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Veliko Tarnovo Hall - Marinela

Psychosis

Simon Riches, Inês Leal, Julieta Azevedo, Fareeha Khan / Richard Bentall (Chair) Speaker

Chair: Richard Bentall, University of Liverpool

14:00 Using virtual reality to assess paranoid ideation and social performance
           Simon Riches, Philippa Garety, Mar Rus-Calafell, Lucia Valmaggia, Kings College London

14:15 Living with Psychosis: A pilot study on patient’s perspectives and benefits of
            mindfulness and self-compassion practices
           Inês Leal, Joana Rodrigues, Margarida Tomé, Mariana Argel, Maria João Ruivo, Paula
           Castilho, University of Coimbra, Portugal

14:30 Efficacy of Contextual Behavioral Therapies In Bipolar Disorder – A Pilot Trial
           Julieta Azevedo,Paula Castilho, António Macedo, University of Coimbra
           Michaela Swales, University of Bangor

14:45 Impact of an auditory hallucinations simulation on trainee and newly qualified clinical
            psychologists
           Simon Riches, Fareeha Khan,Kings College London & South London and Maudsley NHS
           Foundation Trust
           Shifaa Kwieder, Helen L. Fisher,Kings College London

15:00 Discussion

 

Abstracts:

1) Using virtual reality to assess paranoid ideation and social performance
Simon Riches, Philippa Garety, Mar Rus-Calafell, Lucia Valmaggia, Kings College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology

Introduction:
Paranoid ideation and social performance impairments overlap significantly. Virtual reality (VR) can enable psychological assessment in ecologically valid social environments. This project, in two linked studies, aimed to recruit a general population sample; test for paranoid ideation and its correlates with cognitive, affective, and behavioural components of social performance; then to pilot a new VR ‘social situation’ paradigm in non-clinical participants with high and low paranoid ideation; and to investigate whether these components of social performance and mood are associated with increased paranoid ideation in a VR ‘social situation’ task.
Method:
In Study 1, a general population online survey (N=609) investigated how trait paranoia relates to components of social performance and mood. In Study 2, two groups were formed from Study 1: participants who scored high and low in trait paranoia (N=89) entered a VR ‘social situation’ task (a party in a bar) to evaluate the acceptability of the VR task and the relationship between paranoid ideation and social performance.
Results:
As hypothesised, in Study 1, trait paranoia was associated with components of social performance; in Study 2, participants found the VR environment acceptable and immersive; exposure to the VR environment elicited a range of cognitive, affective, and behavioural components of social performance; and high trait paranoia participants reported higher state paranoia and greater negative components of social performance.
Discussion:
The VR environment was shown to be valid for measuring paranoid ideation and social performance by replicating Phase 1 associations of high trait paranoia with both high state paranoia and greater negative appraisals of social performance.This result builds on previous research which demonstrates measurement of the relationship between paranoia and environmental stress in VR environments but, in this study, uses a new immersive, interactive, multi-avatar bar-room environment and targets specific components of social performance known to be associated with paranoia.Furthermore, our participants found the newly designed VR environment acceptable and immersive, and no adverse effects were reported. A key strength of the study is that it explores the link between paranoid ideation and social performance in an ecologically valid, standardised virtual environment, which has the potential to be manipulated experimentally and used therapeutically in ways that can personalise treatments. The VR study controlled for potential confounders, such as group differences in gender, ethnicity, employment status, social anxiety, way of finding out about the study, and previous VR or gaming experience; whereas statistically significant group differences in age, education, and relationship status may have contributed to effects on social performance and paranoid ideation.
Conclusions:
The VR task has assessment and treatment applications for people with psychosis, who can experience paranoia in social situations.

