European Child & Adolescent Psychiatry

, Volume 25, Issue 3, pp 311–319 | Cite as

Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions

  • Tamatha Ruffell
  • Matilda Azis
  • Nedah Hassanali
  • Catherine Ames
  • Sophie Browning
  • Karen Bracegirdle
  • Richard Corrigall
  • Kristin R. Laurens
  • Colette Hirsch
  • Elizabeth Kuipers
  • Lucy Maddox
  • Suzanne Jolley
Original Contribution


The psychosocial processes implicated in the development and maintenance of psychosis differ according to both the dimensional attributes (conviction, frequency, associated distress, adverse life impact) and the content or type (e.g. grandiosity, hallucinations, paranoia) of the psychotic symptoms experienced. This has informed the development of ‘targeted’ cognitive behavioural therapy for psychosis (CBTp): interventions focusing on specific psychological processes in the context of particular symptom presentations. In adults, larger effect sizes for change in primary outcomes are typically reported in trials of targeted interventions, compared to those for trials of generic CBTp approaches with multiple therapeutic foci. We set out to test the theoretical basis for developing targeted CBTp interventions for young people with distressing psychotic-like, or unusual, experiences (UEs). We investigated variations in the psychosocial processes previously associated with self-reported UE severity (reasoning, negative life events, emotional problems) according to UE dimensional attributes and content/type (using an established five-factor model) in a clinically referred sample of 72 young people aged 8–14 years. Regression analyses revealed associations of conviction and grandiosity with reasoning; of frequency, and hallucinations and paranoia, with negative life events; and of distress/adverse life impact, and paranoia and hallucinations, with emotional problems. We conclude that psychological targets for intervention differ according to particular characteristics of childhood UEs in much the same way as for psychotic symptoms in adults. The development of targeted interventions is therefore indicated, and tailoring therapy according to presentation should further improve clinical outcomes for these young people.


Psychotic-like experience (PLE) Cognitive model Psychosis Cognitive therapy CBT 



The authors thank all participating children, parents and community staff. We also gratefully acknowledge the financial support from Guy’s & St Thomas’ Charity (ref. R100417). EK, KRL and CH were partly supported by and/or affiliated with the National Institute for Health Research Specialist Biomedical Research Centre (BRC) for Mental Health at the South London and Maudsley National Health Service Foundation Trust and Institute of Psychiatry, Psychology & Neuroscience, King’s College London, UK. KRL was supported in part by a National Institute of Health Research Career Development Fellowship (CDF/08/01/015).

Role of the funding source

The design of the study, collection, analysis and interpretation of data, the writing of the report and the decision to submit the paper for publication were independent of the sponsors. The corresponding author confirms that she had full access to all the data for the study and the final responsibility for the decision to submit for publication.

Compliance with Ethical Standards

Conflict of Interest

On behalf of all authors, the corresponding author states that there is no conflict of interest. The authors were employed by their academic institutions and/or the UK publicly funded the health services. There is no employment, consultancy, stock ownership, honorarium, legal undertaking or any other interest that could potentially result in a conflict of interest or bias to the report of the work.

Ethical standards

All participants gave written informed assent, with parental consent, as approved by a recognised national ethical review body.


  1. 1.
    Fonseca-Pedrero E, Paino M, Lemos-Giráldez S, Muñiz J (2011) Schizotypal traits and depressive symptoms in nonclinical adolescents. Compr Psychiatry 52:293–300CrossRefPubMedGoogle Scholar
  2. 2.
    Murray GK, Jones PB (2012) Psychotic symptoms in young people without psychotic illness: mechanisms and meaning. Br J Psychiatry 201:4–6CrossRefPubMedGoogle Scholar
  3. 3.
    Lin A, Wigman JTW, Nelson B, Vollebergh WAM, van Os J, Baksheev G, Ryan J, Raaijmakers QA, Thompson A, Yung AR (2011) The relationship between coping and subclinical psychotic experiences in adolescents from the general population—a longitudinal study. Psychol Med 41:2535–2546CrossRefPubMedGoogle Scholar
  4. 4.
    Wigman JTW, van Winkel R, Raaijmakers QA, Ormel J, Verhulst FC, Reijneveld SA, van Os J, Vollebergh WA (2011) Evidence for a persistent, environment-dependent and deteriorating subtype of subclinical psychotic experiences: a 6-year longitudinal general population study. Psychol Med 41:2317–2329CrossRefPubMedGoogle Scholar
  5. 5.
    Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE (2001) A cognitive model of the positive symptoms of psychosis. Psychol Med 31:189–195CrossRefPubMedGoogle Scholar
  6. 6.
    Garety PA, Bebbington P, Fowler D, Freeman D, Kuipers E (2007) Implications for neurobiological research of cognitive models of psychosis: a theoretical paper. Psychol Med 37:1377–1391CrossRefPubMedGoogle Scholar
  7. 7.
    David AS (2010) Why we need more debate on whether psychotic symptoms lie on a continuum with normality. Psychol Med 40:1935–1942CrossRefPubMedGoogle Scholar
  8. 8.
    National Institute for Health and Care Excellence (2013) Psychosis and schizophrenia in children and young people. Recognition and Management. National Collaborating Centre for Mental Health (CG155).
  9. 9.
    Garety PA, Hemsley DR (1987) Characteristics of delusional experience. Eur Arch Psychiatry Neurol Sci 236:294–298CrossRefPubMedGoogle Scholar
  10. 10.
    Fine C, Gardner M, Craigie J, Gold I (2007) Hopping, skipping or jumping to conclusions? Clarifying the role of the JTC bias in delusions. Cogn Neuropsychiatry 12:46–77CrossRefPubMedGoogle Scholar
  11. 11.
    Freeman D (2007) Suspicious minds: the psychology of persecutory delusions. Clin Psychol Rev 27:425–457CrossRefPubMedGoogle Scholar
  12. 12.
    Garety PA, Freeman D, Jolley S, Dunn G, Bebbington PE, Fowler DG, Kuipers E, Dudley R (2005) Reasoning, emotions, and delusional conviction in psychosis. J Abnorm Psychol 114:373–384CrossRefPubMedGoogle Scholar
  13. 13.
    Garety PA, Gittins M, Jolley S, Bebbington P, Dunn G, Kuipers E, Fowler D, Freeman D (2013) Differences in cognitive and emotional processes between persecutory and grandiose delusions. Schizophr Bull 39:629–639PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Freeman D, Stahl D, McManus S, Meltzer H, Brugha T, Wiles N, Bebbington P (2012) Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Soc Psychiatry Psychiatr Epidemiol 47:1195–1203CrossRefPubMedGoogle Scholar
  15. 15.
    Oliver JE, McLachlan K, Jose PE, Peters E (2012) Predicting changes in delusional ideation: the role of mindfulness and negative schemas. Psychol Psychother 85:243–259CrossRefPubMedGoogle Scholar
  16. 16.
    Smith B, Fowler DG, Freeman D, Bebbington P, Bashforth H, Garety P, Dunn G, Kuipers E (2006) Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophr Res 86:181–188CrossRefPubMedGoogle Scholar
  17. 17.
    Startup H, Freeman D, Garety PA (2007) Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behav Res Ther 45:523–537CrossRefPubMedGoogle Scholar
  18. 18.
    Fowler D, Hodgekins J, Garety P, Freeman D, Kuipers E, Dunn G, Smith B, Bebbington PE (2011) Negative cognition, depressed mood, and paranoia: a longitudinal pathway analysis using structural equation modeling. Schizophr Bull 38:1063–1073PubMedCentralCrossRefPubMedGoogle Scholar
  19. 19.
    Birchwood M, Meaden A, Trower P, Gilbert P, Plaistow J (2000) The power and omnipotence of voices: subordination and entrapment by voices and significant others. Psychol Med 30:337–344CrossRefPubMedGoogle Scholar
  20. 20.
    Freeman D, Fowler D (2009) Routes to psychotic symptoms: trauma, anxiety and psychosis-like experiences. Psychiatry Res 169:107–112PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Gracie A, Freeman D, Green S, Garety PA, Kuipers E, Hardy A, Ray K, Dunn G, Bebbington P, Fowler D (2007) The association between traumatic experience, paranoia and hallucinations: a test of the predictions of psychological models. Acta Psychiatr Scand 116:280–289CrossRefPubMedGoogle Scholar
  22. 22.
    Raune D, Bebbington P, Dunn G, Kuipers E (2006) Event attributes and the content of psychotic experiences in first-episode psychosis. Psychol Med 36:221–230CrossRefPubMedGoogle Scholar
  23. 23.
    Garety PA, Waller H, Emsley R, Jolley S, Kuipers E, Bebbington P, Dunn G, Fowler D, Hardy A, Freeman D (2015) Cognitive mechanisms of change in delusions: an experimental investigation targeting reasoning to effect change in paranoia. Schizophr Bull 41:400–410PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Freeman D, Garety P (2014) Advances in understanding and treating persecutory delusions: a review. Soc Psychiatry Psychiatr Epidemiol 49:1179–1189PubMedCentralCrossRefPubMedGoogle Scholar
  25. 25.
    Thomas N, Hayward M, Peters E, van der Gaag M, Bentall RP, Jenner J, Strauss C, Sommer IE, Johns LC, Varese F, García-Montes JM, Waters F, Dodgson G, McCarthy-Jones S (2014) Psychological therapies for auditory hallucinations (voices): current status and key directions for future research. Schizophr Bull 40(Suppl 4):S202–S212PubMedCentralCrossRefPubMedGoogle Scholar
  26. 26.
    National Institute for Health & Care Excellence (NICE) (2009) Schizophrenia-core interventions in the treatment and management of schizophrenia in adults in primary and secondary care (CG82). National Institute for Health & Care Excellence, LondonGoogle Scholar
  27. 27.
    NICE (2014) Psychosis and schizophrenia: treatment and management (CG178). National Institute for Health & Care Excellence, LondonGoogle Scholar
  28. 28.
    Fisher HL, Appiah-Kusi E, Grant C (2012) Anxiety and negative self-schemas mediate the association between childhood maltreatment and paranoia. Psychiatry Res 196:323–324CrossRefPubMedGoogle Scholar
  29. 29.
    Thompson A, Sullivan S, Lewis G, Zammit S, Heron J, Horwood J, Thomas K, Gunnell D, Hollis C, Wolke D, Harrison G (2011) Association between locus of control in childhood and psychotic symptoms in early adolescence: results from a large birth cohort. Cogn Neuropsychiatry 16:385–402CrossRefPubMedGoogle Scholar
  30. 30.
    Ames CS, Jolley S, Laurens KR, Maddox L, Corrigall R, Browning S, Hirsch CR, Hassanali N, Bracegirdle K, Kuipers E (2013) Modelling psychosocial influences on the distress and impairment caused by psychotic-like experiences in children and adolescents. Eur Child Adolesc Psychiatry 23:715–722CrossRefPubMedGoogle Scholar
  31. 31.
    Hassanali N, Ruffell T, Browning S, Bracegirdle K, Ames C, Corrigall R, Laurens KR, Hirsch C, Kuipers E, Maddox L, Jolley S (2014) Cognitive bias and unusual experiences in childhood. Eur Child Adolesc Psychiatry. doi: 10.1007/s00787-014-0644-6 Google Scholar
  32. 32.
    Noone D, Ames C, Laurens K, Hirsch C, Browning S, Bracegirdle K, Hassanali N, Corrigall R, Kuipers E, Jolley S (2015) A preliminary investigation of schematic beliefs and unusual experiences in children. Eur Psychiatry. doi: 10.1016/j.eurpsy.2014.12.006 PubMedGoogle Scholar
  33. 33.
    Wong KK, Freeman D, Hughes C (2014) Suspicious young minds: paranoia and mistrust in 8- to 14-year-olds in the UK and Hong Kong. Br J Psychiatry 205:221–229CrossRefPubMedGoogle Scholar
  34. 34.
    Galbraith ND, Manktelow KI, Chen-Wilson CH, Harris RA, Nevill A (2014) Different combinations of perceptual, emotional, and cognitive factors predict three different types of delusional ideation during adolescence. J Nerv Ment Dis 202:668–676CrossRefPubMedGoogle Scholar
  35. 35.
    Downs JM, Cullen AE, Barragan M, Laurens KR (2013) Persisting psychotic-like experiences are associated with both externalising and internalising psychopathology in a longitudinal general population child cohort. Schizophr Res 144:99–104CrossRefPubMedGoogle Scholar
  36. 36.
    Laurens KR, Hobbs MJ, Sunderland M, Green MJ, Mould GL (2012) Psychotic-like experiences in a community sample of 8000 children aged 9 to 11 years: an item response theory analysis. Psychol Med 42:1495–1506CrossRefPubMedGoogle Scholar
  37. 37.
    Wigman JT, Vollebergh WA, Raaijmakers QA, Iedema J, van Dorsselaer S, Ormel J, Verhulst FC, van Os J (2011) The structure of the extended psychosis phenotype in early adolescence—a cross-sample replication. Schizophr Bull 37:850–860PubMedCentralCrossRefPubMedGoogle Scholar
  38. 38.
    Armando M, Nelson B, Yung AR, Ross M, Birchwood M, Girardi P, Nastro PF (2010) Psychotic-like experiences and correlation with distress and depressive symptoms in a community sample of adolescents and young adults. Schizophr Res 119:258–265CrossRefPubMedGoogle Scholar
