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iMAgery focused psychological therapy for persecutory delusions in PSychosis (iMAPS): a multiple baseline experimental case series

Published online by Cambridge University Press:  08 April 2020

Christopher D.J. Taylor*
Affiliation:
Secondary Care Psychological Therapies Service, Pennine Care NHS Foundation Trust, Humphrey House, Angouleme Way, BuryML9 0EQ, UK Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick Street, ManchesterM13 9PL, UK
Penny E. Bee
Affiliation:
Division of Nursing, Midwifery and Social Work, School of Health Sciences, University of Manchester, Manchester, UK
James Kelly
Affiliation:
Greater Manchester Mental Health NHS Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, ManchesterM25 3BL, UK Lancaster University, Faculty of Health and Medicine, Furness College, LancasterLA1 4YG, UK
Richard Emsley
Affiliation:
Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
Gillian Haddock
Affiliation:
Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, Brunswick Street, ManchesterM13 9PL, UK Greater Manchester Mental Health NHS Foundation Trust, Trust Headquarters, Bury New Road, Prestwich, ManchesterM25 3BL, UK
*
*Corresponding author. Email: [email protected]

Abstract

Background:

Many people with psychosis experience persecutory delusions and report negative schematic beliefs and intrusive mental images which may be maintaining factors for psychotic symptoms.

Aims:

This study examined the feasibility and acceptability of a new psychological therapy targeting schemas and images (iMAPS therapy).

Method:

The study used a randomised multiple baseline design. Participants with first episode psychosis were randomised using a multiple baseline design with 2–5 assessments. Six sessions of therapy, consisting of a combination of imagery techniques and imagery rescripting techniques, was used. In each session, participants completed a Mental Imagery in Psychosis Questionnaire (MIPQ) and imagery interview. Mood and delusional beliefs (PSYRATS) were also measured at each session.

Results:

Five participants with first episode psychosis completed the baseline visits and attended all therapy sessions. One participant declined the final assessment. Results demonstrated significant reductions in negative schematic beliefs, delusions, imagery distress and other measures of schema (YSQ, SMI). Although multiple baseline randomisation strengthens the study, it lacked a control arm and blind assessments.

Conclusions:

iMAPS appears a feasible and acceptable treatment for psychosis, and further evaluation is indicated.

