Hostname: page-component-8448b6f56d-m8qmq Total loading time: 0 Render date: 2024-04-16T13:51:41.831Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive Processes during Acute Psychosis: The Role of Heightened Responsibility and Catastrophic Misinterpretations

Published online by Cambridge University Press:  23 June 2009

Olga Luzón ,
Chris Harrop  and
Fiona Nolan
Olga Luzón*
Affiliation:
Royal Holloway University of London, Egham, UK
Chris Harrop
Affiliation:
West London Mental Health NHS Trust, West Middlesex Hospital, Isleworth, UK
Fiona Nolan
Affiliation:
University College London, UK
*
Reprint requests to Olga Luzón, Royal Holloway University of London, Egham, Surrey TW20 0EX, UK. E-mail: olga.luzon@rhul.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: This study investigated the role of cognitive mechanisms underlying obsessive compulsive and panic disorders in psychosis, and in particular, their possible contributions to acute psychosis. Method: A total of 90 participants were recruited comprising three equal-size groups, including two clinical groups (acute and stable) and one non-clinical matched control group. Symptom severity and distress was assessed using the PSYRATS, and questionnaire measures of anxiety and obsessive beliefs were administered to all participants. Results: Individuals with a diagnosis of psychosis reported significantly higher levels of obsessional beliefs and anxiety sensitivity than the non-clinical group. Furthermore, acutely psychotic patients reported a significantly higher sense of responsibility and catastrophic misinterpretation than the stable psychiatric controls, and than samples of OCD and GAD patients. Conclusions: Results suggest that these anxiety processes are particularly important during acute psychotic episodes, beyond the reported comorbidity. The theoretical and clinical implications of these findings, the limitations of the methodology employed, and suggestions for future research are discussed.

Keywords

Acute psychosisanxietycatastrophic misinterpretationscognitive distortionsheightened responsibilityobsessive-compulsive disorder
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 37 , Issue 4 , July 2009 , pp. 357 - 377
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Arntz, A., Voncken, M. and Goosen, A. C. (2007). Responsibility and obsessive-compulsive disorder: an experimental test. Behaviour Research and Therapy, 45, 425–435.CrossRefGoogle ScholarPubMed
Baker, C. A. and Morrison, A. P. (1998). Cognitive processes in auditory hallucinations: attributional biases and metacognition. Psychological Medicine, 28, 1199–1208.CrossRefGoogle ScholarPubMed
Bentall, R. P. (1990). Reconstructing Schizophrenia. London: Routledge.Google Scholar
Bentall, R. P. and Slade, P. D. (1985). Reality testing and auditory hallucinations: a signal detection analysis. British Journal of Clinical Psychology, 24, 159–169.CrossRefGoogle ScholarPubMed
Bentall, R. P., Kaney, S. and Bowen-Jones, K. (1995). Persecutory delusions and recall of threat-related, depression-related and neutral words. Cognitive Therapy and Research, 19, 331–343.CrossRefGoogle Scholar
Bentall, R. P., Kinderman, P. and Kaney, S. (1994). The self, attributional processes and abnormal beliefs: towards a model of persecutory delusions. Behaviour Research and Therapy, 32, 331–341.CrossRefGoogle Scholar
Birchwood, M. J. (1996). Early intervention in psychotic relapse: cognitive approaches to detection and management. In Haddock, G. and Slade, P. D. (Eds.), Cognitive-Behavioural Interventions with Psychotic Disorders (pp. 171–211). London: Routledge.Google Scholar
