Anthony P. Morrison's research while affiliated with Greater Manchester West Mental Health NHS Foundation Trust and other places

Publications (260)

Article
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Background Cognitive Behavioural Therapy for psychosis (CBTp) has an established evidence base and is recommended by clinical guidelines to be offered during the acute phases of psychosis. However, few research studies have examined the efficacy of CBTp interventions specifically adapted for the acute mental health inpatient context with most resea...
Article
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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
Background: Automated virtual reality therapies are being developed to increase access to psychological interventions. We assessed the experience with one such therapy of patients diagnosed with psychosis, including satisfaction, side effects, and positive experiences of access to the technology. We tested whether side effects affected therapy. M...
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Background Automated delivery of psychological therapy using immersive technologies such as virtual reality (VR) might greatly increase the availability of effective help for patients. We aimed to evaluate the efficacy of an automated VR cognitive therapy (gameChange) to treat avoidance and distress in patients with psychosis, and to analyse how an...
Article
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Background Many patients with mental health disorders become increasingly isolated at home due to anxiety about going outside. A cognitive perspective on this difficulty is that threat cognitions lead to the safety-seeking behavioural response of agoraphobic avoidance. Aims We sought to develop a brief questionnaire, suitable for research and clin...
Article
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Cognitive Behaviour Therapy for psychosis (CBTp) is the psychological therapy recommended for people with psychosis and can start in the acute phase. However, there is not consensus on how CBTp should be delivered in an acute mental health inpatient setting. This study aimed to gain consensus from therapists on how CBTp should be delivered in this...
Article
Psychosis is a mental health difficulty which is widely stigmatized. The stigma of psychosis can lead to detrimental consequences and cause further distress. The aim of this study was to explore the experience of stigma and discrimination of psychosis from the perspective of service users from ethnic minority backgrounds. A total of 21 semistructur...
Article
People can derive health benefits from social group memberships. However, joining groups can be difficult for people experiencing psychosis due to the social impacts of the condition and public and internalised stigma. We interviewed a diverse group of 26 people experiencing psychosis and explored through thematic analysis their perceptions of how...
Article
Background Onset of psychosis commonly occurs in adolescence, and long-term prognosis can be poor. There is growing evidence, largely from adult cohorts, that Cognitive Behavioural Therapy for Psychosis (CBTp) and Family Interventions (FI) can play a role in managing symptoms and difficulties associated with psychosis. However, adolescents have dis...
Article
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Background. Agoraphobic avoidance of everyday situations is a common feature in many mental health disorders. Avoidance can be due to a variety of fears, including concerns about negative social evaluation, panicking, and harm from others. The result is inactivity and isolation. Behavioural avoidance tasks (BATs) provide an objective assessment of...
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Introduction Aggregate data meta-analyses have shown heterogeneous treatment effects for cognitive–behavioural therapy (CBT) for patients with schizophrenia spectrum diagnoses. This heterogeneity could stem from specific intervention or patient characteristics that could influence the clinical effectiveness of CBT, termed treatment effect modifiers...
Article
The Talking With Voices (TWV) pilot trial assesses feasibility and acceptability of a novel dialogical intervention to ameliorate distress associated with auditory hallucinations. The single-site, single-blind (rater) feasibility randomised controlled trial recruited adult participants with a diagnosis of schizophrenia-spectrum disorder who were al...
Preprint
Full-text available
Background Cognitive Behavioural Therapy for psychosis (CBTp) is a psychological therapy which should be offered during the acute phases of psychosis. However, few research studies have examined the efficacy of CBTp interventions specifically adapted for the acute mental health inpatient context with most research trials being conducted with white...
Article
Background: Despite wide usage of the Questionnaire about the Process of Recovery 10 (QPR), the minimum important difference (MID) for the measure has not been identified. Establishing the MID for the QPR is required in order to facilitate the interpretation of outcomes in clinical practice and the use of this scale in research, to measure meaningf...
