OBJECTIVES:Studies of unusual sensory experiences, like hallucinations, in people at risk of psychosis usually focus on auditory experiences. This study explored how common experiences across a range of sensory modalities were in people at an ultra-high risk of developing psychosis. Particular attention was paid to the number of modalities reported and their impact. It was hypothesised that people reporting a greater number of modalities of hallucinations would report greater levels of general distress, more delusional ideation, lower emotional well-being and poorer functioning. In addition, the contribution of sleep problems and post traumatic stress disorder (PTSD) symptoms in the reporting of hallucinations in different modalities was explored. DESIGN:A single-group cross-sectional design was used. METHODS:People at an ultra-high risk of developing psychosis completed measures of hallucinations, delusions, general distress, functioning, emotional well-being, trauma and sleep. RESULTS:Nearly all participants reported hallucinations in the auditory domain. They also reported a range of other unusual sensory experiences, with visual and somatic/tactile hallucinations being reported by over half. Single sensory experiences or unimodal hallucinations were less common than hallucinations in two or more modalities, which were reported by 88% of the participants. The number of modalities of hallucinations was significantly associated with greater general distress, delusional ideation, reduced emotional well-being and to some extent functioning. PTSD and sleep were identified as potential causal factors for hallucinations across modalities. CONCLUSIONS:Psychological therapies need to account for these experiences and could feasibly target them with treatments that focus on sleep or trauma.

INTRODUCTION:Visual Hallucinations (VHs) (seeing things that others do not, or visions) are a common feature of psychosis, causing significant distress and disability. Services rarely ask about these important experiences, and crucially there are no proven beneficial psychological treatments. There are at least two key challenges faced when treating VHs. First, people report not knowing why they see things others don't, which leads them to feel alone and different from others. Second, they feel they cannot trust their own eyes to tell what is real or not, which can lead to fears they will be hurt or harmed by the VH, or even if they know the experience is not real, they may fear that they are losing their mind, or that they are not able to control or manage their experiences. For these reasons, they may struggle to put skills and strategies into practice when in the presence of the VH. Consequently, we have developed a novel treatment that addresses these core issues. First, we have a psycho-education and coping strategies package called Visual Unusual Sensory Experiences (VUSE) that uses the best aspects of digital technology (animations, videos) to explain why people have VHs and provides normalising information to help the person to feel less alone. It introduces coping strategies that are then tested in Virtual Reality sessions (VR for Visions VRV) where a representation of the visual experience is provided, enabling the person to safely develop skills and gain a sense of mastery and empowerment. We now plan to test this approach in a proof-of-concept study to help determine if this will help people use these skills in the real world and so help reduce distress, improve functioning and quality of life. We will address uncertainties in the feasibility of developing and delivering this treatment and inform its future use in a larger trial. METHODS AND ANALYSIS:The study is a single arm feasibility trial (n=16) evaluating VUSE+VRV and treatment as usual. The study is recruiting people with psychosis and distressing VHs in one NHS Trust and uses independent but non-blind research assistants to undertake assessments before, during and after treatment (at baseline, 6, 12 week) and at follow-up (16 weeks). Quantitative information on recruitment rates, adherence and completion of outcome assessments (VHs, other psychiatric symptoms, quality of life and perceived recovery) will be collected. Qualitative interviews will capture service-users' experience of therapy. Analyses will focus on feasibility outcomes and provide initial estimates of intervention effects. Thematic analysis of the qualitative interviews will assess the acceptability of the intervention. ETHICS AND DISSEMINATION:The trial has received NHS Ethical and Health Research Authority approval (25/EM/0077). Informed consent will be obtained from all participants. Findings will be disseminated directly to participants, and services as well as through open access peer-reviewed publication(s). TRIAL REGISTRATION NUMBER:ISRCTN11350954.

INTRODUCTION:People with psychosis have high rates of post-traumatic stress-disorder (PTSD). The STAR (Study of Trauma And Recovery) randomised controlled trial found that a Trauma-Focused therapy integrated with Cognitive Behaviour Therapy for psychosis (TF-CBTp) added to Treatment-As-Usual (TAU) reduced PTSD symptoms in people with psychosis compared to TAU only. We hypothesized that TF-CBTp would also reduce PTSD symptoms in daily life, using Experience Sampling Methodology (ESM), which would be associated with improvements on a clinical measure of PTSD. METHODS:Participants were adults with PTSD and schizophrenia-spectrum diagnoses, a subsample of the STAR trial (N=153; TF-CBTp+TAU=73, TAU=80). Participants completed ESM assessments of intrusive memories, hyperarousal, dissociation, avoidance and negative trauma-related cognitions through a smartphone app multiple times daily over six days, at baseline and 9-months post-randomisation (end-of-therapy). RESULTS:No between-group differences were found in ESM measures of momentary PTSD symptoms at 9-months. Significant timepoint×therapy interactions indicated greater decrease over time in hyperarousal, negative cognitions, and avoidance, and in variability of intrusive memories, in TF-CBTp+TAU compared to TAU. ESM measures at 9-months were significantly associated with improvements on the Clinician-Administered PTSD Scale for DSM-5. CONCLUSION:While findings are tentatively in favour of TF-CBTp, the robust reductions in PTSD symptoms found in the STAR trial using retrospective outcome measures were not fully replicated with ESM, suggesting these methodologies may be capturing different features of symptom expression and processes of therapeutic change. Including both approaches in future research could provide a fuller picture of therapy effects on 'in-the-moment' versus reflective reports of experiences.

Studies of unusual sensory experiences, like hallucinations, in people at risk of psychosis usually focus on auditory experiences. This study explored how common experiences across a range of sensory modalities were in people at an ultra-high risk of developing psychosis. Particular attention was paid to the number of modalities reported and their impact. It was hypothesised that people reporting a greater number of modalities of hallucinations would report greater levels of general distress, more delusional ideation, lower emotional well-being and poorer functioning. In addition, the contribution of sleep problems and post traumatic stress disorder (PTSD) symptoms in the reporting of hallucinations in different modalities was explored. A single-group cross-sectional design was used. People at an ultra-high risk of developing psychosis completed measures of hallucinations, delusions, general distress, functioning, emotional well-being, trauma and sleep. Nearly all participants reported hallucinations in the auditory domain. They also reported a range of other unusual sensory experiences, with visual and somatic/tactile hallucinations being reported by over half. Single sensory experiences or unimodal hallucinations were less common than hallucinations in two or more modalities, which were reported by 88% of the participants. The number of modalities of hallucinations was significantly associated with greater general distress, delusional ideation, reduced emotional well-being and to some extent functioning. PTSD and sleep were identified as potential causal factors for hallucinations across modalities. Psychological therapies need to account for these experiences and could feasibly target them with treatments that focus on sleep or trauma.

BACKGROUND:People with psychosis have high rates of post-traumatic stress disorder (PTSD), which is associated with a poor prognosis. We aimed to investigate the effectiveness of a trauma-focused therapy integrated with cognitive behavioural therapy for psychosis (CBTp) in people with psychosis. METHODS:STAR was a rater-blind, parallel-group, pragmatic randomised controlled trial conducted across five UK sites. We randomly assigned (1:1) adults with co-occurring PTSD and psychosis in secondary care to trauma-focused CBTp plus treatment as usual or treatment as usual only, using randomly varying block size, stratified by site. Trauma-focused CBTp is a flexible, individualised, formulation-based therapy integrating trauma-focused therapeutic components with CBTp, lasting 9 months. The primary outcome was PTSD symptom severity, assessed using clinician-administered PTSD scale for DSM-5 (CAPS-5), at 4 months (mid-therapy) and 9 months (primary endpoint). Secondary outcomes were (1) percentage of participants showing PTSD remission from diagnosis and clinically significant change, individual symptom clusters, post-traumatic cognitions, and dissociation; (2) psychosis symptoms; (3) mood disorders; (4) psychological recovery; and (5) social functioning, assessed at the same timepoints. We used linear mixed models in the intention-to-treat population at 9 months, incorporating all outcome data including at 4 months. Lived experience experts were integral throughout the research. This study was registered prospectively with ISRCTN, ISRCTN93382525. FINDINGS:Between Oct 1, 2020, and March 20, 2023, we randomly assigned 305 participants (151 [49·5%] to treatment as usual and 154 [50·5%] to trauma-focused CBTp plus treatment as usual). The mean age of participants was 38·9 years (SD 12·4). 127 (42%) participants were men, 171 (56%) were women and seven (2%) were non-binary or preferred not to say; 232 (76%) were White. All reported repeated and multiple traumas. Of 154 in the trauma-focused CBTp plus treatment-as-usual group, 144 (94%) engaged with therapy and 146 (95%) received a minimal therapeutic dose. 267 (88%) of 305 participants attended a follow-up assessment (4 months, 9 months, or both); at 9 months, 241 (79%) participants provided primary outcome data and 169-248 (55-81%) provided secondary outcome data. There were significant effects on CAPS-5 scores (adjusted mean difference in PTSD symptom severity -8·67 [95% CI -13·41 to -3·94]; p=0·0003; Cohen's d -0·73) and on 22 (81%) of 27 secondary outcomes, unadjusted for multiple testing (Cohen's d ranging from -0·26 to -0·82), including all PTSD outcomes (except derealisation and depersonalisation); delusions, paranoia, and hallucinations in other modalities; suicidal ideation, depression, anxiety, and stress; and psychological recovery. There were no effects on voices, referential beliefs, substance use, or social functioning (Cohen's d ranging from -0·05 to -0·28). 62 (50%) of 125 participants in the therapy group showed PTSD remission compared with 25 (22%) of 116 in the treatment-as-usual group (odds ratio [OR; PTSD present] 0·11, 95% CI 0·03-0·32; p=0·0001) and 56 (45%) participants in the therapy group compared with 31 (27%) in the treatment-as-usual group had clinically significant change in CAPS-5 score (OR 4·45, 95% CI 1·59-12·44; p=0·0044; number needed to treat for PTSD remission was 4). No serious adverse event was unexpected and related to trial procedures (78 reported in each group), with the most common being physical illness or injury. INTERPRETATION:Trauma-focused CBTp is safe, highly acceptable, and effective in people with co-occurring psychosis and PTSD. This underserved population should no longer be denied access to psychological interventions to treat their trauma sequelae. FUNDING:UK National Institute for Health and Care Research (Health Technology Assessment).

Background To drive improvement in clinical services, an important innovation will be to regularly assess patients' psychotic experiences in order to guide, monitor and, when needed, alter treatment provision. The great heterogeneity in presentations of psychosis means that a comprehensive assessment battery is impractical. A plausible solution is computerised adaptive testing (CAT), which uses real-time computation to present the most informative questions to an individual. Fewer questions are needed to reach similar precision as a full questionnaire.Objective We tested the potential of a CAT for paranoia to halve the number of items that need to be presented.Methods We used the established item response theory psychometric properties of the 10-item Revised Green et al Paranoid Thoughts Scale (Persecution) to run CAT simulations in four datasets in which participants had completed the full scale: a representative survey of 10 382 UK adults; a clinical trial with 319 patients with psychosis; a cohort study of 836 National Health Service (NHS) male patients with psychosis; and a clinical trial with 89 patients with persecutory delusions. The CAT algorithm used the graded response model and the test was concluded when the SE of estimation dropped below 0.3 or five items had been answered.Findings On average, the CAT administered 4.2, 4.0, 4.2 and 4.0 items to each person in the four datasets. The correlations between the CAT score and the full-scale paranoia score were 0.95, 0.94, 0.94 and 0.87. Minimal systematic error in paranoia estimation occurred (mean bias scores=-0.01, -0.06, -0.07 to -0.10). Estimation was the least precise for people at the boundary of normal and elevated levels of paranoia.Conclusions In datasets with people across the whole paranoia continuum, accurate estimates of paranoia can be provided by a CAT with fewer than half the items of the full scale. Tailored testing may work well with people with psychosis.Clinical implications CAT may be a way to implement informative measurement-based care in psychosis services.