Birchwood, M. J., Jackson, C. and Fowler, D. (2000). (Eds.), Early Intervention in Psychosis: a guide to concepts, evidence and interventions. Chichester: John Wiley and Sons.Google Scholar
Cartwright-Hatton, S. and Wells, A. (1997). Beliefs about worry and Intrusions: the metacognitions questionnaire and its correlates. Journal of Anxiety Disorders, 11, 279–296.CrossRefGoogle ScholarPubMed
Chadwick, P. D. (2006). Person-Based Cognitive Therapy for Distressing Psychosis. New York: Wiley.CrossRefGoogle Scholar
Chadwick, P. D., Birchwood, M. J. and Trower, P. (1996). Cognitive Therapy for Delusions, Voices and Paranoia. Chichester: John Wiley and Sons.Google Scholar
Clark, D. M. (1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461–470.CrossRefGoogle ScholarPubMed
Cosoff, S. J. and Hafner, R. J. (1998). The prevalence of comorbid anxiety in schizophrenia, schizoaffective and bipolar disorder. Australian and New Zealand Journal of Psychiatry, 32, 67–72.CrossRefGoogle ScholarPubMed
Davey, G. C L. and Levy, S. (1998). Catastrophic worrying: personal inadequacy and a perseverative iterative style as features of the catastrophising process. Journal of Abnormal Psychology, 107, 576–586.CrossRefGoogle Scholar
De Hert, M. and Peuskens, J. (2000). Psychiatric aspects of suicidal behaviour: schizophrenia. In Hawton, K. and van Heeringen, K. (Eds.), The International Handbook of Suicide and Attempted Suicide (pp. 121–134). Chichester, UK: Wiley.CrossRefGoogle Scholar
Deacon, B. and Abramowitz, J. (2006). A pilot study of two-day cognitive-behavioral therapy for panic disorder. Behaviour Research and Therapy, 44, 807–817.CrossRefGoogle ScholarPubMed
Drake, R. E., Haddock, G., Tarrier, N., Bentall, R. and Lewis, S. (2007). The Psychotic Symptom Rating Scales (PSYRATS): their usefulness and properties in first episode psychosis. Schizophrenia Research, 89, 119–122.CrossRefGoogle ScholarPubMed
Emsley, R. A., Oosthuizen, P. P., Joubert, A. F., Roberts, M. C. and Stein, D. J. (1999). Depressive and anxiety symptoms in patients with schizophrenia and schizophreniform disorder. Journal of Clinical Psychiatry, 60, 747–751.CrossRefGoogle ScholarPubMed
Fear, C. F. and Healy, D. (1997). Probabilistic reasoning in obsessive-compulsive and delusional disorders. Psychological Medicine, 27, 199–208.CrossRefGoogle ScholarPubMed
Field, A. (2005). Discovering Statistics Using SPSS (2nd ed.). London: SAGE Publications.Google Scholar
Freeman, D. and Garety, P. A. (1999). Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and Cognitive Psychotherapy, 27, 47–62.CrossRefGoogle Scholar
Freeman, D., Garety, P. A. and Kuipers, E. (2001). Persecutory delusions: developing the understanding of belief maintenance and emotional distress. Psychological Medicine, 31, 1293–1306.CrossRefGoogle ScholarPubMed
Freeman, D., Garety, P. A., Kuipers, E., Fowler, D. and Bebbington, P. E. (2002). A cognitive model of persecutory delusions. British Journal of Clinical Psychology, 41, 331–347.CrossRefGoogle ScholarPubMed
Freeman, D., Garety, P. A., Kuipers, E., Fowler, D., Bebbington, P. E. and Dunn, G. (2007). Acting on persecutory delusions: the importance of safety seeking. Behaviour Research and Therapy, 45, 89–99.CrossRefGoogle ScholarPubMed
García-Montes, J. M., Perez-Alvarez, M., Soto-Balbuena, C., Perona-Garcelan, S. and Cangas, A. J. (2005). Metacognitions in patients with hallucinations and obsessive-compulsive disorder: the superstition factor. Behaviour Research and Therapy, 44, 1091–1104.CrossRefGoogle ScholarPubMed
Garety, P. A. and Hemsley, D. R. (1994). Delusions. London: Psychology Press.Google Scholar
