The role of magical thinking in hallucinations. Comparisons of clinical and non-clinical groups.

BACKGROUND: Magical thinking consists of accepting the possibility that events that, according to the causal concepts of a culture, cannot have any causal relationship, but might somehow nevertheless have one. Magical thinking has been related to both obsessive-compulsive disorder and schizophrenia. AIMS: The purpose of this study was to investigate the role of magical thinking in hallucinations of patients diagnosed with schizophrenia. METHODS: Four groups were recruited for this purpose from a clinical population (hallucinating schizophrenic patients, patients diagnosed with psychoses who had never hallucinated, obsessive-compulsive disorder patients and a clinical control group) and a non-clinical control group, who were given the Magical Ideation Scale. RESULTS: The results show that magical ideation differentiates the group of schizophrenic patients with auditory hallucinations from the rest of the groups that participated in the design. Items related to "mind reading", to the presence of auditory illusions in response to sound stimuli, and to the sense of sometimes being accompanied by an evil presence are the most closely related to the presence of auditory hallucinations. CONCLUSIONS: Magical thinking, understood as beliefs in non-consensual modes of causation, is closely linked to auditory hallucinations in patients diagnosed with schizophrenia.

Relationship between childhood trauma, mindfulness, and dissociation in subjects with and without hallucination proneness.

The purpose of this study was to examine the relationship between childhood traumas, mindfulness, and dissociation (more specifically, absorption and depersonalization) in healthy subjects with and without hallucination proneness. A sample of 318 subjects was given the Launay-Slade Hallucination Scale-Revised (R. P. Bentall & P. Slade, 1985). From this sample, 2 groups were formed: one with high and the other with low hallucination proneness. Furthermore, all participants were given the Tellegen Absorption Scale (A. Tellegen & G. Atkinson, 1974), the Cambridge Depersonalization Scale (M. Sierra & G. E. Berrios, 2000), the Southampton Mindfulness Questionnaire (P. D. J. Chadwick et al., 2008), and the Trauma Questionnaire (J. R. E. Davidson, D. Hughes, & D. G. Blazer, 1990). The results showed that in the group with high hallucination proneness, there were significantly more subjects with traumatic experiences than in the group with low predisposition, although no significant difference in the mean number of traumatic experiences undergone in childhood was found between the 2 groups, although there was a trend toward significance. A correlation analysis showed a significant negative association between mindfulness on the one hand and absorption and depersonalization on the other. A positive relationship was also found between childhood traumas and absorption and depersonalization. Finally, multiple mediation analysis showed that the absorption and depersonalization variables acted as mediators between childhood traumas and hallucination proneness. We discuss the importance of the relationship between the variables studied and hallucination proneness and suggest some approaches for their treatment.

Relationship of absorption, depersonalisation, and self-focused attention in subjects with and without hallucination proneness.

INTRODUCTION: The purpose of this work was to study the relationship of absorption, depersonalisation, and self-focused attention in subjects prone to hallucination. METHODS: A sample of 218 healthy subjects was given the LSHS-R Hallucination Scale (Bentall & Slade, 1985). Three groups, subjects with high, medium, and low hallucination proneness, were formed from this sample. The Tellegen Absorption Scale (TAS; Tellegen & Atkinson, 1974), Cambridge Depersonalisation Scale (CDS; Sierra & Berrios, 2000), and Self-Absorption Scale (SAS; McKenzie & Hoyle, 2008) were also given to all the participants. The Metacognitions Questionnaire (MCQ-30; Wells & Cartwright-Hatton, 2004) was used as a covariant to control for the effects of emotional vulnerability on the dependent variables studied. RESULTS: The results showed that subjects highly prone to hallucinations had significantly higher absorption, depersonalisation, and self-focused attention than the subjects in the other two groups. A hierarchical regression analysis showed that absorption and depersonalisation predict hallucination proneness. CONCLUSIONS: The importance of the absorption, depersonalisation, and self-focused attention variables for understanding the aetiology of hallucinations is discussed in the Conclusions, where some approaches to its treatment are also suggested.

Dissociative experiences as mediators between childhood trauma and auditory hallucinations.

The purpose of this work was to study the relationship between reported traumatic experiences in childhood and positive psychotic symptoms. We hypothesized that dissociative experiences were potential mediators between childhood trauma and hallucinations, but not delusions. The sample comprised 71 patients diagnosed with psychoses. They were assessed with the Dissociative Experiences Scale (DES-II; Carlson & Putnam, 1993), a questionnaire on trauma (TQ; Davidson, Hughes, & Blazer, 1990), and the Positive and Negative Syndrome Scale (PANSS; Kay, Opler, & Lindenmayer, 1988) delusions and hallucinations items. The results showed that childhood trauma was positively associated with the dissociation scale scores (r = .40) and also the hallucination (r = .36) and delusions scale scores (r = .32). Furthermore, it was demonstrated that the dissociation variable was a potential mediator between childhood trauma and hallucinations, but not between childhood trauma and delusions. Of the 3 DES-II factors, only depersonalization showed a mediating relationship between childhood trauma and hallucinations. The main conclusion is that the impact of childhood trauma on hallucinations may not simply be direct, but mediated by dissociative experiences, especially depersonalization. Clinical implications are also briefly discussed.

Relationship of metacognition, absorption, and depersonalization in patients with auditory hallucinations.

OBJECTIVES: The purpose of this work was to study the relationship of metacognition, absorption, and depersonalization in hallucinating patients. DESIGN: A within-subjects correlational design was employed. METHODS: We formed four groups from a clinical population (schizophrenic patients with hallucinations, schizophrenic patients with no hallucinations but with delusions, schizophrenic patients recovered from positive symptoms, and patients with a non-psychotic psychiatric disorder) and a non-clinical control group. All participants were given the Metacognitions Questionnaire (MCQ-30, Wells & Cartwright-Hatton, 2004), the Tellegen Absorption Scale (TAS, Tellegen & Atkinson, 1974) and the Cambridge Depersonalization Scale (CDS, Sierra & Berrios, 2000). RESULTS: Schizophrenic subjects with hallucinations scored significantly higher on the depersonalization scale than any other group, and significantly higher on the absorption scale than any group except for the clinical patient controls. Schizophrenic patients with hallucinations also had significantly more dysfunctional metacognitive beliefs than subjects with no psychiatric pathology. It was further found that the metacognition variable correlated positively with the absorption and depersonalization variables, and that these variables in turn correlated positively with each other. Finally, it should be stressed that the variables that best predict hallucination severity are depersonalization and the MCQ-30 subscale `Need to control thoughts'. CONCLUSIONS: We discuss the role of metacognitive and dissociative variables in understanding hallucinations and suggest some approaches to their treatment.

New life for schizophrenia psychotherapy in the light of phenomenology.

Recent contributions to the theoretical conception and empirical evaluation of schizophrenia in the light of phenomenology are opening the way to new perspectives in psychotherapy. The phenomenological conception understands schizophrenia as a disturbance of the basic sense of selfhood (ipseity) characterized by hyper-reflexivity and diminished sense of self. Evaluation consists of examining the anomalous self-experience in a series of domains, which makes the conception presented operable. On this basis, a phenomenologically informed psychotherapy is introduced. Its characteristics are pointed out and early intervention is reviewed (the last frontier in psychosis) from this perspective. Finally, a series of psychotherapies which, although they do not have a phenomenological origin, may be seen from that perspective, are re-examined. These are the narrative, mindfulness and acceptance and commitment therapies.

Depersonalization as a mediator in the relationship between self-focused attention and auditory hallucinations.

The purpose of this work was to study the potentially mediating role of certain dissociative factors, such as depersonalization, between self-focused attention and auditory hallucinations. A total of 59 patients diagnosed with schizophrenic disorder completed a self-focused attention scale ( M. F. Scheier & C. S. Carver, 1985 ), the Cambridge Depersonalization Scale (M. Sierra & G. E. Berrios, 2000), and the hallucination and delusion items on the Positive and Negative Syndrome Scale (S. R. Kay, L. A. Opler, & J. P. Lindenmayer, 1988). The results showed that self-focused attention correlated positively with auditory hallucinations, with delusions, and with depersonalization. It was also demonstrated that depersonalization has a mediating role between self-focused attention and auditory hallucinations but not delusions. In the discussion, the importance of dissociative processes in understanding the formation and maintenance of auditory hallucinations is suggested.

Avoidance and activation as keys to depression: adaptation of the Behavioral Activation for Depression Scale in a Spanish sample.

In this paper we present the adaptation of the Behavioral Activation for Depression Scale (BADS), developed by Kanter, Mulick, Busch, Berlin, and Martell (2007), in a Spanish sample. The psychometric properties were tested in a sample of 263 participants (124 clinical and 139 non-clinical). The results show that, just as in the original English version, the Spanish BADS is a valid and internally consistent scale. Construct validity was examined by correlation with the BDI-II, AAQ, ATQ, MCQ-30, STAI and EROS. Factor analysis justified the four-dimensions of the original instrument (Activation, Avoidance/Rumination, Work/School Impairment and Social Impairment), although with some differences in the factor loadings of the items. Further considerations about the usefulness of the BADS in the clinical treatment of depressed patients are also suggested.

The Structure of Behavior as Unity of Psychology According to Mariano Yela.

BACKGROUND: As Mariano Yela is one of the most eminent Spanish psychologists, the centenary of his birth is a good occasion to revisit his work. Despite being best known for his contributions to psychometrics, Yela has also made important contributions to theoretical psychology, with particular interest in the question of its unity-diversity. METHOD: Some of his most important theoretical works, presented in various contexts, were reviewed. RESULTS: One conception of psychology and one concern are emphasized throughout his work. The conception of psychology is based on behavior as meaningful action. The concern is to see any possible unity in the diversity of psychology. CONCLUSIONS: The structure of behavior defined by subject, situation and action emerge as the basis on which the unity of psychology could be established. If anything, unity of diversity. Some implications are discussed.

Ecstasy (MDMA): A rebellion coherent with the system.

Aim: This study attempts to demonstrate the relevance of the socio-cultural model of drugs in explaining the impressive development of ecstasy in the last 45 years. Method: First the study describes the use of ecstasy by groups which have left their imprint on the substance: university students, gays, yuppies and the "New Age" movement. Then the link between ecstasy and techno music led to the socially integrated "club" phenomenon, and the "rave", which began as a rupturing, nonconformist phenomenon. Findings: According to this argument, in spite of its clearly counterculture beginnings, the "rave" movement and its most characteristic drug, ecstasy, have gradually become integrated into mainstream culture, somehow reinforcing the functioning of capitalist postmodernity. Our study explains ecstasy's history in reference to the cultural contradictions of capitalism and the functions that it currently fulfils for young people. Based on this analysis, the implications of the cultural perspective are discussed as a paradigm of research in drug use, stressing notions of subculture, myths and rituals. It also proposes a harmonious articulation of academic and common knowledge as the most appropriate method for their study. Conclusion: A cultural approach to drug use could assist in unblocking a field so in need of conceptual and empirical revision.

[Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art].

Empirically Supported Psychological Treatments for Children and Adolescents: State of the Art. BACKGROUND: The empirical evidence accumulated on the efficacy, effectiveness, and efficiency of psychotherapeutic treatments in children and adolescents calls for an update. The main goal of this paper objective was to carry out a selective review of empirically supported psychological treatments for a variety of common psychological disorders and problems in childhood and adolescence. METHOD: A review was carried out of the psychological treatments for different psychological disorders and problems in social-emotional or behavioral adjustment in the child-adolescent population according to the Spanish National Health System (Clinical Practice Guidelines) levels of evidence and degrees of recommendation. RESULTS: The findings suggest that psychological treatments have empirical support for addressing a wide range of psychological problems in these developmental stages. The degree of empirical support ranges from low to high depending on the phenomenon analyzed. The review suggests unequal progress in the different fields of intervention. CONCLUSIONS: From this update, psychologists will be able to make informed decisions when implementing those empirically supported treatments to address the problems that occur in childhood and adolescence.

[Evidence-Based Psychological Treatments for Adults: A Selective Review]

Evidence-Based Psychological Treatments for Adults: A Selective Review. BACKGROUND: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. METHOD: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. RESULTS: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. CONCLUSIONS: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help.

A preliminary exploration of trauma, dissociation, and positive psychotic symptoms in a Spanish sample.

The purpose of this research was to study traumatic and dissociative experiences in a sample of Spanish psychotic patients. A total of 37 psychotic patients filled out the Dissociative Experiences Scale (E. B. Carlson & F. W. Putnam, 1993), a questionnaire on traumas (J. R. E. Davidson, D. Hughes, & D. G. Blazer, 1990), and the Positive and Negative Syndrome Scale delusion and hallucinations items (S. R. Kay, L. A. Opler, & J. P. Lindenmayer, 1988). The results showed that 40.5% of the subjects in the sample had undergone at least 1 traumatic experience as children and 64.9% had as adults. Patients with hallucinations had experienced a higher mean number of childhood traumatic experiences than patients without hallucinations. No significant difference in the mean number of traumatic events was found between patients with and without delusions. There was no significant difference in the mean number of adulthood traumatic events between patients with and without hallucinations and delusions. Subjects with childhood traumas scored higher on the Dissociative Experiences Scale than those who had had such experiences as adults. Patients with hallucinations and delusions also scored higher on the dissociation scale than patients who did not show those positive psychotic symptoms.

Effects of Behavioral Activation on the Quality of Life and Emotional State of Lung Cancer and Breast Cancer Patients During Chemotherapy Treatment.

Research suggests that the progressive abandonment of activities in cancer patients are related to depression and worse quality of life. Behavioral activation (BA) encourages subjects to activate their sources of reinforcement and modify the avoidance responses. This study assesses the effectiveness of BA in improving quality of life and preventing emotional disorders during chemotherapy treatment. One sample of lung cancer patients and another of breast cancer patients were randomized into a BA experimental group (E.G.lung/4sess.n = 50; E.G.breast/6sess.n = 33) and a control group (C.G.lung/4sess.n = 40; C.G.breast/6sess.n = 35), respectively. In each session and in follow-ups (3/6/9 months), all participants completed different assessment scales. The results converge to show the effectiveness of BA, encouraging cancer patients to maintain rewarding activities which can activate their sources of day-to-day reinforcement and modify their experience avoidance patterns. BA appears to be a practical intervention which may improve social and role functioning and the emotional state of cancer patients during chemotherapy treatment.

Relationship between self-focused attention and dissociation in patients with and without auditory hallucinations.

The purpose of this work was to study the relationship between self-focused attention and dissociative experiences in 4 groups of subjects: patients with a psychotic disorder who suffer from auditory hallucinations, patients with psychoses who have recovered from their hallucinations, patients with psychoses who have never had them, and a fourth nonclinical group. The private self-consciousness scale, revised version by Scheier and Carver, J Appl Soc Psychol. 1985;15:687-699, was used to measure self-focused attention, and the dissociative experience scale (DES-II, Bernstein and Putnam, J Nerv Ment Dis. 1986;174:727-735) was used for dissociation. The results showed that the attention of subjects with hallucinations was more self-focused than the nonclinical group, but did not differentiate significantly from groups of patients without hallucinations. On the other hand, patients with hallucinations and those recovered from them had a higher percentage of dissociative experiences than the rest of the groups in the total DES-II score and in its 3 factors, dissociative amnesia, depersonalization, and absorption. We also found a positive correlation between self-focusing and dissociative experiences in subjects with hallucinations. The depersonalization factor on the DES-II was the only factor predicting auditory hallucinations. The conclusions discuss the relevance of dissociative factors and self-focused attention to understanding the etiology of auditory hallucinations and their contributions to current cognitive models of hallucinations.

Changing relationship with voices: new therapeutic perspectives for treating hallucinations.

A growing body of research on verbal hallucinations shows the importance of beliefs about and relationships with the voices for their pathological course. In particular, beliefs about the omnipotence of the voices and the need to control them, and relationships with them that involve efforts to resist or fight them, have shown themselves to be more pathogenic than effective. Likewise, treatments aimed at eliminating the voices, be they based on medication or 'traditional' cognitive-behavioural therapy, have not always been successful. A series of strategies focused on changing relationships with the voices instead of trying to eliminate them-including mindfulness, acceptance, experiential role plays and re-authoring lives-is emerging as a new perspective for the treatment of hallucinations. All of these strategies are based on the person, not on the syndrome, which also represents a new conception of the problem, in a phenomenological-social perspective, alternative to the predominant medical conception.

Hyperreflexivity as a condition of mental disorder: a clinical and historical perspective.

