Search results
Found 12151 matches for
The Oxford Agoraphobic Avoidance Scale.
BACKGROUND: Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of avoidance and in situ anxiety but are challenging to administer and lack standardisation. Our aim was to draw on the principles of BATs to develop a self-report measure of agoraphobia symptoms. METHOD: The scale was developed with 194 patients with agoraphobia in the context of psychosis, 427 individuals in the general population with high levels of agoraphobia, and 1094 individuals with low levels of agoraphobia. Factor analysis, item response theory, and receiver operating characteristic analyses were used. Validity was assessed against a BAT, actigraphy data, and an existing agoraphobia measure. Test-retest reliability was assessed with 264 participants. RESULTS: An eight-item questionnaire with avoidance and distress response scales was developed. The avoidance and distress scales each had an excellent model fit and reliably assessed agoraphobic symptoms across the severity spectrum. All items were highly discriminative (avoidance: a = 1.24-5.43; distress: a = 1.60-5.48), indicating that small increases in agoraphobic symptoms led to a high probability of item endorsement. The scale demonstrated good internal reliability, test-retest reliability, and validity. CONCLUSIONS: The Oxford Agoraphobic Avoidance Scale has excellent psychometric properties. Clinical cut-offs and score ranges are provided. This precise assessment tool may help focus attention on the clinically important problem of agoraphobic avoidance.
Randomised controlled trial of automated VR therapy to improve positive self-beliefs and psychological well-being in young people diagnosed with psychosis: a study protocol for the Phoenix VR self-confidence therapy trial.
INTRODUCTION: The confidence of young people diagnosed with psychosis is often low. Positive self-beliefs may be few and negative self-beliefs many. A sense of defeat and failure is common. Young people often withdraw from many aspects of everyday life. Psychological well-being is lowered. Psychological techniques can improve self-confidence, but a shortage of therapists means that very few patients ever receive such help. Virtual reality (VR) offers a potential route out of this impasse. By including a virtual coach, treatment can be automated. As such, delivery of effective therapy is no longer reliant on the availability of therapists. With young people with lived experience, we have developed a staff-assisted automated VR therapy to improve positive self-beliefs (Phoenix). The treatment is based on established cognitive behavioural therapy and positive psychology techniques. A case series indicates that this approach may lead to large improvements in positive self-beliefs and psychological well-being. We now aim to conduct the first randomised controlled evaluation of Phoenix VR. METHODS AND ANALYSIS: 80 patients with psychosis, aged between 16 and 30 years old and with low levels of positive self-beliefs, will be recruited from National Health Service (NHS) secondary care services. They will be randomised (1:1) to the Phoenix VR self-confidence therapy added to treatment as usual or treatment as usual. Assessments will be conducted at 0, 6 (post-treatment) and 12 weeks by a researcher blind to allocation. The primary outcome is positive self-beliefs at 6 weeks rated with the Oxford Positive Self Scale. The secondary outcomes are psychiatric symptoms, activity levels and quality of life. All main analyses will be intention to treat. ETHICS AND DISSEMINATION: The trial has received ethical approval from the NHS Health Research Authority (22/LO/0273). A key output will be a high-quality VR treatment for patients to improve self-confidence and psychological well-being. TRIAL REGISTRATION NUMBER: ISRCTN10250113.
Better Sleep: Evidence-Based Interventions
Although clinicians often recognise the importance of sleep problems in people with psychotic experiences, the recommended Cognitive Behavioural Treatments are rarely used. Insomnia and nightmares are the most common sleep disorders experienced by people with psychosis, but other sleep disorder comorbidities are extremely common. This chapter outlines evidence-based CBT techniques for treating insomnia and nightmares in the context of co-occurring psychotic symptoms and bipolar affective disorder. Case examples illustrate how to optimise these techniques when other sleep comorbidities are present (e.g. circadian rhythm disruption) and during particular phases of illness (from ultra-high risk to an acute episode). The reader will gain an insight into patients’ perspectives on sleep problems and experiences of treatment. Common supervision dilemmas and barriers to implementation will be addressed in order to guide treatment planning in clinical practice.
Using the 11-item Version of the RCADS to Identify Anxiety and Depressive Disorders in Adolescents.