Garety, P. A., Hemsley, D. R. and Wessley, S. (1991). Reasoning in deluded schizophrenic and paranoid patients. Journal of Nervous and Mental Disease, 179, 194–201.CrossRefGoogle ScholarPubMed
Garety, P. A., Kuipers, E., Fowler, D., Freeman, D. and Bebbington, P. E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31, 189–195.CrossRefGoogle ScholarPubMed
Gumley, A., White, C. and Power, K. (1999). An interacting cognitive subsystems model of relapse and the course of psychosis. Clinical Psychology and Psychotherapy, 6, 261–278.3.0.CO;2-C>CrossRefGoogle Scholar
Haddock, G. and Lewis, S. (2005). Psychological interventions in early psychosis. Schizophrenia Bulletin, 31, 697–704.CrossRefGoogle ScholarPubMed
Haddock, G., McCarron, J., Tarrier, N. and Faragher, E. B. (1999). Scales to measure dimensions of hallucinations and delusions: the psychotic symptom rating scales (PSYRATS). Psychological Medicine, 29, 879–889.CrossRefGoogle ScholarPubMed
Harrop, C. E. and Trower, P. (2001). “Why does schizophrenia develop at late adolescence?” Clinical Psychology Review, 21, 241–265.CrossRefGoogle ScholarPubMed
Herz, M. I. and Melville, C. (1980). Relapse in schizophrenia. American Journal of Psychiatry, 137, 801–805.Google ScholarPubMed
Jones, S. R. and Fernyhough, C. (2006). The roles of thought suppression and metacognitive beliefs in proneness to auditory verbal hallucinations in a non-clinical sample. Personality and Individual Differences, 41, 1421–1432.CrossRefGoogle Scholar
Julien, D., O'Connor, K. P., Aardema, F. and Todorov, C. (2006). The specificity of belief domains in obsessive–compulsive symptom subtypes. Personality and Individual Differences, 41, 1205–1216.CrossRefGoogle Scholar
Kay, S. R., Fiszbein, A. and Opler, L. A. (1987). The positive and negative syndrome scale for schizophrenia. Schizophrenia Bulletin, 13, 261–276.CrossRefGoogle ScholarPubMed
Larøi, F. and Van der Linden, M. (2005). Metacognitions in proneness towards hallucinations and delusions. Behaviour Research and Therapy, 43, 1425–1441.CrossRefGoogle ScholarPubMed
Lewis, S., Tarrier, N., Haddock, G., Bentall, R., Kinderman, P., Kingdon, D., Leadley, K., Benn, A., Grazebrook, K., Haley, C., Akhatar, S., Davies, L., Palmer, S., Faragher, B. and Dunn, G. (2002). Randomised controlled trial of cognitive-behavioural therapy in early schizophrenia: acute-phase outcomes. British Journal of Psychiatry, 181, 91–97.CrossRefGoogle Scholar
Mancini, F., D'Olimpio, F. and Cieri, L. (2004). Manipulation of responsibility in non-clinical subjects: does expectation of failure exacerbate obsessive–compulsive behaviors? Behaviour Research and Therapy, 42, 449–457.CrossRefGoogle ScholarPubMed
Marlowe, K. (2003). Cognitive-behavioural therapy for psychosis. British Journal of Psychiatry, 183, 262–264.CrossRefGoogle ScholarPubMed
Mathews, A. (1990). Why worry? The cognitive function of anxiety. Behaviour Research and Therapy, 28, 455–468.CrossRefGoogle ScholarPubMed
McGorry, P. D., Hickie, I. B., Yung, A. R., Pantelis, C. and Jackson, H. J. (2006). Clinical staging of psychiatric disorders: a heuristic framework for choosing earlier, safer and more effective interventions. Australian and New Zealand Journal of Psychiatry, 40, 616–622.CrossRefGoogle ScholarPubMed
Moorey, H. and Soni, S. D. (1994). Anxiety symptoms in stable chronic schizophrenics. Journal of Mental Health, 3, 257–262.CrossRefGoogle Scholar
Morrison, A. P. (1998). A cognitive analysis of auditory hallucinations: are voices to schizophrenia what bodily sensations are to panic? Behavioural and Cognitive Psychotherapy, 26, 289–302.CrossRefGoogle Scholar
Morrison, A. P. (2001). The interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29, 257–276.CrossRefGoogle Scholar
Morrison, A. P. and Baker, C. A. (1998). Cognitive processes in auditory hallucinations: attributional biases and metacognition. Psychological Medicine, 28, 1199–1208.Google Scholar
Morrison, A. P. and Wells, A. (2003). A comparison of metacognitions in patients with hallucinations, delusions, panic disorder, and non-patient controls. Behaviour Research and Therapy, 41, 251–256.CrossRefGoogle ScholarPubMed
Morrison, A. P., Frame, L. and Larkin, W. (2003). Relationships between trauma and psychosis: a review and integration. British Journal of Clinical Psychology, 42 (4), 331–353.CrossRefGoogle ScholarPubMed
Morrison, A. P., French, P. and Wells, A. (2007). Metacognitive beliefs across the continuum of psychosis: comparisons between patients with psychotic disorders, patients at ultra-high risk and non-patients. Behaviour Research and Therapy. Retrieved from doi:10.1016/j.brat.2007.01.002.CrossRefGoogle Scholar
Morrison, A. P., Haddock, G. and Tarrier, N. (1995). Intrusive thoughts and auditory hallucinations: a cognitive approach. Behavioural and Cognitive Psychotherapy, 23, 265–280.CrossRefGoogle Scholar
Myers, S. and Wells, A. (2005). Obsessive-compulsive symptoms: the contribution of metacognitions and responsibility. Journal of Anxiety Disorders, 19, 806–817.CrossRefGoogle ScholarPubMed
Neria, Y., Bromet, E. J., Sievers, S., Lavelle, J. and Fochtmann, L. J. (2002). Trauma exposure and posttraumatic stress disorder in psychosis: findings from a first-admission cohort. Journal of Consulting and Clinical Psychology, 70, 246–251.CrossRefGoogle ScholarPubMed
Obsessive Compulsive Cognitions Working Group (2003). Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part 1. Behaviour Research and Therapy, 41, 863–878.CrossRefGoogle Scholar
Obsessive Compulsive Cognitions Working Group (2005). Psychometric validation of the Obsessive Belief Questionnaire and Interpretation of Intrusions Inventory, Part 2: factor analyses and testing of a brief version. Behaviour Research and Therapy, 43, 1527–1542.CrossRefGoogle Scholar
Peters, E. R., Day, S. and Garety, P. A. (1997). From preconscious to conscious processing – where does the abnormality lie in delusions? Schizophrenia Research, 24, 120.CrossRefGoogle Scholar
Peters, E. R., Joseph, S. A. and Garety, P. A. (1999). Measurement of delusional ideation in the normal population: introducing the PDI (Peters et al. Delusions Inventory). Schizophrenia Bulletin, 25, 553–576.CrossRefGoogle Scholar
Phillips, M. L., Senior, C. and David, A. S. (2000). Perception of threat in schizophrenics with persecutory delusions: an investigation using visual scan paths. Psychological Medicine, 30, 157–167.CrossRefGoogle ScholarPubMed
Rachman, S. J. (1976). Obsessional compulsive checking. Behaviour Research and Therapy, 14, 269–277.CrossRefGoogle ScholarPubMed
Robins, L. N. and Regier, D. A. (Eds.) (1991). Psychiatric Disorders in America: the epidemiological catchment area study. New York: The Free Press.Google Scholar
Salkovskis, P. M. (1985). Obsessional-compulsive problems: a cognitive behavioural analysis. Behaviour Research and Therapy, 23, 571–583.CrossRefGoogle ScholarPubMed
Salkovskis, P. M. (1991). The importance of behaviour in the maintenance of anxiety and panic: a cognitive account. Behavioural Psychotherapy, 19, 6–19.CrossRefGoogle Scholar
Salkovskis, P. M. (1996). Cognitive-behavioural approaches to the understanding of obsessional problems. In Rapee, R. M. (Ed.), Current Controversies in the Anxiety Disorders. New York: Guilford Press.Google Scholar
