Hostname: page-component-848d4c4894-x5gtn Total loading time: 0 Render date: 2024-05-31T05:03:47.767Z Has data issue: false hasContentIssue false
  • English
  • Français

Targeting affect leads to reduced paranoia in people with psychosis: a single case series

Published online by Cambridge University Press:  19 October 2020

Daniel Silva ,
Tess Maguire ,
Pamela McSherry  and
Katherine Newman-Taylor Open the ORCID record for Katherine Newman-Taylor [Opens in a new window]
Daniel Silva*
Affiliation:
Psychology Department, University of Southampton, Building 44, Highfield Campus, SouthamptonSO17 1BJ, UK
Tess Maguire
Affiliation:
Psychology Department, University of Southampton, Building 44, Highfield Campus, SouthamptonSO17 1BJ, UK
Pamela McSherry
Affiliation:
Psychology Department, University of Southampton, Building 44, Highfield Campus, SouthamptonSO17 1BJ, UK
Katherine Newman-Taylor
Affiliation:
Psychology Department, University of Southampton, Building 44, Highfield Campus, SouthamptonSO17 1BJ, UK Psychology Department, Southern Health NHS Foundation Trust, College Keep, Terminus Terrace, SouthamptonSO14 3DT, UK
*
*Corresponding author. Email: Daniel.Silva@southernhealth.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Current psychological interventions for psychosis focus primarily on cognitive and behavioural management of delusions and hallucinations, with modest outcomes. Emotions are not usually targeted directly, despite evidence that people with psychosis have difficulty identifying, accepting and modifying affective states.

Aims:

This study assessed the impact of emotion regulation skills practice on affect and paranoia in seven people who met criteria for a diagnosis of schizophrenia or schizoaffective disorder.

Method:

The study utilised a single case ABA design and measured emotion regulation skills, affect and paranoia over baseline, intervention and withdrawal of intervention phases. We predicted that eight sessions of skills rehearsal would lead to improved emotion regulation, reduced negative affect, increased positive affect, and reduced paranoia.

Results:

Most participants were able to learn to regulate their emotions, and reported reduced negative affect and paranoia. There was no clear pattern of change for positive affect.

Conclusions:

These findings suggest that emotion can be targeted in psychosis, and is associated with reduced paranoia. Emotion regulation may constitute a key treatment target in cognitive behavioural therapy for psychosis.

Keywords

distress toleranceemotion regulationparanoiapsychosisschizophreniaDBT
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 3 , May 2021 , pp. 302 - 313
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

APA (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Descriptions and Diagnostic Guidelines (6th edn). Geneva, Switzerland: World Health Organization.Google Scholar
Bak, M., Drukker, M., Hasmi, L., & van Os, J. (2016). An n=1 clinical network analysis of symptoms and treatment in psychosis. PLoS ONE, 11, 1–15. https://doi.org/10.1371/journal.pone.0162811 Google ScholarPubMed
Bankoff, S. M., Karpel, M. G., Forbes, H. E., & Pantalone, D. W. (2012). A systematic review of dialectical behavior therapy for the treatment of eating disorders. Eating Disorders, 20, 196–215.CrossRefGoogle ScholarPubMed
Cole, P., Weibel, S., Nicastro, R., Hasler, R., Dayer, A., Aubry, J. M., & Perroud, N. (2016). CBT/DBT skills training for adults with attention deficit hyperactivity disorder (ADHD). Psychiatria Danubina, 28 (suppl 1), 103–107.Google Scholar
Cristea, I. A., Gentili, C., Cotet, C. D., Palomba, D., Barbui, C., & Cuijpers, P. (2017). Efficacy of psychotherapies for borderline personality disorder: a systematic review and meta-analysis. JAMA Psychiatry, 74, 319–328.CrossRefGoogle ScholarPubMed
Ellett, L., Freeman, D., & Garety, P.A. (2008). The psychological effect of an urban environment on individuals with persecutory delusions: the Camberwell walk study. Schizophrenia Research, 99, 77–84.CrossRefGoogle ScholarPubMed
Favrod, J., Nguyen, A., Chaix, J., Pellet, J., Frobert, L., Fankhauser, C., … & Rexhaj, S. (2019). Improving pleasure and motivation in schizophrenia: a randomized controlled clinical trial. Psychotherapy and Psychosomatics, 88, 84–95.CrossRefGoogle ScholarPubMed
Fleming, A. P., McMahon, R. J., Moran, L. R., Peterson, A. P., & Dreessen, A. (2015). Pilot randomized controlled trial of dialectical behavior therapy group skills training for ADHD among college students. Journal of Attention Disorders, 19, 260–271.CrossRefGoogle ScholarPubMed
Freeman, D., Garety, P.A., Bebbington, P.E., Smith, B., Rollinson, R., Fowler, D., Kuipers, E., Ray, K., & Dunn, G. (2005). Psychological investigation of the structure of paranoia in a non-clinical population. British Journal of Psychiatry, 186, 427–435.CrossRefGoogle Scholar
Garis, R. I., & Farmer, K. C. (2002). Examining costs of chronic conditions in a Medicaid population. Managed Care, 11, 43–50.Google Scholar
Gast, D. L. (2010). Single Subject Research Methodology in Behavioral Sciences. New York, NY, USA: Routledge.Google Scholar
Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.CrossRefGoogle Scholar
Green, C. E. L., Freeman, D., Kuipers, E., Bebbington, P., Fowler, D., Dunn, G., & Garety, P. A. (2008). Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS). Psychological Medicine, 38, 101–111.CrossRefGoogle Scholar
Gumley, A. I., Gillham, A., Taylor, K., & Schwannauer, M. (eds) (2013). Psychosis and Emotion: The Role of Emotions in Understanding Psychosis, Therapy and Recovery. London, UK: Routledge.CrossRefGoogle Scholar
Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. Journal of Nervous and Mental Disease, 196, 136–143.CrossRefGoogle Scholar
Henry, J. D., Bailey, P. E., von Hippel, C., Rendell, P. G., & Lane, A. (2010). Alexithymia in schizophrenia. Journal of Clinical and Experimental Neuropsychology, 32, 890–897.CrossRefGoogle Scholar
Hirvikoski, T., Waaler, E., Alfredsson, J., Pihlgren, C., Holmström, A., Johnson, A., … & Nordström, A. L. (2011). Reduced ADHD symptoms in adults with ADHD after structured skills training group: results from a randomized controlled trial. Behaviour Research and Therapy, 49, 175–185.CrossRefGoogle ScholarPubMed
Huberty, C. J., & Lowman, L. L. (2000). Group overlap as a basis for effect size. Educational and Psychological Measurement, 60, 543–563.CrossRefGoogle Scholar
Jones, C., Hacker, D., Meaden, A., Cormac, I., Irving, C. B., Xia, J., … & Chen, J. (2018). Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia. Cochrane Database of Systematic Reviews, 11.Google ScholarPubMed
Kazdin, A. E. (2019). Single-case experimental designs. Evaluating interventions in research and clinical practice. Behaviour Research and Therapy, 117, 3–17.CrossRefGoogle ScholarPubMed
Khoury, B., & Lecomte, T. (2012). Emotion regulation and schizophrenia. International Journal of Cognitive Therapy, 5, 67–76.CrossRefGoogle Scholar
Kimhy, D., Vakhrusheva, J., Jobson-Ahmed, L., Tarrier, N., Malaspina, D., & Gross, J. J. (2012). Emotion awareness and regulation in individuals with schizophrenia: implications for social functioning. Psychiatry Research, 200, 193–201.CrossRefGoogle ScholarPubMed
Kramer, I., Simons, C. J., Wigman, J. T., Collip, D., Jacobs, N., Derom, C., … & Wichers, M. (2014). Time-lagged moment-to-moment interplay between negative affect and paranoia: new insights in the affective pathway to psychosis. Schizophrenia Bulletin, 40, 278–286.CrossRefGoogle ScholarPubMed
Kratochwill, T. R., Hitchcock, J. H., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M., & Shadish, W. R. (2013). Single-case intervention research design standards. Remedial and Special Education, 34, 26–38.CrossRefGoogle Scholar
Kratochwill, T. R., Hitchcock, J., Horner, R., Levin, J., Odom, S. L., Rindskopf, D., & Shadish, W. R. (2010). Single-case technical documentation. http://www.behavior.org/resources/422.pdf Google Scholar
Kratochwill, T. R., & Levin, J. R. (eds). (2014). Visual analysis of single-case intervention research: conceptual and methodological issues. In Kratochwill, T. R. & Levin, J. R. (eds), School Psychology Series. Single-Case Intervention Research: Methodological and Statistical Advances (pp. 91–125). American Psychological Association. https://doi.org/10.1037/14376-004 Google Scholar
Lawlor, C., Hepworth, C., Smallwood, J., Carter, B., & Jolley, S. (2020). Self-reported emotion regulation difficulties in people with psychosis compared with non-clinical controls: a systematic literature review. Clinical Psychology & Psychotherapy, 27, 107–135.CrossRefGoogle ScholarPubMed
Laws, K. R., Darlington, N., Kondel, T. K., McKenna, P. J., & Jauhar, S. (2018). Cognitive behavioural therapy for schizophrenia – outcomes for functioning, distress and quality of life: a meta-analysis. BMC Psychology, 6, 32.CrossRefGoogle ScholarPubMed
Lenz, A. S., Taylor, R., Fleming, M., & Serman, N. (2014). Effectiveness of dialectical behavior therapy for treating eating disorders. Journal of Counselling & Development, 92, 26–35.CrossRefGoogle Scholar
Leung, D. H. Y. (2001). Statistical methods for clinical studies in the presence of surrogate end points. Journal of the Royal Statistical Society: Series A (Statistics in Society), 164, 485–503.CrossRefGoogle Scholar
Lincoln, T. M., Hartmann, M., Köther, U., & Moritz, S. (2015a). Do people with psychosis have specific difficulties regulating emotions? Clinical Psychology & Psychotherapy, 22, 637–646.CrossRefGoogle ScholarPubMed
Lincoln, T. M., Hartmann, M., Köther, U., & Moritz, S. (2015b). Dealing with feeling: specific emotion regulation skills predict responses to stress in psychosis. Psychiatry Research, 228, 216–222.CrossRefGoogle ScholarPubMed
Lincoln, T. M., Sundag, J., Schlier, B., & Karow, A. (2017). The relevance of emotion regulation in explaining why social exclusion triggers paranoia in individuals at clinical high risk of psychosis. Schizophrenia Bulletin, 44, 757–767.CrossRefGoogle Scholar
Linehan, M. (2014). DBT Skills Training Manual (2nd edn). Guilford Publications.Google Scholar
Linehan, M. M., Dimeff, L. A., Reynolds, S. K., Comtois, K. A., Welch, S. S., Heagerty, P., & Kivlahan, D. R. (2002). Dialectical behavior therapy versus comprehensive validation therapy plus 12-step for the treatment of opioid dependent women meeting criteria for borderline personality disorder. Drug and Alcohol Dependence, 67, 13–26.CrossRefGoogle ScholarPubMed
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J. C., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. American Journal on Addictions, 8, 279–292.Google ScholarPubMed
Llerena, K., Strauss, G. P., & Cohen, A. S. (2012). Looking at the other side of the coin: a meta-analysis of self-reported emotional arousal in people with schizophrenia. Schizophrenia Research, 142, 65–70.CrossRefGoogle ScholarPubMed
Lobo, M. A., Moeyaert, M., Cunha, A. B., & Babik, I. (2018). Single-case design, analysis, and quality assessment for intervention research. Journal of Neurologic Physical Therapy, 41, 187.CrossRefGoogle Scholar
López-Díaz, Á., Lara, I., & Lahera, G. (2018). Is the prevalence of the deficit syndrome in schizophrenia higher than estimated? Results of a meta-analysis. Psychiatry Investigation, 15, 94.CrossRefGoogle ScholarPubMed
Ludwig, L., Mehl, S., Schlier, B., Krkovic, K., & Lincoln, T. M. (2020). Awareness and rumination moderate the affective pathway to paranoia in daily life. Schizophrenia Research, 216, 161–167.CrossRefGoogle ScholarPubMed
Moreno-Küstner, B., Martin, C., & Pastor, L. (2018). Prevalence of psychotic disorders and its association with methodological issues. A systematic review and meta-analyses. PloS One, 13, e0195687.CrossRefGoogle ScholarPubMed
Morley, S. (2018). Single Case Methods in Clinical Psychology: A Practical Guide. London, UK: Routledge.Google Scholar