The purpose of this study was to identify items from the Revised Children's Anxiety and Depression Scale - RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire - MFQ- C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire - SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. We compared two samples of adolescents and their parents - a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P. Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the RCADS-47-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not. The 11 RCADS items accurately discriminated between the community and clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.
Adolescents' perceived barriers and facilitators to seeking and accessing professional help for anxiety and depressive disorders: a qualitative interview study.
Anxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents with anxiety/depressive disorders identified in the community. Twenty-two adolescents, aged 11-17 years, who met diagnostic criteria for a current anxiety and/or depressive disorder were identified through school-based screening. In-depth qualitative interviews were conducted one-to-one with each adolescent and adolescents' parents were interviewed separately for the purpose of data triangulation. Data were analysed using reflexive thematic analysis. We identified four themes capturing adolescent perceived barriers and facilitators to seeking/accessing professional help for anxiety and depressive disorders: (1) making sense of difficulties, (2) problem disclosure, (3) ambivalence to seeking help, and (4) the instrumental role of others. Barriers/facilitators identified within each theme reflect important developmental characteristics of adolescence, such as a growing need for autonomy and concerns around negative social evaluation. At the same time, the results highlight adolescents' dependency on other people, mainly their parents and school staff, when it comes to successfully accessing professional help for their mental health difficulties. This study identifies a number of barriers/facilitators that influence help-seeking behaviour of adolescents with anxiety and/or depressive disorders. These factors need to be addressed when targeting treatment utilisation rates in this particular group of young people.
Evaluating anxiety in elective coronary angiography study: rationale, design, and study methodology.
AIMS: Prevalence of anxiety disorder in coronary artery disease reaches up to 15% and about half of patients with coronary artery disease have anxiety or depression comorbidity. Prevalence of anxiety in patients undergoing percutaneous coronary intervention ranges 24-72%. Depression can often overlap with anxiety symptoms and the evaluation of anxiety in elective coronary angiography study (ANGST) aims to determine the prevalence of anxiety by excluding patients with comorbid depressive symptoms. ANGST also aims to determine how anxiety correlates with psychological parameters (personality traits, coping strategies) and with outcome of elective coronary angiography (ECA). METHODS: We will conduct a prospective single-center cross-section study in patients undergoing ECA. Anxiety will be evaluated at four time points using self-rating questionnaires: 14 days prior to ECA; 2-4 h before ECA; 24 h after ECA, but prior to discharge; and 4-6 weeks after discharge. The primary outcome of ANGST is the burden of anxiety experienced by patients without depressive symptoms and a correlation of anxiety with ECA outcome. CONCLUSION: Our study aims to provide evidence on which personality traits and coping strategies affect the levels of anxiety. We will also determine psychometric properties of the two questionnaires used in our study. The results will have implications for improvement of interventions designed to recognize anxiety and will offer future research of psychological and/or pharmacological interventions to reduce the burden of anxiety.
The STEPPS Group Treatment Program as an alternative in helping people with borderline personality disorder
Borderline personality disorder is a complex mental disorder which has severe impact on the quality of an individual's life. Although it is the most common type of personality disorder in the population of people with mental disorders, it has so far proven to be rather resistant to pharmacological treatments. This may suggest that effective psychotherapeutic methods need to be developed to help people with this diagnosis. There have been several attempts to develop successful therapeutic interventions for borderline personality disorder. Most of them were developed either from cognitive-behavioural or from psychoanalytic paradigm. More recent studies have focused on developing a more holistic approach. One such approach is the STEPPS program. This programme combines elements from cognitive-behavioural and systemic approaches. STEPPS is a 20-week, manually based group treatment for patients with borderline personality disorder. In comparison with other established approaches, the STEPPS program does not interfere with patient's other ongoing treatments. In this article we present the basics of the STEPPS program. We also provide a review of studies, investigating the effectiveness of the program. We also discuss advantages and disadvantages of the program and suggest some topics for further research.
