Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions

Abstract

The psychosocial processes implicated in the development and maintenance of psychosis differ according to both the dimensional attributes (conviction, frequency, associated distress, adverse life impact) and the content or type (e.g., grandiosity, hallucinations, paranoia) of the psychotic symptoms experienced. This has informed the development of 'targeted' cognitive behavioural therapy for psychosis (CBTp): interventions focusing on specific psychological processes in the context of particular symptom presentations. In adults, larger effect sizes for change in primary outcomes are typically reported in trials of targeted interventions, compared to those for trials of generic CBTp approaches with multiple therapeutic foci. We set out to test the theoretical basis for developing targeted CBTp interventions for young people with distressing psychotic-like, or unusual, experiences (UEs). We investigated variations in the psychosocial processes previously associated with self-reported UE severity (reasoning, negative life events, emotional problems) according to UE dimensional attributes and content/type (using an established five-factor model) in a clinically referred sample of 72 young people aged 8-14 years. Regression analyses revealed associations of conviction and grandiosity with reasoning; of frequency, and hallucinations and paranoia, with negative life events; and of distress/adverse life impact, and paranoia and hallucinations, with emotional problems. We conclude that psychological targets for intervention differ according to particular characteristics of childhood UEs in much the same way as for psychotic symptoms in adults. The development of targeted interventions is therefore indicated, and tailoring therapy according to presentation should further improve clinical outcomes for these young people.Key words: psychotic-like experience (PLE); cognitive model; psychosis; cognitive therapy; CBT 4 IntroductionUnusual, or psychotic-like, experiences are changes in thinking and perception that are phenomenologically similar to the symptoms of psychosis, for example, hearing a voice that no-one else can hear [1]. The prevalence of such experiences in childhood is high (around two-thirds of the general population, by self-report) suggesting that they cannot be considered, in isolation, to reliably confer increased risk of psychosis [2]. Rather, it seems that increasing likelihood of future mental illness is determined by particular characteristics and correlates of unusual experiences (UEs), such as associated distress and adverse life events [3,4]. This is consistent with the continuum premise underpinning cognitive models of the development and maintenance of psychosis [5,6]. In these models, UEs are one of a multiplicity of biopsychosocial factors that are hypothesised to cumulatively increase the risk of developing psychosis, but are not in themselves, indicative of 'illness'. Although the degree of continuity of psychotic symptoms with normal experiences has been questioned [7], the implication that UEs ...

Toward earlier identification and preventative intervention in schizophrenia: evidence from the London Child Health and Development Study

“…paranoia, hallucinations) and dimensional attributes (e.g. frequency, impact) [ 78 ] and provide potential targets for psychological intervention in children with PLEs.…”

“…Longitudinal selected sample (biennial assessments) 111 children and caregivers, comprising: 46 TD; 33 ASz; 26 FHx; and 6 children meeting both ASz and FHx criteria a Biennial assessments completed at ages 9–12 years (baseline); 11–14 years (follow-up 1); 13–16 years (follow-up 2); and 17–18 years (follow-up 3) (Note: a further 39 children with alternative illness risk profiles, including bipolar disorder, were recruited in insufficient numbers to provide viable groups for examination) [ 30 , 34 , 35 , 39 , 43 , 48 , 52 , 53 , 55 , 56 ] 4. CHADS-associated intervention samples Clinical case series: four children from the community sample who completed a new, manualised cognitive behavioural intervention for children presenting psychotic-like experiences and emotional distress [ 74 ] Coping with unusual experiences for children study (CUES): doi 10.1186/ISRCTN13766770 (Lead: Dr. S. Jolley)—for children aged 8–14 years presenting to Child and Adolescent Mental Health Services with unusual experiences and emotional distress [ 75 – 78 ] Coping with unusual experiences for 12–18 (CUES+): doi 10.1186/ISRCTN21802136 (Lead: Dr. S. Jolley)—for users of adolescent community mental health services (aged 12–18 years) who report distressing unusual experiences CHADS London Child Health and Development Study, TD typically developing children, ASz children presenting a triad of developmental antecedents of schizophrenia, FHx children with a family history of schizophrenia/schizoaffective disorder a Includes eight FHx children recruited via contact with patients receiving treatment in the local health service rather than via school screening …”

The Coping with Unusual Experiences for Children Study (CUES): A pilot randomized controlled evaluation of the acceptability and potential clinical utility of a cognitive behavioural intervention package for young people aged 8–14 years with unusual experiences and emotional symptoms

“…Item totals (ratings across dimensions of conviction, frequency, distress, and impact: range 0–11) were summed to create a total severity score, and, by selecting only those items where distress or impact was rated >0, a total UED‐severity score. Dimension ratings were summed across items to create total conviction (0–18), frequency (0–27), and combined distress/impact (0–54) scores (Ruffell et al ., ). Secondary UE outcomes for this study comprised the following: the number of UEs endorsed as somewhat or certainly true (UE‐number, 0–9); the number of UEs endorsed with distress/adverse impact >0 (UED‐number, 0–9); UE‐frequency (total frequency dimension scores, 0–27); UE‐D&I (combined distress/impact dimension scores (0–54); and UED‐severity (0–99).…”

Stronger than your voices: A cognitive behavioral therapy for youth suffering from auditory verbal hallucinations

“…Also, applying therapy such as competitive memory training (COMET; specifically targeting low self-esteem) next to CBT constitutes additive value regarding AVH appraisals and emotional impact of voices (van der Gaag, van Oosterhout, Daalman, Sommer, & Korrelboom, 2012). In youth, targeted CBT for psychotic experiences is also expected to be effective (Ruffell et al, 2016). Therefore, more thorough and symptom-specific psychotherapeutic interventions for youth with distressing voices are urgently needed.…”