Article
Theoretical models and qualitative research suggest that dissociation can be functional in some circumstances, despite being a cause of concern for many. This is the first study that evaluates a novel questionnaire on positive appraisals of dissociation (the Positive Beliefs about Dissociation Questionnaire; PBD-Q), and its link with dissociation f...
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Background When psychosis emerges in young people there is a risk of poorer outcomes, and access to evidence-based treatments is paramount. The current evidence base is limited. Antipsychotic medications show only a small benefit over placebo, but young people experience more side effects than adults. There is sparse evidence for psychological inte...
Article
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Objectives: Previous studies have suggested that dissociation might represent an important mechanism in the maintenance of auditory verbal hallucinations (i.e., voices) in people who have a history of traumatic life experiences. This study investigated whether a cognitive behavioural therapy (CBT) intervention for psychosis augmented with techniqu...
Article
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Background Evidence for the effectiveness of treatments in early-onset psychosis is sparse. Current guidance for the treatment of early-onset psychosis is mostly extrapolated from trials in adult populations. The UK National Institute for Health and Care Excellence has recommended evaluation of the clinical effectiveness and cost-effectiveness of a...
Article
Background Recovery from psychosis is increasingly being viewed as a combination of symptomatic, functional, and personal recovery. Negative and depressive symptoms have been linked to community functioning, and negative affect has been linked to personal recovery. The current study examines differential associations of symptoms with functional and...
Article
Background and objectives The cognitive model of voices suggests that negative appraisals of hallucinatory experiences result in responses, such as rumination, which maintain voice-hearing. Our principal aim was to investigate the effect of rumination on the frequency of voice-hearing. Methods A two-group randomised experimental design was employe...
Article
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Various clinical guidelines recommend cognitive behavioural therapy (CBT) to treat psychosis without reference to patients' thought disorder. However, there is a risk that disorganized thinking hampers CBT. We tested the prediction that thought disorder would interfere with the effectiveness of CBT for hallucinations and delusions, compared to trea...
Article
Aims: Current National Institute for Health and Care Excellence (NICE) guidelines for psychosis recommend psychological therapy with or without family intervention for individuals at-risk of developing psychosis. NICE guidelines have a specific research recommendation to investigate the clinical and cost effectiveness of combined individual and fa...
Article
This study assessed the relationship between distress, severity and frequency of attenuated psychotic symptoms in individuals meeting Ultra High Risk (UHR) criteria, both at baseline and over time. It also assessed distress in relation to attenuated symptoms and whether cognitive behavioural therapy (CBT) reduced distress over time by symptom type....
Article
Public stigma towards people with mental health problems has been demonstrated in Western societies. Little is known about non‐Western cultures and whether cultures differ in their perceptions of people with mental health problems. Aim of this study was to examine cultural differences in prejudice, stereotypes, and discrimination towards people wit...
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Background The period before the formation of a persecutory delusion may provide causal insights. Patient accounts are invaluable in informing this understanding. Aims To inform the understanding of delusion formation, we asked patients about the occurrence of potential causal factors – identified from a cognitive model – before delusion onset. M...
Article
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Introduction Many patients with psychosis experience everyday social situations as anxiety-provoking. The fears can arise, for example, from paranoia, hallucinations, social anxiety or negative-self beliefs. The fears lead patients to withdraw from activities, and this isolation leads to a cycle of worsening physical and mental health. Breaking thi...
Article
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Background Adolescent-onset psychosis is associated with more severe symptoms and poorer outcomes than adult-onset psychosis. The National Institute for Clinical Excellence (NICE) recommend that adolescents with first episode psychosis (FEP) should be offered a combination of antipsychotic medication (APs), cognitive behavioural therapy (CBT) and f...
Article
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Background: The Clinical High Risk state for Psychosis (CHR-P) has become the cornerstone of modern preventive psychiatry. The next stage of clinical advancements rests on the ability to formulate a more accurate prognostic estimate at the individual subject level. Individual Participant Data Meta-Analyses (IPD-MA) are robust evidence synthesis met...
