Distress in psychosis - Version 1
Research type
Research Study
Full title
From attachment to distress in psychosis: exploring emotional processes and metacognition as mediating factors
IRAS ID
172056
Contact name
Melissa Akoral
Contact email
Sponsor organisation
QMU
Duration of Study in the UK
1 years, 0 months, 10 days
Research summary
Research Summary
The purpose of this mixed methods research is to explore distress levels in psychosis. Some people experience psychosis yet do not come into contact with mental health services because they are not distressed by their experience. Attachment theory is a theory of distress at the centre of developmental psychology, providing a life-span model of psychological functioning, metacognition and emotion regulation. Emotional experiences and processes have long been noted to play a significant role in the development and maintenance of psychosis experiences and therefore distress. Early evidence suggests that some factors have a mediating effect on this relationship. Hence, emotion awareness, beliefs about emotions, emotion regulation and metacognition are of interest in this study as mediating factors between attachment and distress levels. This research aims to improve understanding of factors that increase distress, and in turn can be used to reduce distress.
The first study will recruit up to 80 participants diagnosed with psychosis from NHS Lothian community mental health teams. Participants who agree to take part will complete five questionnaires, lasting less than an hour. Data will be analysed quantitatively to determine how all the factors relate to each other.
The second study will follow-up with 8-12 participants from the previous study. Participants who agree will be asked to take part in a semi-structured interview about their experience of psychosis.The interviews are expected to last about an hour, they will be audio-recorded and transcribed by the researcher. This will then be analysed using Interpretative Phenomenological Analysis (IPA), a qualitative research methodology focused on understanding lived experience and how participants themselves make sense of their experience.
Data collection will take place between June 2015 and June 2016. The research will be submitted towards a PhD in Psychology at QMU in June 2017.
Summary of Results
Distress associated with psychosis experiences has been related to the maintenance of psychosis experiences and people’s need for care. However, the mechanisms responsible for its maintenance remain unclear. Thus, this mixed methods project investigates experiential and psychological vulnerability factors contributing to distress related to psychosis in a clinical sample living in the community. This is done in order to determine whether specific vulnerability factors also act as maintenance factors for people in care. Therefore, these are assumed to be distinct.
In the first study, a cross-sectional design (N= 60) was used to investigate the role of specific emotion regulation and metacognitive difficulties in the relationship between insecure attachment dimensions and distress related to psychosis experiences. Multiple regression analyses were conducted to determine which subscales predicted distress related to psychosis and significant predictors were taken forward to mediation models. Mediation analysis showed that only need for control mediated the relationship between insecure attachment and distress related to positive symptoms. Further, only limited access to emotion regulation strategies mediated the relationship between attachment anxiety and distress associated with both negative symptoms and to depressive symptoms in psychosis. These results expand on previous research by suggesting specific vulnerability factors that are related to distress associated with different symptoms.
In the second study, Interpretative Phenomenological Analysis was used to analyse 10 in-depth qualitative interviews which explored people’s appraisals of their experiences of psychosis. Four inter-related themes emerged; (1)lacking control, (2)change – renegotiating a personal and social identity, (3)living in fear, and (4)multiple realities. The importance of ‘control’ is highlighted throughout all the themes, as negative appraisals about perceived control underpins experiences. This study demonstrates the importance of people’s appraisals to how they make meaning of and respond to psychosis experiences.
Together, these studies emphasise that distress relates to psychosis experiences as a whole rather than specific symptoms. The two studies were integrated and interpreted using a joint display method. People’s perceived lack of control and unhelpful interpersonal relationships were found to contribute to the maintenance of distress related to psychosis experiences. Implications of these findings are discussed.REC name
South East Scotland REC 02
REC reference
15/SS/0069
Date of REC Opinion
19 May 2015
REC opinion
Further Information Favourable Opinion