Self-attacking and self-reassurance in persecutory delusions: a comparison of healthy, depressed and paranoid individuals.

Previous research has found that reduced self-reassurance and heightened verbal 'self-attacking' of a sadistic and persecutory nature are both associated with greater subclinical paranoia. Whether these processes are also linked to clinical paranoia remains unclear. To investigate this further, we asked 15 people with persecutory delusions, 15 people with depression and 19 non-psychiatric controls to complete several self-report questionnaires assessing their forms and functions of self-attacking. We found that people with persecutory delusions engaged in more self-attacking of a hateful nature and less self-reassurance than non-psychiatric controls, but not people with depression. Participants with persecutory delusions were also less likely than both healthy and depressed participants to report criticising themselves for self-corrective reasons. Hateful self-attacking, reduced self-reassurance and reduced self-corrective self-criticism may be involved in the development or maintenance of persecutory delusions. Limitations, clinical implications and directions for future research are discussed.

Think Effectively About Mood Swings (TEAMS): a case series of cognitive-behavioural therapy for bipolar disorders.

BACKGROUND AND OBJECTIVES: An integrative cognitive model for bipolar disorder proposes that multiple and extreme appraisals of changes in internal state and their reciprocal impact on behaviour, physiology and the environment provide the core mechanism in maintaining and escalating bipolar symptoms (Mansell, Morrison, Reid, Lowens, & Tai, 2007a). METHODS: A case series of cognitive-behavioural therapy (CBT) based on this model, known as the TEAMS approach (Think Effectively About Mood Swings), with seven participants was conducted. An A-B direct replication design with multiple baseline and follow-up assessments at one, three and six months was used. Treatment involved 12 sessions of CBT with an emphasis on addressing extreme positive and negative appraisals of internal state change. RESULTS: Improvements were reported for symptoms, functioning, cognitions and self-critical processes with large effect sizes on a range of measures, especially depression, at end of therapy and one-month follow-up. Five participants also showed clinically significant change in depression at both time-points. CONCLUSIONS: This study provides preliminary evidence for the feasibility, acceptability and efficacy of CBT based on this model which warrants further evaluation.

Cognitive-behavioural therapy and motivational intervention for schizophrenia and substance misuse. 18-month outcomes of a randomised controlled trial.

BACKGROUND: Comorbid substance misuse in people with schizophrenia is associated with poor clinical and social outcomes. There are few studies of psychological treatments for this population and little long-term follow-up of their benefits. AIMS: To investigate symptom, substance use, functioning and health economy outcomes for patients with schizophrenia and their carers 18 months after a cognitive-behavioural treatment (CBT) programme. METHOD: Patients with dual diagnosis from a randomised controlled trial of motivational intervention, individual CBT and family intervention were assessed on multiple outcomes at 18-month follow-up. Carers were assessed on symptom, functioning and needs over 12 months. Health economy data were collected over 18 months. RESULTS: There were significant improvements in patient functioning compared with routine care over 18 months. No significant differences between treatment groups were found in carer or cost outcomes. CONCLUSIONS: The treatment programme was superior to routine care on outcomes relating to illness and service use, and the cost was comparable to the control treatment.