Skip to main content

The journey to psychosis: an exploration of specific psychological pathways

Social Psychiatry and Psychiatric Epidemiology volume 49, pages 1541–1544 (2014)Cite this article

Abstract

Recent models of psychosis have implicated specific psychological processes in the aetiology of this disorder, and these factors may form a route to later symptoms—either directly or via a mediating pathway after exposure to adversity. Researchers are beginning to bring together findings that look into specific pathways between early experiences of adversity and different symptoms of psychosis, including thought disorder, hallucinations and persecutory delusions. The adversity-specific pathways include parental communication deviance, source monitoring biases, and insecure attachment. Researchers have also begun to utilise specific psychological factors as targets for treatment, and these include a focus on a worrying thinking style, negative beliefs about the self, interpersonal sensitivity, sleep disturbance, anomalous internal experience, and reasoning biases. Research on the impact of psychological processes is beginning to mount and is likely to improve our understanding of aetiology and lead to significant advances in the treatment of psychotic symptoms and disorders.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

43,34 €

Price includes VAT (Finland)
Tax calculation will be finalised during checkout.

References

  1. Bentall RP, Corcoran R, Howard R, Blackwood N, Kinderman P (2001) Persecutory delusions: a review and theoretical integration. Clin Psychol Rev 21:1143–1192

    PubMed  Article  CAS  Google Scholar 

  2. Freeman D, Garety PA, Kuipers E, Fowler D, Bebbington PE (2002) A cognitive model of persecutory delusions. Br J Clin Psychol 41:331–347

    PubMed  Article  Google Scholar 

  3. Garety PA, Kuipers E, Fowler D, Freeman D, Bebbington PE (2001) A cognitive model of the positive symptoms of psychosis. Psychol Med 31:189–195

    PubMed  Article  CAS  Google Scholar 

  4. 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(10):1377–1391

    PubMed  Article  Google Scholar 

  5. Morrison AP (2001) The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cognit Psychother 29(3):257–276

    Google Scholar 

  6. Freeman D, Garety P (2014) Advances in understanding and treating persecutory delusions: a review. Soc Psychiatry Psychiatr Epidemiol 49(8):1179–1189

  7. Bentall R, Sousa P, Varese F, Wickham S, Sitko K, Haarmans M, Read J (2014) From adversity to psychosis: pathways and mechanisms from specific adversities to specific symptoms. Soc Psychiatry Psychiatr Epidemiol 49(7):1011–1022

    PubMed  Article  Google Scholar 

  8. Varese F, Smeets F, Drukker M et al (2012) Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective and cross-sectional cohort studies. Schizophr Bull 38(4):61–671

    Article  Google Scholar 

  9. Morgan C, Fisher H (2007) Environmental factors in schizophrenia: childhood trauma—a critical review. Schizophr Bull 33(1):3–10

    PubMed  Article  PubMed Central  Google Scholar 

  10. Varese F, Barkus E, Bentall RP (2011) Dissociation mediates the relationship between childhood trauma and hallucination-proneness. Psychol Med 42:1025–1036

    PubMed  Article  Google Scholar 

  11. Perona-Garcelán S et al (2012) Dissociative experiences as mediators between childhood trauma and auditory hallucinations. J Trauma Stress 25(3):323–329

    PubMed  Article  Google Scholar 

  12. Sitko K et al (2014) Associations between specific psychotic symptoms and specific childhood adversities are mediated by attachment styles: an analysis of the National Comorbidity Survey. Psychiatry Res 217:202–209

    PubMed  Article  Google Scholar 

  13. Beards S, Gayer-Anderson C, Borges S, Dewey ME, Fisher HL, Morgan C (2013) Life events and psychosis: a review and meta-analysis. Schizophr Bull 39(4):740–747

    PubMed  Article  PubMed Central  Google Scholar 

  14. Morgan C, Charalambides M, Hutchinson G, Murray RM (2010) Migration, ethnicity, and psychosis: toward a sociodevelopmental model. Schizophr Bull 36(4):655–664

    PubMed  Article  PubMed Central  Google Scholar 

  15. Morgan C, Reininghaus U, Fearon P, Hutchinson G, Morgan K, Dazzan P, Boydell J, Kirkbride JB, Doody GA, Jones PB, Murray RM, Craig T (2014) Modelling the interplay between childhood and adult adversity in pathways to psychosis: initial evidence from the AESOP study. Psychol Med 44(2):407–419

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  16. Fisher HL, Appiah-Kusi E, Grant C (2012) Anxiety and negative self-schemas mediate the association between childhood maltreatment and paranoia. Psychiatry Res 196:323–324

    PubMed  Article  Google Scholar 

  17. Freeman D, Thompson C, Vorontsova N, Dunn G, Carter L-A, Garety P, Kuipers E, Slater M, Antley A, Glucksman E, Ehlers A (2013) Paranoia and post-traumatic stress disorder in the months after a physical assault. Psychol Med 43:2673–2684

    PubMed  Article  CAS  PubMed Central  Google Scholar 

  18. 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 116:280–289

    PubMed  Article  CAS  Google Scholar 

  19. Bebbington P, Jonas S, Kuipers E, King M, Cooper C, Brugha T, Meltzer H, McManus S, Jenkins R (2011) Childhood sexual abuse and psychosis: data from a cross-sectional national psychiatric survey in England. Br J Psychiatry 199(1):29–37

    PubMed  Article  Google Scholar 

  20. Fisher HL, Schreier A, Zammit S, Maughan B, Munafo MR, Lewis G, Wolke D (2013) Pathways between childhood victimization and psychosis-like symptoms in the ALSPAC Birth Cohort. Schizophr Bull 39(5):1045–1055

    PubMed  Article  PubMed Central  Google Scholar 

  21. Freeman D, Dunn G, Startup H, Pugh K, Cordwell J, Mander H, Cernis E, Wingham G, Shirvell K, Kingdon D (2014) An explanatory randomised controlled trial testing the effects of cognitive behaviour therapy for worry on persecutory delusions in psychosis: the Worry Intervention Trial (WIT) (submitted)

  22. Garety P, Waller H, Emsley R, Jolley S, Kuipers E, Bebbington P, Dunn G, Fowler D, Hardy A, Freeman D (2014) Cognitive mechanisms of change in delusions: an experimental investigation targeting reasoning to effect change in paranoia. Schizophr Bull. doi:10.1093/schbul/sbu103

  23. Fowler D, Hodgekins J, Garety P, Freeman D, Kuipers E, Dunn G, Smith B, Bebbington P (2012) Negative cognition, depressed mood and paranoia: a longitudinal pathway analysis using structural equation modelling. Schizophr Bull 38:1063–1073

    PubMed  Article  PubMed Central  Google Scholar 

  24. Vorontsova N, Garety P, Freeman D (2013) Cognitive factors maintaining persecutory delusions in psychosis: the contribution of depression. J Abnorm Psychol 122:1121–1131

    PubMed  Article  Google Scholar 

  25. Hall PL, Tarrier N (2003) The cognitive-behavioural treatment of low self-esteem in psychotic patients: a pilot study. Behav Res Ther 41:317–332

    PubMed  Article  Google Scholar 

  26. 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 the persistence of persecutory ideation. Soc Psychiatry Psychiatr Epidemiol 47:1195–1203

    PubMed  Article  Google Scholar 

  27. Freeman D et al (2008) A virtual reality study of paranoid thinking in the general population. Br J Psychiatry 192:258–263

    PubMed  Article  Google Scholar 

  28. Myers E, Startup H, Freeman D (2011) Cognitive behavioural treatment of insomnia in patients with persecutory delusions. J Behav Ther Exp Psychiatry 42:330–336

    PubMed  Article  PubMed Central  Google Scholar 

  29. Bell V, Freeman D (2014) A pilot trial of cognitive behavioural therapy for interpersonal sensitivity in individuals with persecutory delusions. J Behav Ther Exp Psychiatry 45(4):441–446

  30. Read J et al (2001) A traumagenic neurodevelopmental model of schizophrenia. Psychiatry Interpers Biol Process 64:319–345

    Article  CAS  Google Scholar 

  31. Read J et al (2014) The traumagenic neurodevelopmental model of psychosis revisited. Neuropsychiatry 4:65–79

    Article  Google Scholar 

  32. Walker EF, Diforio D (1997) Schizophrenia: a neural diathesis-stress model. Psychol Rev 104(4):667–685

    PubMed  Article  CAS  Google Scholar 

  33. Borges S, Gayer-Anderson C, Mondelli V (2013) A systematic review of the activity of the hypothalamic-pituitary-adrenal axis in first episode psychosis. Psychoneuroendocrinology 38:603–611

    PubMed  Article  CAS  Google Scholar 

  34. McGowan PO, Sasaki A, D’Alessio AC et al (2009) Epigenetic regulation of the glucocorticoid receptor in human brain associates with childhood abuse. Nat Neurosci 12:342–348

    PubMed  Article  CAS  PubMed Central  Google Scholar 

Download references

Acknowledgments

SB is supported by an Economic and Social Research Council Ph.D. studentship. HF is supported by a Medical Research Council Population Health Scientist fellowship.

Conflict of interest

There is no conflict of interest.

Author information

Affiliations

  1. Health Service and Population Research Department, Centre for Epidemiology and Public Health, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, UK

    Stephanie Beards

  2. MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK

    Helen L. Fisher

Authors
  1. Stephanie Beards
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Helen L. Fisher
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Stephanie Beards.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Beards, S., Fisher, H.L. The journey to psychosis: an exploration of specific psychological pathways. Soc Psychiatry Psychiatr Epidemiol 49, 1541–1544 (2014). https://doi.org/10.1007/s00127-014-0953-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-014-0953-6

Keywords

  • Psychosis
  • Adversity
  • Mechanisms
  • Thought disorder
  • Hallucinations
  • Delusions