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Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions

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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 develo** 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.

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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.

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Authors and Affiliations

  1. King’s College London, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, London, SE5 8AF, UK

    Tamatha Ruffell, Matilda Azis, Nedah Hassanali, Catherine Ames, Colette Hirsch, Elizabeth Kuipers & Suzanne Jolley

  2. South London and Maudsley NHS Foundation Trust, London, UK

    Catherine Ames, Sophie Browning, Karen Bracegirdle, Richard Corrigall & Lucy Maddox

  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 Psychiatry, King’s College London, London, UK

    Kristin R. Laurens, Colette Hirsch & Elizabeth Kuipers

  4. King’s College London, Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, London, UK

    Kristin R. Laurens

  5. Research Unit for Schizophrenia Epidemiology, School of Psychiatry, University of New South Wales, Sydney, Australia

    Kristin R. Laurens

  6. Schizophrenia Research Institute, Sydney, Australia

    Kristin R. Laurens

  7. University of Western Australia, Crawley, Australia

    Colette Hirsch

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  1. Tamatha Ruffell
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  2. Matilda Azis
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  3. Nedah Hassanali
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  4. Catherine Ames
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  7. Richard Corrigall
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  8. Kristin R. Laurens
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  9. Colette Hirsch
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  10. Elizabeth Kuipers
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  11. Lucy Maddox
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  12. Suzanne Jolley
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Corresponding author

Correspondence to Suzanne Jolley.

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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.

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All participants gave written informed assent, with parental consent, as approved by a recognised national ethical review body.

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Ruffell, T., Azis, M., Hassanali, N. et al. Variation in psychosocial influences according to the dimensions and content of children’s unusual experiences: potential routes for the development of targeted interventions. Eur Child Adolesc Psychiatry 25, 311–319 (2016). https://doi.org/10.1007/s00787-015-0739-8

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