A qualitative study of the acceptability of cognitive bias modification for paranoia (CBM-pa) in patients with psychosis.

BACKGROUND: Cognitive Bias Modification (CBM) has been used successfully as a computer-based intervention in disorders such as anxiety. However, CBM to modify interpretations of ambiguous information relevant to paranoia has not yet been tested. We conducted a qualitative investigation of a novel intervention called CBM for paranoia (CBM-pa) to examine its acceptability in patients with psychosis. METHODS: Eight participants with psychosis who completed CBM-pa were identified by purposive sampling and invited for a semi-structured interview to explore the facilitators and barriers to participation, optimum form of delivery, perceived usefulness of CBM-pa and their opinions on applying CBM-pa as a computerised intervention. The interviews were transcribed and analysed using thematic analysis by researchers working in collaboration with service users. RESULTS: Themes emerged relating to participants' perception about delivery, engagement, programme understanding, factors influencing experience, perceived impact and application of CBM-pa. CBM-pa was regarded as easy, straightforward and enjoyable. It was well-accepted among those we interviewed, who understood the procedure as a psychological intervention. Patients reported that it increased their capacity for adopting alternative interpretations of emotionally ambiguous scenarios. Although participants all agreed on the test-like nature of the current CBM-pa format, they considered that taking part in sessions had improved their overall wellbeing. Most of them valued the computer-based interface of CBM-pa but favoured the idea of combining CBM-pa with some form of human interaction. CONCLUSIONS: CBM-pa is an acceptable intervention that was well-received by our sample of patients with paranoia. The current findings reflect positively on the acceptability and experience of CBM-pa in the target population. Patient opinion supports further development and testing of CBM-pa as a possible adjunct treatment for paranoia. TRIAL REGISTRATION: Current Controlled Trials ISRCTN: 90749868 . Retrospectively registered on 12 May 2016.

The influence of positive and negative affect on emotional attention.

BACKGROUND AND OBJECTIVES: Mechanisms of engagement and disengagement of attention to emotional information are thought to contribute to the onset and maintenance of anxiety and depression, a conclusion based largely on findings in analogue subclinical samples. However, we argue that traditionally defined analogue samples can be misleading. Firstly, research has challenged the adequacy of conventional measures of subclinical traits by illustrating that supposedly distinct scales are highly inter-correlated and do not therefore measure independent constructs. Secondly, recent research in clinical groups has revealed results opposite to those expected from the analogue literature, suggesting speeded, rather than impaired, disengagement from threat. METHODS: We present analogue findings, from a sample of 70 healthy participants, allowing a purer distinction between the phenomenology of anxiety versus depression using the orthogonal traits of positive and negative affect to classify individuals. RESULTS: Using emotional peripheral cueing we found that, at short cue durations, dysphoric individuals' (those with low positive and high negative affect) attention to facial expressions was slowed by emotional compared to neutral invalid cues. LIMITATIONS: Limitations included a small sample size and limited generalisability due to sampling from a student population. CONCLUSIONS: The data suggest that, in line with the previous subclinical literature, dysphoric individuals are slow to disengage attention from emotional information at early stages of processing and are consistent with the possibility that patterns of orienting of attention might be qualitatively different in subclinical versus clinical populations.

Coercion, competence, and consent in offenders with personality disorder.

Competence to consent to treatment has not previously been examined in a personality disorder cohort without comorbid mental disorder. We examined competence and coercion in 174 individuals diagnosed with severe personality disorder using two validated tools (the MacArthur Competence Assessment Tool for Treatment and the MacArthur Coercion Assessment Scale - Short Form). Competence was not categorically impaired, but there were variations within the sample on dimensional competence measures. Further, there were significant negative correlations between experienced coercion and competence. Higher coercion scores were associated with two components of competence: lower understanding and reasoning. Patients who consented to treatment had higher scores on competence measures and experienced less coercion. These findings suggest that therapeutic approaches that decrease experienced coercion and increase competence may increase the engagement of individuals diagnosed with severe personality disorders in treatment.

Examining the effects of thought records and behavioral experiments in instigating belief change.

OBJECTIVE: While the efficacy and effectiveness of CBT protocols are well established, much less is known about the comparative contribution of the various techniques within CBT. The present study examined the relative efficacy, in comparison to a control condition, of two central techniques in CBT: thought records (TRs) and behavioral experiments (BEs). METHOD: A mixed within and between participants design was used to compare the efficacy of a single session TR and a single session BE intervention with a control intervention, in a non-clinical sample. Ninety one participants were randomly allocated to one of the three conditions. RESULTS: The overall pattern of results suggests that both TR and BE had a beneficial therapeutic impact in comparison to the control condition on beliefs, anxiety, behavior and a standardized measure of symptoms. There was evidence of a small advantage of the BE over the TR intervention in that the target belief changed earlier and change generalized to beliefs about others as well as the self. CONCLUSIONS: The findings confirm the utility of both TR and BE interventions and point to BEs as more useful in effecting belief change in that the change in the BE condition occurred sooner and generalized further.

A systematic review of outcome measures used in forensic mental health research with consensus panel opinion.

