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Automated VR therapy for improving positive self-beliefs and psychological well-being in young patients with psychosis: a proof of concept evaluation of Phoenix VR self-confidence therapy
- Daniel Freeman, Jason Freeman, Memoona Ahmed, Phoebe Haynes, Helen Beckwith, Aitor Rovira, Andre Lages Miguel, Rupert Ward, Matthew Bousfield, Ludovic Riffiod, Thomas Kabir, Felicity Waite, Laina Rosebrock
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 52 / Issue 3 / May 2024
- Published online by Cambridge University Press:
- 09 November 2023, pp. 277-287
- Print publication:
- May 2024
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Background:
Low self-confidence in patients with psychosis is common. This can lead to higher symptom severity, withdrawal from activities, and low psychological well-being. There are effective psychological techniques to improve positive self-beliefs but these are seldom provided in psychosis services. With young people with lived experience of psychosis we developed a scalable automated VR therapy to enhance positive-self beliefs.
Aims:The aim was to conduct a proof of concept clinical test of whether the new VR self-confidence therapy (Phoenix) may increase positive self-beliefs and psychological well-being.
Method:Twelve young patients with non-affective psychosis and with low levels of positive self-beliefs participated. Over 6 weeks, patients were provided with a stand-alone VR headset so that they could use Phoenix at home and were offered weekly psychologist meetings. The outcome measures were the Oxford Positive Self Scale (OxPos), Brief Core Schema Scale, and Warwick-Edinburgh Well-being Scale (WEMWBS). Satisfaction, adverse events and side-effects were assessed.
Results:Eleven patients provided outcome data. There were very large end-of-treatment improvements in positive self-beliefs (OxPos mean difference = 32.3; 95% CI: 17.3, 47.3; Cohen’s d=3.0) and psychological well-being (WEMWBS mean difference = 11.2; 95% CI: 8.0, 14.3; Cohen’s d=1.5). Patients rated the quality of the VR therapy as: excellent (n=9), good (n=2), fair (n=0), poor (n=0). An average of 5.3 (SD=1.4) appointments were attended.
Conclusions:Uptake of the VR intervention was high, satisfaction was high, and side-effects extremely few. There were promising indications of large improvements in positive self-beliefs and psychological well-being. A randomized controlled clinical evaluation is warranted.
Cognitive bias modification for paranoia (CBM-pa): a randomised controlled feasibility study in patients with distressing paranoid beliefs
- Jenny Yiend, Charlene L. M. Lam, Nora Schmidt, Bryony Crane, Margaret Heslin, Thomas Kabir, Philip McGuire, Christopher Meek, Elias Mouchlianitis, Emmanuelle Peters, Daniel Stahl, Antonella Trotta, Sukhwinder Shergill
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- Journal:
- Psychological Medicine / Volume 53 / Issue 10 / July 2023
- Published online by Cambridge University Press:
- 14 June 2022, pp. 4614-4626
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Background
Cognitive Bias Modification for paranoia (CBM-pa) is a novel, theory-driven psychological intervention targeting the biased interpretation of emotional ambiguity associated with paranoia. Study objectives were (i) test the intervention's feasibility, (ii) provide effect size estimates, (iii) assess dose–response and (iv) select primary outcomes for future trials.
MethodsIn a double-blind randomised controlled trial, sixty-three outpatients with clinically significant paranoia were randomised to either CBM-pa or an active control (text reading) between April 2016 and September 2017. Patients received one 40 min session per week for 6 weeks. Assessments were given at baseline, after each interim session, post-treatment, and at 1- and 3-months post-treatment.
ResultsA total of 122 patients were screened and 63 were randomised. The recruitment rate was 51.2%, with few dropouts (four out of 63) and follow-up rates were 90.5% (1-month) and 93.7% (3-months). Each session took 30–40 min to complete. There was no statistical evidence of harmful effects of the intervention. Preliminary data were consistent with efficacy of CBM-pa over text-reading control: patients randomised to the intervention, compared to control patients, reported reduced interpretation bias (d = −0.48 to −0.76), improved symptoms of paranoia (d = −0.19 to −0.38), and lower depressed and anxious mood (d = −0.03 to −0.29). The intervention effect was evident after the third session.
ConclusionsCBM-pa is feasible for patients with paranoia. A fully powered randomised control trial is warranted.
Virtual reality (VR) therapy for patients with psychosis: satisfaction and side effects
- Daniel Freeman, Laina Rosebrock, Felicity Waite, Bao Sheng Loe, Thomas Kabir, Ariane Petit, Robert Dudley, Kate Chapman, Anthony Morrison, Eileen O'Regan, Charlotte Aynsworth, Julia Jones, Elizabeth Murphy, Rosie Powling, Heather Peel, Harry Walker, Rory Byrne, Jason Freeman, Aitor Rovira, Ushma Galal, Ly-Mee Yu, David M. Clark, Sinéad Lambe
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- Journal:
- Psychological Medicine / Volume 53 / Issue 10 / July 2023
- Published online by Cambridge University Press:
- 28 April 2022, pp. 4373-4384
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Background
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.
MethodsIn 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.
Results79 (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%).
ConclusionsPatients 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.
The Oxford Agoraphobic Avoidance Scale
- Sinead Lambe, Jessica C. Bird, Bao Sheng Loe, Laina Rosebrock, Thomas Kabir, Ariane Petit, Sophie Mulhall, Lucy Jenner, Charlotte Aynsworth, Elizabeth Murphy, Julia Jones, Rosie Powling, Kate Chapman, Robert Dudley, Anthony Morrison, Eileen O. Regan, Ly-Mee Yu, David Clark, Felicity Waite, Daniel Freeman
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- Journal:
- Psychological Medicine / Volume 53 / Issue 4 / March 2023
- Published online by Cambridge University Press:
- 23 August 2021, pp. 1233-1243
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Background
Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and in situ anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms.
MethodThe scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test–retest reliability was assessed with 264 participants.
ResultsAn eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: a = 1.24–5.43; distress: a = 1.60–5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test–retest reliability, and validity.
ConclusionsThe Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.
Why do patients with psychosis listen to and believe derogatory and threatening voices? 21 reasons given by patients
- Bryony Sheaves, Louise Johns, Laura Griffith, Louise Isham, The McPin Hearing Voices Lived Experience Advisory Panel, Thomas Kabir, Daniel Freeman
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- Journal:
- Behavioural and Cognitive Psychotherapy / Volume 48 / Issue 6 / November 2020
- Published online by Cambridge University Press:
- 29 July 2020, pp. 631-645
- Print publication:
- November 2020
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Background:
Around two-thirds of patients with auditory hallucinations experience derogatory and threatening voices (DTVs). Understandably, when these voices are believed then common consequences can be depression, anxiety and suicidal ideation. There is a need for treatment targeted at promoting distance from such voice content. The first step in this treatment development is to understand why patients listen to and believe voices that are appraised as malevolent.
Aims:To learn from patients their reasons for listening to and believing DTVs.
Method:Theoretical sampling was used to recruit 15 participants with non-affective psychosis from NHS services who heard daily DTVs. Data were obtained by semi-structured interviews and analysed using grounded theory.
Results:Six higher-order categories for why patients listen and/or believe voices were theorised. These were: (i) to understand the voices (e.g. what is their motive?); (ii) to be alert to the threat (e.g. prepared for what might happen); (iii) a normal instinct to rely on sensory information; (iv) the voices can be of people they know; (v) the DTVs use strategies (e.g. repetition) to capture attention; and (vi) patients feel so worn down it is hard to resist the voice experience (e.g. too mentally defeated to dismiss comments). In total, 21 reasons were identified, with all participants endorsing multiple reasons.
Conclusions:The study generated a wide range of reasons why patients listen to and believe DTVs. Awareness of these reasons can help clinicians understand the patient experience and also identify targets in psychological intervention.