Hyperreflexivity, understood as intensified self-consciousness in which subjects disengage from normal forms of involvement with nature and society, often considering themselves as objects of focal awareness, is proposed here as a condition of mental disorders, without which they would not exist. This thesis is argued from a dual perspective: clinical and historical. In the clinical perspective, it is shown that hyperreflexivity is not merely concomitant with mental disorders, but indeed has causal priority over them. Empirical evidence of a correlational, experimental and therapeutic nature, or deriving from cultural change, supports this claim of causal priority. In the historical perspective, it is shown that hyperreflexivity depends on certain historical-cultural circumstances that have prevailed since the Renaissance. These circumstances have to do with the emergence of the modern subject, displaced, autonomous and condemned to a hapless 'interior journey'. This means that mental disorders as such would not have existed prior to that era. Nor in the wake of the Renaissance would mental disorders automatically come into being, depending as they do on a reflexive, institutional clinical context, which would not emerge until practically the nineteenth century, but which would extend swiftly from then on.

Psychology as a Science of Subject and Comportment, beyond the Mind and Behavior.

The turn of qualitative inquiry suggests a more open, plural conception of psychology than just the science of the mind and behavior as it is most commonly defined. Historical, ontological and epistemological binding of this conception of psychology to the positivist method of natural science may have exhausted its possibilities, and after having contributed to its prestige as a science, has now become an obstacle. It is proposed that psychology be reconceived as a science of subject and comportment in the framework of a contextual hermeneutic, social, human behavioral science. Thus, without rejecting quantitative inquiry, psychology recovers territory left aside like introspection and pre-reflective self-awareness, and reconnects with traditions marginalized from the main stream. From this perspective psychology might also recover its credibility as a human science in view of current skepticism.

Activation vs. Experiential Avoidance as a Transdiagnostic Condition of Emotional Distress: An Empirical Study.

Background: From a contextual transdiagnostic approach, this study focuses on the importance of the processes of Experiential Avoidance and Activation in explaining and treating psychological problems. There exists widespread empirical evidence to suggest that the response pattern known as Experiential Avoidance, a general unwillingness to remain in contact with particular private experiences through the use of maladaptive avoidance strategies, acts as a functional dimension in various psychological problems. Activation, that is, maintaining contact with experiences/conditions of life and consequently with associated sources of reward, is a condition present in most therapeutic processes. Although a great deal of research has analyzed the relationship of the value of reward with the etiology and maintenance of psychological problems, Activation, as a transdiagnostic factor, has been studied less. The aim of this paper is to carry out an empirical study of the relationship between Activation, EA and emotional state and analyze the capacity of these two conditions to discriminate the intensity and symptomatology type in subjects with emotional distress. Methods: The Hospital Anxiety and Depression Scale (HADS), Environmental Reward Observation Scale (EROS) and Behavioral Activation for Depression Scale (BADS) were completed by 240 health center users. Results: Of the participants, 55% showed clinically relevant emotional distress. All cases of depression showed clinical anxiety. To discriminate between subjects without (n = 109) and with emotional distress (n = 131), analyses of the ROC curves and logistic regression analysis identified the BADS-Avoidance/Rumination followed by the EROS. To discriminate between subjects with anxiety but without depression (n = 61) and with anxiety and depression (n = 70), the most efficient scales were EROS followed by BADS-Social Impairment. Conclusion: It was shown that people with no emotional complaints maintained greater contact with life experiences and with environmental sources of reward than those with emotional distress. Response patterns showing Experiential Avoidance and a reduction in Activation responses were associated with clinical distress. A reduction in Activation was the condition which distinguished those people with the greatest distress and also the greatest comorbidity of symptoms of depression and anxiety. These data support the transdiagnostic nature of Activation and suggest greater attention should be paid to this concept.

Treating anxiety and depression of cancer survivors: Behavioral activation versus acceptance and commitment therapy.

BACKGROUND: Behavioral activation (BA) and acceptance and commitment therapy (ACT) are considered particularly useful treatments when dealing with emotional problems of cancer survivors. The efficacy of these two treatments, applied on a group basis, were evaluated and compared. METHOD: An analysis was carried out of pre-post treatment changes in the emotional state and patterns of activation/avoidance of 52 cancer patients, with anxiety and/or depression, randomly assigned to three groups (BA/ACT/waiting list control). RESULTS: Both therapies were superior to no treatment in all the variables evaluated. Significant differences were found between the two treatments in favor of ACT in social impairment and avoidance/rumination. CONCLUSIONS: BA and ACT, applied on a group basis, are efficacious in the treatment of those emotional difficulties most prevalent in cancer survivors. Results suggest that activation and avoidance are the mechanisms responsible for the changes.