Biochemical and genetic dissection of the RNA-binding surface of the FinO domain of Escherichia coli ProQ.

RNA-binding proteins play important roles in bacterial gene regulation through interactions with both coding and noncoding RNAs. ProQ is a FinO-domain protein that binds a large set of RNAs in Escherichia coli, though the details of how ProQ binds these RNAs remain unclear. In this study, we used a combination of in vivo and in vitro binding assays to confirm key structural features of E. coli ProQ's FinO domain and explore its mechanism of RNA interactions. Using a bacterial three-hybrid assay, we performed forward genetic screens to confirm the importance of the concave face of ProQ in RNA binding. Using gel shift assays, we directly probed the contributions of ten amino acids on ProQ binding to seven RNA targets. Certain residues (R58, Y70, and R80) were found to be essential for binding of all seven RNAs, while substitutions of other residues (K54 and R62) caused more moderate binding defects. Interestingly, substitutions of two amino acids (K35, R69), which are evolutionarily variable but adjacent to conserved residues, showed varied effects on the binding of different RNAs; these may arise from the differing sequence context around each RNA's terminator hairpin. Together, this work confirms many of the essential RNA-binding residues in ProQ initially identified in vivo and supports a model in which residues on the conserved concave face of the FinO domain such as R58, Y70, and R80 form the main RNA-binding site of E. coli ProQ, while additional contacts contribute to the binding of certain RNAs.

Complex PTSD symptoms predict positive symptoms of psychosis in the flow of daily life.

BACKGROUND: Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms. METHODS: This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology. RESULTS: DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms. CONCLUSIONS: Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

Alcohol use disorder, cannabis use disorder, and eating disorder symptoms among male and female college students.

BACKGROUND AND OBJECTIVES: Eating disorders (EDs) and substance use disorders are prevalent among college students in the United States, with underlying common mechanisms suggesting co-occurrence of these in the student population. As treatment prognosis of EDs improves when they are identified and treated with early intervention, it is essential to understand which substance use behaviors associate with EDs in students. METHODS: Using a sample of 471 college students recruited for a study on high risk drinking (i.e., students needed to pregame regularly to be included), we explored the associations between ED symptomatology and two common substances used in this population: alcohol and cannabis. As most research on EDs focuses on female students only or does not separate out males and females, we examined whether sex assigned at birth moderated the association between ED symptomatology and substance use outcomes. RESULTS: About one-third (32.4%) of the sample screened positive for an ED, with females significantly more likely to screen positive. Males were significantly more likely to screen positive for an alcohol or cannabis use disorder. Screening positive for an ED associated with cannabis use frequency and cannabis use disorder symptoms, but not with alcohol outcomes. Sex moderated the association between ED and cannabis use disorder symptoms, with positive ED screen male students experiencing the highest cannabis use disorder symptoms. DISCUSSION AND CONCLUSIONS: It is necessary to further assess how sex differences in substance use and ED symptomatology inform each other. SCIENTIFIC SIGNIFICANCE: Findings underscore the need to assess and screen for cannabis use disorder among students who screen positive for an ED, and, more specifically, with focused attention on male students with ED symptoms.

The revised Psychosis Attachment Measure: further psychometric evidence.

PURPOSE: Disorganised attachment is a key concept in understanding the development of psychosis. However, existing questionnaires of adult attachment do not adequately measure this construct hindering future research into the psychosocial causes of psychosis. The most widely measure of adult attachment in people experiencing psychosis is the Psychosis Attachment Measure (PAM). The measure has recently been revised to include disorganised attachment items. This study develops previous research by providing a rigorous examination the psychometric properties of the revised questionnaire (PAM-R). METHODS: A total of 407 participants with self-reported experiences of psychosis completed a battery of questionnaires which included the PAM-R and other measures which were conceptually related to the concept of disorganised attachment. RESULTS: Confirmatory factor analysis (CFA) indicated a three-factor solution with factors corresponding to anxious, avoidant, and disorganised attachment. The majority of the fit statistics were acceptable with the exception of the RMSEA statistic. Internal consistency and test-retest reliability were good for all subscales. The disorganised subscale correlated in expected directions with other measures of attachment, dissociation, trauma, and psychotic experiences. CONCLUSION: The PAM-R is a valid and reliable measure of adult attachment. It is a practical assessment tool for clinicians and researchers to measure insecure and disorganised attachment patterns that is acceptable to people experiencing psychosis.