Type
Main
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Arntz, A., & Jacob, G. (2012). Schema Therapy in Practice: An Introductory Guide to the Schema Mode Approach. Chichester, UK: Wiley-Blackwell.Google Scholar
Bamelis, L. L., Evers, S. M., Spinhoven, P., & Arntz, A. (2014). Results of a multicenter randomized controlled trial of the clinical effectiveness of schema therapy for personality disorders. American Journal of Psychiatry, 171, 305322. doi: 10.1176/appi.ajp.2013.12040518CrossRefGoogle ScholarPubMed
Beck, J. S. (2011). Cognitive Behavior Therapy: Basics and Beyond. New York, USA: Guilford Press.Google Scholar
Bullock, G., Newman-Taylor, K., & Stopa, L. (2016). The role of mental imagery in non-clinical paranoia. Journal of Behavior Therapy and Experimental Psychiatry, 50, 264268. doi: 10.1016/j.jbtep.2015.10.002CrossRefGoogle ScholarPubMed
Craig, P., Dieppe, P., Macintyre, S., Michie, S., Nazareth, I., & Petticrew, M. (2008). Developing and evaluating complex interventions: the new Medical Research Council guidance. British Medical Journal, 337, a1655.CrossRefGoogle ScholarPubMed
Durham, R. C., Guthrie, M., Morton, R. V., Reid, D. A., Treliving, L. R., Fowler, D., & MacDonald, R. R. (2003). Tayside–Fife clinical trial of cognitive-behavioural therapy for medication-resistant psychotic symptoms. British Journal of Psychiatry, 182, 303311.CrossRefGoogle ScholarPubMed
Fowler, D., Freeman, D., Smith, B., Kuipers, E., Bebbington, P., Bashforth, H., … & Garety, P. (2006). The Brief Core Schema Scales (BCSS): psychometric properties and associations with paranoia and grandiosity in non-clinical and psychosis samples. Psychological Medicine, 36, 749759. doi: 10.1017/S0033291706007355CrossRefGoogle ScholarPubMed
Freeman, D., Bradley, J., Waite, F., Sheaves, B., DeWeever, N., Bourke, E., … & Lister, R. (2016). Targeting recovery in persistent persecutory delusions: a proof of principle study of a new translational psychological treatment. Behavioural and Cognitive Psychotherapy, 44, 539552.CrossRefGoogle ScholarPubMed
Freeman, D., & Garety, P. A. (2000). Comments on the content of persecutory delusions: does the definition need clarification? British Journal of Clinical Psychology, 39, 407414.CrossRefGoogle ScholarPubMed
Freeman, D., Kingdon, D., Startup, H., & Dunn, G. (2011). The effects of reducing worry in patients with persecutory delusions: finding out of worries can be reduced by brief cognitive therapy. Project Protocol Version 2. MRC/NIHR Efficacy and Mechanism Evaluation Programme. https://njl-admin.nihr.ac.uk/document/download/2013075Google Scholar
Freeman, D., Pugh, K., Dunn, G., Evans, N., Sheaves, B., Waite, F., … & Fowler, D. (2014). An early Phase II randomised controlled trial testing the effect on persecutory delusions of using CBT to reduce negative cognitions about the self: the potential benefits of enhancing self confidence. Schizophrenia Research, 160, 186192.CrossRefGoogle ScholarPubMed
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D., & Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189195. doi: 10.1017/s0033291701003312CrossRefGoogle ScholarPubMed
Giesen-Bloo, J., van Dyck, R., Spinhoven, P., van Tilburg, W., Dirksen, C., van Asselt, T., … & Arntz, A. (2006). Outpatient psychotherapy for borderline personality disorder: randomized trial of schema-focused therapy vs transference-focused psychotherapy. Archives of General Psychiatry, 63, 649658. doi: 10.1001/archpsyc.63.6.649CrossRefGoogle ScholarPubMed
Hackmann, A., Bennett-Levy, J., & Holmes, E. A. (2011). Oxford Guide to Imagery in Cognitive Therapy. Oxford, UK: Oxford University Press.CrossRefGoogle Scholar
Hackmann, A., Surawy, C., & Clark, D. M. (1998). Seeing yourself through other’s eyes: a study of spontaneously occuring images in social phobia. Behavioural and Cognitive Psychotherapy, 26, 312.CrossRefGoogle Scholar
Haddock, G., McCarron, J., Tarrier, N., & Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29, 879889. doi: 10.1017/S0033291799008661CrossRefGoogle Scholar
Hales, S., Blackwell, S. E., DiSimplico, M., Iyadurai, L., Young, K., & Holmes, E. A. (2014). Imagery based cognitive behavioural assessment. In Brown, G. P. & Clark, D. A. (eds), Assessment in Cognitive Therapy (pp. 6993). New York, USA: Guilford Press.Google Scholar
Hatcher, R. L., & Gillaspy, J. A. (2006). Development and validation of a revised short version of the working alliance inventory. Psychotherapy Research, 16, 1225. doi: 10.1080/10503300500352500CrossRefGoogle Scholar