Cognitive behavioural therapy for psychogenic nonepileptic seizures (PNES) in an adult with a learning disability: A case study
Background: Psychogenic nonepileptic seizures (PNES) are attacks that often look like epileptic seizures (ES). Unlike ES, PNES are not triggered by underlying neurological factors. PNES are relatively rare in the general population; however, their prevalence in people with learning disabilities is much higher—up to 10%. Individuals with PNES and learning disabilities often have psychiatric comorbidities, such as anxiety disorders, depression and posttraumatic stress disorder. There are currently no treatment guidelines for PNES in people with or without learning disabilities. However, talking therapies, such as cognitive-behavioural therapy (CBT), are recommended. This study explores the effectiveness of CBT for the treatment of PNES in a woman (Susan) with PNES and learning disabilities. Methods: We used a single-case experimental design (SCED) to investigate the effectiveness of CBT intervention. Specifically, the withdrawal (also known as ABA) design was applied. The patient's average PNES frequency, as well as idiosyncratic mood measure and standardised outcome measures for people with learning disabilities (Glasgow Anxiety Scale for People with an Intellectual Disability and Mini-Maslow Assessment of Needs Scale-Learning Disabilities), were used to assess the effectiveness of treatment. Findings: Results show that Susan's monthly PNES frequency reduced from phase A1 (assessment phase) to phase B (treatment phase), and this persisted to the follow-up phase (phase A2). However, the reduction was not statistically significant. The intervention was associated with improvements in Susan's mood, anxiety and quality of life. Reduction of Susan's anxiety was clinically significant. Conclusions: This SCED study demonstrates that CBT might be associated with reduction of PNES frequency and improvements in general functioning in people with PNES and learning disabilities; however, further research, especially around confounding variables is needed.
The psychosocial stressors of siblings of people with experiences of psychosis (SOPEP): A systematic narrative review across cultures.
OBJECTIVES: This study aimed to synthesise the psychosocial stressors of siblings of people with experiences of psychosis (SOPEP). Understanding the specific needs of siblings across diverse cultures would help mental health services to provide culturally specific psychosocial family and sibling-centred support. This may result in improved relationships between families, better psychosocial well-being for siblings and better outcomes for patients. METHODS: Following PRISMA guidelines, a systematic review was conducted to explore the psychosocial stressors of SOPEP. Six databases were utilised to identify literature using qualitative methodology. RESULTS: Twenty-two studies were included that investigated the Psychosocial Stressors of SOPEP. SOPEP's experiences were influenced by various stages: individual factors, social factors, physical and macro-level environments. Six key components contributed to SOPEP's psychosocial stressors and facilitated or hindered their intentions, behaviours and experiences of caregiving. These were the SOPEP's beliefs about psychosis, caregiving beliefs, family and cultural values, personality traits, pragmatic challenges and access to resources. CONCLUSIONS: Globally, SOPEP and families may benefit from their involvement in family interventions and individual support that facilitates caregiving and acknowledges their responsibilities, resources, psychosocial needs and emotional experiences.
Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies.
Mental health disorders in children and adolescents are highly prevalent yet undertreated. A detailed understanding of the reasons for not seeking or accessing help as perceived by young people is crucial to address this gap. We conducted a systematic review (PROSPERO 42018088591) of quantitative and qualitative studies reporting barriers and facilitators to children and adolescents seeking and accessing professional help for mental health problems. We identified 53 eligible studies; 22 provided quantitative data, 30 provided qualitative data, and one provided both. Four main barrier/facilitator themes were identified. Almost all studies (96%) reported barriers related to young people's individual factors, such as limited mental health knowledge and broader perceptions of help-seeking. The second most commonly (92%) reported theme related to social factors, for example, perceived social stigma and embarrassment. The third theme captured young people's perceptions of the therapeutic relationship with professionals (68%) including perceived confidentiality and the ability to trust an unknown person. The fourth theme related to systemic and structural barriers and facilitators (58%), such as financial costs associated with mental health services, logistical barriers, and the availability of professional help. The findings highlight the complex array of internal and external factors that determine whether young people seek and access help for mental health difficulties. In addition to making effective support more available, targeted evidence-based interventions are required to reduce perceived public stigma and improve young people's knowledge of mental health problems and available support, including what to expect from professionals and services.
