Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions
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.
KeywordsPsychotic-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.
All participants gave written informed assent, with parental consent, as approved by a recognised national ethical review body.
- 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.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
- 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). http://www.guidance.nice.org.uk/cg155
- 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
- 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.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.NICE (2014) Psychosis and schizophrenia: treatment and management (CG178). National Institute for Health & Care Excellence, LondonGoogle Scholar
- 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.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
- 45.Dunn LM, Dunn LM, Whetton C, Burley J (1997) British picture vocabulary scale, 2nd edn. NFER-Nelson, WindsorGoogle Scholar
- 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.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
- 51.IBM Corp (2011) IBM SPSS statistics for windows, version 20.0. IBM, ArmonkGoogle Scholar