Objectives
Attenuated symptoms of psychosis are a core feature of At‐Risk Mental States. However, subthreshold levels of paranoia are also common among nonpsychosis populations. At present, little is ...known about whether the processes underpinning the experience of paranoid ideation in high‐risk youth differ as a consequence of meeting At‐Risk Mental States (ARMS) for psychosis criteria.
Methods
This study utilized path analysis techniques to examine the relationships between schematic beliefs, negative affect and the experience of paranoia for two groups: a group meeting criteria for ARMS (n = 133) and a group presenting with emerging complex mental health difficulties who did not meet the criteria for ARMS (n = 137).
Results
While the ARMS group displayed significantly greater maladaptive schematic beliefs and more severe symptomatology, the associations between schematic beliefs, symptoms of negative affect and paranoia did not differ as a consequence of ARMS status.
Conclusions
While meeting the ARMS criteria is associated with experiencing more maladaptive cognitions and more negative symptomatology among at‐risk youth, the associations between these cognitive beliefs and symptoms may be similar for youth who do not meet ARMS. These findings have implications for broadening the scope of at‐risk/high‐risk and for developing effective interventions for young people presenting with emerging difficulties.
Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to ...investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England.
A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022.
Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not.
The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences.
Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals).
•Barriers, such as stigma, are experienced by patients before engaging with services.•Primary care is not viewed as where common mental health disorders are supported.•The patient-healthcare professional relationship is pivotal to accessing support.
Objectives
Little is known about the factors that can maintain the distress related to voice‐hearing experiences in youth. Building upon understandings developed with adults, this study aimed to ...explore the associations between negative relating between hearer and voices, persecutory beliefs about voices and voice‐related distress in a clinical sample of adolescents. The study also aimed to investigate associations between relating to voices and wider patterns of social relating.
Design
This was an observational, cross‐sectional, survey study.
Methods
Thirty‐four young people (age 14–18 years) who were hearing voices completed measures about voices (characteristics, relating and beliefs) and relating to social others (negative relating styles, social connectedness and belongingness). Participants were patients of NHS mental health services. Bivariate correlations explored associations between relating to voices and distress, beliefs about voices and distress, and between relating to voices and social relating variables.
Results
Perceiving the voices as dominant, intrusive, and persecutory and resisting them was significantly associated with distress. Adjusting for loudness and negative content rendered the association between persecutory beliefs and distress non‐significant. Fear of separation and of being alone in relation to social others was associated with distancing from voices. Being suspicious, uncommunicative and self‐reliant and/or being sadistic and intimidating towards social others was significantly associated with dependence towards the voices. Greater hearer‐to‐voice dependence was associated with lower perceived social belongingness and connectedness.
Conclusions
Beliefs about voices being persecutory, dominant, intrusive and resisting voices seem to be significant contributors of distress in young people. In terms of proximity and power, relating to voices and social others appears to be contrasting.
Young women who are not in education, employment, or training (NEET) experience poorer health and social outcomes compared to non-NEET young women and to NEET young men, especially in deprived areas ...with intersecting inequalities. The evidence on effective public health approaches is scarce. Interventions that target hope, which NEET young women notably lack, offer a promising theory-driven and intuitive means to prevent mental health problems and improve social outcomes. Hope can be defined as a goal-focused mindset comprising self-agency (motivation and self-belief) and pathways (identifying routes to achieving goals). Hope is implicated in a variety of evidence-based psychosocial interventions for young people, but is not directly targeted by existing prevention programmes for NEET populations. The current study used a phased qualitative research design and participatory methods to model a hope-focused intervention for NEET young women. Phase 1 investigated population needs and intervention parameters through semi-structured interviews with 28 key informants living or working in disadvantaged coastal communities in South-East England. The sample comprised eight NEET young women, four family members, and 16 practitioners from relevant support organisations. Phase 2 refined intervention parameters and outcomes through co-design sessions with four NEET young women, followed by a theory of change workshop with 10 practitioners. The resulting intervention model is articulated as a mentor-supported, in-person psychosocial intervention that builds hope by enhancing positive sense of self and time spent in meaningful activities, before explicitly teaching the skills needed to identify, set, and pursue personally meaningful goals.
Research into hallucinatory experiences has focused primarily upon hallucinations within the auditory modality, to the relative neglect of other modalities. Furthermore, the exploration of auditory ...hallucinations (or ‘voices’) has focused primarily upon the experiences of people with a diagnosis of psychosis. The presence of multi-modal hallucinations may have implications across diagnoses for levels of distress, formulation and the targeting of psychological interventions.
This study presents a cross-sectional analysis of observational data from the PREFER survey (N = 335). Linear regression was used to explore the relationships between voice-related distress and the presence, number, type and timing of multi-modal hallucinations.
Simple relationships were not found between distress and the presence of hallucinations in visual, tactile, olfactory or gustatory modalities, or in the number of modalities experienced. When considering the degree to which another modality hallucination was experienced simultaneously with voices, there was some evidence that the degree of co-occurrence with visual hallucinations was predictive of distress.
