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Cannabis use severely affects the outcome of people with psychotic disorders, yet there is a lack of treatments. To address this, in 2019 the National Health Service (NHS) Cannabis Clinic for Psychosis (CCP) was developed to support adults suffering from psychosis to reduce and/or stop their cannabis use.
Aims
Examine outcome data from the first 46 individuals to complete the CCP's intervention.
Method
The sample (N = 46) consisted of adults (aged ≥ 18) with psychosis under the care of the South London and Maudsley NHS Foundation Trust, referred to the CCP between January 2020 and February 2023, who completed their intervention by September 2023. Clinical and functional measures were collected before (T0) and after (T1) the CCP intervention (one-to-one sessions and peer group attendance). Primary outcomes were changes in the Cannabis Use Disorders Identification Test-Revised (CUDIT-R) score and pattern of cannabis use. Secondary outcomes included T0–T1 changes in measures of delusions, paranoia, depression, anxiety and functioning.
Results
A reduction in the mean CUDIT-R score was observed between T0 (mean difference = 17.10, 95% CI = 15.54–18.67) and T1, with 73.91% of participants achieving abstinence and 26.09% reducing the frequency and potency of their use. Significant improvements in all clinical and functional outcomes were observed, with 90.70% being in work or education at T1 compared with 8.70% at T0. The variance in CUDIT-R scores explained between 34 and 64% of the variance in our secondary measures.
Conclusions
The CCP intervention is a feasible strategy to support cannabis use cessation/reduction and improve clinical and functional outcomes of people with psychotic disorders.
Automated virtual reality therapies are being developed to increase access to psychological interventions. We assessed the experience with one such therapy of patients diagnosed with psychosis, including satisfaction, side effects, and positive experiences of access to the technology. We tested whether side effects affected therapy.
Methods
In a clinical trial 122 patients diagnosed with psychosis completed baseline measures of psychiatric symptoms, received gameChange VR therapy, and then completed a satisfaction questionnaire, the Oxford-VR Side Effects Checklist, and outcome measures.
Results
79 (65.8%) patients were very satisfied with VR therapy, 37 (30.8%) were mostly satisfied, 3 (2.5%) were indifferent/mildly dissatisfied, and 1 (0.8%) person was quite dissatisfied. The most common side effects were: difficulties concentrating because of thinking about what might be happening in the room (n = 17, 14.2%); lasting headache (n = 10, 8.3%); and the headset causing feelings of panic (n = 9, 7.4%). Side effects formed three factors: difficulties concentrating when wearing a headset, feelings of panic using VR, and worries following VR. The occurrence of side effects was not associated with number of VR sessions, therapy outcomes, or psychiatric symptoms. Difficulties concentrating in VR were associated with slightly lower satisfaction. VR therapy provision and engagement made patients feel: proud (n = 99, 81.8%); valued (n = 97, 80.2%); and optimistic (n = 96, 79.3%).
Conclusions
Patients with psychosis were generally very positive towards the VR therapy, valued having the opportunity to try the technology, and experienced few adverse effects. Side effects did not significantly impact VR therapy. Patient experience of VR is likely to facilitate widespread adoption.
In Chapter 5, the author examines the role of intimacy between filhas de criação and their biological family members in criação. Challenging misconceptions about criação, she discusses evidence that some filhas de criação run away from their biological homes and to their informally adoptive homes. While, in some cases, filhas de criação are blocked from seeing their biological family members, in many cases, ongoing relationships with their biological families provide the opportunity for siblings to serve as co-conspirators and co-collaborators in each other’s search for freedom and independence. An unexpected finding is also that contact with biological family members may sometimes compel filhas de criação to extend the time that they provide unpaid and exploitative labor to an adoptive family. This chapter reveals the transgressive role that biological siblings can have in the lives of filhas de criação, while also highlighting the capacity for systems of domination to co-opt these same family ties and bonds to secure its proliferation.
In Chapter 2, the author employs a Goffmanian analysis to reveal the strategic discourses, interactions, and practices that comprise the performances that adoptive families use in order to mask domination. Moving beyond a family’s framing of criação as altruistic, she deconstructs concrete examples that expose how adoptive families exert domination over filhas de criação through the use of symbolic inclusion in family events, the strategic use of racialized “family” language/titles, threats of punishment, and contingent (and paltry) monetary exchanges. The author argues that these strategies sustain the illusion of the full family status of filhas de criação through the cultivation of affective, social, and economic dependency, which women often interpret as family belonging.