Salkovskis, P. M. and Kirk, J. (1996). Obsessional disorders. In Hawton, K. (Ed.), Cognitive Behavioural Therapy for Psychiatric Problems – a practical guide. Oxford: Oxford University Press.Google Scholar
Salkovskis, P. M., Rachman, S., Ladouceur, R., Freeston, M., Taylor, S., Kyrios, M. and Sica, C. (1996). Defining Responsibility in Obsessional Problems. In Obsessive compulsive beliefs working group meetings. Northampton: Smith College.Google Scholar
Salkovskis, P. M., Shafran, R., Rachman, S. and Freeston, M. H. (1999). Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research. Behaviour Research and Therapy, 37, 1055–1072.CrossRefGoogle Scholar
Shepherd, M., Watt, D., Falloon, I. and Nigel, S. (1989). The natural history of schizophrenia: a five-year follow-up study of outcome and prediction in a representative sample of schizophrenics. Psychological Medicine, 15, 46.Google Scholar
Startup, H. M., Freeman, D. and Garety, P. A. (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy, 45, 523–537.CrossRefGoogle ScholarPubMed
Tabachnick, B. G. and Fidell, L. S. (2001). Using Multivariate Statistics (4th ed.). New York: Harper and Row.Google Scholar
Tarrier, N., Lewis, S., Haddock, G., Bentall, R., Drake, R., Kinderman, P., Kingdon, D., Siddle, R., Everitt, J., Leadley, K., Benn, A., Grazebrook, K., Haley, C., Akhatar, S., Davies, L., Palmer, S. and Dunn, G. (2004). Cognitive-behavioural therapy in first-episode and early schizophrenia: 18-month follow-up of a randomised controlled trial. British Journal of Psychiatry, 184, 231–239.CrossRefGoogle ScholarPubMed
Taylor, S., Abramowitz, J., McKay, D., Calamari, J. E., Sookman, D., Kyrios, M., Wilhelm, S. and Carmin, C. (2006). Do dysfunctional beliefs play a role in all types of obsessive–compulsive disorder? Anxiety Disorders, 20, 85–97.CrossRefGoogle ScholarPubMed
Taylor, S., Zvolensky, M., Cox, B., Deacon, B., Heimberg, R., Ledley, D., Abramowitz, J. S., Holaway, R. M., Sandin, B., Stewart, S. H., Coles, M., Eng, W., Daly, E. S., Arrindell, W. A., Bouvard, M. and Cardenas, S. J. (2007). Robust dimensions of anxiety sensitivity: development and initial validation of the Anxiety Sensitivity Index-3. Psychological Assessment, 19, 176–188.CrossRefGoogle ScholarPubMed
Tibbo, P., Kroetsch, M., Chue, P. and Warneke, L. (2000). Obsessive-compulsive disorder in schizophrenia. Journal of Psychiatric Research, 34, 139–146.CrossRefGoogle ScholarPubMed
Tien, A. Y. and Eaton, W. W. (1992). Psychopathologic factors for the schizophrenia syndrome. Archives of General Psychiatry, 49, 37–46.CrossRefGoogle ScholarPubMed
Tolin, D. F., Worhunsky, P. and Maltby, N. (2006). Are “obsessive” beliefs specific to OCD? a comparison across anxiety disorders. Behaviour Research and Therapy, 44, 469–480.CrossRefGoogle Scholar
Turnbull, G. and Bebbington, P. (2001). Anxiety and the schizophrenic process: clinical and epidemiological evidence. Social Psychiatry and Psychiatric Epidemiology, 36, 235–243.CrossRefGoogle ScholarPubMed
Wells, A., Clark, D. M., Salkovskis, P. M., Ludgate, J., Hackmann, A. and Gelder, M. G. (1995). Social phobia: the role of in-situation safety behaviours in maintaining anxiety and negative beliefs. Behavior Therapy, 26, 153–161.CrossRefGoogle Scholar
Young, H. E. and Bentall, R. P. (1997). Probabilistic reasoning in deluded, depressed and normal subjects: effects of task difficulty and meaningful versus non-meaningful material. Psychological Medicine, 27, 455–465.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.