The key components of a clinical psychology formulation: A consensus study.

OBJECTIVE: Psychological formulation is a key competency for clinical psychologists. However, there is a lack of consensus regarding the key components and processes of formulation that are hypothesized to contribute to poor reliability of formulations. The aim of this study was to develop consensus on the essential components of a formulation to inform training for clinical psychologists and best practice guidelines. METHODS: A Delphi methodology was used. Items were generated from the literature and discussed and refined with a panel of experts (n = 10). In round one, 110 clinical psychologists in the United Kingdom rated the importance of components of formulation via an online questionnaire. Criteria for consensus were applied and statements were rerated in round two if consensus was not achieved. RESULTS: Consensus was achieved on 30 items, with 18 statements regarding components of a formulation and 12 statements regarding formulation process. Items that clinicians agreed upon emphasized the importance of integrating sociocultural, biological, strengths and personal meaning alongside well-established theoretical frameworks. Consensus was not reached on 20 items, including whether a formulation should be parsimonious or adhere to a model. CONCLUSION: Our findings provide mixed evidence regarding consensus on the key components of formulation. There was an agreement that formulation should be client-led and incorporate strengths and sociocultural factors. Further research should explore client perspectives on the key components of formulation and how these compare to the clinicians' perspectives.

Momentary displays of compassion and the relationship between psychosis, mood and risk incidents on inpatient wards: An experience sampling study.

OBJECTIVES: Psychosis can be thought of as a threat-based experience. Compassion has been shown to be effective in reducing threat, although highly distressed individuals may struggle to be self-compassionate. This study explored the effects of compassionate interactions with staff on inpatients with psychosis. METHOD: Experience Sampling Method (ESM) was used to investigate the relationships between compassion from staff and paranoia, voice hearing, distress related to psychosis experiences, affect and risk incidents in daily life. Twenty-two service users residing on inpatient mental health wards took part. Baseline measures of compassion, fears of compassion and affect were taken. Participants completed ESM assessments 10 times per day, over 6 days. RESULTS: Compassion from staff was associated with a small increase in voice hearing, but was not associated with paranoia, paranoia-related distress, voice-related distress, negative affect, positive affect, or risk incidents in daily life. Baseline fears of compassion moderated the relationships between compassion from staff and some of the service user outcomes. For inpatients scoring low on fears of compassion, compassionate interactions were associated with increased positive affect and lower paranoia. However, for those scoring high on fears of compassion, this relationship was reversed, and compassionate interactions were associated with higher paranoia and lower positive affect. CONCLUSION: People with psychosis who have fears of compassion may benefit from receiving support to address these fears in order to experience the benefit from the compassion of staff. The results should be interpreted with caution due to the low number of observations and limited statistical power.

Working alliance in treating staff and patients with Schizophrenia Spectrum Disorder living in Residential Facilities.

OBJECTIVES: Working Alliance (WA) is important in the care of patients with Schizophrenia Spectrum Disorders (SSD). This study aims to determine which sociodemographic and clinical factors are associated with WA, as assessed by patients and staff members in Residential Facilities (RFs), and may predict WA dyads' discrepancies. METHODS: Three hundred and three SSD patients and 165 healthcare workers were recruited from 98 RFs and characterized for sociodemographic features. WA was rated by the Working Alliance Inventory (WAI) for patients (WAI-P) and staff members (WAI-T). SSD patients were assessed for the severity of psychopathology and psychosocial functioning. RESULTS: Pearson's correlation revealed a positive correlation (ρ = .314; p < .001) between WAI-P and WAI-T ratings. Linear regression showed that patients with higher education reported lower WAI-P ratings (ß = -.50, p = .044), while not being engaged in work or study was associated with lower WAI-T scores (ß = -4.17, p = .015). A shorter lifetime hospitalization was associated with higher WAI-P ratings (ß = 5.90, p = .008), while higher psychopathology severity negatively predicted WAI-T (ß = -.10, p = .002) and WAI-P ratings (ß = -.19, p < .001). Better functioning level positively foresaw WAI-T (ß = .14, p < .001) and WAI-P ratings (ß = .12, p < .001). Regarding discrepancies, staff members' age was associated with higher dyads discrepancy in Total scale and Agreement subscale scores, which were also associated with more severe negative symptoms, while patients' age was negatively correlated to Relationship subscale discrepancy. CONCLUSIONS: This study provides insight into the factors that influence WA in SSD patients and health workers in RFs. The findings address interventions to improve WA and ultimately patient outcomes.

How can we measure psychological safety in mental healthcare staff? Developing questionnaire items using a nominal groups technique.

There have been growing concerns about the well-being of staff in inpatient mental health settings, with studies suggesting that they have higher burnout and greater work-related stress levels than staff in other healthcare sectors. When addressing staff well-being, psychological safety can be a useful concept. However, there is no measure of psychological safety that is suitable for use in inpatient mental health settings. Edmondson (1999) is the most commonly used measure of psychological safety, but it was designed for use in general physical healthcare settings. As inpatient mental health settings are unique environments, transferability of knowledge from physical to mental healthcare settings cannot be assumed. We sought to develop questionnaire items that capture psychological safety among healthcare staff working in acute inpatient mental healthcare settings. We used the nominal group technique, a consensus method involving rounds of discussion, idea generation, and item rating/ranking to identify priorities. Twenty-eight stakeholders participated, including 4 who had lived experience of mental health problems, 11 academics and 18 healthcare professionals (8 participants identified with more than 1 category). The study involved a workshop with three parts: (i) an overview of current research and limitations of the Edmondson (1999) measure as outlined above, (ii) discussion on what items should be retained from the Edmondson (1999) measure, and (iii) discussion on what items should be added to the Edmondson (1999) measure. Twenty-one items were generated and retained to capture psychological safety in inpatient mental health settings. These measure professionals' sense of being valued by their team and organization, feeling supported at work, feeling physically safe and protected from physical harm, and knowing they can raise concerns about risk and safety. This is the first study to generate questionnaire items suitable for measuring staff psychological safety in mental health settings. These have been generated via a consensus method to ensure stakeholders' views are reflected. Further research is needed to evaluate factor structure, internal reliability, and convergent validity.

"If You Don't Eat, You Can Get Drunk Faster": A Qualitative Investigation of Food and Alcohol Disturbance (FAD) Expectancies.

Background: Food and alcohol disturbance (FAD; i.e., use of any compensatory behavior within the context of a drinking episode to offset alcohol-related calories and/or enhance the effects of alcohol) is prevalent among U.S. college students and associated with negative consequences. Expectancies for anticipated outcomes of alcohol use and thinness/restriction behaviors, which comprise FAD, serve as promising targets of intervention for these behaviors individually; however, no study to date has identified or examined FAD expectancies, specifically. Objectives: The purpose of this study was to qualitatively examine the positive and negative FAD expectancies described by students experienced with FAD. Methods: Semi-structured open-ended interviews were conducted with 22 undergraduates with a lifetime history of FAD behavior (72.7% female, 77.3% white non-Hispanic, Mage=20.14). Results: Positive FAD expectancy themes included: Mood Improvement, Appearance/Weight-related Benefits, Alcohol Enhancement, and Social Approval and Connectedness. Negative FAD expectancy themes included: Reputational and Social Concerns, Negative Physical Consequences, Negative Psychological Consequences, and Cognitive and Behavioral Impairment. Conclusions: Results suggest that while there are many similarities, FAD expectancies are distinct from existing alcohol and thinness/restriction expectancies. Specifically, the Mood Improvement theme conceptualizes mood-related improvement within the context of both positive and negative reinforcement and both the Social Approval and Connectedness and Social and Reputational Consequences themes focus on the ways in which one's peers may view and interact with others. Findings lay the groundwork for identifying expectancies that underlie FAD behaviors and provide directions for future research and intervention efforts.

Gender Differences in Normative Misperceptions of Food and Alcohol Disturbance Among a Multi-Site Sample of College Students.

Background: Engagement in food and alcohol disturbance (FAD; e.g., restricting caloric intake in the context of using alcohol to quicken/increase intoxication [FAD-intoxication] and/or to offset calories consumed from alcohol [FAD-calories]) confers risk to college students. Much research suggests that students overestimate the frequency of high-risk drinking among their peers, leading to greater participation in personal high-risk drinking. However, limited work has examined social norms related to FAD and their association with FAD behaviors. Objectives: The present study investigated: (a) whether normative misperceptions exist for FAD, (b) whether FAD norms are associated with FAD behaviors, and (c) whether gender moderates the association between FAD norms and FAD behaviors. Participants were 1,499 college students from six universities who consumed alcohol in the last month and identified as a woman or man. A plurality of participants identified as being White, non-Hispanic (59.5%) and female (68.1%), with a mean age of 19.66 (SD = 2.09) years. Results: Analyses revealed that students overestimated the frequency and approval of both FAD-intoxication and FAD-calories behaviors among their same-gender peers. Notably, these misperceptions were greater for FAD participators compared to FAD abstainers. Moreover, the associations between FAD norms and FAD behaviors were generally stronger for women compared to men. Conclusions: Our preliminary findings identify social norms as a potential target for interventions aiming to reduce FAD among college students. Further, our results provide preliminary evidence that college women, especially those who engage in FAD, may reap the greatest benefit from interventions targeting normative misperceptions (e.g., personalized normative feedback) related to FAD.

Understanding the Factors That Contribute to Creating a Collaborative Psychological Formulation: A Qualitative Systematic Review.

OBJECTIVES: Creating a formulation is one of the key competencies of a clinical psychologist and is understood to be important for guiding therapeutic input and understanding client distress. However, client experience of formulations can vary, with some reporting it is unhelpful and distressing. This novel review explores the experiences of clinicians and clients when creating a formulation, specifically the barriers and facilitators to collaborating on a formulation. This ultimately aims to improve client experience and engagement in formulation. METHODS: A systematic search of PubMed, Web of Science, PsycINFO and EMBASE was conducted using PRISMA guidelines. The protocol was registered on PROSPERO. This search was conducted using terms related to 'psychological formulation' and 'experience'. Nineteen qualitative papers met inclusion criteria and were appraised using the Critical Appraisal Skills Programme. Findings that pertained to formulation were thematically synthesised. RESULTS: Three analytical themes were identified: toleration of the formulation process-'a necessary evil', which highlights the potential emotional impact of formulation on the client and indicates the importance of responding to client readiness and expectations of formulation; development of the therapeutic relationship-'it's like a two way thing, isn't it?', which suggests that client empowerment, adapting to client needs and clinicians creating a safe and containing environment facilitated the formulation process; systemic factors-'walking a tightrope', which highlights the constraints of resources and team dynamics in therapists' ability to engage in collaborative formulation. CONCLUSION: Facilitators to a collaborative formulation include the following: simple formulations, thorough assessment and preparation for formulation, 'doing with' activities such as timelines and diagrams and working environments that include supportive colleagues and time for reflection and training.

A Systematic Review of Momentary Social Predictors of Positive Psychosis Experiences.