2058 miRNA manipulation to improve CFTR correction in cystic fibrosis
- William Thomas Harris, Farruk Kabir
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- Journal:
- Journal of Clinical and Translational Science / Volume 2 / Issue S1 / June 2018
- Published online by Cambridge University Press:
- 21 November 2018, p. 20
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OBJECTIVES/SPECIFIC AIMS: CFTR is the mutant protein that causes cystic fibrosis (CF), a fatal respiratory diseases affecting 1 in 3500 children. CFTR modulators are small molecules that directly address mutant CFTR function. Improving correction of the F508del CFTR mutation (affecting 90% of CF patients) is one of the most pressing unmet needs in CF. Currently available F508del therapeutics only marginally improve CF, In vitro, we have identified a miRNA that impairs utility of CFTR directed therapies. miR-145 is upregulated by TGF-β (a genetic modifier of CF lung disease) with a direct binding site on the 3’-untranslated region of CFTR mRNA. Binding of miR-145 to CFTR destabilizes mRNA transcript and impedes protein translation. Overexpression of miR-145 abolishes benefit of F508del CFTR correction. Antagonists to miR-145 block TGF-β suppression of CFTR function and augment response to CFTR correction. This project evaluate in vivo impact of TGF-beta and miRNA manipulation on CFTR functional readouts including nasal potential difference (NPD) and short circuit current (Isc) across tracheal explants in addition to standard biochemical measures. METHODS/STUDY POPULATION: Wild-type Sprague-Dawley rats were inoculated with an adenoviral vector containing bioactive TGF-beta or sham at 1×109 pfu/animal placed in the left nares. Seven days post-inoculation, functional, and biochemical measures were conducted. NPD was measured with a microelectrode placed in the left nare and grounded the tail. The nare was sequentially perfused with standard Ringer’s solution, amiloride (to block the ENaC sodium channel), low chloride Ringer’s (to stimulate chloride efflux), forskolin (to open the CFTR channel) and CFTRinh-172 (to block the CFTR channel. Tracheal explants were harvested, microdissected, and placed on modified Ussing chambers. RESULTS/ANTICIPATED RESULTS: We have inoculated WT rats with bioactive TGF-β Versus sham delivered by intranasal inoculation of an adenoviral vector. Functional readout of CFTR function is by Isc across tracheal epithelia and NPD. Lung homogenates are analyzed for TGF-β signaling, miRNA expression, and CFTR transcripts. Both tracheal explants and NPD indicate TGF-β stimulation diminishes CFTR function in vivo. In tracheal explants, TGF-β exposure diminishes CFTR response to forskolin-stimulation by 75%. Loss of current after CFTR inhibition (CFTRinh-172) is halved. By nasal PD, TGF-β inoculation similarly halves the bioelectric response to low chloride and forskolin stimulation. Evaluation by qPCR reveals a strong increase in TGF-β signaling demarcated by PAI-1, prompting a reduction in CFTR mRNA. miR-145 is expressed highly in rat pulmonary tissue, but no change in overall miR-145 levels was detected between TGF-β and sham exposed rats. This finding reflects what we have observed in human lungs, with a localized increased miR-145 expression in CF epithelia, but similarly high levels of miR-145 in both CF and non-CF whole lung homogenates. Although expressed at lower levels than miR-145, we did find increased expression in TGF-β relevant miR-101, miR-494, and miR-144 that have a predicted binding site on rat 3’-UTR in TGF-β exposed Versus sham lungs. DISCUSSION/SIGNIFICANCE OF IMPACT: Our data indicate the relevance of TGF-β stimulation to suppress CFTR synthesis and function in vivo. Future work will evaluate whether these additional miRNA with CFTR binding sites may mediate TGF-β suppression of CFTR in the rat model, and the utility of miRNA manipulation to augment F508del CFTR correction.
