Hostname: page-component-8448b6f56d-t5pn6 Total loading time: 0 Render date: 2024-04-18T19:54:21.264Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of attachment imagery on paranoia and mood: evidence from two single case studies

Published online by Cambridge University Press:  29 June 2020

Cathryn Pitfield ,
Tess Maguire  and
Katherine Newman-Taylor Open the ORCID record for Katherine Newman-Taylor [Opens in a new window]
Cathryn Pitfield*
Affiliation:
Psychology Department, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
Tess Maguire
Affiliation:
Psychology Department, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK
Katherine Newman-Taylor
Affiliation:
Psychology Department, University of Southampton, Shackleton Building, Highfield Campus, Southampton, SO17 1BJ, UK Psychology Department, Southern Health NHS Foundation Trust, College Keep, Terminus Terrace, SouthamptonSO14 3DT, UK
*
*Corresponding author. Email: cp19g15@soton.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Cognitive behavioural therapy (CBT) for psychosis currently yields modest outcomes and must be improved. Attachment imagery may be an effective means of reducing severity of paranoid beliefs and associated affect. Experimental studies have demonstrated these effects in non-clinical groups. The impact in clinical populations remains untested.

Aims:

This study assessed the impact of a brief attachment imagery task on paranoia and mood, in two people with a diagnosis of schizophrenia.

Method:

Two single case studies are presented. Both participants were working age adults with persecutory delusions. The study utilised an A-B-A design. Participants were recruited for a 6-week period, with a 2- and 3-week baseline respectively, 1-week intervention phase, and follow-up phase matched to duration of baseline. Trait paranoia and attachment were measured at the start of the baseline. State paranoia and affect were measured daily over the 6-week period.

Results:

For both participants, the baseline phase was characterised by high and variable levels of paranoia, which reduced during the intervention phase, with a return to baseline scores at follow-up. We found a similar pattern for negative affect, and the reverse pattern for positive affect.

Conclusions:

Attachment imagery may function as an effective emotion regulation strategy for people with psychosis. Continued use is likely to be needed to maintain gains. This brief task could prove valuable to people needing skills to manage paranoia and mood, and give clinicians confidence that people can manage short-term distress in CBT for psychosis, for example when addressing past trauma.

Keywords

attachmentemotion regulationimagerymoodparanoiasingle case
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 48 , Issue 5 , September 2020 , pp. 572 - 583
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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

