Paul Chadwick

Bio: Paul Chadwick is an academic researcher from King's College London. The author has contributed to research in topic(s): Mindfulness & Cognitive therapy. The author has an hindex of 39, co-authored 83 publication(s) receiving 6877 citation(s). Previous affiliations of Paul Chadwick include University of Birmingham & Royal South Hants Hospital.

The omnipotence of voices. A cognitive approach to auditory hallucinations.

Abstract: We offer provisional support for a new cognitive approach to understanding and treating drug-resistant auditory hallucinations in people with a diagnosis of schizophrenia. Study 1 emphasises the relevance of the cognitive model by detailing the behavioural, cognitive and affective responses to persistent voices in 26 patients, demonstrating that highly disparate relationships with voices-fear, reassurance, engagement and resistance-reflect vital differences in beliefs about the voices. All patients viewed their voices as omnipotent and omniscient. However, beliefs about the voice's identity and meaning led to voices being construed as either 'benevolent' or 'malevolent'. Patients provided cogent reasons (evidence) for these beliefs which were not always linked to voice content; indeed in 31% of cases beliefs were incongruous with content, as would be anticipated by a cognitive model. Without fail, voices believed to be malevolent provoked fear and were resisted and those perceived as benevolent were courted. However, in the case of imperative voices, the primary influence on whether commands were obeyed was the severity of the command. Study 2 illustrates how these core beliefs about voices may become a new target for treatment. We describe the application of an adapted version of cognitive therapy (CT) to the treatment of four patients' drug-resistant voices. Where patients were on medication, this was held constant while beliefs about the voices' omnipotence, identity, and purpose were systematically disputed and tested. Large and stable reductions in conviction in these beliefs were reported, and these were associated with reduced distress, increased adaptive behaviour, and unexpectedly, a fall in voice activity. These changes were corroborated by the responsible psychiatrists. Collectively, the cases attest to the promise of CT as a treatment for auditory hallucinations.

Cognitive Therapy for Delusions, Voices and Paranoia

Abstract: A Cognitive View of Delusions and Voices. The Practice of Therapy and the Problem of Engagement. Delusions: Assessment and Formulation. Challenging Delusions. Voices: Engagement and Assessment. Disputing and Testing Beliefs about Voices. Cognitive Therapy for Paranoia. Challenging Cases and Issues. From a Symptom Model to a Person Model. References. Appendices. Index.

Responding mindfully to unpleasant thoughts and images: Reliability and validity of the Southampton mindfulness questionnaire (SMQ)

Abstract: Objective. To assess the reliability and validity of the Southampton mindfulness questionnaire (SMQ), a 16-item measure of mindful awareness of distressing thoughts and images. Methods. A total of 256 people participated, comprising a non-clinical community sample of 134 (83 meditators and 51 non-meditators) and a clinical sample of 122 people with a current distressing psychosis. To assess concurrent validity, non-clinical participants and half clinical participants (total 197 participants) completed the mindful attention awareness scale (MAAS). Predicted links were assessed with affect, and 59 patients completed a validated measure to assess link between mindfulness and intensity of 'delusional' experience. Results. The scale has a single factor structure, was internally reliable, significantly correlated with the MAAS, showed expected associations with affect, and distinguished among meditators, non-meditators and people with psychosis. Conclusions. The data support use of the SMQ in clinical practice and research to assess mindful responding to distressing thoughts and images.

Cognitive approach to depression and suicidal thinking in psychosis. 1. Ontogeny of post-psychotic depression.

Abstract: Background Depression in schizophrenia is a rather neglected field of study, perhaps because of its confused nosological status. Three course patterns of depression in schizophrenia, including post-psychotic depression (PPD), are proposed. Aims We chart the ontogeny of depression and psychotic symptoms from the acute psychotic episode over a 12-month period and test the validity of the proposed course patterns. Method One hundred and five patients with ICD-10 schizophrenia were followed up on five occasions over 12 months following the acute episode, taking measures of depression, positive symptoms, negative symptoms, neuroleptic exposure and side-effects. Results Depression accompanied acute psychosis in 70% of cases and remitted in line with the psychosis; 36% developed PPD without a concomitant increase in psychotic symptoms. Conclusions The results provided support for the validity of two of the three course patterns of depression in schizophrenia, including PPD. Post-psychotic depression occurs de novo without concomitant change in positive or negative symptoms.

The omnipotence of voices: testing the validity of a cognitive model.