Young people at risk of psychosis often present to services with unusual sensory experiences (USE). Managing Unusual Sensory Experiences (MUSE) is a digital intervention that therapists can use with clients to support better understanding of these experiences and how to manage them. This study aimed to test the feasibility of delivering MUSE within a RCT design. We conducted a randomised, single-blind, feasibility study of MUSE + Treatment as Usual (TAU), compared to TAU, for individuals experiencing USE in At-Risk Mental State (ARMS) services across two mental health trusts in England. Assessments were conducted at baseline, 12 weeks (post-treatment), and 20 weeks (follow-up). Ninety-three people were randomised (47 to TAU and 46 to MUSE+TAU). 79 % of participants completed the primary outcome measures at the primary timepoint (post-treatment). For the primary outcomes, the functioning (SOFAS) score at 12 weeks favoured MUSE+TAU (SOFAS adjusted mean difference 4·19 [95 % CI:10·22 to 1·85] with a Cohen’s d of -0·28 [95 % CI:0·68 to 0·12]) and further improved at 20 weeks (adjusted mean difference -5·33 [95 % CI:11·65 to 1·0]; Cohen’s d -0·35 [95 % CI:0·77 to 0·07]). The other primary outcome measure (PSYRATS-AH) explored impact on USE and found no difference at 12 weeks (mean adjusted difference 0·01 [95 % CI:4·88 to 4·87], Cohen’s d 0·00 [95 % CI:0·48 to 0·48]), but slightly favoured TAU at 20 weeks (adjusted mean difference -1·43 [95 % CI:6·53 to 3·66], Cohen’s d -0·14 [95 % CI:0·64 to 0·36]). MUSE is a promising intervention for therapists to use in support of individuals at risk of psychosis.

Introduction Persecutory delusions are very common in severe mental health disorders such as schizophrenia. Existing treatments often do not work well enough. We developed a face-to-face theory-driven psychological intervention, called Feeling Safe, that produces very large reductions in persistent persecutory delusions. The challenge now is to make Feeling Safe widely available. So, we developed a 6-month supported online version, called Feeling Safer. The aim is an intervention that patients can easily access and use, reduces persecutory delusions and can be supported by a range of mental health professionals in less contact time than face-to-face therapy. Initial proof of concept testing of Feeling Safer was very encouraging. In a randomised controlled trial, we now plan to test whether Feeling Safer is efficacious for patients and can be successfully delivered by any of three different mental health staff groups (peer-support workers, graduate psychologists and cognitive behavioural therapy (CBT) therapists). We will also test whether Feeling Safer works equally across gender, age, ethnicity and cognitive functioning (moderation) and whether Feeling Safer works via the targeted psychological processes (mediation).Methods and analysis The study design is a multicentre, single-blind (outcome assessor), parallel, four-arm randomised controlled trial; 484 patients with persistent persecutory delusions will be randomised to one of the four conditions (1:1:1:1): Feeling Safer (added to treatment as usual (TAU)) supported by peer-support workers, or Feeling Safer (added to TAU) supported by graduate mental health workers including assistant psychologists, or Feeling Safer (added to TAU) supported by CBT therapists or TAU. Feeling Safer will be provided for 6 months with a staff member. Assessments will be conducted at 0, 3, 6 and 9 months by research assistants blind to group allocation. The primary outcome is severity of persecutory delusions at 6 months rated with the Psychotic Symptoms Rating Scale—Delusions. The secondary outcomes are other psychiatric symptoms (depression, anxiety, insomnia, agoraphobia and paranoia), psychological well-being, recovery, activity and health-related quality of life. Analysis will be conducted under a treatment policy strategy following the intention-to-treat principle, incorporating data from all participants including those who do not complete treatment. Moderation and mediation will be tested. A within-trial cost-effectiveness analysis will be conducted of Feeling Safer compared with TAU.Ethics and dissemination The trial has received ethical approval from the NHS Health Research Authority (23/LO/0951). Informed consent will be obtained from all participants. A key output will be an open-access publication in a peer-reviewed journal reporting on the clinical effectiveness of a high-quality supported online programme for the treatment of persecutory delusions that has the potential to be used at scale in mental health services.Trial registration number ISRCTN93974770.

