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Title: Psychosis and savouring
Author: Applegate, E.
ISNI:       0000 0004 7428 6099
Awarding Body: University of Liverpool
Current Institution: University of Liverpool
Date of Award: 2018
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Background: This thesis examines savouring in people experiencing psychosis. Savouring involves the mental rehearsal of past, present and future positive experiences to intensify positive emotion (Bryant & Veroff, 2007; Addis, Wong & Schacter, 2007). The positive symptoms of psychosis, such as unusual perceptual experiences or beliefs, are often accompanied by negative symptoms that include reduced emotional expression and decreased motivated activity (Strauss, 2013). Attenuated positive and negative symptom traits, known as positive and negative schizotypy, are notable in the general population, and provide evidence that psychotic phenomena may exist on a continuum with ordinary human experiences, rather than separately within a 'discrete disease model' (Shevlin, McElroy, Bentall, Reininghaus & Murphy, 2017). People experiencing negative symptoms and those rating highly on measures of negative schizotypy report that they savour positive events in the past, present and future less often than unaffected control participants, and this relationship has been associated with reduced goal-directed activity (Applegate, El-Deredy & Bentall, 2009; 2014; Cassar, Applegate & Bentall, 2013). These groups may savour less due to cognitive difficulties, (Gard, Kring, Gard, Horan, & Green, 2007; Strauss, 2013) or because, according to social defeat theory, it may not feel socially safe to express positive emotion (White, Laithewaite & Gilbert, 2013). This thesis therefore aims to address three research questions; 1) what is currently known about savouring in psychosis; 2) could fear of positive emotion and lack of social safeness underpin reduced savouring; and 3) how could psychological interventions for negative symptoms be enhanced if the current findings are replicated in a clinical sample. Research rationale: Psychosis is estimated to affect 21 million people worldwide (World Health Organisation, WHO, 2018). A previous systematic review suggests that 15-20% of those experiencing psychosis will report negative symptoms (Buchanan, 2007). Thus, negative symptoms not only affect a vast number of people but they also represent a significant public health challenge, and a serious unmet health need for those who experience them because, as yet no fully effective treatment has been identified (Fusar-Poli et al., 2015). People experiencing psychosis, and their relatives, report that negative symptoms are particularly difficult to cope with, as changes to motivation, energy and functioning levels contrast starkly with prior capabilities (Rabinowitz, Berardo, Bugarski-Kirola & Marder, 2013; Mairs, 2017). Whilst positive symptoms might cause more noticeable changes in behaviour initially, it is the negative symptoms that often prevent participation in fulfilling activities such as employment, education and relationships (Snyder, Gur & Wasmer-Andrews, 2007). Negative symptoms are more strongly associated with poorer quality of life and lower social and occupational functioning than positive symptoms (Rabinowitz et al., 2012). Negative symptoms may be further exacerbated by extrapyramidal side effects, substance misuse, social withdrawal (due to increasing suspiciousness), and reactive low mood (Carpenter, Heinrichs & Wagman, 1988). A large scale, two-year follow-up study of people experiencing psychosis (N = 7678) found that identification of two or more negative symptoms at baseline was associated with increased likelihood of one or more readmissions, that lasted for an extended period of time (Patel et al, 2015). Whilst specialised psychosocial treatments for negative symptoms exist, and include cognitive-behavioural, activity-based and integrated interventions, (Mairs, 2017) all treatments have thus far proven to lack clinical effectiveness (Fusar-Poli et al., 2015). A meta-analysis of 34 randomised controlled trials (RCTs) of Cognitive Behaviour Therapy for psychosis (CBTp) found a small effect size of CBTp on negative symptoms (.21) and only two interventions were specifically designed to target negative symptoms (Wykes, Steel, Everitt, & Tarrier, 2008). A more recent meta-analysis of 168 RCTs testing a wide range of pharmacological and psychosocial interventions for negative symptoms, found that whilst some trials reported statistically significant effects on symptoms, no treatments translated into clinically meaningful outcomes, such as improved quality of life or functioning (Fusar-Poli et al., 2015). Therefore, better targeted, better evidenced and more clinically meaningful interventions are needed. The last major call for action to improve treatments for negative symptoms in the research community was led by the NIMH-MATRICS consensus group in 2006 (Kirkpatrick, Fenton, Carpenter & Marder, 2006). Thus it is necessary for renewed efforts to be made and it is hoped that this thesis will stimulate new research that enhances functioning, well-being and hope in people experiencing negative symptoms.
Supervisor: Flood, Andrea ; Bucci, Sandra ; Kelly, James Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral