Targeting reasoning biases in delusions: A pilot study of the Maudsley Review Training Programme for individuals with persistent, high conviction delusions

Waller, Helen; Freeman, Daniel; Jolley, Suzanne; Dunn, Graham; Garety, Philippa

doi:10.1016/j.jbtep.2011.03.001

Cited by 107 publications

(79 citation statements)

References 34 publications

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“…Post-training and at 2-week follow-up, we found significant and large effects on improving belief flexibility and reducing delusional conviction, and a small, non-significant effect on data-gathering (Waller 2011). Over half of the participants (62%) benefited.…”

Section: An Enhanced Studymentioning

confidence: 72%

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Jumping to conclusions: the psychology of delusional reasoning

Garety¹,

Freeman²,

Jolley³

et al. 2011

Adv. psychiatr. treat

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SummaryDelusions are a key symptom of psychosis and they are frequently distressing and disabling. Existing treatments, both pharmacological and psychological, are only partially effective. It is important to develop new treatment approaches based on theoretically derived and empirically tested processes. Delusions are associated with a reasoning bias: the jumping to conclusions (JTC) bias involves gathering limited information to reach decisions. It is proposed that this bias influences appraisals of psychotic experiences leading to the formation and persistence of delusions. Existing treatments do not influence JTC. A new intensive treatment approach – ‘reasoning training’ – is described. It aims to encourage participants to gather information, consider alternative explanations for events and review the evidence before reaching a decision. Preliminary data suggest that it is possible to change the JTC bias and that this improves belief flexibility and may reduce delusional conviction. The concepts and methods of this new approach have implications for clinical practice.

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Section: An Enhanced Studymentioning

confidence: 72%

“…Our second study is now completed and it includes 13 participants with delusions assessed in detail, pre-and posttraining and at 2-week follow-up (Waller 2011). The training intervention has been substantially developed (Box 5).…”

Section: An Enhanced Studymentioning

confidence: 99%

Jumping to conclusions: the psychology of delusional reasoning

Garety¹,

Freeman²,

Jolley³

et al. 2011

Adv. psychiatr. treat

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“…Thinking Well is a brief protocol-based therapy that targets jumping-to-conclusions and belief inflexibility, the reasoning styles that contribute to paranoia [17]. We have already shown that this therapy improved reasoning and reduced paranoia in a case series, a randomised experimental study and two feasibility randomised controlled trials [10,[18][19][20]. However, its effects declined following the end of therapy, and some people reported that the intervention was insufficiently personalised, enjoyable or applicable to daily life.…”

Section: Introductionmentioning

confidence: 99%

How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo

Hardy¹,

Wojdecka²,

West³

et al. 2018

JMIR Ment Health

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Background Real-world implementation of psychological interventions for psychosis is poor.Barriers include therapy being insufficiently usable and useful for a diverse range of people.User-centred, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence and effectiveness.Objective To optimise the usability of an existing psychological intervention, Thinking Well, which targets reasoning processes in paranoia using a basic digital interface.Methods We conducted inclusive, user-centred design research characterised by purposive sampling of 'extreme' users from the margins of groups, ethnographic investigation of the problem context, and iterative prototyping of solutions. The UK Design Council's Double Diamond method was used. This consisted of 4 phases: discover, including a case series of Thinking Well, stakeholder interviews, desk research, user profiling, system mapping and a mood board; define, consisting of workshops to synthesise findings and generate the design brief; develop, involving concept workshops and prototype testing; and deliver, in which the final minimal viable product was storyboarded and iteratively coded.Results Consistent with our previous work, the Thinking Well case series showed medium/large effects on paranoia and wellbeing, and small effects on reasoning. These were maintained at follow-up despite some participants reporting difficulties with the therapy interface. Insights from the discover phase confirmed that usability was challenged by information complexity and poor accessibility. Participants were generally positive about the potential of technology to be enjoyable, help manage paranoia and provide tailored interpersonal support from therapists and peers, although reported privacy and security concerns. The define phase highlighted that the therapy redesign should support monitoring, simplify information processing, enhance enjoyment and trust, promote personalisation and normalisation, and offer flexible interpersonal support. During the develop phase over 60 concepts were created, with two key concepts of thoughts visualised as bubbles, and therapy as a journey selected for storyboarding. The output of the deliver phase was a minimal viable product of an innovative digital therapy, SlowMo. SlowMo works by helping people to notice their worries and fast thinking habits, and encourages them to slow down for a moment to find ways of feeling safer. A webapp supports the delivery of eight face-to-face sessions, which are synchronised to a native mobile app.Conclusions SlowMo makes use of personalisation, ambient information and visual metaphors to tailor the appeal, engagement and memorability of therapy to a diversity of needs. Feasibility testing has been promising, and the efficacy of SlowMo therapy is now being tested in a multi-centred randomised controlled trial. The study demonstrates that developments in psychological theory and techniques can be enhanced by improving the usability of the therapy interface in order to ...