The co-occurrence of voices with visual hallucinations may be associated with relatively greater distress, but not consistently, and the association between multimodal hallucinations and clinical impact appear complex and potentially variable from individual to individual. Further study of associated variables such as perceived voice power may further illuminate these relationships.
Although recommended in national treatment guidelines, there is much that is still unknown about CBT for psychosis (CBTp) in terms of the process and experience of the therapy. One way to investigate ...these gaps in knowledge is to explore service users' experiences through qualitative research.
To consolidate existing qualitative explorations of CBTp from a service user perspective.
Qualitative synthesis and comparison with previous research findings.
Two analytical themes were created from initial descriptive themes common to multiple studies: "The ingredients in the process of therapy" and "What is the process of therapy?"
Qualitative synthesis is a useful method for generating new insights from multiple qualitative studies. Service user perspectives on CBTp corroborate existing research and may also offer more novel findings regarding the ingredients and process of therapy. However, qualitative studies are limited in number and do not always maximize the prominence of service user experience.
Calls have been made to rethink the mental health support currently available for young people. This study aims to help re-focus and reduce the inaccessibility of mental health services by offering ...an adapted version of a theoretically-driven, evidence-based, guided psychosocial intervention known as 'Groups 4 Health' (G4H). To date, the G4H intervention has mainly been trialled in Australia, with promising positive effects on social connection, mental health and well-being. The present study examines the feasibility of running a randomised controlled trial when delivering the G4H intervention for young people in the UK. The TOGETHER study is a feasibility randomised controlled trial of an adapted version of the G4H intervention. Participants are aged 16-25, currently experiencing mental health difficulties and recruited from mental health services. The target sample size is 30, with 15 in each trial arm. Participants are randomly allocated to either G4H plus treatment as usual, or treatment as usual alone. The primary outcomes of interest are the feasibility of recruitment, randomisation, data collection and retention to the study at 10 and 14 week follow up, as well as the acceptability, and accessibility of the study protocol and G4H intervention. The results of this study will indicate if further optimisation is required to improve the feasibility, acceptability and accessibility of the intervention and study protocol procedures as perceived by end users and practitioners. This offers a significant opportunity to support the local and national demand for accessible, innovative, and effective psychosocial youth mental health support.
Background
Calls have been made to rethink the mental health support currently available for young people. This study aims to help re-focus and reduce the inaccessibility of mental health services by ...offering an adapted version of a theoretically-driven, evidence-based, guided psychosocial intervention known as ‘Groups 4 Health’ (G4H). To date, the G4H intervention has mainly been trialled in Australia, with promising positive effects on social connection, mental health and well-being. The present study examines the feasibility of running a randomised controlled trial when delivering the G4H intervention for young people in the UK.
Methods
The TOGETHER study is a feasibility randomised controlled trial of an adapted version of the G4H intervention. Participants are aged 16–25, currently experiencing mental health difficulties and recruited from mental health services. The target sample size is 30, with 15 in each trial arm. Participants are randomly allocated to either G4H plus treatment as usual, or treatment as usual alone. The primary outcomes of interest are the feasibility of recruitment, randomisation, data collection and retention to the study at 10 and 14 week follow up, as well as the acceptability, and accessibility of the study protocol and G4H intervention.
Discussion
The results of this study will indicate if further optimisation is required to improve the feasibility, acceptability and accessibility of the intervention and study protocol procedures as perceived by end users and practitioners. This offers a significant opportunity to support the local and national demand for accessible, innovative, and effective psychosocial youth mental health support.
Trial registration
ISRCTN registry (
ISRCTN12505807
). Registration date: 11/04/2022.
Hearing voices can be a common and distressing experience. Psychological treatment in the form of cognitive behavioural therapy for psychosis (CBTp) is effective, but is rarely available to patients. ...The barriers to increasing access include a lack of time for clinicians to deliver therapy. Emerging evidence suggests that CBTp delivered in brief forms can be effective and offer one solution to increasing access.
We adapted an existing form of CBTp, coping strategy enhancement (CSE), to focus specifically on distressing voices in a brief format. This intervention was evaluated within an uncontrolled study conducted in routine clinical practice.
This was a service evaluation comparing pre-post outcomes in patients who had completed CSE over four sessions within a specialist out-patient service within NHS Mental Health Services. The primary outcome was the distress scale of the Psychotic Symptoms Rating Scale - Auditory Hallucinations (PSYRATS-AH).
Data were available from 101 patients who had completed therapy. A reduction approaching clinical importance was found on the PSYRATS distress scale post-therapy when compared with the baseline.
The findings from this study suggest that CSE, as a focused and brief form of CBTp, can be effective in the treatment of distressing voices within routine clinical practice. Within the context of the limitations of this study, brief CSE may best be viewed as the beginning of a therapeutic conversation and a low-intensity intervention in a stepped approach to the treatment of distressing voices.
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