Urbanicity, persecutory delusions, and clinical intervention: the development of a brief CBT module for helping patients with persecutory delusions enter social urban environments

Daniel Freeman, Helen Waller, Ruth Ann Harpur-Lewis, Rosanna Moore, Philippa Garety, Paul Bebbington, Elizabeth Kuipers, Richard Emsley, Graham Dunn, David Fowler, Suzanne Jolley, Daniel Freeman, Helen Waller, Ruth Ann Harpur-Lewis, Rosanna Moore, Philippa Garety, Paul Bebbington, Elizabeth Kuipers, Richard Emsley, Graham Dunn, David Fowler, Suzanne Jolley

Abstract

Background: Substantial epidemiological research has shown that psychotic experiences are more common in densely populated areas. Many patients with persecutory delusions find it difficult to enter busy social urban settings. The stress and anxiety caused by being outside lead many patients to remain in-doors. We therefore developed a brief CBT intervention, based upon a formulation of the way urban environments cause stress and anxiety, to help patients with paranoid thoughts to feel less distressed when outside in busy streets.

Aims: The aim was to pilot the new intervention for feasibility and acceptability and gather preliminary outcome data.

Method: Fifteen patients with persecutory delusions in the context of a schizophrenia diagnosis took part. All patients first went outside to test their reactions, received the intervention, and then went outside again.

Results: The intervention was considered useful by the patients. There was evidence that going outside after the intervention led to less paranoid responses than the initial exposure, but this was only statistically significant for levels of distress.

Conclusions: Initial evidence was obtained that a brief CBT module specifically focused on helping patients with paranoia go outside is feasible, acceptable, and may have clinical benefits. However, it could not be determined from this small feasibility study that any observed improvements were due to the CBT intervention. Challenges in this area and future work required are outlined.

Keywords: CBT; Delusions; schizophrenia; urbanicity.

Figures

Figure 1.
Figure 1.
Examples of slides from the intervention module “Getting Out and About”

References

    1. Ben-Zeev D., Davis K., Kaiser S., Krzos I. and Drake R. E. (2012). Mobile technologies among people with serious mental illness: current use and opportunities for future services. Administration and Policy in Mental Health and Mental Health Services Research. doi: 10.1007/s10488-012-0424-x
    1. Ellett L., Freeman D. and Garety P. A. (2008). The psychological effect of an urban environment on individuals with persecutory delusions: the Camberwell walk study. Schizophrenia Research, 99, 77–84.
    1. Foster C., Startup H., Potts L. and Freeman D. (2010). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, 41, 45–51.
    1. Fowler D., Hodgekins J., Painter M., Reilly T., Crane C., Macmillan I., et al. (2009). Cognitive behaviour therapy for improving social recovery in psychosis. Psychological Medicine, 39, 1627–1636.
    1. Freeman D. (2007). Suspicious minds: the psychology of persecutory delusions. Clinical Psychology Review, 27, 425–457.
    1. Freeman D. (2011). Improving cognitive treatments for delusions. Schizophrenia Research, 132, 135–139.
    1. Freeman D. and Garety P. A. (2000). Comments on the content of persecutory delusions: does the definition need clarification? British Journal of Clinical Psychology, 39, 407–414.
    1. Freeman D., Garety P., Kuipers E., Fowler D., Bebbington P. E. and Dunn G. (2007). Acting on persecutory delusions: the importance of safety seeking. Behaviour Research and Therapy, 45, 89–99.
    1. Freeman D., McManus S., Brugha T., Meltzer H., Jenkins R. and Bebbington P. (2011). Concomitants of paranoia in the general population. Psychological Medicine, 41, 923–936.
    1. Freeman D., Pugh K., Green C., Valmaggia L., Dunn G. and Garety P. (2007). A measure of state persecutory ideation for experimental studies. The Journal of Nervous and Mental Disease, 195, 781–784.
    1. IBM (2011). SPSS Statistics Version 20.0.0. Armonk, NY: SPSS, Inc., IBM Company.
    1. Johns L., Cannon M., Singleton N., Murray R., Farrell M., Brugha T., et al. (2004). The prevalence and correlates of self-reported psychotic symptoms in the British population. British Journal of Psychiatry, 185, 298–305.
    1. Kelly B., O'Callaghan E., Waddington J., Feeney L., Browne S., Scully P., et al. (2010). Schizophrenia and the city. Schizophrenia Research, 116, 75–89.
    1. Key F., Craske M. and Reno R. (2003). Anxiety-based cognitive-behavioural therapy for paranoid beliefs. Behavior Therapy, 34, 97–115.
    1. Krabbendam L. and van Os J. (2005). Schizophrenia and urbanicity. Schizophrenia Bulletin, 31, 795–799.
    1. Lincoln T., Hohenhaus F. and Hartmann M. (2012). Can paranoid thoughts be reduced by targeting negative emotions and self-esteem? An experimental investigation of a brief compassion-focused intervention. Cognitive Therapy and Research. doi: 10.1007/s10608-012-9470-7
    1. McGrath J., Saha S., Welham J., El Saadi O., MacCauley C. and Chant D. (2004). A systematic review of the incidence of schizophrenia. BMC Medicine, 2, 13. doi: 10.1186/1741-7015-2-13
    1. McManus F., Scadura C. and Clark D. (2008). Why social anxiety persists: an experimental investigation of the role of safety behaviours as a maintaining factor. Journal of Behavior Therapy and Experimental Psychiatry, 39, 147–161.
    1. Moritz S., Kerstan A., Veckenstedt R., Randjbar S., Vitzthum F., Schmidt C., et al. (2011). Further evidence for the efficacy of a metacognitive group training in schizophrenia. Behaviour Research and Therapy, 49, 151–157.
    1. Myers E., Startup H. and Freeman D. (2011). Cognitive behavioural treatment of insomnia in patients with persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, 42, 330–336.
    1. Myin-Germeys I., Oorschot M., Collip D., Lataster J., Delespaul P. and van Os J. (2009). Experience sampling research in psychopathology. Psychological Medicine, 39, 1533–1547.
    1. Perneger T. (1998). What's wrong with Bonferroni adjustments. British Medical Journal, 316, 1236–1238.
    1. Salkovskis P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy, 19, 6–19.
    1. Scott J., Chant D., Andrews G. and McGrath J. (2006). Psychotic-like experiences in the general community: the correlates of CIDI psychosis screen items in an Australian sample. Psychological Medicine, 36, 231–238.
    1. Selten J.-P. and Cantor-Graae E. (2005). Social defeat: risk factor for schizophrenia? British Journal of Psychiatry, 187, 101–102.
    1. Sundquist K., Frank G. and Sundquist J. (2004). Urbanisation and incidence of psychosis and depression: follow-up study of 4.4 million women and men in Sweden. British Journal of Psychiatry, 184, 293–298.
    1. Van Os J., Hanssen M., Bijl R. and Vollebergh W. (2001). Prevalence of psychotic disorder and community level of psychotic symptoms: an urban-rural comparison. Archives of General Psychiatry, 58, 663–668.
    1. Waller W., Freeman D., Jolley S., Dunn G. and Garety P. (2011). Targeting reasoning biases in delusions. Journal of Behavior Therapy and Experimental Psychiatry, 42, 414–421.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir