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Title: An exploration of shame, the psychosis continuum and the quality of the voice-hearing relationship
Author: Carden, L.
ISNI:       0000 0004 6496 1206
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2017
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This thesis examines the relationship between shame and the psychosis continuum and proceeds with a specific focus on hearing voices. Two chapters are presented. Chapter one consists of a systematic review of the literature examining the nature of the relationship between shame and the psychosis continuum. Chapter two is an empirical paper exploring whether experiences of social deprivation and shame are associated with the beliefs that individuals hold about their voices or the relationships that they have with them. This introductory chapter provides a brief overview of the constructs examined and the ethical standpoint of the research. The term psychosis is used to describe disturbances in thinking, perception, mood, and behaviour (e.g., delusions, hallucinations, incoherent speech; Cooke, 2014; National Institute for Health and Care Excellence, 2014) that are often associated with a range of social adversities (Longden & Read, 2016). In England, the annual prevalence of psychotic disorder is four individuals per 1000. The pooled annual incidence, that is the number of individuals developing the disorder for the first time in one year, is 32 cases per 100,000, with incidence being higher in men prior to the age of 45 years and becoming increasingly equal thereafter (Kirkbride et al., 2012). Many individuals with psychotic experiences are often diagnosed with schizophrenia spectrum disorders with the use of diagnostic systems such as the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2013). This is despite growing criticism regarding the reliability and construct validity of these systems, their failure to account for the impact of a range of social adversities and their limited ability to predict real-life outcomes (Read, 2013; Read, Bentall, & Fosse, 2009). There is growing evidence that psychotic experiences occur on a continuum in the general population (van Os, Hanssen, Bijl, & Ravelli, 2000) with clinical psychoses representing the upper or more extreme end of the continuum (Shevlin, McElroy, Bentall, Reininghaus, & Murphy, 2017). 'Hearing voices' is a term that is utilised by many including the Hearing Voices Network (HVN, 2013) to describe what is frequently referred to in the literature as auditory verbal hallucinations–sensory perceptions with a compelling sense of reality that occur without external stimulation (APA, 2007). Hearing voices is a common experience (Johns et al., 2014) that is often, yet not always, associated with distress (Birchwood, Meaden, Trower, Gilbert, & Plaistow, 2000). Research has identified associations between the relationships and beliefs that an individual has about their voices and the level of distress experienced (Birchwood & Chadwick, 1997). Findings have also identified a mirroring of the relational dynamic between the voice-hearer and their voices and others in their external environment (Birchwood et al., 2004). The importance of negative emotions including shame is increasingly being recognised in relation to the development and maintainence of psychotic experiences (e.g., Birchwood, Iqbal, Chadwick, & Trower, 2000; Birchwood et al., 2004; Birchwood, Trower, Brunet, Gilbert, Iqbal, & Jackson, 2006; Freeman & Garety, 2003; Gumley, 2007). Shame is a negative emotion that involves intense feelings of inferiority and defectiveness and the desire to escape and hide (Tangney, 1995). It is an internal subjective emotion that involves evaluation of the self in relation to others (Gilbert, 1997; 1998) and therefore could be seen to be relevant to voicehearing where mirroring of the relationship between the voice-hearer and their voice(s) and external others has been identified. Therapies that target shame such as compassion-focused therapy are being increasingly utilised in individuals experiencing or recovering from psychosis (Braehler, Gumley, Harper, Wallace, Norrie, & Gilbert, 2013; Gumley, Braehler, Laithwaite, MacBeth, & Gilbert, 2010). The HVN is an international network of individuals with lived experience of voice-hearing who conceptualise voice-hearing as a meaningful response to difficult life experiences. They describe the importance of understanding the content and meaning of voice-hearing experiences and of accepting individual interpretations or explanations (HVN, 2013). The ethos of the HVN is adopted as one of the primary frameworks for the current study. This framework–of viewing voice-hearing experiences as meaningful responses to difficult life events–is also utilised in chapter one when examining other experiences of psychosis. Despite reference to literature that uses diagnostic language, the current research aims to be transdiagnostic and to investigate associations between specific internal and external markers of status and specific psychotic experiences. Within this research it is also acknowledged that for some individuals' psychotic or more specifically voice-hearing experiences may not be distressing and that in fact they may be perceived to be valuable.
Supervisor: Pooja, S. ; Seddon, C. ; Taylor, P. Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral