Clara Strauss - Academia.edu (original) (raw)
Papers by Clara Strauss
Trials, Jan 16, 2015
Obsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of... more Obsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of the population. Exposure and response prevention (ERP) is a behaviour therapy for OCD with the strongest evidence for effectiveness of any psychological therapy for the condition. Even so, only about half of people offered ERP show recovery after the therapy. An important reason for ERP failure is that about 25% of people drop out early, and even for those who continue with the therapy, many do not regularly engage in ERP tasks, an essential element of ERP. A mindfulness-based approach has the potential to reduce drop-out from ERP and to improve ERP task engagement with an emphasis on accepting difficult thoughts, feelings and bodily sessions and on becoming more aware of urges, rather than automatically acting on them. This is a pilot randomised controlled trial of mindfulness-based ERP (MB-ERP) with the aim of establishing parameters for a definitive trial. Forty participants diagnose...
Trials, 2014
Background: Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis wi... more Background: Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis with moderate effect sizes, but the evidence for cognitive behaviour therapy specifically for distressing voices is less convincing. An alternative symptom-based approach may be warranted and a body of literature has explored distressing voices from an interpersonal perspective. This literature has informed the development of relating therapy and findings from a case series suggested that this intervention was acceptable to hearers and therapists. Methods/Design: An external pilot randomized controlled trial (RCT) comparing outcomes for 15 patients receiving 16 hours (weekly sessions of one hour) of relating therapy and their usual treatment with 15 patients receiving only their usual treatment. Participants will be assessed using questionnaires at baseline, 16 weeks (post-intervention), and 36 weeks (follow-up). Discussion: Expected outcomes will include a refined study protocol and an estimate of the effect size to inform the sample size of a definitive RCT. If evidence from a fully powered RCT suggests that relating therapy is effective, the therapy will extend the range of evidence-based psychological therapies available to people who hear distressing voices. Trial registration: Current Controlled Trials ISRCTN registration number 44114663. Registered on 13 June 2013.
PloS one, 2014
Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a hi... more Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = -0.59, 95% CI = -0.12 to -1.06). Effects were demonstrated for depressive sympt...
Clinical Psychology Review, 2015
We systematically review mediation studies on mechanisms of MBCT and MBSR.
Schizophrenia bulletin, 2014
The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted... more The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer's own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional const...
This study sets out to develop an understanding of participants' experiences of person-based cogn... more This study sets out to develop an understanding of participants' experiences of person-based cognitive therapy groups for distressing voices, a therapy that integrates cognitive therapy with mindfulness principles and practice. Qualitative data were gathered during 10 interviews with participants, most of whom had a diagnosis of psychosis. A semi-structured schedule was used to guide the interviews and data were analysed using thematic analysis. Three themes unique to PBCT emerged: Relating to voices, Relating to self and Relating to others. The value of a mindfulness approach and the importance of changed beliefs about voice strength and power emerged as sub-themes in the "Relating to voices" theme. A sense of self-separate to voices and a developing positive view of self-emerged as sub-themes in the "Relating to self" theme. The "Relating to others" theme referred to changed social relationships during and following the group. The study provided support for the value of PBCT groups for distressing voices. Findings from the study supported the mechanisms of change suggested by the therapy model, namely, that benefit is gained through re-evaluating beliefs about voices, strengthening positive self-schema, mindfulness practice and principles and moving towards a symbolic sense of self.
The present study examines the impact of group Person-Based Cognitive Therapy (PBCT) for distress... more The present study examines the impact of group Person-Based Cognitive Therapy (PBCT) for distressing voices within an uncontrolled evaluation. In particular it utilizes a framework of acceptance of voices and self to enhance well-being and reduce distress and perceived voice-control. Sixty-two participants entered one of nine PBCT groups conducted over 8e12 sessions. Fifty participants completed therapy. Measures of well-being, distress, control and relating characteristics were completed pre-and posttherapy and at brief follow-up. Data were subjected to an intention-to-treat analysis. The groups achieved significant benefits in terms of well-being, distress, control and dependence upon the voice. The present study is the first to report significant improvement in both distress and control. Consequently, Group PBCT for distressing voices may prove a useful addition to existing psychological interventions and is worthy of further investigation. The findings are discussed in relation to clinical implications and limitations.
British Journal of Clinical Psychology, 2012
Objective. This pilot randomized controlled trial (RCT) assesses Person-Based Cognitive Therapy (... more Objective. This pilot randomized controlled trial (RCT) assesses Person-Based Cognitive Therapy (PBCT), an integration of cognitive therapy and mindfulness, as a treatment for chronic depression.
Behaviour Research and Therapy, 2013
Objectives: There is growing evidence that mindfulness has positive consequences for both psychol... more Objectives: There is growing evidence that mindfulness has positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online, mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population. Method: One hundred and four students were randomly allocated to either immediately start a twoweek, self-guided, online, mindfulness-based intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the intervention period. Results: Intention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no significant changes on these measures were found for the control group.
Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of ... more Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review, 34,[118][119][120][121][122][123][124][125][126][127][128][129] The formatted, published version is at: http://dx.
Schizophrenia bulletin, 2014
This report from the International Consortium on Hallucinations Research considers the current st... more This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (...
Trials, Jan 16, 2015
Obsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of... more Obsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of the population. Exposure and response prevention (ERP) is a behaviour therapy for OCD with the strongest evidence for effectiveness of any psychological therapy for the condition. Even so, only about half of people offered ERP show recovery after the therapy. An important reason for ERP failure is that about 25% of people drop out early, and even for those who continue with the therapy, many do not regularly engage in ERP tasks, an essential element of ERP. A mindfulness-based approach has the potential to reduce drop-out from ERP and to improve ERP task engagement with an emphasis on accepting difficult thoughts, feelings and bodily sessions and on becoming more aware of urges, rather than automatically acting on them. This is a pilot randomised controlled trial of mindfulness-based ERP (MB-ERP) with the aim of establishing parameters for a definitive trial. Forty participants diagnose...
Trials, 2014
Background: Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis wi... more Background: Evidence exists for the effectiveness of cognitive behaviour therapy for psychosis with moderate effect sizes, but the evidence for cognitive behaviour therapy specifically for distressing voices is less convincing. An alternative symptom-based approach may be warranted and a body of literature has explored distressing voices from an interpersonal perspective. This literature has informed the development of relating therapy and findings from a case series suggested that this intervention was acceptable to hearers and therapists. Methods/Design: An external pilot randomized controlled trial (RCT) comparing outcomes for 15 patients receiving 16 hours (weekly sessions of one hour) of relating therapy and their usual treatment with 15 patients receiving only their usual treatment. Participants will be assessed using questionnaires at baseline, 16 weeks (post-intervention), and 36 weeks (follow-up). Discussion: Expected outcomes will include a refined study protocol and an estimate of the effect size to inform the sample size of a definitive RCT. If evidence from a fully powered RCT suggests that relating therapy is effective, the therapy will extend the range of evidence-based psychological therapies available to people who hear distressing voices. Trial registration: Current Controlled Trials ISRCTN registration number 44114663. Registered on 13 June 2013.
PloS one, 2014
Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a hi... more Mindfulness-based interventions (MBIs) can reduce risk of depressive relapse for people with a history of recurrent depression who are currently well. However, the cognitive, affective and motivational features of depression and anxiety might render MBIs ineffective for people experiencing current symptoms. This paper presents a meta-analysis of randomised controlled trials (RCTs) of MBIs where participants met diagnostic criteria for a current episode of an anxiety or depressive disorder. Post-intervention between-group Hedges g effect sizes were calculated using a random effects model. Moderator analyses of primary diagnosis, intervention type and control condition were conducted and publication bias was assessed. Twelve studies met inclusion criteria (n = 578). There were significant post-intervention between-group benefits of MBIs relative to control conditions on primary symptom severity (Hedges g = -0.59, 95% CI = -0.12 to -1.06). Effects were demonstrated for depressive sympt...
Clinical Psychology Review, 2015
We systematically review mediation studies on mechanisms of MBCT and MBSR.
Schizophrenia bulletin, 2014
The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted... more The phenomenological diversity of auditory verbal hallucinations (AVH) is not currently accounted for by any model based around a single mechanism. This has led to the proposal that there may be distinct AVH subtypes, which each possess unique (as well as shared) underpinning mechanisms. This could have important implications both for research design and clinical interventions because different subtypes may be responsive to different types of treatment. This article explores how AVH subtypes may be identified at the levels of phenomenology, cognition, neurology, etiology, treatment response, diagnosis, and voice hearer's own interpretations. Five subtypes are proposed; hypervigilance, autobiographical memory (subdivided into dissociative and nondissociative), inner speech (subdivided into obsessional, own thought, and novel), epileptic and deafferentation. We suggest other facets of AVH, including negative content and form (eg, commands), may be best treated as dimensional const...
