Amy Hardy

Amy Hardy
King's College London and South London and Maudsley NHS Foundation Trust · Institute of Psychiatry, Psychology and Neuroscience & Psychological Interventions for Outpatients with Psychosis (PICuP) Clinic

PhD, DClinPsy

About

66
Publications
23,207
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Publications

Publications (66)
Article
Full-text available
In recent years, empirical data and theoretical accounts relating to the relationship between childhood victimization and psychotic experiences have accumulated. Much of this work has focused on co-occurring Posttraumatic Stress Disorder or putative causal mechanisms in isolation from each other. The complexity of posttraumatic stress reactions exp...
Article
Full-text available
Background: Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centered, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence, and effectiveness. Objective: This study...
Article
Background Understanding the interplay between trauma-related psychological mechanisms and psychotic symptoms may improve the effectiveness of interventions for post-traumatic stress reactions in psychosis. Network theory assumes that mental health problems persist not because of a common latent variable, but from dynamic feedback loops between sym...
Article
Full-text available
Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically...
Article
Full-text available
Importance Persistent paranoia is common among patients with psychosis. Cognitive-behavioral therapy for psychosis can be effective. However, challenges in engagement and effectiveness remain. Objective To investigate the effects on paranoia and mechanisms of action of SlowMo, a digitally supported reasoning intervention, plus usual care compared...
Article
Full-text available
Background People with psychosis have high rates of trauma, with a post-traumatic stress disorder (PTSD) prevalence rate of approximately 15%, which exacerbates psychotic symptoms such as delusions and hallucinations. Pilot studies have shown that trauma-focused (TF) psychological therapies can be safe and effective in such individuals. This trial,...
Article
Objectives: SlowMo is the first blended digital therapy for paranoia, showing significant small-moderate reductions in paranoia in a recent large-scale randomized controlled trial (RCT). This study explored the subjective service-user experience of the SlowMo therapy content and design; the experience of the blended therapy approach, including the...
Article
Full-text available
Objectives: SlowMo therapy is a pioneering blended digital therapy for paranoia, augmenting face-to-face therapy with an interactive 'webapp' and a mobile app. A recent large-scale trial demonstrated small-moderate effects on paranoia alongside improvements in self-esteem, worry, well-being and quality of life. This paper provides a comprehensive...
Article
Full-text available
Background Post-traumatic mechanisms are theorised to contribute to voice-hearing in people with psychosis and a history of trauma. Phenomenological links between trauma and voices support this hypothesis, as they suggest post-traumatic processes contribute to the content of, and relationships with, voices. However, research has included small samp...
Article
Full-text available
Background People with psychosis experience higher rates of childhood victimisation compared to the general population, which may impact on mental health and recovery. This study aimed to identify childhood victimisation profiles in a clinical sample to inform recommendations for routine care. Methods Participants were 146 adults (ages 19–65 years...
Article
Full-text available
Background and objectives There has been limited investigation of therapies targeting trauma-related psychological mechanisms hypothesised to play a role in post-traumatic and psychosis symptoms. Imagery rescripting (ImRs) is a therapeutic technique which involves transforming images, such as episodic memories, to modify associated distressing beli...
Article
Full-text available
Background The SlowMo study demonstrated the effects of SlowMo, an eight-session digitally supported reasoning intervention, on paranoia in a large-scale randomized-controlled trial with 362 participants with schizophrenia-spectrum psychosis. Aim The current evaluation aimed to investigate the impact of Patient and Public Involvement (PPI) in the...
Article
Full-text available
Background Reasoning may play a causal role in paranoid delusions in psychosis. SlowMo, a new digitally supported cognitive–behavioural therapy, targets reasoning to reduce paranoia. Objectives To examine the effectiveness of SlowMo therapy in reducing paranoia and in improving reasoning, quality of life and well-being, and to examine its mechanis...
Article
Full-text available
Background Remote therapy promises a cost-effective way of increasing delivery of psychological-therapy in underserved populations. However, research shows a “digital divide”, with some groups experiencing digital exclusion. Aims To assess whether technology, accessibility, and demographic factors influence remote therapy uptake among individuals...
Article
Objectives Evidence suggests social-cognitive difficulties are linked to poor community functioning in people with psychosis, however, there is limited evidence that social-cognition interventions improve functioning. This may be due to poor generalization of therapy learning; digital technologies may be useful to support this. This study evaluates...
Article
Full-text available
Background AVATAR therapy is a novel intervention targeting distressing auditory verbal hallucinations (henceforth ‘voices’). A digital simulation (avatar) of the voice is created and used in a three-way dialogue between participant, avatar and therapist. To date, therapy has been delivered over 6 sessions, comprising an initial phase, focusing on...
Article
Full-text available
Abstact Despite empirical evidence for multifactorial causes of voice-hearing, people's own beliefs about what caused their voices are understudied. People with distressing voices (n=125) completed measures of trauma, post-traumatic stress disorder (PTSD) symptoms, and beliefs about causality. Most participants reported trauma in the past (97%) and...
Preprint
BACKGROUND SlowMo is a digitally supported therapy for paranoia that was developed using inclusive, human-centred design to improve outcomes and address barriers to implementation. SlowMo significantly improved paranoia and wellbeing compared to treatment as usual in a recent randomised controlled trial of 362 people with psychosis. OBJECTIVE This...
Article
Background: Marginalized groups are more likely to experience problems with technology-related access, motivation, and skills. This is known as the "digital divide." Technology-related exclusion is a potential barrier to the equitable implementation of digital health. SlowMo therapy was developed with an inclusive, human-centered design to optimiz...
Article
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Background Evidence supports the use of group therapy for symptom reduction and improving functioning in people with psychosis. However, research guidelines highlight the importance of establishing the feasibility of interventions. Adherence is an important indicator of feasibility and an essential step in supporting the development of the evidence...
Article
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Purpose: Existing reviews of trauma and psychosis have identified associations between childhood emotional abuse (CEA) and psychosis. However, conceptual issues relating to assessment of CEA limit the conclusions that can be drawn from the literature. The aim of this review was to identify and evaluate studies reporting an association between child...
Article
Full-text available
Paranoid thoughts are common across the psychosis continuum. It is well established that reasoning biases (conceived as an overreliance on fast thinking and lack of willingness and/or ability to engage in slow thinking) contribute to paranoia. Targeted therapies have shown promise in improving reasoning in order to reduce paranoia. Psychometrically...
Article
Full-text available
Objective There is mounting evidence that traumatic life events play a role in auditory hallucinations (AH). Theory suggests that some AH are decontextualized trauma memory intrusions. Exposure‐based trauma‐focused therapies that target trauma memory intrusions may therefore be a promising new treatment. We aimed to assess the feasibility and accep...
Article
Background and objectives: People with a diagnosis of psychosis often experience low motivation and reduced activity levels. Autobiographical memory deficits have been identified in people with psychosis and this may limit the role of memory retrieval in supporting motivation. This pilot study adapted a recently developed protocol, Memflex, which...
Article
Full-text available
Traumatic events are associated with increased risk of auditory hallucinations (AHs) and posttraumatic stress symptoms have been implicated in this relationship. We aimed to explore the moment-to-moment relationship between posttraumatic stress symptoms and AHs in daily-life. Twenty-eight people with persistent AHs and a history of traumatic events...
Article
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Purpose: Current models of psychosis posit a developmental and maintaining role for anxiety, supported by robust empirical evidence. Given the central role for anxiety in psychosis, valid and reliable assessment is necessary. This systematic review is the first to critically appraise measures of anxiety applied to psychosis samples. Methods: Web...
Article
Full-text available
Many people who hear voices (also termed auditory‐verbal hallucinations) have experienced traumatic or adverse life events. There is growing evidence that, for a number of people, these events are an important contributing factor to voice‐hearing experiences. Psychological mechanisms implicated in the trauma‐voice‐hearing relationship overlap with...
Article
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The negative symptoms of psychosis and depressive symptomatology share several features, e.g. low motivation, apathy and reduced activity. Understanding the associations between these two sets of symptoms will support improved assessment and the development of interventions targeting these difficulties in people with psychosis. This is the first la...
Article
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Following publication of the original article [1], the authors reported a typing mistake in the spelling of author Iain O’Leary. The original article has been corrected.
Article
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Background At least 40% of people with psychosis have persistent distressing symptoms despite optimal medication treatment. Cognitive behaviour therapy for psychosis (CBTp) is the only NICE-recommended individual therapy for psychosis, with effects on symptoms, distress and quality of life. Yet <10% of service-users receive it and 94% of trusts str...
Article
Full-text available
Background: Best practice guidelines recommend traumatic events should be assessed in psychosis to support the identification and, when indicated, treatment of post-traumatic stress reactions. However, routine assessment in frontline services is rare, and available tools are not tailored to psychosis. Assessment obstacles include lengthy measures,...
Preprint
Full-text available
Background: Real-world implementation of psychological interventions for psychosis is poor. Barriers include therapy being insufficiently usable and useful for a diverse range of people. User-centred, inclusive design approaches could improve the usability of therapy, which may increase uptake, adherence and effectiveness. Objective: To optimise t...
Article
Full-text available
There is growing evidence for the role of attachment in psychosis, however, to date there has been no quantitative review of the prevalence of insecure attachment in psychosis. The current study sought to systematically appraise studies investigating the prevalence of insecure attachment and the association with psychosis-spectrum experiences using...
Article
Full-text available
Background Paranoia is one of the most common symptoms of schizophrenia-spectrum disorders, and is associated with significant distress and disruption to the person’s life. Developing more effective and accessible psychological interventions for paranoia is a clinical priority. Our research team has approached this challenge in two main ways: first...
Article
Objectives: To assess the utility of using the posttraumatic checklist (PCL) as a screening measure for identifying posttraumatic stress disorder (PTSD) in individuals diagnosed with a psychotic disorder. Methods: The PCL was administered to 165 participants as part of a clinical trial. Those scoring 44 or above on the PCL underwent further assessm...
Article
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We question the conclusions of Sin and Spain’s meta-analysis of therapy for post-traumatic stress disorder in psychosis and tentatively suggest direct trauma memory exposure is delivered, without adaptation, when people consent (Sin, J., & Spain, D. (2016). Psychological interventions for trauma in individuals who have psychosis: A systematic revie...
Article
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Background: Posttraumatic stress disorder (PTSD) in response to psychosis and associated experiences (psychosis-related PTSD, or PR-PTSD) is the subject of a growing field of research. However, a wide range of PR-PTSD prevalence rates has been reported. This may be due to definitional and methodological inconsistencies in the assessment of PR-PTSD....
Article
Full-text available
Background: There is limited evidence for effective interventions in the treatment of post-traumatic stress symptoms within individuals diagnosed with schizophrenia. Clinicians have concerns about using exposure treatments with this patient group. The current trial was designed to evaluate a 16-session cognitive restructuring programme, without di...
Article
Full-text available
Evidence suggests a causal role for trauma in psychosis, particularly for childhood victimization. However, the establishment of underlying trauma-related mechanisms would strengthen the causal argument. In a sample of people with relapsing psychosis (n = 228), we tested hypothesized mechanisms specifically related to impaired affect regulation, in...
Article
Background “People always judge me negatively, they watch and gossip about me everywhere I go. I don’t even feel safe at home. I’m so anxious and overwhelmed. I wish I could feel safer and do more with my life.” (Robert) Paranoid thoughts, like those experienced by Robert, affect approximately 1 in 5 of the general population (Bebbington et al, 20...
Article
Full-text available
Delusional beliefs with persecutory content are common in psychosis, but difficult to treat. Interventions targeting hypothesised causal and maintaining factors have been proposed as a way of improving therapy. The current study is a feasibility randomised controlled trial of the 'Thinking Well (TW)' intervention: This novel approach combines the r...
Article
Full-text available
For many patients with persecutory delusions, leaving home and going into crowded streets is a key clinical problem. In this study we aimed to inform treatment development by determining the psychological mechanisms whereby busy urban environments increase paranoia. In a randomized design with prespecified mediation analysis, we compared the effect...
Article
Full-text available
Background and Objectives Clinical responsiveness to cognitive behavioural therapy for psychosis (CBTp) varies. Recent research has demonstrated that illness perceptions predict active engagement in therapy, and, thereby, better outcomes. In this study, we aimed to investigate the psychometric properties of a modification of the Illness Perceptions...
Article
Full-text available
Background: Given the evidence that reasoning biases contribute to delusional persistence and change, several research groups have made systematic efforts to modify them. The current experiment tested the hypothesis that targeting reasoning biases would result in change in delusions. Methods: One hundred and one participants with current delusio...
Article
Full-text available
Religious delusions are common and are considered to be particularly difficult to treat. In this study we investigated what psychological processes may underlie the reported treatment resistance. In particular, we focused on the perceptual, cognitive, affective and behavioural mechanisms held to maintain delusions in cognitive models of psychosis,...
Chapter
Introduction and Current Evidence-Base The Protocol Session Structure Monitoring Protocol Content Presentation Discussion Acknowledgements References
Article
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A recent study indicated that 94.4% of reported sexual assault cases in the UK do not result in successful legal prosecution, also known as the rate of attrition (Kelly, Lovett, & Regan, 2005). Scant research has examined the role of trauma-related psychological processes in attrition. Victims of sexual assault (N =22) completed questions about per...
Article
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The current study investigated the relationship between trauma and predisposition to hallucinations and to paranoia in a non-clinical sample. A total of 228 students completed online measures of trauma, post traumatic stress disorder (PTSD), schematic beliefs, perceptual anomalies, and predisposition to hallucinations and paranoia. Associations wer...
Article
Illness perception, a measure of illness representations developed from physical medicine, has recently been applied to psychosis. We investigated how illness perceptions relate to affect and expressed emotion (EE) in carer-patient dyads, particularly if their perceptions differed. We interviewed 82 carer-patient dyads, after a relapse of psychosis...
Article
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High expressed emotion in carers predicts relapse in psychosis, but it is not known why this is so. In our cognitive model of psychosis, we postulated that the effect is mediated through affective changes. To investigate the relationships between carer expressed emotion, patients' symptoms and carer characteristics during a recent relapse of psycho...
Article
Full-text available
Recent research indicates that there may be phenomenological, symptom, and diagnostic associations between trauma and hallucinations. However, the nature of the relationship is poorly understood from a psychological perspective. We report a theoretically informed phenomenological study. From descriptions of reported traumas and hallucinations, we a...
Data
Full-text available
A literature search yielded no studies investigating Wegner's (1989) proposal that repeated suppression attempts and rebound opportunities (indulgence cycles) lead to an escalation of intrusions, providing a mechanism whereby an unwanted intrusive thought may develop into a clinical obsession. It was predicted, based on Wegner's (1994) ironic proce...

Projects

Projects (2)
Project
To evaluate clinicians’ and service users’ report of current practice in relation to best practice recommendations for trauma and posttraumatic stress in psychosis, establish barriers to implementing the recommendations, investigate preferences regarding assessment and treatment of posttraumatic stress, and explore the experiences of service users who have received, in line with NICE guidance, a trauma-focused cognitive-behaviour therapy for psychosis.
Project
People often experience worries about other people intentionally causing harm, also known as paranoia. Paranoia is one of the most common symptoms of severe mental health problems and is associated with marked distress and disruption to people’s lives. Paranoia tends to be associated with certain thinking habits, called fast thinking. We all think fast and this can be helpful in some situations. At other times, fast thinking may contribute to us feeling more stressed than we need to be. SlowMo is a therapy which has been developed by service users, designers, researchers, technologists and clinicians. It works by supporting people to notice their upsetting worries and fast thinking habits, and then provides tips to help them slow down for a moment to notice new information and ways of feeling safer. SlowMo consists of eight individual, face to face sessions, assisted by a website with interactive stories and games, to help people find out how fast thinking habits can contribute to upsetting thoughts. People try out tips to learn what helps them slow down and cope with worries, and a mobile app supports the use of these strategies in daily life. The aim of this trial is to find out whether SlowMo reduces paranoia. The study will also investigate how SlowMo works (do changes in fast thinking reduce worries about others) and whether differences in beliefs, memory, and motivation influence this. People from three NHS areas (London, Sussex and Oxford), once they agree, will be chosen randomly to receive SlowMo plus standard treatment (180 people) or standard treatment (180 people). At the start of the trial and then after 12 and 24 weeks, participants complete a number of questionnaires to assess their paranoia and related symptoms as well as their mental wellbeing. The SlowMo trial is funded by the NHS’s National Institute of Health Research and Medical Research Council.