Hayward, M., Strauss, C., & Bogen-Johnston, L. (2014). Relating therapy for voices (the R2V study): study protocol for a pilot randomized controlled trial. Trials, 15, 1.CrossRefGoogle ScholarPubMed
Holmes, E. A., Bonsall, M. B., Hales, S. A., Mitchell, H., Renner, F., Blackwell, S. E., … & Di Simplicio, M. (2016). Applications of time-series analysis to mood fluctuations in bipolar disorder to promote treatment innovation: a case series. Translational Psychiatry, 6, e720. doi: 10.1038/tp.2015.207CrossRefGoogle ScholarPubMed
Holmes, E. A., & Mathews, A. (2010). Mental imagery in emotion and emotional disorders. Clinical Psychology Review, 30, 349362.CrossRefGoogle ScholarPubMed
Hutton, P. (2016). Positive clinical psychology and the promotion of happiness, compassion, and autonomy in people with psychosis. In Wood, A. M. & Johnson, J. (eds), The Wiley Handbook of Positive Clinical Psychology (pp. 245260). Chichester, UK: Wiley.CrossRefGoogle Scholar
IBM (2015). Statistical Package For Social Sciences for Windows version 23.0. Surrey, UK.Google Scholar
Ison, R., Medoro, L., Keen, N., & Kuipers, E. (2014). The use of rescripting imagery for people with psychosis who hear voices. Behavioural and Cognitive Psychotherapy, 42, 129142. doi: 10.1017/S135246581300057XCrossRefGoogle ScholarPubMed
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261276. doi: 10.1093/schbul/13.2.261CrossRefGoogle Scholar
Kesting, M.-L., & Lincoln, T. M. (2013). The relevance of self-esteem and self-schemas to persecutory delusions: a systematic review. Comprehensive Psychiatry, 54, 766789.CrossRefGoogle ScholarPubMed
Kingdon, D. G., & Turkington, D. (1994). Cognitive-Behavioral Therapy of Schizophrenia. London, UK: Guilford Press.Google ScholarPubMed
Klingberg, S., Herrlich, J., Wiedemann, G., Wölwer, W., Meisner, C., Engel, C., Jakobi-Malterre, U. E., Buchkremer, G., & Wittorf, A. (2012). Adverse effects of cognitive behavioral therapy and cognitive remediation in schizophrenia: results of the treatment of negative symptoms study. Journal of Nervous and Mental Disease, 200, 569576. doi: 10.1097/NMD.0b013e31825bfa1dCrossRefGoogle ScholarPubMed
Kosslyn, S. M., Ganis, G., & Thompson, W. L. (2001). Neural foundations of imagery. Nature Reviews Neuroscience, 2, 635642. doi: 10.1038/35090055CrossRefGoogle ScholarPubMed
Laing, J., Morland, T., & Fornells-Ambrojo, M. (2016). The phenomenology and generation of positive mental imagery in early psychosis. Clinical Psychology & Psychotherapy, 26, 523532.CrossRefGoogle Scholar
Lancaster, G. A., Dodd, S., & Williamson, P. R. (2004). Design and analysis of pilot studies: recommendations for good practice. Journal of Evaluation in Clinical Practice, 10, 307312.CrossRefGoogle ScholarPubMed
Lobbestael, J., van Vreeswijk, M., Spinhoven, P., Schouten, E., & Arntz, A. (2010). Reliability and validity of the short Schema Mode Inventory (SMI). Behavioural and Cognitive Psychotherapy, 38, 437458.CrossRefGoogle Scholar
Morina, N., Lancee, J., & Arntz, A. (2017). Imagery rescripting as a clinical intervention for aversive memories: a meta-analysis. Journal of Behavior Therapy and Experimental Psychiatry, 55, 615. doi: 10.1016/j.jbtep.2016.11.003CrossRefGoogle ScholarPubMed
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29, 257276. doi: 10.1017/s1352465801003010CrossRefGoogle Scholar
Morrison, A. P. (2004). The use of imagery in cognitive therapy for psychosis: a case example. Memory, 12, 517524. doi: 10.1080/09658210444000142CrossRefGoogle ScholarPubMed
Mulligan, J., Haddock, G., Hartley, S., Davies, J., Sharp, T., Kelly, J., Neil, S. T., Taylor, C. D. J., Welford, M., Price, J., Rivers, Z., & Barrowclough, C. (2014). An exploration of the therapeutic alliance within a telephone-based cognitive behaviour therapy for individuals with experience of psychosis. Psychology and Psychotherapy: Theory, Research and Practice, 87, 393410. http://onlinelibrary.wiley.com/doi/10.1111/papt.12018/fullCrossRefGoogle Scholar
Newman-Taylor, K., McSherry, P., & Stopa, L. (2019). Imagery rescripting in non-clinical paranoia: a pilot study of the impact on key cognitive and affective processes. Behavioural and Cognitive Psychotherapy, 48, 5466. doi: 10.1017/S1352465819000419CrossRefGoogle ScholarPubMed
Paulik, G., Steel, C., & Arntz, A. (2019). Imagery rescripting for the treatment of trauma in voice hearers: a case series. Behavioural and Cognitive Psychotherapy, 47, 709725. doi: 10.1017/S1352465819000237CrossRefGoogle ScholarPubMed
Pearson, J., Naselaris, T., Holmes, E. A., & Kosslyn, S. M. (2015). Mental imagery: functional mechanisms and clinical applications. Trends in Cognitive Sciences, 19, 590602.CrossRefGoogle ScholarPubMed
Pitt, L., Kilbride, M., Nothard, S., Welford, M., & Morrison, A. P. (2007). Researching recovery from psychosis: a user-led project. Psychiatric Bulletin, 31, 5560. doi: 10.1192/pb.bp.105.008532CrossRefGoogle Scholar
Priebe, S., & McCabe, R. (2006). The therapeutic relationship in psychiatric settings. Acta Psychiatrica Scandinavica, 113, 6972.CrossRefGoogle Scholar
Pyle, M., Norrie, J., Schwannauer, M., Kingdon, D., Gumley, A., Turkington, D., … & Morrison, A. P. (2016). Design and protocol for the Focusing on Clozapine Unresponsive Symptoms (FOCUS) trial: a randomised controlled trial. BMC Psychiatry, 16, 280.CrossRefGoogle ScholarPubMed
Reisberg, D., Pearson, D. G., & Kosslyn, S. M. (2003). Intuitions and introspections about imagery: the role of imagery experience in shaping an investigator’s theoretical views. Applied Cognitive Psychology, 17, 147160. doi: 10.1002/acp.858CrossRefGoogle Scholar
Schulze, K., Freeman, D., Green, C., & Kuipers, E. (2013). Intrusive mental imagery in patients with persecutory delusions. Behaviour Research and Therapy, 51, 714. doi: 10.1016/j.brat.2012.10.002CrossRefGoogle ScholarPubMed
Sheaves, B., Onwumere, J., Keen, N., & Kuipers, E. (2015). Treating your worst nightmare: a case-series of imagery rehearsal therapy for nightmares in individuals experiencing psychotic symptoms. The Cognitive Behaviour Therapist, 8, e27.CrossRefGoogle Scholar
Taylor, C. D. J., Bee, P. E., Emsley, R., Taylor, P., Ibbs, L., Baker, C., & Haddock, G. (under review). Detailed examination of the role of negative and positive schema in predicting psychotic symptoms in psychosis: An experience sampling study. [Manuscript submitted for publication.]Google Scholar
Taylor, C. D. J., Bee, P. E., & Haddock, G. (2017). Does schema therapy change schemas and symptoms? A systematic review across mental health disorders. Psychology and Psychotherapy: Theory, Research & Practice, 90, 456479. doi: 10.1111/papt.12112CrossRefGoogle ScholarPubMed
Taylor, C. D. J., Bee, P. E., Kelly, J., & Haddock, G. (2019). iMAgery focused therapy for persecutory delusions in PSychosis (iMAPS): a novel treatment approach. Cognitive and Behavioural Practice, 25, 575588. doi: 10.1016/j.cbpra.2018.10.002CrossRefGoogle Scholar
Taylor, C. D. J., Haddock, G., Speer, S., & Bee, P. E. (2020). Characterizing core beliefs in psychosis: a qualitative study. Behavioural and Cognitive Psychotherapy, 48, 6781. doi: 10.1017/S1352465819000274CrossRefGoogle ScholarPubMed
Taylor, C. D. J., & Harper, S. F. (2017). Early maladaptive schema, social functioning and distress in psychosis: a preliminary investigation. Clinical Psychologist, 21, 135142. doi: 10.1111/cp.12082CrossRefGoogle Scholar
Tiernan, B., Tracey, R., & Shannon, C. (2014). Paranoia and self-concepts in psychosis: a systematic review of the literature. Psychiatry Research, 216, 303313.CrossRefGoogle ScholarPubMed
Wells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T., & Brewin, C. R. (2009). Metacognitive therapy in recurrent and persistent depression: a multiple-baseline study of a new treatment. Cognitive Therapy and Research, 33, 291300.CrossRefGoogle Scholar
White, R., Gumley, A., McTaggart, J., Rattrie, L., McConville, D., Cleare, S., & Mitchell, G. (2011). A feasibility study of acceptance and commitment therapy for emotional dysfunction following psychosis. Behaviour Research and Therapy, 49, 901907.CrossRefGoogle ScholarPubMed
WHO (1992). The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva, Switzerland: World Health Organization.Google Scholar
Wild, J., Hackmann, A., & Clark, D. M. (2007). When the present visits the past: updating traumatic memories in social phobia. Journal of Behavior Therapy and Experimental Psychiatry, 38, 386401. doi: 10.1016/j.jbtep.2007.07.003CrossRefGoogle ScholarPubMed
Wood, L., Burke, E. M., Byrne, R., & Morrison, A. P. (2016). Examining service user experiences of a cognitive therapy intervention for self-stigma in psychosis. Psychosis, 8, 238249. doi: 10.1080/17522439.2015.1135184CrossRefGoogle Scholar
Young, J., Klosko, J., & Weishaar, M. (2003). Schema Therapy: A Practitioner’s Guide. New York, USA: Guilford Press.Google Scholar
Young, J. E. (2003). Young Schema Questionnaire Short Form (YSQ-S3) Version Three. New York, USA: Cognitive Therapy Center of New York.Google Scholar
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