1 - Measures of outcomes that are valued by service users
- from Part I - Methodological issues
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- By Thomas Kabir, Institute of Psychiatry, King's College London, UK, Til Wykes, Institute of Psychiatry, King's College London, UK
- Edited by Graham Thornicroft, { Author Role= exceeds the limit of 5 characters including spacing}, Michele Tansella, { Author Role= exceeds the limit of 5 characters including spacing}
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- Book:
- Mental Health Outcome Measures
- Published by:
- Royal College of Psychiatrists
- Published online:
- 25 February 2017, pp 3-14
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Summary
This book has many chapters on outcome assessments, from the global functioning scales to more specific and detailed measures for use in service evaluation as well as in measuring treatment outcome. So we suspect that the reader will be asking a number of questions before dipping into this first chapter, specifically on measures of outcome that are valued by service users. These we are sure will include:
• Will this chapter examine new measures of outcome that are not covered by other chapters?
• Will any new measures look radically different from those already described in other chapters?
• Why is there a chapter on outcomes that are valued by service users?
The answers to the first two questions are: yes, but not many; and probably not. But it is the answer to the last question which is key. A chapter has been specifically allocated to this topic because such measures are important in evaluations of mental healthcare. Many professionals will consider that this is just a focus on what is politically correct and that service users’ experiences are not generally that helpful or, more often, that their clinical carers usually know best. We have some sympathy with the view that when healthcare resources are scarce there is a need to measure outcomes that reflect the performance of services and that this is sometimes at variance with service users’ views. Service users may not be interested in symptom remission, patient throughput or even the assessment of their global functioning. They may be more interested in their definition of recovery or simply their happiness and sometimes these aspirations may lie outside the remit of mental health service provision.
But even with this understanding of different perspectives, we believe that the pendulum has swung too far and for too long in the direction of outcomes which may not be relevant to service users, may not be appropriately measured even if they are relevant, or may just be the opposite of what service users would expect of a mental health service. In this chapter we try to rebalance the field by introducing or describing outcome measures that are accepted by service users, and show how methods involving service users can be used to develop new, relevant and acceptable measures of outcome that reflect the purpose of services.
1 - Measures of outcomes that are valued by service users
- from Part I - Methodological issues
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- By Thomas Kabir, Department of Psychiatry, University Medical Center Groningen, University of Groningen, The Netherlands, Til Wykes, Professor of Clinical Psychology and Rehabilitation at the Institute of Psychiatry, King's College London, UK, Director of NIHR Mental Health Research Network, and Editor of the Journal of Mental Health
- Edited by Graham Thornicroft, Michelle Tansella
-
- Book:
- Mental Health Outcome Measures
- Published online:
- 02 January 2018
- Print publication:
- 01 September 2010, pp 3-14
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Summary
This book has many chapters on outcome assessments, from the global functioning scales to more specific and detailed measures for use in service evaluation as well as in measuring treatment outcome. So we suspect that the reader will be asking a number of questions before dipping into this first chapter, specifically on measures of outcome that are valued by service users. These we are sure will include:
• Will this chapter examine new measures of outcome that are not covered by other chapters?
• Will any new measures look radically different from those already described in other chapters?
• Why is there a chapter on outcomes that are valued by service users?
The answers to the first two questions are: yes, but not many; and probably not. But it is the answer to the last question which is key. A chapter has been specifically allocated to this topic because such measures are important in evaluations of mental healthcare. Many professionals will consider that this is just a focus on what is politically correct and that service users’ experiences are not generally that helpful or, more often, that their clinical carers usually know best. We have some sympathy with the view that when healthcare resources are scarce there is a need to measure outcomes that reflect the performance of services and that this is sometimes at variance with service users’ views. Service users may not be interested in symptom remission, patient throughput or even the assessment of their global functioning. They may be more interested in their definition of recovery or simply their happiness and sometimes these aspirations may lie outside the remit of mental health service provision.
But even with this understanding of different perspectives, we believe that the pendulum has swung too far and for too long in the direction of outcomes which may not be relevant to service users, may not be appropriately measured even if they are relevant, or may just be the opposite of what service users would expect of a mental health service. In this chapter we try to rebalance the field by introducing or describing outcome measures that are accepted by service users, and show how methods involving service users can be used to develop new, relevant and acceptable measures of outcome that reflect the purpose of services.