Using a brief 11-item version of the RCADS to identify anxiety and depressive disorders in adolescents
Objective: The purpose of this study was to identify items from the Revised Children’s Anxiety and Depression Scale – RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire – MFQ-C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire – SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. Methods: We compared two samples of adolescents and their parents – a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P.Results: Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 addressing depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the original RCADS-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not.Conclusions: The 11 RCADS items accurately discriminated between the community and the clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.
The Korean Version of the Oxford Cognitive Screen (K-OCS) Normative Study.
OBJECTIVE: To generate a Korean version of the Oxford Cognitive Screen (K-OCS) and obtain cutoff scores that determine the impairment of each subdomain. Post-stroke cognitive impairment (PSCI) negatively impacts the rehabilitation process and independence in daily life. Its obscure manifestations require effective screening for appropriate rehabilitation. However, in most rehabilitation clinics, psychological evaluation tools for Alzheimer's dementia have been used without such considerations. The OCS is a screening assessment tool for PSCI and vascular dementia that can evaluate the cognitive domains most often affected by stroke, including language, attention, memory, praxis, and numerical cognition. It comprises 10 subtasks and enables quick and effective cognitive evaluation. METHODS: The K-OCS, which considers Korea's unique cultural and linguistic characteristics, was developed with the approval and cooperation of the original author. Enrollment of participants without disabilities was announced at Duksung Women's University, Yongin Sevrance Hospital, CHA Bundang Medical Center. The study was conducted between September 2020 and March 2022 on 97 male and female participants aged ≥30 years. RESULTS: All the 97 participants completed the task. In this study, the 5th percentile score was presumed to be the cutoff value for each score, and the values are provided here. The cutoff score for each OCS subtask was similar to that of the original British version. CONCLUSION: We suggest the usability of the K-OCS as a screening tool for PSCI by providing the cutoff value of each subtask.
Bystanders’ collective responses set the norm against hate speech
AbstractHate speech incidents often occur in social settings, from public transport to football stadiums. To counteract a prevailing passive attitude towards them, governmental authorities, sociologists, and philosophers stress bystanders’ responsibility to oppose or block hate speech. Here, across two online experiments with UK participants using custom visual vignettes, we provide empirical evidence that bystanders’ expression of opposition can affect how harmful these incidents are perceived, but only as part of a collective response: one expressed by a majority of bystanders present. Experiment 1 (N = 329) shows that the silence or intervention of three bystanders affects the harm caused by hate speech, but one bystander does not. Experiment 2 (N = 269) shows this is not simply a matter of numbers but rather one of norms: only unanimous opposition reduces the public perception of the damage created by the incident. Based on our results, we advance an empirical norm account: group responses to hate speech modulate its harm by indicating either a permissive or a disapproving social norm. Our account and results, showing the need to consider responses to hate speech at a collective level, have direct implications for social psychology, the philosophy of language and public policies.
Diagnostic Features for Human Categorisation of Adult and Child Faces
Knowing how humans differentiate children from adults has useful implications in many areas of both forensic and cognitive psychology. Yet, how we extract age from faces has been surprisingly underexplored in both disciplines. Here, we used a novel data-driven experimental technique to objectively measure the facial features human observers use to categorise child and adult faces. Relying on more than 35,000 trials, we used a reverse correlation technique that enabled us to reveal how specific features which are known to be important in face-perception – position, spatial-frequency (SF), and orientation – are associated with accurate child and adult discrimination. This showed that human observers relied on evidence in the nasal bone and eyebrow area for accurate adult categorisation, while they relied on the eye and jawline area to accurately categorise child faces. For orientation structure, only facial information of vertical orientation was linked to face-adult categorisation, while features of horizontal and, to a lesser extent oblique orientations, were more diagnostic of a child face. Finally, we found that SF diagnosticity showed a U-shaped pattern for face-age categorisation, with information in low and high SFs being diagnostic of child faces, and mid SFs being diagnostic of adult faces. Through this first characterisation of the facial features of face-age categorisation, we show that important information found in psychophysical studies of face-perception in general (i.e., the eye area, horizontals, and mid-level SFs) is crucial to the practical context of face-age categorisation, and present data-driven procedures through which face-age classification training could be implemented for real-world challenges.