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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

Abstract

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.

Keywords

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

Notes

Acknowledgments

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.

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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

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