 

2) Living with Psychosis: A pilot study on patient’s perspectives and benefits of mindfulness and self-compassion practices
Inês Leal, Faculty of Psychology and Educacional Sciences, University of Coimbra, Portugal; Joana Rodrigues, Faculty of Psychology and Educacional Sciences, University of Coimbra, Portugal;Margarida Tomé, Faculty of Psychology and Educacional Sciences, University of Coimbra, Portugal; Mariana Argel, Faculty of Medicine, University of Coimbra, Portugal;Maria João Ruivo, Center for research in Neuropsychology and Cognitive Behavioral Intervention. Faculty of Psychology and Educacional Sciences & Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal;  Paula Castilho, Center for research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educacional Sciences, University of Coimbra, Portugal. 

Introduction:
With the increasing evidence-based support of recovery-based models for severe mental illness and contextual approaches to psychosis, authors recommend that along with reducing the sense of threat there is also the need to stimulate the soothing-safeness system through mindfulness and compassion practices. Several studies have tested the effectiveness of these practices with promising results both in psychopathology and recovery-related outcomes. However, and to our knowledge, no other study had focused on patients’ feedback about these specific practices, which in the light of the recovery model, is of extreme importance. Therefore, this experimental study aimed to understand: 1) whether patients with psychosis consider this approach useful, understanding their feedback on specific practices; 2) the endorsement of mindfulness and compassion skills during and after the exercises; 3) the impact on recovery-related measures (well-being, positive and negative affect).
Method:
Patients were first referred by their psychiatrists and invited to participate in four individual sessions, in a range of two months. In Session 0, after informed consent was obtained, participants were assessed with the Clinical Interview for Psychosis Disorders from which scores for PANSS, GAF and PSP were derived. Self-response instruments were also filled in (EADS-21; SMQ; MHC-SF; SELFCS). From Session 0 to 2 inclusive, participants were asked to fill the Daily Report of Emotions after a random phone call during the week following each session. Session 1 addressed the Three Systems of Affect Regulation linked to psychotic symptoms and associated difficulties, followed by Mindfulness of Breathing. At Session 2 was provided a rational about the Three Flows of Compassion, followed by two exercises: Loving-Kindness and Compassionate Self. At the end of the session participants filled in the same quantitative measures. In all sessions a session summary sheet was filled in and an audio recording was sent so they can practice at home. In order to understand the feedback of the participants regarding the exercises, the last session examined qualitative information.
Results:
This is an ongoing study and we expect to have results by June, 2018. We hypothesise that participants will evaluate the exercises as useful and feasible with benefits in terms of well-being, positive affect and improvement of negative affect.
Discussion and Conclusions:
If the mindfulness and compassion exercises are considered useful and feasible by the participants and benefits confirmed our results will complement the existing research on the advantages of contextual interventions for people with psychosis.

 

3) Efficacy of Contextual Behavioral Therapies In Bipolar Disorder – A Pilot Trial
Julieta Azevedo, CINEICC - Neuropsychological, Cognitive and Behavioural Center for Research, Faculty of Psychology and Educational Sciences & Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal;António Macedo, Department of Psychological Medicine, Faculty of Medicine, University of Coimbra, Portugal;Michaela Swales, University of Bangor, United Kingdom;Paula Castilho, CINEICC - Neuropsychological, Cognitive and Behavioural Center for Research, Faculty of Psychology and Educational Sciences, University of Coimbra, Portugal