Background Symptoms of complex post-traumatic stress disorder (cPTSD) may play a role in the maintenance of psychotic symptoms. Network analyses have shown interrelationships between post-traumatic sequelae and psychosis, but the temporal dynamics of these relationships in people with psychosis and a history of trauma remain unclear. We aimed to explore, using network analysis, the temporal order of relationships between symptoms of cPTSD (i.e. core PTSD and disturbances of self-organization [DSOs]) and psychosis in the flow of daily life. Methods Participants with psychosis and comorbid PTSD ( N = 153) completed an experience-sampling study involving multiple daily assessments of psychosis (paranoia, voices, and visions), core PTSD (trauma-related intrusions, avoidance, hyperarousal), and DSOs (emotional dysregulation, interpersonal difficulties, negative self-concept) over six consecutive days. Multilevel vector autoregressive modeling was used to estimate three complementary networks representing different timescales. Results Our between-subjects network suggested that, on average over the testing period, most cPTSD symptoms related to at least one positive psychotic symptom. Many average relationships persist in the contemporaneous network, indicating symptoms of cPTSD and psychosis co-occur, especially paranoia with hyperarousal and negative self-concept. The temporal network suggested that paranoia reciprocally predicted, and was predicted by, hyperarousal, negative self-concept, and emotional dysregulation from moment to moment. cPTSD did not directly relate to voices in the temporal network. Conclusions cPTSD and positive psychosis symptoms mutually maintain each other in trauma-exposed people with psychosis via the maintenance of current threat, consistent with cognitive models of PTSD. Current threat, therefore, represents a valuable treatment target in phased-based trauma-focused psychosis interventions.

BACKGROUND:Altered functional connectivity in several functional networks has been found in people with psychosis, especially in the default mode (DMN), salience (SAL) and central executive (CEN) networks. Functional connectivity in people with psychosis is influenced by traumatic life experiences. Trauma histories typical of people with psychosis are associated with complex post-traumatic stress disorder (cPTSD), but no studies have explored whether post-traumatic sequelae contribute to functional dysconnectivity in people with psychosis. METHODS:Using resting-state fMRI, we compared two groups meeting diagnostic criteria for schizophrenia spectrum disorders (N = 106); one group additionally met ICD-11 criteria for comorbid cPTSD, whereas the other did not. We assessed between-group differences in functional connectivity between 15 pre-defined regions of the DMN, SAL and CEN. Post-hoc correlations were used to test whether intra- and/or inter-network connectivity related to cPTSD symptom severity in the comorbid cPTSD group. RESULTS:The comorbid cPTSD group demonstrated significantly lower functional connectivity within the DMN, SAL and CEN, as well as increased negative connectivity between the SAL and CEN. The control group showed significantly decreased connectivity of the DMN with the SAL and CEN. PTSD symptoms correlated positively with intra-SAL connectivity and DMN-SAL dysconnectivity, whereas DSOs correlated positively with intra-SAL dysconnectivity and reduced DMN-CEN connectivity. CONCLUSIONS:Our findings broadly align with the tripartite network model explaining psychopathology in terms of DMN, SAL and CEN dysconnectivity. Intra-network dysconnectivity in subgroups of people with psychosis may relate to post-traumatic sequelae, whereas inter-network dysconnectivity may be more central in trauma-unrelated psychoses.

BACKGROUND:Hallucinations and other unusual sensory experiences (USE) are common in people with psychosis. Yet access to effective psychological therapies remains limited. We evaluated if we can increase access to psychological therapy by using a brief treatment, focused only on understanding and dealing with hallucinations (Managing Unusual Sensory Experiences; MUSE), delivered by a less trained but more widely available workforce that harnessed the benefits (engaging content, standardisation) afforded by digital technology. The delivery of this in a real-world setting was considered within the non-adoption, abandonment, scale-up, spread, and sustainability (NASSS) framework. METHOD:Thirty-eight people with psychosis and distressing hallucinatory experiences were offered sessions of MUSE, delivered by trained and supervised assistant psychologists. MUSE was evaluated within an uncontrolled study conducted in routine clinical practice. Assessments pre- and post-treatment enabled consideration of the impact of the real-world intervention. RESULTS:There was good uptake (88.4%), and receipt of MUSE (89% received four or more sessions). On average participants received 8.69 sessions. The participants reported significant reductions in voice hearing, paranoia, as well as improved quality of life. The feedback from the participants indicated that MUSE delivered by a less trained workforce was acceptable and beneficial. CONCLUSIONS:In a real-world setting we were able to offer and deliver sessions of a brief psychological psycho-education and coping skills enhancement package to people with distressing USE in the context of psychosis. The delivery of MUSE when considered against the NASSS framework appears to be a good candidate for adoption in services.

BACKGROUND:Individuals with an at risk mental state (ARMS) often experience hallucinatory-type experiences, which we refer to as unusual sensory experiences (USE). However, it is not known whether individuals want to know more about USE or discuss these in therapy. Our preferences study asked whether individuals who are referred into a treatment trial for USE in ARMS consider attention to USE important. METHODS:Ninety-four service users of ARMS services within two UK National Health Service (NHS) mental health trusts completed the study-specific, "Preferences for psychological therapy or support" questionnaire. Questions elicited preferences for target of therapeutic work and therapist approach. Analysis employs a repeated measures ANOVA with post hoc analysis of difference between preferences. RESULTS:Treatment preferences which help understand causes of USE and how to manage USE were the group priority above talking therapy generally or a focus on low mood or anxiety. Provision of medication was the lowest priority in treatment preference though it was important to some. Overall, working with a therapist to make sense of experiences was more important than having space to talk, new ideas for coping, or working collaboratively on goals. CONCLUSIONS:Psychological intervention for individuals with at-risk mental state needs to include acceptable and credible psychoeducation on causes of USE and how to manage these.

BackgroundOne in three people with psychosis experience visions. However, little is known about what people see, and current treatments have limited benefits.ObjectivesTo improve the understanding and treatment of visions, this study explored the phenomenology of visions in people with psychosis.MethodsTwelve people with psychosis participated in semi-structured interviews. Reflective thematic analysis was used.ResultsThree main themes were generated covering important aspects of phenomenology: 'Content', 'Coherence' and 'Quality'. The first theme 'Content: People see people', demonstrated that the most distressing visions were of people. The second theme 'Coherence: Visions of people who behave like people', captured how visions were coherent with real human behaviour, often by being multimodal experiences that spoke to and touched the observer. The third theme, 'Quality: They look too real' highlighted the compelling sense of authenticity of the visions, making them indistinguishable from reality.ConclusionVisions represent what we expect to see in everyday life: people, who act and look real. This powerful combination provides insight into the absorbing and all-encompassing nature of visions and their impact on participant's lives. The framework of 'Content', 'Coherence' and 'Quality' provides guidance to support clinicians and researchers to better explore the phenomenology of visions in psychosis.

Hallucinations are a common feature of psychosis, yet access to effective psychological treatment is limited. The Managing Unusual Sensory Experiences for First-Episode-Psychosis (MUSE-FEP) trial aimed to establish the feasibility and acceptability of a brief, hallucination-specific, digitally provided treatment, delivered by a non-specialist workforce for people with psychosis. MUSE uses psychoeducation about the causal mechanisms of hallucinations and tailored interventions to help a person understand and manage their experiences. We undertook a two-site, single-blind (rater) Randomised Controlled Trial and recruited 82 participants who were allocated 1:1 to MUSE and treatment as usual (TAU) (n=40) or TAU alone (n=42). Participants completed assessments before and after treatment (2 months), and at follow up (3-4 months). Information on recruitment rates, adherence, and completion of outcome assessments was collected. Analyses focussed on feasibility outcomes and initial estimates of intervention effects to inform a future trial. The trial is registered with the ISRCTN registry 16793301. Criteria for the feasibility of trial methodology and intervention delivery were met. The trial exceeded the recruitment target, had high retention rates (87.8%) at end of treatment, and at follow up (86.6%), with good acceptability of treatment. There were 3 serious adverse events in the therapy group, and 5 in the TAU group. Improvements were evident in both groups at the end of treatment and follow up, with a particular benefit in perceived recovery in the MUSE group. We showed it was feasible to increase access to psychological intervention but a definitive trial requires further changes to the trial design or treatment.

Auditory hallucinations are common in people with histories of adversity, possibly indicating a causal relationship. However, hallucinations occur in multiple sensory modalities and the relationship between trauma and hallucinations in other sensory domains is less explored. We examined the occurrence of hallucinatory experiences in different sensory modalities in people with psychosis who also met criteria for Post-Traumatic Stress Disorder (n = 67). Particular attention was paid to the number of modalities reported and whether the experiences were linked to the person's adversity. This linkage was explored in two ways. First, it was predicted that those people reporting more trauma experiences and symptoms of PTSD would report a greater number of hallucination modalities. Second, we examined if there was content or thematic linkage between the trauma and the hallucinatory experiences. There were high levels of reported auditory (89.6 %), visual (58.2 %) and tactile (46.3 %) hallucinations. Hallucinations in two or more modalities were the norm (71.6 % of the participants). The number of hallucination modalities was moderately associated with a greater number of past traumas and PTSD symptoms. There was a high degree of content and thematic linkage between the trauma and the hallucinations. The linkage between trauma and auditory hallucinations extends to other sensory domains.

Background Post-traumatic stress disorder (PTSD) has been shown to predict psychotic symptomology. However, few studies have examined the relative contribution of PTSD compared to broader post-traumatic sequelae in maintaining psychosis. Complex PTSD (cPTSD), operationalized using ICD-11 criteria, includes core PTSD (intrusions, avoidance, hyperarousal) as well as additional "disturbances of self-organisation" (DSO; emotional dysregulation, interpersonal difficulties, negative self-concept) symptoms, more likely to be associated with complex trauma histories. It was hypothesized that DSOs would be associated with positive psychotic symptoms (paranoia, voices, and visions) in daily life, over and above core PTSD symptoms.Methods This study (N = 153) employed a baseline subsample of the Study of Trauma And Recovery (STAR), a clinical sample of participants with comorbid post-traumatic stress and psychosis symptoms. Core PTSD, DSO and psychosis symptoms were assessed up to 10 times per day at quasi-random intervals over six consecutive days using Experience Sampling Methodology.Results DSOs within the preceding 90 min predicted paranoia, voices, and visions at subsequent moments. These relationships persisted when controlling for core PTSD symptoms within this timeframe, which were themselves significant. The associations between DSOs and paranoia but not voices or visions, were significantly stronger than those between psychosis and core PTSD symptoms.Conclusions Consistent with an affective pathway to psychosis, the findings suggest that DSOs may be more important than core PTSD symptoms in maintaining psychotic experiences in daily life among people with comorbid psychosis and cPTSD, and indicate the potential importance of addressing broad post-traumatic sequelae in trauma-focused psychosis interventions.