Article
Trauma and dissociation may be important factors contributing to the experiences of distressing voice hearing. However, there is scant mention of how to target and treat such processes when working with people with psychosis. This case study reports on an initial attempt to work with dissociation and trauma memories in a person with voices. A singl...
Article
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Background Clozapine (clozaril, Mylan Products Ltd) is a first-choice treatment for people with schizophrenia who have a poor response to standard antipsychotic medication. However, a significant number of patients who trial clozapine have an inadequate response and experience persistent symptoms, called clozapine-resistant schizophrenia (CRS). The...
Article
While previous research has demonstrated the negative impact of stigma in individuals with mental health problems, little is known about cross-cultural differences in experiences and explanations of mental health, in particular in young people, despite the first episode of psychosis often occurring in adolescence. Aim of this study was to examine c...
Article
Background: While formalised mental health peer support is on the increase, there continues to be a lack of consensus regarding the peer supporter role. Aim: The aim was to develop consensus on the essential components, personal costs, personal benefits, barriers and facilitators involved in providing mental health peer support. Methods: The Delp...
Article
Objective:: Qualitative research has identified personal costs and benefits for peer supporters associated with their role; however, quantitative evidence is sparse. This study used quantitative methods to explore relationships in experiences of providing peer support with constructs of empowerment, hope, recovery, quality of life and internalised...
Article
Peer support is sometimes formalized and offered as an intervention in mental health services and organizations. Evidence suggests that empowerment, self-efficacy, and internalized stigma are theoretically linked and implicated in the change processes involved in peer support. This review aimed to synthesize quantitative evidence published in the E...
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This study aimed to describe the causal beliefs of individuals experiencing psychosis, specifically exploring how they are developed and maintained. Individuals with experience of psychosis were recruited from mental health services for in-depth interviews. A thematic analysis was used to analyse transcripts and key themes were identified. Fifteen...
Article
This study investigated the effect of “dose” and the components of Cognitive Behavioral Therapy (CBT) on treatment effects. It is a secondary analysis of the ACTION (Assessment of Cognitive Therapy Instead of Neuroleptics) trial which investigated CBT for people with schizophrenia spectrum disorders that chose not to take antipsychotic medication....
Article
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Background: Although clozapine is the treatment of choice for treatment-refractory schizophrenia, 30-40% of patients have an insufficient response, and others are unable to tolerate it. Evidence for any augmentation strategies is scarce. We aimed to determine whether cognitive behavioural therapy (CBT) is an effective treatment for clozapine-resis...
Article
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Aim The Metacognitions Questionnaire‐30 (MCQ‐30) has been used to assess metacognitive beliefs in a range of mental health problems. The aim of this study is to assess the validity of the MCQ‐30 in people at risk for psychosis. Methods One hundred eighty‐five participants meeting criteria for an at risk mental state completed the MCQ‐30 as part of...
Article
Objective: To investigate the impact of expressed emotion (EE) on the risk of developing the first psychotic episode (FEP). Method: The European Prediction of Psychosis Study (EPOS) investigated 245 patients who were at clinical high risk (CHR) of psychosis. The predictive value of EE alone and as a part of the multivariate EPOS model was evalua...
Article
Background: Little evidence is available for head-to-head comparisons of psychosocial interventions and pharmacological interventions in psychosis. We aimed to establish whether a randomised controlled trial of cognitive behavioural therapy (CBT) versus antipsychotic drugs versus a combination of both would be feasible in people with psychosis. M...
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Negative metacognitive beliefs are central determinants of distress in the metacognitive model of psychological vulnerability to stress. The current study tested this assertion in 75 undergraduate students assigned to either experimental (metacognitive belief manipulation) or control (no metacognitive belief manipulation) condition. All participant...
Article
Evidence from randomised controlled trials suggest that both antipsychotic medication and cognitive behaviour therapy (CBT) can be helpful to people with a diagnosis of a schizophrenia spectrum disorder. On this basis, many clinical guidelines recommend that people with psychosis should be offered both antipsychotic medication and CBT and that they...