BACKGROUND: Social factors can play an important role in the development and maintenance of psychosis. Clarifying this relationship is vital for advancing theoretical understanding and development of targeted interventions. Psychosis is increasingly researched with an experience sampling methodology (ESM), which provides an ecologically valid approach, that reduces recall biases. Studies examining momentary associations between social factors and psychosis have not yet been summarised. METHOD: We identified 29 ESM studies investigating associations between social factors and positive psychotic experiences through a pre-registered systematic search of the published literature. RESULTS: Being alone did not predict increase in psychosis; however, appraisals and feelings associated with being alone such as feeling socially disconnected, lonely and unwanted did. Being with familiar company was found to reduce psychosis experiences but feeling stressed by the current company increased psychosis. CONCLUSIONS: While issues with sample size and generalisability mean these results should be interpreted with caution, some putative conclusions can be made. Individuals with psychosis or emerging symptoms should be offered interventions that improve social networks such as peer support, community participation and engagement skills training. These individuals may also benefit from virtual reality or compassion-based interventions which aim to dampen perceived social threat. Moreover, digital interventions which monitor changes in social variables that predict relapse in symptoms would allow early intervention to prevent mental health crises.

Optimization of a bacterial three-hybrid assay through in vivo titration of an RNA-DNA adapter protein.

Noncoding RNAs regulate gene expression in every domain of life. In bacteria, small RNAs (sRNAs) regulate gene expression in response to stress and are often assisted by RNA-chaperone proteins, such as Hfq. We have recently developed a bacterial three-hybrid (B3H) assay that detects the strong binding interactions of certain E. coli sRNAs with proteins Hfq and ProQ. Despite the promise of this system, the signal-to-noise has made it challenging to detect weaker interactions. In this work, we use Hfq-sRNA interactions as a model system to optimize the B3H assay, so that weaker RNA-protein interactions can be more reliably detected. We find that the concentration of the RNA-DNA adapter is an important parameter in determining the signal in the system and have modified the plasmid expressing this component to tune its concentration to optimal levels. In addition, we have systematically perturbed the binding affinity of Hfq-RNA interactions to define, for the first time, the relationship between B3H signal and in vitro binding energetics. The new pAdapter construct presented here substantially expands the range of detectable interactions in the B3H assay, broadening its utility. This improved assay will increase the likelihood of identifying novel protein-RNA interactions with the B3H system and will facilitate exploration of the binding mechanisms of these interactions.

Experimental studies of paranoid thinking in clinical and nonclinical populations: a systematic review and meta-analysis.

Paranoia is common in clinical and nonclinical populations, consistent with continuum models of psychosis. A number of experimental studies have been conducted that attempt to induce, manipulate or measure paranoid thinking in both clinical and nonclinical populations, which is important to understand causal mechanisms and advance psychological interventions. Our aim was to conduct a systematic review and meta-analysis of experimental studies (non-sleep, non-drug paradigms) on psychometrically assessed paranoia in clinical and nonclinical populations. The review was conducted using PRISMA guidelines. Six databases (PsycINFO, PubMed, EMBASE, Web of Science, Medline and AMED) were searched for peer-reviewed experimental studies using within and between-subject designs to investigate paranoia in clinical and nonclinical populations. Effect sizes for each study were calculated using Hedge's g and were integrated using a random effect meta-analysis model. Thirty studies were included in the review (total n = 3898), which used 13 experimental paradigms to induce paranoia; 10 studies set out to explicitly induce paranoia, and 20 studies induced a range of other states. Effect sizes for individual studies ranged from 0.03 to 1.55. Meta-analysis found a significant summary effect of 0.51 [95% confidence interval 0.37-0.66, p < 0.001], indicating a medium effect of experimental paradigms on paranoia. Paranoia can be induced and investigated using a wide range of experimental paradigms, which can inform decision-making about which paradigms to use in future studies, and is consistent with cognitive, continuum and evolutionary models of paranoia.

What should inpatient psychological therapies be for? Qualitative views of service users on outcomes.