The book begins with a reference to a chilling ad placed in the local newspaper by a couple in Brazil looking to “adopt” a girl” to provide unpaid domestic labor. The author exposes how the rhetoric of family is used to facilitate labor exploitation of children and establishes the normalization of this practice in contemporary Brazil. Moving from the “circulation of children” to the exploitation of adult filhas de criação, Hordge-Freeman explains how racial, gender, and class domination shape the historical backdrop for the emergence of exploitative work–family relationships. Grounding this work, she introduces the theoretical concept of “affective captivity” as a framework that allows her to elaborate on the structural and affective factors involved with exploitative forms of informal adoption (criação). She notes the distinctiveness of her methodology, which includes longitudinal interviews (conducted over ten years) and the unique perspective of ethnographic observations of her live-in experiences with filhas de criação. Hordge-Freeman emphasizes the importance of an intersectional approach to contextualize the ambiguities between work and family in a way that leads to the enduring nature of these exploitative relationships.
In Chapter 6, the author examines the impact of intense, uncompensated, and often lifelong domestic work on the health and well-being of filhas de criação. Building conceptually on notions of “embodied inequality,” the chapter emphasizes physical health (sleep deprivation, back pains, etc.), mental health (elevated anxiety, lowered emotional stability and self-esteem), and sexual health (exposure to sexual harassment and discouragement of healthy sexual development) to center the multidimensional ways that criação infringes on the emotions and bodies of filhas de criação. Evidence suggests that the bodies of Black and impoverished women are expendable. Beyond the correlations between criação and low self-reported health, the author explains how health and disability perpetuate exploitation: the precarious health status of filhas de criação is not simply a result of their exploitation, but rather it leads to physical disability, which incentivizes them to remain tied to their informally adoptive families.
In Chapter 3, the author explores the emotional and affective ruptures that offer signals to filhas de criação about their second-class status in these families. As ruptures do not always (or even often) lead to critiques of the adoptive family, she focuses on how filhas de criação identify, interpret, and respond to these moments in order to examine how they make meaning of their abuse and exploitation. She analyzes their differential responses to their adoptive family’s incongruent affective performances, and the way that they resolve them through ambiguous discourses of love and affection. As the author examines the contours of affective captivity, she shows that filhas de criação are not passive, but rather can manipulate the system of affective relations for their own ends.
In the concluding chapter, the author reiterates how the hyper-exploitation of filhas de criação is sustained by an affective architecture of domination that interlocks morality and family to produce affective captivity. Zooming out from informal adoption, she highlights the role of consciousness-raising and leveraging transnational connections in order to eradicate labor exploitation. She also explores the relevance of this work for a more robust racial and gender analysis of human trafficking and labor exploitation around the world. In doing so, the author critiques the tendency to criminalize all informal family arrangements and, instead, promotes alternative approaches that are culturally relevant and realistic for Brazil’s uncertain future. There are glimmers of hope that emerge from the individual journeys of the women in this study. However, the more significant finding is that the level of structural violence that they experience, paired with their affective captivity in their oppressors’ lives, offers a chilling commentary that the most powerful weapon used in the service of domination can be love.
In Chapter 4, the author highlights the role of morality in camouflaging exploitative aspects of criação. Conceptually, she constructs the idea of a moral assemblage (moral ideologies, beliefs, and repertoires) that persuade filhas de criação to reframe their exploitation as morally righteous and encourages them to forgive, forget, or accept their treatment as second-class family members. Adding complexity to traditional representations, she illustrates how filhas de criação evaluate the morality of white men under the logic of “good masters,” especially when they are juxtaposed with their “evil” wives. Ultimately, the author argues that a strong sense of moral obligation (forged by a complex constellation of practices, discourses, and emotions) provides the justification for filhas de criação to sacrifice everything for the protection and reproduction of their adoptive family members.
In Chapter 7, the author pinpoints the diverse strategies of resistance and agency employed by filhas de criação throughout the life course. She suggests that their resistance to racial, gender, and class domination, much like their captivity, occurs on multiple levels, including through their affective performances, their manipulation of the family ideology, escape, subterfuge, and their reinterpretation and rejection of certain family relationships. By organizing these resistance strategies based on women’s status at the time of the interview (those who escaped and severed ties, those who moved out but remain attached to their adoptive families, and those who plan to live with their families until they die), the author illustrates how resistance and emancipation exist at all levels of family embeddedness and are enacted in ways that allow filhas de criação to find their own sense of freedom.