INTRODUCTION:Vivid mental imagery has been proposed to increase the likelihood of experiencing hallucinations. Typically, studies have employed a modality general approach to mental imagery which compares imagery across multiple domains (e.g., visual, auditory and tactile) to hallucinations in multiple senses. However, modality specific imagery may be a better predictor of hallucinations in the same domain. The study examined the contribution of imagery to hallucinations in a non-clinical sample and specifically whether imagery best predicted hallucinations at a modality general or modality specific level. METHODS:In study one, modality general and modality specific accounts of the imagery-hallucination relationship were contrasted through application of self-report measures in a sample of 434 students. Study two used a subsample (n = 103) to extend exploration of the imagery-hallucinations relationship using a performance-based imagery task. RESULTS:A small to moderate modality general relationship was observed between self-report imagery and hallucination proneness. There was only evidence of a modality specific relationship in the tactile domain. Performance-based imagery measures were unrelated to hallucinations and self-report imagery. CONCLUSIONS:Mental imagery may act as a modality general process increasing hallucination proneness. The observed distinction between self-report and performance-based imagery highlights the difficulty of accurately measuring internal processes.

Objectives. There is a paucity of psychological treatments for visual hallucinations (VH). A key aspect in the psychological treatment of hallucination-related distress is normalisation to explain that these experiences are commonplace and can be non-distressing. In order to normalise VH, it is vital that more is known about VH in non-clinical populations. This study investigated the prevalence, content, context, appraisals, distress, and behavioural reactions to VH in a non-clinical sample. Design. A cross-sectional study was conducted. Methods. 466 students completed the Multi-Modality Unusual Sensory Experiences Questionnaire-VH subscale with additional contextual follow-up questions. Results. Of the 466 participants, 395 (84.8%) reported anomalous visual experiences. 176 (37.77%) participants reported VH similar to the content seen in psychosis. Of the overall sample, 17.38% felt their experience met the VH definition. Participants mainly saw figures, when alone and in the evening. Participants endorsed normalising appraisals: 112 out of 176 (78.87%) believed their mind was playing tricks on them and 83 (58.45%) believed they were tired. However, many also believed the VH was a threat to their mental (66, 46.48%) or physical well-being (41, 28.87%). These negative appraisals were associated with distress. Conclusion. VH are seemingly common in non-clinical populations and are similar in a number of ways to those of people with psychosis. Awareness that VH occur on a continuum could normalise people's experiences and reduce their negative appraisals and related distress.

IntroductionIndividuals who access at-risk mental state (ARMS) services often have unusual sensory experiences and levels of distress that lead them to seek help. The Managing Unusual Sensory Experiences (MUSE) treatment is a brief symptom targeted intervention that draws on psychological explanations to help account for unusual experiences. Practitioners use formulation and behavioural experiments to support individuals to make sense of their experiences and enhance coping strategies. The primary objective of this feasibility trial is to resolve key uncertainties before a definitive trial and inform parameters of a future fully powered trial.Methods and analysis88 participants aged 14–35 accepted into ARMS services, experiencing hallucinations/unusual sensory experiences which are considered by the patient to be a key target problem will be recruited from UK National Health Service (NHS) sites and randomised using 1:1 allocation (stratified by site, gender, and age) to either 6–8 sessions of MUSE or time-matched treatment as usual. Participants and therapists will be unblinded, research assessors are blinded. Blinded assessment will occur at baseline, 12 weeks and 20 weeks postrandomisation. Data will be reported in line with Consolidated Standards of Reporting Trials. Primary trial outcomes are feasibility outcomes, primary participant outcomes are functioning and hallucinations. Additional analysis will investigate potential psychological mechanisms and secondary mental well-being outcomes. Trial progression criteria follows signal of efficacy and uses an analytical framework with a traffic-light system to determine viability of a future trial. Subsequent analysis of the NHS England Mental Health Services Data Set 3 years postrandomisation will assess long-term transition to psychosis.Ethics and disseminationThis trial has received Research Ethics Committee approval (Newcastle North Tyneside 1 REC; 23/NE/0032). Participants provide written informed consent; young people provide assent with parental consent. Dissemination will be to ARMS Services, participants, public and patient forums, peer-reviewed publications and conferences.Trial registration numberISRCTN58558617.