Targeting affect leads to reduced paranoia in people with psychosis: a single case series.

BACKGROUND: Current psychological interventions for psychosis focus primarily on cognitive and behavioural management of delusions and hallucinations, with modest outcomes. Emotions are not usually targeted directly, despite evidence that people with psychosis have difficulty identifying, accepting and modifying affective states. AIMS: This study assessed the impact of emotion regulation skills practice on affect and paranoia in seven people who met criteria for a diagnosis of schizophrenia or schizoaffective disorder. METHOD: The study utilised a single case ABA design and measured emotion regulation skills, affect and paranoia over baseline, intervention and withdrawal of intervention phases. We predicted that eight sessions of skills rehearsal would lead to improved emotion regulation, reduced negative affect, increased positive affect, and reduced paranoia. RESULTS: Most participants were able to learn to regulate their emotions, and reported reduced negative affect and paranoia. There was no clear pattern of change for positive affect. CONCLUSIONS: These findings suggest that emotion can be targeted in psychosis, and is associated with reduced paranoia. Emotion regulation may constitute a key treatment target in cognitive behavioural therapy for psychosis.

Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes.

BACKGROUND: Paranoia is often accompanied by distressing intrusions associated with traumatic memories, yet one of the best-evidenced interventions, imagery rescripting (IR), is not routinely offered. This is likely to be due to poor understanding of the effects of IR on postulated mechanisms of change as well as the absence of a robust evidence base. AIMS: This study aimed to establish proof of principle that IR impacts key cognitive-affective processes associated with distressing intrusions - memory characteristics and self-representations - and level of paranoia. METHOD: We used a within-subject repeated measures design to examine the effect of single-session IR on memory characteristics (level of intrusions, vividness, distress, encapsulated belief strength, emotion intensity and frequency), self-representation variables, affect and paranoia. Fifteen participants were seen once before and once after the IR session, to gather baseline and follow-up data. RESULTS: As predicted, participants reported reductions in memory characteristics, improved self-esteem and positive affect, and reduced negative affect and paranoia, with large effect sizes. These effects were maintained at follow-up. CONCLUSIONS: While a within-subject design is useful for initial exploration of novel interventions, controlled studies are needed to determine causality. This is the first study to examine mechanisms of IR in paranoia. A controlled trial is now warranted.

Service user experience of adapted dialectical behaviour therapy in a community adult mental health setting.

BACKGROUND: Dialectical behaviour therapy (DBT), a skill-based cognitive behavioural treatment, is increasingly used in the treatment of borderline personality disorder (BPD). AIMS: The study examined service users' perspective on the effectiveness of an adapted DBT programme, delivered within a community adult mental health setting. METHODS: Semi-structured interviews and focus groups were conducted with eight participants with a diagnosis of BPD about their experience of the programme. RESULTS: Thematic analysis focused on two key themes: evaluation of therapy and treatment impact. Therapy-specific factors and personal challenges emerged as important themes. Treatment impact raised issues relating to a renewed sense of identity and changes in daily life. CONCLUSIONS: The study describes the positive and negative experiences of service users with BPD attending an adapted DBT programme.