively with deservedness. Both depression and negative metacognitive beliefs about paranoid thinking were specifically related to paranoia but not deservedness. Conclusions: This study provides evidence for the role of negative cognition, metacognition and negative affect in the development of paranoid beliefs, which has implications for psychological interventions and our understanding of psychosis.