Myin-Germeys, I., & van Os, J. (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review, 27, 409–424.CrossRefGoogle ScholarPubMed
Newman-Taylor, K., & Stopa, L. (2013). The fear of others: a pilot study of social anxiety processes in paranoia. Behavioural and Cognitive Psychotherapy, 41, 66.CrossRefGoogle ScholarPubMed
Nittel, C. M., Lincoln, T. M., Lamster, F., Leube, D., Rief, W., Kircher, T., & Mehl, S. (2018). Expressive suppression is associated with state paranoia in psychosis: an experience sampling study on the association between adaptive and maladaptive emotion regulation strategies and paranoia. British Journal of Clinical Psychology, 57, 291–312.CrossRefGoogle Scholar
Nugent, K. L., Chiappelli, J., Rowland, L. M., Daughters, S. B., & Hong, L. E. (2014). Distress intolerance and clinical functioning in persons with schizophrenia. Psychiatry Research, 220, 31–36.CrossRefGoogle ScholarPubMed
O’Driscoll, C., Laing, J., & Mason, O. (2014). Cognitive emotion regulation strategies, alexithymia and dissociation in schizophrenia, a review and meta-analysis. Clinical Psychology Review, 34, 482–495.CrossRefGoogle ScholarPubMed
Ottenbacher, K. J. (1993). Interrater agreement of visual analysis in single-subject decisions: quantitative review and analysis. American Journal on Mental Retardation, 98, 135–142.Google ScholarPubMed
Panos, P. T., Jackson, J. W., Hasan, O., & Panos, A. (2014). Meta-analysis and systematic review assessing the efficacy of dialectical behavior therapy (DBT). Research on Social Work Practice, 24, 213–223.CrossRefGoogle Scholar
Parker, R. I., Vannest, K. J., Davis, J. L., & Sauber, S. B. (2011). Combining nonoverlap and trend for single-case research: Tau-U. Behavior Therapy, 42, 284–299.CrossRefGoogle ScholarPubMed
Perry, Y., Henry, J. D., & Grisham, J. R. (2011). The habitual use of emotion regulation strategies in schizophrenia. British Journal of Clinical Psychology, 50, 217–222.CrossRefGoogle Scholar
Persons, J. B., & Boswell, J. F. (2019). Single case and idiographic research: Introduction to the special issue. Behaviour Research and Therapy, 117, 1–2.CrossRefGoogle ScholarPubMed
Reininghaus, U., Kempton, M. J., Valmaggia, L., Craig, T. K., Garety, P., Onyejiaka, A., Gayer-Anderson, C., So, S. H., Hubbard, K., Beards, S., & Dazzan, P. (2016). Stress sensitivity, aberrant salience, and threat anticipation in early psychosis: an experience sampling study. Schizophrenia Bulletin, 42, 712–722.CrossRefGoogle Scholar
Schizophrenia Commission (2012). The Abandoned Illness: A Report from the Schizophrenia Commission. London: Rethink Mental Illness.Google Scholar
Schizophrenia Commission (2017). The Schizophrenia Commission Progress Report: Five Years On. London: Rethink Mental Illness.Google Scholar
Schlier, B., Moritz, S., & Lincoln, T. M. (2016). Measuring fluctuations in paranoia: validity and psychometric properties of brief state versions of the Paranoia Checklist. Psychiatry Research, 241, 323–332.CrossRefGoogle ScholarPubMed
Shadish, W. R. (2014). Statistical analyses of single-case designs: the shape of things to come. Current Directions in Psychological Science, 23, 139–146.CrossRefGoogle Scholar
Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: development and validation of a self-report measure. Motivation and Emotion, 29, 83–102.CrossRefGoogle Scholar
Tate, R. L., Perdices, M., Rosenkoetter, U., Wakim, D., Godbee, K., Togher, L., & McDonald, S. (2013). Revision of a method quality rating scale for single-case experimental designs and n-of-1 trials: the 15-item Risk of Bias in N-of-1 Trials (RoBiNT) Scale. Neuropsychological Rehabilitation, 23, 619–638.CrossRefGoogle ScholarPubMed
Telch, C. F., Agras, W. S., & Linehan, M. M. (2001). Dialectical behavior therapy for binge eating disorder. Journal of Consulting and Clinical Psychology, 69, 1061.CrossRefGoogle ScholarPubMed
Tsang, E. W. (2014). Generalizing from research findings: the merits of case studies. International Journal of Management Reviews, 16, 369–383.CrossRefGoogle Scholar
van der Gaag, M., Valmaggia, L. R., & Smit, F. (2014). The effects of individually tailored formulation-based cognitive behavioural therapy in auditory hallucinations and delusions: a meta-analysis. Schizophrenia Research, 156, 30–37.CrossRefGoogle ScholarPubMed
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: the PANAS scales. Journal of Personality and Social Psychology, 54, 1063.CrossRefGoogle ScholarPubMed
Wilcox, R. R., & Keselman, H. J. (2003). Modern robust data analysis methods: measures of central tendency. Psychological Methods, 8, 254.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.