Philippa Garety

Philippa Garety
King's College London | KCL · Department of Psychology

PhD

About

332
Publications
136,098
Reads
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26,223
Citations
Citations since 2017
79 Research Items
9719 Citations
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Additional affiliations
January 2012 - present
University of Oxford
January 2012 - present
Canterbury Christ Church University
October 2010 - present
South London and Maudsley NHS Foundation Trust
Position
  • Joint Leader, Psychosis Clinical Academic Group

Publications

Publications (332)
Article
Full-text available
Reasoning biases, specifically jumping to conclusions and belief inflexibility, may play a causal role in persistent paranoia. SlowMo, a new digitally supported blended cognitive-behavioural therapy, targets these biases. Adopting the terms ‘fast’ and ‘slow thinking’ as a heuristic to support therapy, SlowMo encourages people to notice a tendency t...
Article
Full-text available
Introduction Many people suffering from psychotic disorders report persistent auditory verbal hallucinations (‘voices’) despite pharmacological and psychological therapy. Interest is growing in approaches that emphasise the personal relationship between the patient and their voice(s). AVATAR therapy is one such approach that uses a digital represen...
Article
Full-text available
Background AVATAR therapy is an innovative therapy designed to support people with distressing voices. Voice hearers co-create a digital representation of their voice and engage in dialogue with it. Although it has been successfully tested in a powered randomised controlled trial (ISRCTN65314790), the participants’ experience of this therapy has no...
Article
Full-text available
Jumping to conclusions (JTC) and impaired social cognition (SC) affect the decoding, processing, and use of social information by people with psychosis. However, the relationship between them had not been deeply explored within psychosis in general, and in first-episode psychosis (FEP) in particular. Our aim was to study the relationship between JT...
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
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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
Objective Low self-esteem has been suggested as a putative mechanism in the development and maintenance of psychosis. Uncertainty still exists about how unstable self-esteem relates to psychotic experiences. The present study examines the potential (temporal) associations between momentary self-esteem, fluctuations in self-esteem, and psychotic exp...
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
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People with psychosis can experience social functioning impairments. Virtual reality (VR) has been used to assess and treat these difficulties. This systematic review (Prospero CRD42015026288) provides an evaluation of these VR applications. PsycINFO, MEDLINE, Embase, Web of Science, Cochrane Library, and Scopus were searched until May 2020. The Ef...
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
Objectives: AVATAR therapy is a novel relational approach to working with distressing voices by engaging individuals in direct dialogue with a digital representation of their persecutory voice (the avatar). Critical to this approach is the avatar transition from abusive to conciliatory during the course of therapy. To date, no observational study...
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
Full-text available
Background Early Intervention in Psychosis (EIP) services improve health outcomes for young people with psychosis in the medium–long term, but 25% of young people disengage in the first 12 months with costs to their mental health, families, society and the NHS. This study will evaluate the effectiveness, cost-effectiveness and implementation of a t...
Article
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Background Voices are commonly experienced as communication with a personified ‘other’ with ascribed attitudes, intentionality and personality (their own ‘character’). Phenomenological work exploring voice characterisation informs a new wave of relational therapies. To date, no study has investigated the role of characterisation in behavioural enga...
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
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
The original CHoice of Outcome In Cbt for psychosEs (CHOICE) measure was designed in collaboration with experts by experience as a patient-reported “Psychological Recovery” outcome measure for cognitive-behavioral therapy for psychosis (CBTp). A short version (CHOICE-SF) was developed to use as a brief outcome measure, with a focus on sensitivity t...
Article
Full-text available
AVATAR therapy offers a unique therapeutic context that uses virtual reality technology to create a virtual embodiment of the voice-hearing experience, enabling the person to visualize their persecutory voice and engage in real-time “face-to-face” dialogue. The present study explores, for the first time, the contribution of sense of voice presence,...
Article
Full-text available
Objectives Psychosis, and in particular auditory verbal hallucinations (AVHs), are associated with adversity exposure. However, AVHs also occur in populations with no need for care or distress. Aims This study investigated whether adversity exposure would differentiate clinical and healthy voice-hearers within the context of a ‘three-hit’ model of...
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
Background It remains poorly understood how negative symptoms are experienced in the daily lives of individuals in the early stages of psychosis. We aimed to investigate whether altered affective experience, anhedonia, social anhedonia, and asociality were more pronounced in individuals with an at-risk mental state for psychosis (ARMS) and individu...
Article
Full-text available
AVATAR therapy represents an effective new way of working with distressing voices based on face-to-face dialogue between the person and a digital representation (avatar) of their persecutory voice. To date, there has been no complete account of AVATAR therapy delivery. This article presents, for the first time, the full range of therapeutic targets...
Article
Full-text available
AVATAR therapy represents an effective new way of working with distressing voices based on face-to-face dialogue between the person and a digital representation (avatar) of their persecutory voice. To date, there has been no complete account of AVATAR therapy delivery. This article presents, for the first time, the full range of therapeutic targets...
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
Virtual reality assisted cognitive behavioral therapy (VR-CBT) has potential to support people who experience paranoid ideation in social settings. However, virtual reality (VR) research using overt social environments is limited; and lack of qualitative studies on paranoid ideation in VR restricts understanding. This study aimed to use predominant...
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
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
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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
Full-text available
Background Certain ways of responding to psychotic experiences (PEs) appear more commonly associated with clinical distress (e.g. avoidance) and other ways with benign or positive outcomes (e.g. reappraisal and acceptance). Past research has largely been limited to retrospective self-report. We aimed to compare clinical and non-clinical individuals...
Article
Implementation of evidence-based cognitive behavioural therapy for psychosis (CBTp) remains low in routine services. The United Kingdom Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT-SMI) initiative aimed to address this issue. The project evaluated whether existing services could improve access to CBTp and...
Article
Initial affective and psychotic reactivity to daily stressors is altered in psychosis, and most notably in early psychosis. In addition to altered initial stress reactivity, results from studies using Experience Sampling Methodology (ESM) and psychophysiological measures indicate that impaired recovery from mild stressors may also be a risk factor...
Article
Sense of presence is an important factor influencing the quality of the virtual reality (VR) experience. However, there is limited understanding of what factors affect presence in virtual environments. This study uses a qualitative methodology, specifically thematic analysis, to investigate factors affecting sense of presence in a VR social environ...
Article
Full-text available
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: 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
Full-text available
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
Virtual reality (VR) enables the real-time assessment of paranoid ideation and of associated social performance. In this two-phase study, we aimed to recruit a general population sample to investigate the association between trait paranoia and cognitive, emotional, and behavioral components of social performance. In phase 1, a general population on...
Article
Cognitive models of psychosis posit that reasoning biases are an important mechanism contributing to the formation of psychotic symptoms, in part through transforming anomalous experiences of aberrant salience into frank psychotic symptoms. This study aimed to investigate the interplay of liberal acceptance (LA) bias, which is a specific type of re...
Article
Introduction: There is an ongoing debate about whether negative affect are consequences or triggers of paranoid thinking. It has also been suggested that aberrant salience is central to the development of delusions. This study modelled the moment-to-moment relationships between negative affect, aberrant salience, and paranoia in acute inpatients wi...
Preprint
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 ai...
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
Paranoid ideation is a core feature of psychosis, and models of paranoia have long proposed that it arises in the context of disturbances in the perception of the self. However, to develop targeted interventions, there is a benefit in clarifying further, which aspects of self-perception are implicated. Interpersonal sensitivity is a personality tra...
Article
Background Hearing voices can be a distressing and disabling experience for some, whilst it is a valued experience for others, so-called ‘healthy voice-hearers’. Cognitive models of psychosis highlight the role of memory, appraisal and cognitive biases in determining emotional and behavioural responses to voices. A memory bias potentially associate...
Article
Depression occurring alongside psychosis is an important treatment target, both in its own right and as a potential maintenance factor for positive psychotic symptoms. The present paper reports a prospective longitudinal analysis of depression and its predictors over six months in a group of 60 participants experiencing persecutory delusions. We hy...
Article
This study assessed the subjective experience of participating in a clinical trial, specifically positive and negative experiences and the experience of audio recording assessment sessions. The study was cross-sectional from a single blinded randomised controlled trial. Forty participants with a primary diagnosis of non-organic psychosis completed...
Article
Full-text available
Improving access to psychotherapies in psychosis requires workforce expansion in resource-challenged systems. The GOALS feasibility randomized controlled trial assessed training and implementation of an evidence-based intervention by frontline workers, targeting recovery goals. Training uptake and therapy fidelity were good. Case managers with cris...
Article
Full-text available
Background Childhood ‘unusual experiences’ (such as hearing voices that others cannot, or suspicions of being followed) are common, but can become more distressing during adolescence, especially for young people in contact with Child and Adolescent Mental Health Services (CAMHS). Unusual experiences that are distressing or have adverse life impact...
Article
Full-text available
Background Cognitive models of psychosis propose that appraisals (ie, the interpretation and meaning attributed to experiences) are central to the transition from anomalous experiences to psychotic symptoms. In the Unusual Experiences Enquiry (UNIQUE) study, we investigated the role of appraisals by comparing individuals with persistent psychotic e...
Article
Full-text available
Background and objectives: There is a pressing need to improve access to evidence-based practice for people with psychosis. The primary aim of this study was to assess clinical feasibility of a manualised, evidence-based CBT intervention (GOALS) targeting a personalised recovery goal, delivered by the frontline workforce, following brief training....
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
Full-text available
Background: A quarter of people with psychotic conditions experience persistent auditory verbal hallucinations, despite treatment. AVATAR therapy is a new approach in which people who hear voices have a dialogue with a digital representation (avatar) of their presumed persecutor, voiced by the therapist so that the avatar responds by becoming less...
Article
Full-text available
The recent literature on reasoning biases in psychosis and delusions is reviewed. The state-of-the-art knowledge from systematic reviews and meta-analyses on the evidence for jumping to conclusions is briefly summarised, before a fuller discussion of the more recent empirical literature on belief flexibility as applied to delusions. The methodology...
Article
Full-text available
Over the last two decades, there has been a rapid increase of studies testing the efficacy and acceptability of virtual reality in the assessment and treatment of mental health problems. This systematic review was carried out to investigate the use of virtual reality in the assessment and the treatment of psychosis. Web of Science, PsychInfo, EMBAS...
Article
Full-text available
Objective Our primary objective was to identify cognitive behavioural therapy (CBT) delivery for people with psychosis (CBTp) using an automated method in a large electronic health record database. We also examined what proportion of service users with a diagnosis of psychosis were recorded as having received CBTp within their episode of care durin...
Article
Objectives: Psychological therapy services are increasingly required to instate routine outcome monitoring (ROM), to demonstrate the clinical and economic impact of interventions. Professionals' views of ROM are an acknowledged barrier to implementation. Service user perspectives have rarely been examined, but acceptability and perceptions of ROM...
Article
Introduction Experiences of depression and anxiety are common among patients with persecutory delusions. It has been theorized that emotional disturbances affect the formation and appraisal of persecutory delusions directly and possibly via increasing the sense of aberrant salience. Objectives Using a time-lagged analysis of experience sampling da...