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Delusional belief flexibility and informal caregiving relationships in psychosis: a potential cognitive route for the protective effect of social support

Published online by Cambridge University Press:  25 October 2013

S. Jolley ,
H. Ferner ,
P. Bebbington ,
P. Garety ,
G. Dunn ,
D. Freeman ,
D. Fowler  and
E. Kuipers
S. Jolley*
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
H. Ferner
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
P. Bebbington
Affiliation:
Department of Mental Health Sciences, UCL, London, UK
P. Garety
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
G. Dunn
Affiliation:
Health Sciences Research Group, School of Community Based Medicine, University of Manchester, UK
D. Freeman
Affiliation:
Department of Psychiatry, University of Oxford, Oxford, UK
D. Fowler
Affiliation:
School of Medicine, Health Policy and Practice, University of East Anglia, UK
E. Kuipers
Affiliation:
King's College London, Institute of Psychiatry, Department of Psychology, University of London, UK
*
*Address for correspondence: Dr S. Jolley, PO77 Department of Psychology, King's College London, Institute of Psychiatry, Denmark Hill, London, SE5 8AF, UK. (Email: Suzanne.Jolley@kcl.ac.uk)
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Abstract

Aims.

For people with psychosis, contact with informal caregivers is an important source of social support, associated with recovery, and with better outcomes following individual cognitive therapy (CBTp). In this study, we tested whether increased flexibility in delusional thinking, an established predictor of positive outcome following CBTp, was a possible mechanism underlying this effect.

Methods.

219 participants with delusions (mean age 38 years; 71% male; 75% White) were grouped according to the presence of a caregiver (37% with a caregiver) and caregiver level of expressed emotion (High/Low EE, 64% Low). Delusional belief flexibility was compared between groups, controlling for interpersonal functioning, severity of psychotic symptoms, and other hypothesised outcome predictors.

Results.

Participants with caregivers were nearly three times more likely than those without to show flexibility (OR = 2.7, 95% CI 1.5 to 5.0, p = 0.001), and five times more likely if the caregiving relationship was Low EE (OR = 5.0, 95% CI 2.0–13.0, p = 0.001). ORs remained consistent irrespective of controlling for interpersonal functioning and other predictors of outcome.

Conclusions.

This is the first evidence that having supportive caregiving relationships is associated with a specific cognitive attribute in people with psychosis, suggesting a potential cognitive mechanism by which outcomes following CBTp, and perhaps more generally, are improved by social support.

Keywords

Caregiversdelusionspsychotic disordersreasoningschizophrenia
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 23 , Issue 4 , December 2014 , pp. 389 - 397
Copyright
Copyright © Cambridge University Press 2013 

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