Arts-based methods for hallucination research.

INTRODUCTION: Neurocognitive models of hallucinations posit theories of misattribution and deficits in the monitoring of mental or perceptual phenomena but cannot yet account for the subjective experience of hallucinations across individuals and diagnostic categories. Arts-based research methods (ABRM) have potential for advancing research, as art depicts experiences which cognitive neuropsychiatry seeks to explain. METHODS: To examine how incorporating ABRM may advance hallucination research and theories, we explore data on the lived experiences of hallucinations in psychiatric and neurological populations. We present a multiple case study of two empirical ABRM studies, which used participant-generated artwork and artist collaborations alongside interviews. RESULTS: ABRM combined with interviews illustrated that hallucinations were infused with sensory features, characterised by embodiment, and situated within lived circumstances. These findings advance neurocognitive models of hallucinations by nuancing their multimodal nature, illustrating their embodied feelings, and exploring their content and themes. The process of generating artworks aided in disclosing difficult to discuss hallucinations, promoted participant self-reflection, and clarified multimodal details that may have been misconstrued through interview alone. ABRM were relevant and acceptable for participants and researchers. CONCLUSION: ABRM may contribute to the development of neurocognitive models of hallucinations by making hallucination experiences more visible, tangible, and accessible.

Globalization of psychology: Implications for the development of psychology in Ethiopia.

The present article reports on the variation of mental health resources across the globe and considers the merits or otherwise of the process of globalization in low- and middle-income countries (LMIC), with a specific emphasis on Ethiopia. Although globalization has gained momentum in recent years, there is a concern that the globalization of Western mental health frameworks is problematic, as these concepts have been developed in a different context and do not accommodate the current diversity in understanding in LMIC countries. The importance of understanding the mental health frameworks of LMIC like Ethiopia, prior to considering if and how aspects of high-income countries (HIC) conceptualizations may be appropriately imported, is therefore reflected upon. Traditional approaches in managing mental health difficulties and possible reasons for the limited engagement with clinical psychology in Ethiopia are considered. Current developments within the fields of mental health and clinical psychology in Ethiopia are discussed, and the need to develop more local research in order to increase understanding and evaluate treatment interventions is recognized. Further consideration and debate by Ethiopian mental health professionals as well as those from HIC are recommended, to promote both reciprocal learning and new local discourses about mental health.

'Living in an alternative reality': adolescents' experiences of psychiatric inpatient care.

BACKGROUND: To date minimal research has investigated adolescent psychiatric inpatient care from a service-user perspective. METHOD: Semi-structured interviews were conducted with 10 adolescents with experience of psychiatric inpatient care. Interviews were analysed using the grounded theory method (Glaser & Strauss, 1967). RESULTS: A core category, 'Living in an Alternative Reality', reflected the unusual nature of the hospitalisation experience. Adolescents reported feelings of restriction and disconnection and used various relational and practical strategies to cope with hospitalisation. CONCLUSIONS: Results suggest that psychiatric hospitalisation can cause strong affective reactions in adolescents, and may affect psychological constructs such as identity and self-esteem.

The feeling, embodiment and emotion of hallucinations in first episode psychosis: A prospective phenomenological visual-ecological study using novel multimodal unusual sensory experience (MUSE) maps.

BACKGROUND: Research and practice typically focus upon unimodal hallucinations, especially auditory verbal hallucinations. Contemporary research has however indicated that voice-hearing may co-occur within a broader milieu of feelings, and multimodal hallucinations may be more common than previously thought. METHODS: An observational design asked participants to prospectively document the feeling and modality of hallucinations for one week prior to an interview. Novel visual diary methods involving drawing, writing and body-mapping generated 42 MUSE maps (multimodal unusual sensory experience), analysed with a participatory qualitative method. Twelve people took part: all experiencing hallucinations daily, accessing early intervention in psychosis services, given psychotic-spectrum diagnoses, and living in the community. The study took place during a seven-month period in 2018 at Leicestershire and Rutland's Psychosis Intervention and Early Recovery service (UK). FINDINGS: All documented hallucinations co-occurred with bodily feelings. Feelings were localised to specific body areas, generalised across the body and extended beyond the body into peripersonal space. Co-occurring emotional feelings most commonly related to confusion, fear and frustration. INTERPRETATION: Hallucinations were characterised by numerous feelings arising at once, often including multimodal, emotional, and embodied features. Within this study, the immediate feeling of hallucination experiences were readily communicated through prospective, visual, and ecological information gathering methods and particularly those which offer multiple modes of communication (e.g. body-map, visual, written, oral). Uptake of visual, ecological and prospective methods may enhance understandings of lived experiences of hallucinations.Funding: University of Leicester.

A critical narrative analysis of psychiatrists' engagement with psychosis as a contentious area.

BACKGROUND: Psychosis, characterised by altered perceptions or interpretations of reality, remains a contested area. Lately, perspectives and conceptualisations of psychosis that have traditionally been more peripheral have gained greater recognition. Both the British Psychological Society and Critical Psychiatry Network have highlighted some contentious areas in recent publications. AIMS: The aim was to use critical narrative analysis to consider what facilitates and inhibits medical professionals with clinical experience of psychosis to engage with the topic of psychosis as a contentious area. METHOD: Semi-structured interviews were conducted with 12 medical professionals, who were at trainee or qualified level with a minimum of 6 months' clinical experience within psychiatry, across three Trusts within the United Kingdom. This purposive sample had a diverse range of perspectives regarding psychosis. Critical narrative analysis comprising six distinct stages, informed the analysis. RESULTS: Participants positioned themselves broadly within one of three groups: biological psychiatrists, critical psychiatrists and those more conflicted. Narrative analysis was undertaken for each participant before being integrated for this article. The research highlighted several factors which either limit or facilitate opportunities within the psychiatric profession to engage with a plurality of views regarding psychosis. These included the significance of power and hierarchy within the profession, the role of dialogue and the prevalence of reflexivity within the profession. CONCLUSION: A pattern was identified of psychiatrists generally associating with like-minded others and not engaging with wider evidence regarding psychosis, partly as a result of the inherent threats to the power and hierarchy of the profession. This led to new ideas being widely unknown or undervalued, potentially to the disservice of clinical practice.

A question of finding harmony: a grounded theory study of clinical psychologists' experience of addressing spiritual beliefs in therapy.

In spite of the increasing emphasis upon spirituality in the psychological literature, research continues to highlight concerns that issues relating to spirituality are regularly overlooked within a therapeutic setting. The aim of the current study was to develop an account of the way in which clinical psychologists understand and address spirituality within therapy. Semi-structured interviews were conducted with eight clinical psychologists. The transcripts were analysed using the qualitative methodology of grounded theory, which also informed the data collection process. Two core categories were developed and termed spirituality as an elusive concept and finding harmony with spiritual beliefs. The diversity of meaning surrounding spirituality and the relative lack of engagement was found to create difficulty for constructing spirituality coherently as a concept. When specifically considering methods for identifying and addressing spiritual beliefs, contrasting approaches were identified. This diversity in understanding and approach has implications for the process and outcome of therapy, which are discussed in detail. Recommendations are suggested for developing spirituality as a more coherent and accessible concept, both within professional dialogue and the therapeutic context.