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“…Previous studies have shown that use of MCT material in an individual treatment format can have beneficial effects on cognitive biases and/or delusions after very few sessions (Balzan et al, 2014;Balzan and Galletly, 2015;Ross et al, 2011;So et al, 2015;Waller et al, 2011). In a randomized, controlled, rater-blind trial of group MCT combined with individualized sessions (Moritz et al, 2011), patients in the MCT arm showed significantly greater improvement in delusion severity and conviction, as well as in jumping-to-conclusions, relative to the active control group.…”

Section: Introductionmentioning

confidence: 95%

“…However, there is still an ongoing debate about its efficacy, (McKenna and Kingdon, 2014) especially when it comes to disentangling 'true' efficacy from unspecific therapy effects (Jauhar et al, 2014;Lynch et al, 2010;Mehl et al, 2015). In an effort to maximize efficacy, recent research has focused on targeted therapies that deal with individual factors thought to contribute to psychotic symptoms, such as worry or reasoning biases (Garety et al, 2015;Moritz et al, 2014a;Waller et al, 2011). It has been suggested that such theory-driven interventions may lead to improved outcomes compared to standard CBT (Mehl et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

Andreou

Wittekind

Fieker

et al. 2017

Journal of Behavior Therapy and Experimental Psychiatry

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Background & Objectives: Theory-driven interventions targeting specific factors that contribute to delusions are receiving increased interest. The present study aimed to assess the efficacy of individualized metacognitive therapy (MCT+), a short manualized intervention that addresses delusion-associated cognitive biases.Methods: 92 patients with current or past delusions were randomized to receive 12 twiceweekly sessions of either MCT+ or a control intervention within a randomized controlled raterblind design. Psychopathology and cognitive biases were assessed at baseline, 6 weeks and 6 months. ANCOVAs adjusted for baseline scores were used to assess differences between groups regarding outcome variables. Both per-protocol and intention-to-treat analyses were conducted.Results: At 6 weeks, there was a significant difference in favor of MCT+ regarding decrease in delusion severity and improvement of self-reflectiveness (medium effect size), and a trend-wise difference regarding probability threshold to decision. These effects increased, when only patients attending a minimum of 4 therapy sessions were considered. Control group patients subsequently showed further improvement while patients in the MCT+ group remained stable, such that there were no differences between groups at the 6-month follow-up.Limitations: Lower attendance rates in the control group possibly leading to unequal therapeutic effort; lower baseline delusion severity in the MCT+ group. Conclusions:The result pattern suggests that MCT+ led to an earlier improvement in delusions and cognitive biases compared to the control intervention. The absence of a long-term effect might reflect floor effects in the MCT+ group, but may also indicate the need for further measures to promote sustainability of MCT+ effects.

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Targeting reasoning biases in delusions: A pilot study of the Maudsley Review Training Programme for individuals with persistent, high conviction delusions

Cited by 107 publications

References 34 publications

Jumping to conclusions: the psychology of delusional reasoning

Jumping to conclusions: the psychology of delusional reasoning

How Inclusive, User-Centered Design Research Can Improve Psychological Therapies for Psychosis: Development of SlowMo

Individualized metacognitive therapy for delusions: A randomized controlled rater-blind study

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