Article
Background: Psychological treatments occupy an important place in evidence-based mental health treatments. Now is an exciting time to fuel treatment research: a pressing demand for improvements is poised alongside new opportunities from closer links with sister scientific and clinical disciplines. The need to improve mental health treatment is grea...
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People with experience of psychosis face stigma and discrimination, which can be a significant barrier to recovery. Internalisation of public stereotypes and prejudice into an individual’s self-identity is an understandable consequence of such discrimination. However, internalised stigma represents a significant barrier to recovery, resulting in a...
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Individuals with psychosis are often subject to external stigma and discrimination and commonly also experience internalized stigma. Attempts to improve attitudes have tended to medicalize the experiences associated with psychosis; however, research increasingly indicates an association between biogenetic attitudes and stigma. This study aims to ev...
Article
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Background: Clinical guidelines recommend cognitive behaviour therapy (CBT) for people with psychosis, however, implementation is poor and not everyone wishes to engage with therapy. Understanding service user (SU) preferences for receiving such treatments is a priority for services. Aims: To explore SU preferences and outcomes of different methods...
Article
Objective: The application of metacognitive processes in the development of paranoia has been examined, with tentative support evident. In the absence of causal conclusions, the present study examined the causal role of metacognitive beliefs in the development of paranoia by manipulating positive and negative metacognitive beliefs on paranoia frequ...
Article
Internalised stigma is problematic for people who experience psychosis therefore psychological interventions are required. This study examine the feasibility and acceptability of a brief Cognitive Behavioural Therapy (CBT) intervention for internalised stigma with psychiatric inpatients experiencing psychosis. A feasibility randomised controlled tr...
Article
Purpose: Research suggests that the way an individual understands a health difficulty can influence their subsequent behaviour. The aim of this study was to explore the psychometric properties of a new causal belief questionnaire for people who have experience of psychosis. We also planned to provide an overview of current causal beliefs within th...
Article
Two transdiagnostic therapies for treating psychological disorder are Metacognitive Therapy (MCT) and Mindfulness Based Stress Reduction (MBSR). These two approaches have yet to be compared and therefore the current study aimed to evaluate the feasibility of a study of group MCT and MBSR in treating anxiety and depression. A feasibility trial with...
Article
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Metacognitive beliefs implicated in the Self-Regulatory Executive Function (S-REF) model (Wells & Matthews, 1994, 1996) have demonstrated significant positive relationships with experiences of psychosis. This study aimed to investigate the effect of manipulating metacognitive beliefs relating to the uncontrollability and danger of thoughts on paran...
Article
Objectives: It is increasingly accepted that paranoia lies on a continuum of severity that can be observed in the general population. Several psychological factors have been implicated in the development of more distressing persecutory ideas including negative affect (i.e., anxiety and depression), beliefs about oneself and other people (i.e., sch...
Article
The Self-Regulatory Executive Function (S-REF) model assumes that unhelpful metacognitive coping strategies characterised by worry, rumination, threat monitoring and attempts to control thoughts, have a central role in psychological disorders and prolonged negative affect. Collectively, these strategies constitute the Cognitive Attentional Syndrome...
Article
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Poor social functioning has been found to be present in those at risk for psychosis. This study aimed to examine metacognitive beliefs as potential predictors of structured activity (measure of social functioning) in those with an At Risk Mental State (ARMS). Regression and correlation analyses were conducted. The sample included 109 young people....
Article
This review investigated whether unhelpful metacognitive coping strategies, such as attentional biases, worry, rumination, and thought control, are associated with experiences of psychosis. These processes, known collectively as the Cognitive Attentional Syndrome (CAS), form a central tenet of the Self-Regulatory Executive Function model. Three res...
Article
Clinicians are often sceptical about offering cognitive behavioural therapy (CBT) to individuals experiencing thought disorder. This view may result from perceived difficulties in clients being able to learn and better understand their experiences through verbal dialogue. However, it may also partly be due to the lack of clear guidance on how to ad...