OBJECTIVE: To describe and assess outcome measures in forensic mental health research, through a structured review and a consensus panel. DATA SOURCES: A search of eight electronic databases, including CINAHL, EMBASE and MEDLINE, was conducted for the period 1990-2006. REVIEW METHODS: In the structured review, search and medical subject heading terms focused upon two factors: the use of a forensic participant sample and the experimental designs likely to be used for outcome measurement. Data extraction included general information about the identity of the reference, specific information regarding the study and information pertaining to the outcome measures used. The consensus exercise was implemented in two stages. At the first stage, participants were asked to complete ratings about the importance of various potential areas of outcome measurement in a written consultation. At the second stage, they were asked to attend a consensus meeting to review and agree results relating to the domains, to consider and rate specific outcome instruments identified as commonly used from the structured review and to discuss strengths, weaknesses and future priorities for outcome measurement in forensic mental health research. RESULTS: The final sample of eligible studies for inclusion in the review consisted of 308 separate studies obtained from 302 references. The consensus group agreed on 11 domains of forensic mental health outcome measurement, all of which were considered important. Nine different outcome measure instruments were used in more than four different studies. The most frequently used outcome measure was used in 15 studies. According to the consensus group, many domains beyond recidivism and mental health were important but under-represented in the review of outcomes. Current instruments that may show future promise in outcome measurement included risk assessment tools. The outcome measure of repeat offending behaviour was by far the most frequently used, occurring in 72% of the studies included in the review. Its measurement varied with position in the criminal justice system, offence specification and method of measurement. The consensus group believed that recidivism is only an indication of the amount of antisocial acts that are committed. CONCLUSIONS: A wide range of domains are relevant to assessing outcomes of interventions in forensic mental health services. Evaluations need to take account of public safety, but also clinical, rehabilitation and humanitarian outcomes. Recidivism is a very high priority; the public expects interventions that will reduce future criminal behaviour. Greater attention needs to be given to validity of measurement, given the enormous variety of approaches to measurement. More research is needed on methods to take account of the heterogeneity of seriousness of forms of recidivism in outcome measurement. Validity of self-report instruments regarding recidivism also needs examination by further research. Mental health is clearly also an important dimension of outcome. The review provides clear support for the view that domains such as quality of life, social function and psychosocial adjustment have not been extensively employed in forensic mental health research, but are relevant and important issues. The role of such instruments needs more consideration.

Differential predictions about future negative events in seasonal and non-seasonal depression.

BACKGROUND: Previous research indicates that individuals with seasonal depression (SD) do not exhibit the memory biases for negative self-referent information that characterize non-seasonal depression (NSD). The current study extended this work by examining processing of self-referent emotional information concerning potential future events in SD. METHOD: SD and NSD patients, along with never-depressed controls, completed a scenario-based measure of likelihood estimation for future positive and negative events happening either to the self or to another person. RESULTS: SD patients estimated future negative events as more likely to happen to both the self and others, relative to controls. In contrast, in the NSD sample this bias was specific to self-referred material. There were no group differences for positive events. CONCLUSIONS: These data provide further evidence that the self-referent bias for processing negative information that characterizes NSD can be absent in SD, this time in the domain of future event processing.

Anxiety and attention to threatening pictures.

Previous research using attentional search tasks has revealed an anxiety-related bias favouring attention to threatening words when they are presented simultaneously with emotionally neutral words. In Experiment 1, using a similar task, a related effect was found here with emotionally threatening pictures. When pictures were used as location cues in a second experiment, high-trait anxious individuals were slower than less anxious controls when responding to targets requiring attentional disengagement from threat, and they were slower in general with pictures judged to be highly threatening. In a third experiment using the same task but with a longer cue exposure, a related disengagement difficulty occurred across both groups, although the more general slowing with severe threat was again confined to the anxious group. We conclude that attentional bias involves both a specific difficulty in disengaging attention from the location of any threat and a more general interference effect that is related to threat level.

Autobiographical memory style in seasonal affective disorder and its relationship to future symptom remission.

Autobiographical memory was examined in participants with seasonal affective disorder (SAD). In Experiment 1, participants with SAD performed an autobiographical memory task (AMT) in the winter, when depressed. The AMT required participants to generate autobiographical memories to positive and negative cue words. Symptom levels were reassessed in the summer, when participants were remitted. The number of overly general memories to positive cues generated when the SAD participants were depressed predicted symptom levels when remitted, over and above initial symptom levels, with greater winter overgenerality being associated with high levels of summer symptoms. However, this was dependent on the exact measure of depressive symptoms used. The degree of overgenerality of memories in SAD participants was further investigated in Experiment 2. Results revealed that SAD participants did not show elevated recall of overgeneral memories relative to controls. The results as a whole indicate that, even when levels of general memories are no greater in a given target group than in controls, the absolute level of general memories to positive cue words is still independently related to symptom outcome.

'Oops!': performance correlates of everyday attentional failures in traumatic brain injured and normal subjects.

Insufficient attention to tasks can result in slips of action as automatic, unintended action sequences are triggered inappropriately. Such slips arise in part from deficits in sustained attention, which are particularly likely to happen following frontal lobe and white matter damage in traumatic brain injury (TBI). We present a reliable laboratory paradigm that elicits such slips of action and demonstrates high correlations between the severity of brain damage and relative-reported everyday attention failures in a group of 34 TBI patients. We also demonstrate significant correlations between self- and informant-reported everyday attentional failures and performance on this paradigm in a group of 75 normal controls. The paradigm (the Sustained Attention to Response Task-SART) involves the withholding of key presses to rare (one in nine) targets. Performance on the SART correlates significantly with performance on tests of sustained attention, but not other types of attention, supporting the view that this is indeed a measure of sustained attention. We also show that errors (false presses) on the SART can be predicted by a significant shortening of reaction times in the immediately preceding responses, supporting the view that these errors are a result of 'drift' of controlled processing into automatic responding consequent on impaired sustained attention to task. We also report a highly significant correlation of -0.58 between SART performance and Glasgow Coma Scale Scores in the TBI group.