Introduction:
Bipolar disorder (BD) is a serious mental disorder characterized by episodes of mania/hypomania and depression, mood instability, significant functional impairment, lower quality of life, and higher rates of suicide than the general population. Pharmacological interventions prevail as the primary intervention in BD, however, most patients are not fully stabilized on drug therapies alone and a large number of patients experience residual symptoms so that full functional recovery is uncommon. Hence, growing evidence support the need to use psychosocial interventions as adjuvant therapies to improve recovery in BD. Even though Psychoeducation (PE) and Cognitive-Behavioral Therapy (CBT) have supporting evidence of their efficacy in BD, there are also contradictory findings, contesting their efficacy. A recent review regarding empirically supported psychosocial interventions for BD, indicate preliminary but positive findings regarding contextual therapies, especially Dialectical Behavior Therapy (DBT) and Mindfulness Based Cognitive Therapy (MBCT) group interventions, and highlighting the necessity for further research. Further empirical research through RCT studies to clarify contextual therapies’ efficacy (particularly DBT, and MBCT) for BD is essential and necessary. This study aims to assess contextual behavioral therapies (DBT skills training, MBCT) efficiency in BD symptoms regulation, recovery variables, emotional regulation skills and also functional improvement.
Method:
The study will follow a pilot trial design through a 4 groups distribution (Experimental Group 1 – DBT + TAU; Experimental Group 2 – MBCT + TAU; CAG – Control Active Group – Psychoeducation + TAU; CG – TAU). The sample collection will take place at local public hospitals and private clinics. Participants will answer a set of self-report measures and be clinically assessed through semi-structured interviews.
Expected results:
We expect to see improvement in personal recovery variables, emotion regulation skills, and psychological distress and enhance positive affect and also functional improvement in everyday life. This PhD research project intends to analyze DBT-skills and MBCT’s efficacy, and if proven, make them available through intervention detailed manuals for mental health professionals.

 

4) Impact of an auditory hallucinations simulation on trainee and newly qualified clinical psychologists
Simon Riches, Fareeha Khan,Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London & South London & Maudsley NHS Foundation Trust, UK;
Shifaa Kwieder, Helen L. Fisher, Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, Kings College London, UK

Introduction:
Simulation training is an effective teaching tool enabling learners to gain subjective understanding. Our aim in this study was to pilot and evaluate a newly-designed auditory hallucinations simulation as a future training tool for clinicians.
Methods:
This was a mixed-methods study in two parts. In Phase 1, trainee and qualified clinical psychologists (N=25) attended the London-based immersive art exhibition, Altered States of Consciousness, which included an auditory hallucinations simulation. The exhibition aimed to improve understanding of what it feels like to hear voices by providing members of the public with an individualised simulation of auditory hallucinations. Co-production with people with lived experience of auditory hallucinations was incorporated into all stages of the development of the exhibition and the research. Participants completed pre-/post-exhibition measures of their mood and attitudes towards auditory hallucinations and other unusual sensory experiences. In Phase 2, approximately six months later, a subgroup of Phase 1 participants (N=15) took part in a semi-structured interview and again completed the post-exhibition questions. Results: In Phase 1, most participants were female (N=23), in the 26-35 age range (N=20), and White British (N=18). There were seventeen trainees and eight qualified clinical psychologists. Post-exhibition, there were significant increases in understanding what it feels like to hear voices (large effect), compassion towards people who hear voices (large effect), and comfort talking to people who hear voices (medium effect). In Phase 2, There were fifteen participants. Most were female (N=14), in the 26-35 age range (N=14), and White British (N=12). There were six first year trainees, five second year trainees, and four clinical psychologists, all of whom were less than one year qualified. Quantitative scores were partially maintained. Thematic analysis of interviews showed that participants identified cognitive (distraction, hypervigilance), emotional (anxiety, irritation, fear, disempowerment), and behavioural (compliance vs. defiance, resignation) responses. Participants reported that the simulation provided numerous benefits to their training and clinical practice, including increases in subjective understanding, compassion, and confidence, and suggested training applications for the simulation.
Discussion:
Our hypothesis, that the simulation would increase clinical psychologists’ understanding and compassion towards voice hearers and would have a positive impact on their clinical practice and training, was supported. The findings indicate that the auditory hallucinations simulation may be a useful training tool for clinical psychologists as well as a range of other healthcare professionals, such as nurses, and for broader groups within the public, such as school children, families, and police. Strengths of the study were its novel design; that it recruited trainee and newly qualified clinical psychologists; and the qualitative methodology that offered a more in-depth account of participants’ subjective experience. Limitations included the small sample size, lack of control group, and utilisation of brief untested scales.
Conclusions:
This simulation has potential for training clinical psychologists and other healthcare professionals who work with people who experience auditory hallucinations. Increases in subjective understanding and confidence in clinicians are likely to benefit the therapeutic relationship and improve outcomes.