Article
NICE guidelines recommend use of treatment protocols that have trial-based evidence of efficacy to guide the delivery of CBT for psychosis. The rationale for using such an approach, and a manual that has been used to ensure fidelity and adherence within six clinical trials, is described. The protocol emphasises principles and values, such as collab...
Article
Cognitive models of psychosis suggest that unhelpful ways of responding to experiences can maintain such experiences and the associated distress. The response styles of attentional avoidance and attentional focusing were manipulated in an analogue voice-hearing task. Predictions were that both would increase detection of words in response to an amb...
Article
Safety-seeking behaviours are responses employed to protect against perceived threat. In relation to anxiety disorders, safety-seeking behaviours have been implicated in both the formation and maintenance of distress. Several studies have highlighted similar findings in relation to psychosis; however, this literature has not yet been synthesized. T...
Article
Internalised shame and self-esteem have both been proposed to play an integral role in the relationship between stigma and its negative psychological sequalae in people who experience psychosis, but there has been little quantitative exploration to examine their roles further. The aim of this study was to examine the relationship of stigma (experie...
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Background: Previous evidence suggests that how an individual conceptualises the cause of a health problem can impact on subsequent perceptions and behaviour. Aims: This study explored the beliefs about the causes of psychosis in a group of mental health professionals. The study also sought to examine the relationship between causal beliefs and...
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Internalised stigma is associated with negative psychological and social outcomes for people with psychosis. Research has shown stigma can impact on wellbeing and increase the risk of transition for people at risk of developing psychosis. There is limited knowledge regarding how internalised stigma differs across ultra-high risk of psychosis and ps...
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Aims: Ongoing NICE guidance recommends research on the clinical and cost effectiveness of psychological treatment alone, compared to antipsychotic medication and compared to psychological treatment and antipsychotic medication combined. The COMPARE study (Cognitive behaviour therapy or Medication for Psychosis- A Randomised Evaluation) was a pilot...
Article
Objectives Cognitive models of psychosis implicate how people respond to their distressing experiences in the maintenance of such experiences. Safety‐seeking behaviours, which are employed in response to a catastrophic misinterpretation of threat, are viewed as unhelpful maintenance factors. However, the concept of safety seeking was developed in r...
Article
Background: Internalized stigma is a significant difficulty for those who experience psychosis, but it has never been conceptualized using cognitive theory. Aims: The aim of this paper is to outline a cognitive model conceptualizing internalized stigma experienced by people who also experience psychosis. Method: Previous literature is reviewed...
Article
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Background: High levels of expressed emotion (EE) increase the risk for relapse in manifest psychosis. Yet, the value of EE for predicting a first psychotic episode has not previously been investigated. Methods: The European Prediction of Psychosis Study (EPOS) investigated the course of patients clinically at high risk for psychosis (CHR) during 1...
Article
Eprint: http://www.tandfonline.com/eprint/fKFm7avpz7ba3MeeszEp/full We rigorously tested the role of rumination in the development of voice-hearing type experiences. One-hundred and two students watched a video depicting a physical assault and then either ruminated about the contents or were distracted. Participants listened to an anomalous audit...
Article
Cognitive behavioural therapy for psychosis (CBTp) is, at times, perceived as a technical therapy that undervalues the importance of human relationships and the fundamental principles on which CBTp itself is based (such as collaboration, validation, optimism and recovery-orientated practice). As such, it can be dismissed by service users or practit...
Article
Objectives: There is consensus that empowerment is key to recovery from mental health problems, enabling a person to take charge of their life and make informed choices and decisions about their life. However, little is known about the mechanisms through which empowerment affects mental health in young people. The current study involved young peop...
Article
This study aimed to confirm the factor structure of the Beliefs about Paranoia Scale (BaPS), a self-report measure to assess metacognitive beliefs about paranoia, and to test hypotheses of a metacognitive model. We hypothesised that positive and negative beliefs about paranoia would be associated with severity of suspiciousness, and that the co-occ...