This study sets out to develop an understanding of participants' experiences of person-based cogn... more This study sets out to develop an understanding of participants' experiences of person-based cognitive therapy groups for distressing voices, a therapy that integrates cognitive therapy with mindfulness principles and practice. Qualitative data were gathered during 10 interviews with participants, most of whom had a diagnosis of psychosis. A semi-structured schedule was used to guide the interviews and data were analysed using thematic analysis. Three themes unique to PBCT emerged: Relating to voices, Relating to self and Relating to others. The value of a mindfulness approach and the importance of changed beliefs about voice strength and power emerged as sub-themes in the "Relating to voices" theme. A sense of self-separate to voices and a developing positive view of self-emerged as sub-themes in the "Relating to self" theme. The "Relating to others" theme referred to changed social relationships during and following the group. The study provided support for the value of PBCT groups for distressing voices. Findings from the study supported the mechanisms of change suggested by the therapy model, namely, that benefit is gained through re-evaluating beliefs about voices, strengthening positive self-schema, mindfulness practice and principles and moving towards a symbolic sense of self.
The present study examines the impact of group Person-Based Cognitive Therapy (PBCT) for distress... more The present study examines the impact of group Person-Based Cognitive Therapy (PBCT) for distressing voices within an uncontrolled evaluation. In particular it utilizes a framework of acceptance of voices and self to enhance well-being and reduce distress and perceived voice-control. Sixty-two participants entered one of nine PBCT groups conducted over 8e12 sessions. Fifty participants completed therapy. Measures of well-being, distress, control and relating characteristics were completed pre-and posttherapy and at brief follow-up. Data were subjected to an intention-to-treat analysis. The groups achieved significant benefits in terms of well-being, distress, control and dependence upon the voice. The present study is the first to report significant improvement in both distress and control. Consequently, Group PBCT for distressing voices may prove a useful addition to existing psychological interventions and is worthy of further investigation. The findings are discussed in relation to clinical implications and limitations.
British Journal of Clinical Psychology, 2012
Objective. This pilot randomized controlled trial (RCT) assesses Person-Based Cognitive Therapy (... more Objective. This pilot randomized controlled trial (RCT) assesses Person-Based Cognitive Therapy (PBCT), an integration of cognitive therapy and mindfulness, as a treatment for chronic depression.
Behaviour Research and Therapy, 2013
Objectives: There is growing evidence that mindfulness has positive consequences for both psychol... more Objectives: There is growing evidence that mindfulness has positive consequences for both psychological and physical health in both clinical and non-clinical populations. The potential benefits of mindfulness underpin a range of therapeutic intervention approaches designed to increase mindfulness in both clinical and community contexts. Self-guided mindfulness-based interventions may be a way to increase access to the benefits of mindfulness. This study explored whether a brief, online, mindfulness-based intervention can increase mindfulness and reduce perceived stress and anxiety/depression symptoms within a student population. Method: One hundred and four students were randomly allocated to either immediately start a twoweek, self-guided, online, mindfulness-based intervention or a wait-list control. Measures of mindfulness, perceived stress and anxiety/depression were administered before and after the intervention period. Results: Intention to treat analysis identified significant group by time interactions for mindfulness skills, perceived stress and anxiety/depression symptoms. Participation in the intervention was associated with significant improvements in all measured domains, where no significant changes on these measures were found for the control group.
Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of ... more Can mindfulness and acceptance be learnt by self-help?: A systematic review and meta-analysis of mindfulness and acceptance-based self-help interventions. Clinical Psychology Review, 34,[118][119][120][121][122][123][124][125][126][127][128][129] The formatted, published version is at: http://dx.
Schizophrenia bulletin, 2014
This report from the International Consortium on Hallucinations Research considers the current st... more This report from the International Consortium on Hallucinations Research considers the current status and future directions in research on psychological therapies targeting auditory hallucinations (hearing voices). Therapy approaches have evolved from behavioral and coping-focused interventions, through formulation-driven interventions using methods from cognitive therapy, to a number of contemporary developments. Recent developments include the application of acceptance- and mindfulness-based approaches, and consolidation of methods for working with connections between voices and views of self, others, relationships and personal history. In this article, we discuss the development of therapies for voices and review the empirical findings. This review shows that psychological therapies are broadly effective for people with positive symptoms, but that more research is required to understand the specific application of therapies to voices. Six key research directions are identified: (...