  39. 39.
    Wigman JT, Vollebergh WA, Jacobs N, Wichers M, Derom C, Thiery E, Raaijmakers QA, van Os J (2012) Replication of the five-dimensional structure of positive psychotic experiences in young adulthood. Psychiatry Res 197:353–355CrossRefPubMedGoogle Scholar
  40. 40.
    Yung AR, Buckby JA, Cotton SM, Cosgrave EM, Killackey EJ, Stanford C, Godfrey K, McGorry PD (2006) Psychotic-like experiences in nonpsychotic help-seekers: associations with distress, depression, and disability. Schizophr Bull 32:352–359PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    Yung AR, Nelson B, Baker K, Buckby JA, Baksheev G, Cosgrave EM (2009) Psychotic-like experiences in a community sample of adolescents: implications for the continuum model of psychosis and prediction of schizophrenia. Aust N Z J Psychiatry 43:118–128CrossRefPubMedGoogle Scholar
  42. 42.
    Appelbaum PS, Robbins PC, Roth LH (1999) Dimensional approach to delusions: comparison across types and diagnoses. Am J Psychiatry 156:1938–1943PubMedGoogle Scholar
  43. 43.
    Kelleher I, Harley M, Murtagh A, Cannon M (2011) Are screening instruments valid for psychotic-like experiences? A validation study of screening questions for psychotic-like experiences using in-depth clinical interview. Schizophr Bull 37:362–369PubMedCentralCrossRefPubMedGoogle Scholar
  44. 44.
    Lin A, Wigman JT, Nelson B, Wood SJ, Vollebergh WA, van Os J, Yung AR (2013) Follow-up factor structure of schizotypy and its clinical associations in a help-seeking sample meeting ultra-high risk for psychosis criteria at baseline. Compr Psychiatry 54:173–180CrossRefPubMedGoogle Scholar
  45. 45.
    Dunn LM, Dunn LM, Whetton C, Burley J (1997) British picture vocabulary scale, 2nd edn. NFER-Nelson, WindsorGoogle Scholar
  46. 46.
    Laurens KR, Hodgins S, Maughan B, Murray RM, Rutter ML, Taylor EA (2007) Community screening for psychotic-like experiences and other putative antecedents of schizophrenia in children aged 9–12 years. Schizophr Res 90:130–146CrossRefPubMedGoogle Scholar
  47. 47.
    Costello A, Edelbrock C, Kalas R, Kessler M, Klaric S (1982) NIMH diagnostic interview schedule for children: child version. National Institute of Mental Health, RockvilleGoogle Scholar
  48. 48.
    So SH, Freeman D, Dunn G, Kapur S, Kuipers E, Bebbington P, Fowler D, Garety PA (2012) Jumping to conclusions, a lack of belief flexibility and delusional conviction in psychosis: a longitudinal investigation of the structure, frequency, and relatedness of reasoning biases. J Abnorm Psychol 121:129–139PubMedCentralCrossRefPubMedGoogle Scholar
  49. 49.
    Wilkinson P, Dubicka B, Kelvin R, Roberts C, Goodyer I (2009) Treated depression in adolescents: predictors of outcome at 28 weeks. Br J Psychiatry 194:334–341CrossRefPubMedGoogle Scholar
  50. 50.
    Goodman R (2001) Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345CrossRefPubMedGoogle Scholar
  51. 51.
    IBM Corp (2011) IBM SPSS statistics for windows, version 20.0. IBM, ArmonkGoogle Scholar
  52. 52.
    Kelleher I, Connor D, Clarke MC, Devlin N, Harley M, Cannon M (2012) Prevalence of psychotic symptoms in childhood and adolescence: a systematic review and meta-analysis of population-based studies. Psychol Med 42:1857–1863CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Tamatha Ruffell
    • 1
  • Matilda Azis
    • 1
  • Nedah Hassanali
    • 1
  • Catherine Ames
    • 1
    • 2
  • Sophie Browning
    • 2
  • Karen Bracegirdle
    • 2
  • Richard Corrigall
    • 2
  • Kristin R. Laurens
    • 3
    • 4
    • 5
    • 6
  • Colette Hirsch
    • 1
    • 3
    • 7
  • Elizabeth Kuipers
    • 1
    • 3
  • Lucy Maddox
    • 2
  • Suzanne Jolley
    • 1
  1. 1.King’s College London, Department of PsychologyInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
  2. 2.South London and Maudsley NHS Foundation TrustLondonUK
  3. 3.National Institute for Health Research Mental Health Biomedical Research Centre and Dementia Unit (BRC/U) at the South London and Maudsley NHS Foundation Trust and Institute of PsychiatryKing’s College LondonLondonUK
  4. 4.King’s College London, Department of Forensic and Neurodevelopmental SciencesInstitute of Psychiatry, Psychology & NeuroscienceLondonUK
  5. 5.Research Unit for Schizophrenia Epidemiology, School of PsychiatryUniversity of New South WalesSydneyAustralia
  6. 6.Schizophrenia Research InstituteSydneyAustralia
  7. 7.University of Western AustraliaCrawleyAustralia

Personalised recommendations