BACKGROUND: There is limited research on what, when and how outcomes should be measured in psychological therapy trials in acute mental health inpatient wards. OBJECTIVES: This study aimed to consider what outcomes service users think are important to measure. METHODS: This qualitative study explored the views of 14 participants, who had an inpatient admission within the last year, on outcomes of psychological therapies using semistructured interviews. Data were analysed using thematic analysis from a critical realist perspective with both inductive and deductive coding. RESULTS: The 126 outcomes that were important to participants were mapped onto an established taxonomy of outcomes across different health areas and the socioecological framework to consider the wider context and help summarise the outcomes. Most of the outcomes were mapped to the intrapersonal and interpersonal level. In addition to the outcome mapping, three themes were constructed from the qualitative data: (1) I am not a problem I am a person, (2) Feeling cared for and loved, (3) What does getting better look like. CONCLUSIONS: Our results highlight the need for patient-reported outcomes which are cocreated with service users, disseminating research and training on preventing dehumanising experiences, enhancing psychological safety and therapeutic relationships and improving access to psychological therapy. PATIENT OR PUBLIC CONTRIBUTION: The wider People with Personal Experience Involvement Committee at the University of Bath were consulted which included a focus group during the early planning stages. We also collaborated with a person with personal experience, at every stage of the research. This included developing our research question and aims, protocol, participant documents (e.g., information and debrief forms), advertisement and recruitment strategy, interview topic guide, the codes, the final themes and quotes and reviewing the manuscript. People with lived experience of being admitted to an acute mental health inpatient ward participated in our study.

Psychological well-being in persons with dementia: The role of caregiver expressed emotion.

OBJECTIVES: Dementia is a growing health concern. Persons with dementia experience higher levels of anxiety and depression, which correlates with poorer quality of life, disability and hospitalization. This is one of the few studies to use a longitudinal design to assess the impact of expressed emotion (EE) on well-being in dementia over time. METHODS: Sixty-one people with dementia and their main informal caregiver were recruited from memory services. Caregiver EE was coded from a Camberwell Family Interview conducted at time one. Person with dementia's outcome measures (quality of life, depression and anxiety) were collected at time one and at 6-months follow-up. RESULTS: Caregiver high EE was associated with higher levels of depression in people with dementia and greater anxiety at follow-up. Emotional over involvement predicted greater anxiety and critical comments predicted greater depression. Low EE appeared to have a protective effect on well-being in people with dementia. People with dementia with low EE caregivers experienced a small reduction in depression and anxiety over time, whereas those with high-EE caregivers maintained baseline levels of depression and anxiety. CONCLUSIONS: Caregiver high EE is associated with poorer psychological outcomes for people with dementia over time. Psychological therapies, such as cognitive behavioural therapy informed family interventions should be used to reduce high EE within carer and person with dementia relationships.

A systematic review of measures of adult disorganized attachment.

BACKGROUND: Disorganized attachment has been identified as an important factor in the development and maintenance of mental health problems. Further research is required to understand the mechanism by which this attachment pattern predisposes individuals to develop, and maintain, personal and social difficulties and mental health problems utilizing valid and reliable measurement tools. The assessment of adult disorganized attachment is therefore important for both applied psychologists and researchers. METHOD: We conducted a systematic review using the COSMIN guidelines to identify and critically appraise instruments which measure adult disorganized attachment. A systematic database search was performed using MEDLINE, EMBASE, Web of Science, PsychInfo and CINHAL in accordance with PRISMA guidelines. RESULTS: Database searching provided 5757 results, with 18 measures identified across 27 eligible papers which were critically evaluated. Measurement properties were promising for the Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale, Attachment Style Questionnaire - Short Form and the Adult Attachment Interview. However, overall, due to inconsistent quality of methodology and reporting of results, it is challenging to reach sufficient conclusions and suggestions regarding the best instrument to use to measure adult disorganized attachment. CONCLUSION: The Childhood Disorganization and Role Reversal Scale, Psychological Treatment Inventory-Attachment Styles Scale. Attachment Style Questionnaire-Short-Form and Adult Attachment Interview are the best available measures of disorganized attachment in adulthood. This review highlights the need for further psychometric testing of existing measures, or development of new instruments, grounded in sound methodology.

Attachment-focused iMAgery therapy for PSychosis (A-iMAPS): A case series targeting psychosis-related trauma.