Bak, M., Drukker, M., Hasmi, L., & van Os, J. (2016). An n=1 clinical network analysis of symptoms and treatment in psychosis. PLoS ONE, 11(9), 1–15. https://doi.org/10.1371/journal.pone.0162811Google ScholarPubMed
Berry, K., Barrowclough, C., & Wearden, A. (2007). A review of the role of adult attachment style in psychosis: unexplored issues and questions for further research. Clinical Psychology Review, 27, 458–475. https://doi.org/10.1016/j.cpr.2006.09.006CrossRefGoogle ScholarPubMed
Berry, K., Wearden, A., Barrowclough, C., & Liversidge, T. (2006). Attachment styles, interpersonal relationships and psychotic phenomena in a non-clinical student sample. Personality and Individual Differences, 41, 707–718. https://doi.org/10.1016/j.paid.2006.03.009CrossRefGoogle Scholar
Bowlby, J. (1973). Attachment and Loss, Volume 2: Separation. New York, NY, USA: Basic Books.Google Scholar
Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London, UK: Routledge.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, 264–268. https://doi.org/10.1016/j.jbtep.2015.10.002CrossRefGoogle ScholarPubMed
Ciocca, G., Collazzoni, A., Limoncin, E., Franchi, C., Mollaioli, D., Di Lorenzo, G., … & Jannini, E. A. (2017). Defence mechanisms and attachment styles in paranoid ideation evaluated in a sample of non-clinical young adults. Rivista Di Psichiatria, 52, 162–167.Google Scholar
Crawford, J. R., & Henry, J. D. (2004). The Positive and Negative Affect Schedule (PANAS): construct validity, measurement properties and normative data in a large non-clinical sample. British Journal of Clinical Psychology, 43, 245–265. https://doi.org/10.1348/0144665031752934CrossRefGoogle Scholar
Darrell-Berry, H., Bucci, S., Palmier-Claus, J., Emsley, R., Drake, R., & Berry, K. (2017). Predictors and mediators of trait anger across the psychosis continuum: the role of attachment style, paranoia and social cognition. Psychiatry Research, 249, 132–138. https://doi.org/10.1016/j.psychres.2017.01.007CrossRefGoogle ScholarPubMed
Davila, J., Ramsay, M., Stroud, C. B., & Steinberg, S. J. (2005). Attachment as vulnerability to the development of psychopathology. In Hanklin, B. L. & Abela, J. R. Z. (eds), Development of Psychopathology: A Vulnerability-Stress Perspective (pp. 215–242). Thousand Oaks, CA, USA: Sage Publications, Inc.CrossRefGoogle Scholar
Dykas, M. J., & Cassidy, J. (2011). Attachment and the processing of social information across the life span: theory and evidence. Psychological Bulletin, 137, 19–46. https://doi.org/10.1037/a0021367CrossRefGoogle ScholarPubMed
Ellett, L. (2013). Mindfulness for paranoid beliefs: evidence from two case studies. Behavioural and Cognitive Psychotherapy, 41, 238–242.CrossRefGoogle ScholarPubMed
Gast, D. L. (2010). Single Subject Research Methodology in Behavioral Sciences. New York, NY, USA: Routledge.Google Scholar
Green, C. E. L., Freeman, D., Kuipers, E., Bebbington, P., Fowler, D., Dunn, G., & Garety, P. A. (2008). Measuring ideas of persecution and social reference: the Green et al. Paranoid Thought Scales (GPTS). Psychological Medicine, 38, 101–111. https://doi.org/10.1017/S0033291707001638CrossRefGoogle Scholar
Gumley, A. I., Schwannauer, M., Macbeth, A., Fisher, R., Clark, S., Rattrie, L., … & Birchwood, M. (2014a). Insight, duration of untreated psychosis and attachment in first-episode psychosis: prospective study of psychiatric recovery over 12-month follow-up. British Journal of Psychiatry, 205, 60–67. https://doi.org/10.1192/bjp.bp.113.126722CrossRefGoogle ScholarPubMed
Gumley, A. I., Taylor, H. E. F., Schwannauer, M., & MacBeth, A. (2014b). A systematic review of attachment and psychosis: measurement, construct validity and outcomes. Acta Psychiatrica Scandinavica, 129, 1–18. https://doi.org/10.1111/acps.12172CrossRefGoogle ScholarPubMed
Hutton, J., Ellett, L., & Berry, K. (2017). Adult attachment and paranoia: an experimental investigation. The Cognitive Behaviour Therapist, 10, e4. https://doi.org/10.1017/S1754470X17000058CrossRefGoogle 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, 129–142.CrossRefGoogle ScholarPubMed
Jones, C., Hacker, D., Meaden, A., Cormac, I., Irving, C. B., Xia, J., Zhao, S., Shi, C., & Chen, J. (2018). Cognitive behavioural therapy plus standard care versus standard care plus other psychosocial treatments for people with schizophrenia. Cochrane Database of Systematic Reviews, 11, CD008712. doi: 10.1002/14651858.CD008712.pub3Google ScholarPubMed
Korver-Nieberg, N., Berry, K., Meijer, C., de Haan, L., & Ponizovsky, A. M. (2015). Associations between attachment and psychopathology dimensions in a large sample of patients with psychosis. Psychiatry Research, 228, 83–88. https://doi.org/10.1016/j.psychres.2015.04.018CrossRefGoogle Scholar
Kratochwill, T. R., Hitchcock, J., Horner, R., Levin, J., Odom, S. L., Rindskopf, D., & Shadish, W. R. (2010). Single-case technical documentation. http://www.behavior.org/resources/422.pdfGoogle Scholar
