Aikaterini Rammou | University of Sussex (original) (raw)

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Papers by Aikaterini Rammou

Frontiers in Psychology

IntroductionDue to the general psychopathological vulnerability of young people who hear distress... more IntroductionDue to the general psychopathological vulnerability of young people who hear distressing voices, research has stressed the importance for clinicians to assess this experience in youth. Nonetheless, the limited literature on the topic comes from studies with clinicians in adult health services and it primarily reports that clinicians do not feel confident in systematically assessing voice-hearing and doubt the appropriateness of doing so. We applied the Theory of Planned Behavior and identified clinicians’ job attitudes, perceived behavioral control, and perceived subjective norms as putative predictors of their intent to assess voice-hearing in youth.MethodNine hundred and ninety-six clinicians from adult mental health services, 467 from Child and Adolescent Mental Health (CAMHS) and Early Intervention in Psychosis (EIP) services and 318 primary care clinicians across the UK completed an online survey. The survey gathered data on attitudes toward working with people who ...

Psychological models in adults have indicated several factors that might play a role in maintaini... more Psychological models in adults have indicated several factors that might play a role in maintaining the distress associated with hearing voices, including negative interrelating between the hearer and the voices and persecutory beliefs about the voices. Additionally, negative relating with voices can be mirrored in the difficult relationships that hearers have with social others. By contrast, little is known about distressing voice-hearing in young people and its possible links with social relating. This thesis focuses on young people’s experiences of voice-hearing and on clinicians’ attitudes working with young people distressed by voice-hearing. It aims to provide preliminary evidence on the factors that contribute to voice-related distress and the association between voice-hearing and young people’s social relating. Clinicians’ attitudes and responses to voice-hearing in youth are also explored. This thesis begins with an introduction to the research area (Chapter 1), followed by...

Psychology and Psychotherapy: Theory, Research and Practice

Cognitive Therapy and Research, 2021

Background Research on gender differences has found that women relate to negative voice hearing e... more Background Research on gender differences has found that women relate to negative voice hearing experiences with more negative emotions and report more distress due to voices, which may be rooted in differences in relating to voices. This study used a robust methodology and a large sample to explore gender differences in relating to voices and voice distress. Methods Matched samples of male (n = 124) and female (n = 124) voice hearers were drawn from a survey for secondary analysis. Voice severity (e.g., frequency or loudness), voice distress, and different types of dysfunctional (i.e., passive or aggressive) and functional (assertive) relating were measured. Group comparisons, mediation models, and network analyses were calculated. Results Female voice hearers reported more severe voices, more voice distress, more passive, and less assertive relating. Mediation and network analyses yielded evidence for pathways from gender to voice distress via relating and via differences in voice...

Schizophrenia Research, 2021

Background: Voice-hearing is a transdiagnostic experience with an evident negative impact on pati... more Background: Voice-hearing is a transdiagnostic experience with an evident negative impact on patients. Good quality measurement is needed to further elucidate the nature, impact and treatment of voice-hearing experiences across patient groups. The Hamilton Program for Schizophrenia Voices Questionnaire (HPSVQ) is a brief self-report measure which requires further psychometric evaluation. Methods: Using data from a transdiagnostic sample of 401 adult UK patients, the fit of a conceptual HPSVQ measurement model, proposing a separation between physical and emotional voice-hearing characteristics, was tested. A structural model was examined to test associations between voice-hearing, general emotional distress (depression, anxiety, stress) and wellbeing. The invariance of model parameters was examined across diagnosis and sex. Results: The final measurement model comprised two factors named 'voice severity' and 'voice-related distress'. The former comprised mainly physical voice characteristics and the latter mainly distress and other negative impacts. Structural model results supported voicerelated distress as mediating the associations between voice severity and emotional distress and wellbeing. Model parameters were invariant across psychosis versus non-psychosis diagnosis and partially invariant across sex; with females experiencing more severe and distressing voices and a more direct association between voice severity and general anxiety. Conclusions: The HPSVQ is a useful self-report measure of voice-hearing with some scope for further exploration and refinement. Voice-related distress appears a key mechanism by which voice severity predicts general distress and wellbeing. Whilst our data broadly support interventions targeting voice-related distress for all patients, females may benefit especially from interventions targeting voice severity and strategies for responding.

Schizophrenia Research, 2020

Background: The effectiveness of psychological treatments for auditory hallucinations ('voices') ... more Background: The effectiveness of psychological treatments for auditory hallucinations ('voices') needs to be enhanced. Some forms of novel treatment are working within relational frameworks to support patients to relate assertively to distressing voices. Yet, no measure of assertive relating to voices is available to assess the extent to which this skill is developed during therapy. This study aimed to assess the factor structure and validity of two new questionnaires: a measure of relating to voices and a measure of social relating. Methods: The relating measures were developed in consultation with members of the international research community and validated in a large sample (N = 402) of voice hearing patients within the UK. The measures were subjected to factor analysis and compared to measures of voice hearing, mental health and well-being to evaluate construct, convergent, discriminant, and criterion validity. Results: Factor analysis confirmed a three-dimensional set of items that measure assertive and non-assertive (passive and aggressive) relating. This resulted in the validation of the 'Approve' questionnaires-two 15-item measures of relating to voices and other people. Conclusion: The Approve questionnaires can be used to assess a patient's suitability for relationally-based psychological therapies for distressing voices and the extent to which assertive relating skills are developed during the therapy.

Schizophrenia Bulletin

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Frontiers in Psychology, May 15, 2018

The experience of hearing voices ('auditory hallucinations') can cause significant distress and d... more The experience of hearing voices ('auditory hallucinations') can cause significant distress and disruption to quality of life for people with a psychosis diagnosis. Psychological therapy in the form of cognitive behavior therapy (CBT) for psychosis is recommended for the treatment of positive symptoms, including distressing voices, but is rarely available to patients in the United Kingdom. CBT for psychosis has recently evolved with the development of symptom-specific therapies that focus upon only one symptom of psychosis at a time. Preliminary findings from randomized controlled trials suggest that these symptom-specific therapies can be more effective for distressing voices than the use of broad CBT protocols, and have the potential to target voices trans-diagnostically. Whilst this literature is evolving, consideration must be given to the potential for a symptom-specific approach to overcome some of the barriers to delivery of evidencebased psychological therapies within clinical services. These barriers are discussed in relation to the United Kingdom mental health services, and we offer suggestions for future research to enhance our understanding of these barriers.

Early intervention in psychiatry, Jan 16, 2017

Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in pa... more Negative symptoms (NS) have been associated with poor outcome and remain difficult to treat in patients with psychosis. This study examined the association of NS with clinical features at first presentation to mental health services for psychosis and with outcomes at 1-year follow-up. Clinical data were utilized from five London Early Intervention Services (EIS) included in the MiData audit database. The sample comprised 484 first-episode psychosis patients with complete Positive and Negative Syndrome Scale data at baseline and 1-year follow-up. Multiple imputation (N = 50) was conducted to account for missing follow-up data. Baseline NS were associated with male gender (B = -1.63, P < .05), younger age at onset (B = -.15, P <. 05), a higher level of impairment on the Global Assessment of Functioning (disability) Scale at baseline (B = -.19, P <. 010), an absence of reported substance misuse prior to baseline assessment (B = -3.05, P <. 001) and unemployment at baseline ...