OBJECTIVES: The experience of psychosis and its sequelae (including treatment experiences) can be traumatic and affect feelings of safety and security. Until relatively recently, trauma therapy has been avoided with psychosis populations due to concerns about additional harm. Intervention-based research is growing, but focus on psychosis-related trauma is limited. Engendering psychological safety may support engagement with trauma-focused therapy, for which attachment theory provides a strong foundation. Imagery can enhance felt security and is an effective modality for working with trauma. Therefore, this study aimed to examine feasibility and preliminary outcomes of a novel attachment-focused imagery therapy (A-iMAPS) addressing psychosis-related trauma. METHODS: A multiple baseline case series: Participants received between two and five baseline assessments then engaged in the six-session A-iMAPS intervention. Participants completed weekly measures of trauma symptoms and felt security. Further measures were completed pre- and post-intervention. RESULTS: Twelve clinical participants were recruited from NHS services in Northwest England and eight retained through baseline and intervention to the end-of-therapy assessment (attending all sessions). A significant improvement was seen for felt security between baseline and intervention phases. Other measures of trauma symptoms, core schemas, paranoia and attachment varied in change from baseline to end of therapy, but some promising preliminary results were seen. CONCLUSIONS: This study shows that a brief attachment-focused imagery therapy is a promising intervention for targeting psychosis-related trauma, for which there are currently no other specific intervention studies. Utilizing an attachment-informed framework when working with trauma in psychosis should be considered in future intervention studies.

'I like to feel needed, you know?': a qualitative examination of sense of purpose in older care home residents.

OBJECTIVES: To explore older care home residents' experiences of maintaining a sense of purpose in life: a core component of psychological wellbeing. METHODS: Fifteen residents (9 female; 6 male), aged 60-95 years, from four care homes, were interviewed about their sense of purpose. Interview transcripts were analysed using inductive thematic analysis. RESULTS: Theme 1 ('Experiencing Loss') comprises two sub-themes that describe the impact of age-related losses on residents' sense of purpose (sub-theme 1) and the different responses that participants had to these losses (sub-theme 2). Theme 2 ('The Protective Effects of Social Connections') describes how social relationships could provide a sense of purpose, as well as the difficulties participants experienced in forming these relationships. Finally, theme 3 ('The Roles of Activities') describes the types of activities that could help residents to maintain a sense of purpose. CONCLUSION: Care home residents experience losses and barriers that make it more difficult to maintain a sense of purpose. However, with appropriate support and opportunities, residents are able to engage in activities and relationships that provide a sense of purpose. To support residents' mental health and wellbeing, care homes should offer varied opportunities for residents to engage in purposeful activities.

Use of Both Alcohol and Cannabis Protective Behavioral Strategies is Associated with Fewer Negative Consequences: A Moderation Analysis.

Background: Concurrent alcohol and cannabis (i.e. marijuana) use (CAM; use of both substances within the same specified time frame) is prevalent among college students and associated with increased risk of negative substance-related consequences. Extant research supports the use of protective behavioral strategies (PBS) for reducing negative consequences associated with both alcohol and cannabis use. However, limited research exists regarding the efficacy of PBS among CAM users, and it is unknown whether using PBS for both alcohol and cannabis augments protective effects. The present study tested four moderation models to evaluate the interactive effects of alcohol and cannabis PBS on alcohol and cannabis negative consequences and use frequency. Methods: A multisite sample of college students (N = 1705) reporting past-month CAM use completed questionnaires regarding substance use behaviors, PBS use, and substance-related negative consequences. Results: Alcohol and cannabis PBS were negatively associated with alcohol and cannabis use, respectively. However, two-way interactions between PBS on substance use were not supported, such that negative associations between PBS and same-substance use were not augmented as other-substance PBS use increased. Interactive effects of alcohol and cannabis PBS on negative alcohol and cannabis consequences were supported, such that negative associations between alcohol PBS and consequences were augmented as cannabis PBS increased and vice versa. Conclusions: Findings suggest that using both types of PBS may increase protective effects against negative consequences among CAM users. Accordingly, promoting both types of PBS may enhance extant harm reduction interventions.