Laing, J., Morland, T., & Fornells-Ambrojo, M. (2016). The phenomenology and generation of positive mental imagery in early psychosis. Clinical Psychology & Psychotherapy, 23, 523–532.CrossRefGoogle ScholarPubMed
Morley, S. (2017). Single-Case Methods in Clinical Psychology: A Practical Guide. Abingdon: UK: Routledge.CrossRefGoogle Scholar
Morrison, A. (2004). The use of imagery in cognitive therapy for psychosis: a case example. Memory, 12, 517–524.CrossRefGoogle ScholarPubMed
National Institute for Health and Care Excellence (2014). Psychosis and schizophrenia in adults: treatment and management (NICE Clinical Guidance No. 178). https://www.nice.org.uk/guidance/cg178Google Scholar
Newman-Taylor, K., Harper, S., & Chadwick, P. (2009). Impact of mindfulness on cognition and affect in voice hearing: evidence from two case studies. Behavioural and Cognitive Psychotherapy, 37, 397–402. https://doi.org/10.1017/S135246580999018XCrossRefGoogle ScholarPubMed
Newman-Taylor, K., Kemp, A., Potter, H., & Au-Yeung, S. K. (2017). An online investigation of imagery to attenuate paranoia in college students. Journal of Child and Family Studies, 27, 853–859. https://doi.org/10.1007/s10826-017-0934-yCrossRefGoogle 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, 54–66.CrossRefGoogle 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, 709–725.CrossRefGoogle ScholarPubMed
Ponizovsky, A. M., Vitenberg, E., Baumgarten-Katz, I., & Grinshpoon, A. (2013). Attachment styles and affect regulation among outpatients with schizophrenia: relationships to symptomatology and emotional distress. Psychology and Psychotherapy: Theory, Research and Practice, 86, 164–182. https://doi.org/10.1111/j.2044-8341.2011.02054.xCrossRefGoogle ScholarPubMed
Russo, D. A., Stochl, J., Hodgekins, J., Iglesias-Gonzalez, M., Chipps, P., Painter, M., … & Perez, J. (2017). Attachment styles and clinical correlates in people at ultra high risk for psychosis. British Journal of Psychology, 109, 1–18. https://doi.org/10.1111/bjop.12249Google 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
Schlier, B., Moritz, S., & Lincoln, T. M. (2016). Measuring fluctuations in paranoia: validity and psychometric properties of brief state versions of the Paranoia Checklist. Psychiatry Research, 241, 323–332. https://doi.org/10.1016/j.psychres.2016.05.002CrossRefGoogle ScholarPubMed
Schulze, K., Freeman, D., Green, C., & Kuipers, E. (2013). Intrusive mental imagery in patients with persecutory delusions. Behaviour Research and Therapy, 51, 7–14.CrossRefGoogle ScholarPubMed
Shaver, P. R., & Mikulincer, M. (2002). Attachment-related psychodynamics. Attachment and Human Development, 4, 133–161. https://doi.org/10.1080/14616730210154171CrossRefGoogle ScholarPubMed
Sin, J., Spain, D., Futura, M., Murrelis, T., & Norman, I. (2017). Psychological interventions for PTSD in people with severe mental illness. Cochrane Database of Systematic Reviews, issue 1.CrossRefGoogle ScholarPubMed
Sitko, K., Varese, F., Sellwood, W., Hammond, A., & Bentall, R. (2016). The dynamics of attachment insecurity and paranoid thoughts: an experience sampling study. Psychiatry Research, 246, 32–38. https://doi.org/10.1016/j.psychres.2016.08.057CrossRefGoogle Scholar
Tate, R., Mcdonald, S., Perdices, M., Togher, L., Schultz, R., & Savage, S. (2008). Rating the methodological quality of single-subject designs and N-of-1 trials. Neuropsychological Rehabilitation, 18, 385–401. https://doi.org/10.1080/09602010802009201CrossRefGoogle 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, 575–588.CrossRefGoogle Scholar
Townend, M. (2003). Cognitive therapy for driving phobia: two single case studies. Behavioural and Cognitive Psychotherapy, 31, 369–375. https://doi.org/10.1017/S1352465803003114CrossRefGoogle Scholar
Vannest, K. J., Parker, R. I., & Gonen, O. (2011). Single case research: web based calculators for SCR analysis (version 1.0). www.singlecaseresearch.orgGoogle Scholar
Wain, H., Kneebone, I. I., & Cropley, M. (2011). Attributional intervention for depression in two people with multiple sclerosis (MS): single case design. Behavioural and Cognitive Psychotherapy, 39, 115–121. https://doi.org/10.1017/S1352465810000536CrossRefGoogle ScholarPubMed
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect; the PANAS scales. Journal of Personality and Social Psychology, 47, 1063–1070.CrossRefGoogle Scholar
Wickham, S., Sitko, K., & Bentall, R. P. (2015). Insecure attachment is associated with paranoia but not hallucinations in psychotic patients: the mediating role of negative self-esteem. Psychological Medicine, 45, 1495–1507. https://doi.org/10.1017/S0033291714002633CrossRefGoogle Scholar
Varese, F., Smeets, F., Drukker, M., Lieverse, R., Lataster, T., Viechtbauer, W., … & Bentall, R. P. (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin, 38, 661–671.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.