ABSTRACT
Acute mental health inpatient wards have been criticized for being nontherapeutic. The study aimed to test the feasibility of delivering a psychologically informed intervention in these settings. This single-arm study evaluated the feasibility of clinical psychologists delivering a ward-based psychological service model over a 6-month period on two acute mental health wards. Data were gathered to assess trial design parameters and the feasibility of gathering patient/staff outcome data. Psychologists were able to deliver key elements of the intervention. Baseline staff and patient participant recruitment targets were met. However, there was significant patient attrition at follow-up, with incorrect contact details on discharge being the primary reason. Implementation of a ward-based psychological intervention appears feasible when implemented flexibly. It is feasible to recruit staff and patient participants and to collect staff outcome measures over a 6-month period. However, greater efforts need to be taken to trace patient movement following discharge.
Subject(s)
Inpatients , Mental Health , Feasibility Studies , Humans , Outcome Assessment, Health CareABSTRACT
OBJECTIVES: The study examined (1) the role of experiential avoidance (EA), conceptualized as intolerance towards aversive mental states, in paranoid delusions and (2) the mechanisms underlying EA. DESIGN: A 6-day prospective momentary assessment study. METHODS: Paranoid patients (N = 41) were studied using the experience sampling method (ESM), a structured diary technique, assessing psychopathology and current context in daily life. RESULTS: The results showed that both low self-esteem and EA contributed to paranoid thinking. The relationship between low self-esteem and paranoia was partially mediated by EA and the relationship between EA and paranoia was partially mediated by low self-esteem. The detrimental effect of EA on self-esteem was more pronounced under high activity-related stress. Both EA and social stress were independently associated with low self-esteem. EA was associated with self-esteem instability. CONCLUSIONS: Our results implicate mental control strategies in the development of paranoia and are compatible with the attributional model of paranoia, which suggests that persecutory delusions arise as a result of dysfunctional attempts to avoid unpleasant thoughts about the self.
Subject(s)
Delusions/psychology , Paranoid Disorders/psychology , Personality Disorders/psychology , Self Concept , Stress, Psychological/psychology , Thinking , Adolescent , Adult , Aged , Delusions/complications , Female , Humans , Life Change Events , Male , Middle Aged , Paranoid Disorders/complications , Personality Disorders/complications , Prospective Studies , Stress, Psychological/complications , Young AdultABSTRACT
The dynamics of self-esteem and paranoia were examined in 41 patients with past or current paranoia and 23 controls using questionnaires and the Experience Sampling Method (a structured diary technique). For some analyses, patients were further divided into three groups: a) individuals who believed that persecution is underserved ("poor me"; PM), b) individuals who believed that persecution is justified ("bad me"; BM), and c) remitted patients. The results revealed that PM and especially BM patients had highly unstable psychological profiles. Beliefs about deservedness of persecution fluctuated over 6 days. BM beliefs were associated with low self-esteem and depression. Measured concurrently, paranoia predicted lower self-esteem in the BM patients. Prospectively, paranoia predicted lower subsequent self-esteem in BM patients but higher subsequent self-esteem in PM patients. Our results suggest that paranoia can serve a defensive function in some circumstances. The reasons for inconsistencies in self-esteem research in relation to paranoia are discussed.
Subject(s)
Delusions/psychology , Paranoid Disorders/psychology , Schizophrenia, Paranoid/psychology , Self Concept , Adult , Female , Humans , Internal-External Control , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
Hypothesized relationships between experiential avoidance (EA), self-esteem, and paranoia were tested using structural equation modeling in a sample of student participants (N = 427). EA in everyday life was also investigated using the Experience Sampling Method in a subsample of students scoring high (N = 17) and low (N = 15) on paranoia. Results showed that paranoid students had lower self-esteem and reported higher levels of EA than nonparanoid participants. The interactive influence of EA and stress predicted negative self-esteem: EA was particularly damaging at high levels of stress. Greater EA and higher social stress independently predicted lower positive self-esteem. Low positive self-esteem predicted engagement in EA. A direct association between EA and paranoia was also found. These results suggest that similar mechanisms may underlie EA and thought suppression. Although people may employ EA to regulate self-esteem, this strategy is maladaptive as it damages self-esteem, incurs cognitive costs, and fosters paranoid thinking.