Abstract: BACKGROUND: A preliminary report by the authors suggested that the range of affect generated by voices (anger, fear, elation) was linked not to the form, content or topography of voice activity, but to the beliefs patients held about them, in particular their supposed power and authority. We argued that this conformed to a cognitive model; that is, voice beliefs represent an attempt to understand the experience of voices, and cannot be understood by reference to the form/content of voices alone. This study puts this cognitive model to empirical test. METHODS: Sixty-two voice hearers conforming to ICD-10 schizophrenia or schizoaffective diagnoses were interviewed and completed standardized measures of voice activity; beliefs about voices and supporting evidence, coping behaviour; affect and depression. RESULTS: Beliefs about the power and meaning of voices showed a close relationship with coping behaviour and affect (malevolent voices were associated with fear and anger and were resisted; benevolent voices were associated with positive effect and were engaged) and accounted for the high rate of depression in the sample (53%). Measures of voice form and topography did not show any link with behaviour or affect and in only one-quarter of cases did neutral observers rate voice beliefs as 'following directly' from voice content. CONCLUSION: The study found support for our cognitive model and therapeutic approach. Factors governing the genesis of these key beliefs remain unknown. A number of hypotheses are discussed, which centre around the possibility that voice beliefs develop as part of an adaptive process to the experience of voices, and are underpinned by core beliefs about the individuals self-worth and interpersonal schemata. Language: en

The validity of the Hospital Anxiety and Depression Scale: An updated literature review

Abstract: Objective: To review the literature of the validity of the Hospital Anxiety and Depression Scale (HADS). Method: A review of the 747 identified papers that used HADS was performed to address the following questions: (I) How are the factor structure, discriminant validity and the internal consistency of HADS? (II) How does HADS perform as a case finder for anxiety disorders and depression? (III) How does HADS agree with other self-rating instruments used to rate anxiety and depression? Results: Most factor analyses demonstrated a twofactor solution in good accordance with the HADS subscales for Anxiety (HADS-A) and Depression (HADS-D), respectively. The correlations between the two subscales varied from .40 to .74 (mean .56). Cronbach’s alpha for HADS-A varied from .68 to .93 (mean .83) and for HADS-D from .67 to .90 (mean .82). In most studies an optimal balance between sensitivity and specificity was achieved when caseness was defined by a score of 8 or above on both HADS-A and HADS-D. The sensitivity and specificity for both HADS-A and HADS-D of approximately 0.80 were very similar to the sensitivity and specificity achieved by the General Health Questionnaire (GHQ). Correlations between HADS and other commonly used questionnaires were in the range .49 to .83. Conclusions: HADS was found to perform well in assessing the symptom severity and caseness of anxiety disorders and depression in both somatic, psychiatric and primary care patients and in the general population. D 2002 Elsevier Science Inc. All rights reserved.

The concept of mind

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Construct Validity of the Five Facet Mindfulness Questionnaire in Meditating and Nonmeditating Samples.

Abstract: Previous research on assessment of mindfulness by self-report suggests that it may include five component skills: observing, describing, acting with awareness, nonjudging of inner experience, and nonreactivity to inner experience. These elements of mindfulness can be measured with the Five Facet Mindfulness Questionnaire (FFMQ). The authors investigated several aspects of the construct validity of the FFMQ in experienced meditators and nonmeditating comparison groups. Consistent with predictions, most mindfulness facets were significantly related to meditation experience and to psychological symptoms and well-being. As expected, relationships between the observing facet and psychological adjustment varied with meditation experience. Regression and mediation analyses showed that several of the facets contributed independently to the prediction of well-being and significantly mediated the relationship between meditation experience and well-being. Findings support the construct validity of the FFMQ in a combination of samples not previously investigated.

The Illusion of Conscious Will

Abstract: Do we consciously cause our actions, or do they happen to us? Philosophers, psychologists, neuroscientists, theologians, and lawyers have long debated the existence of free will versus determinism. In this book Daniel Wegner offers a novel understanding of the issue. Like actions, he argues, the feeling of conscious will is created by the mind and brain. Yet if psychological and neural mechanisms are responsible for all human behavior, how could we have conscious will? The feeling of conscious will, Wegner shows, helps us to appreciate and remember our authorship of the things our minds and bodies do. Yes, we feel that we consciously will our actions, Wegner says, but at the same time, our actions happen to us. Although conscious will is an illusion, it serves as a guide to understanding ourselves and to developing a sense of responsibility and morality. Approaching conscious will as a topic of psychological study, Wegner examines the issue from a variety of angles. He looks at illusions of the will -- those cases where people feel that they are willing an act that they are not doing or, conversely, are not willing an act that they in fact are doing. He explores conscious will in hypnosis, Ouija board spelling, automatic writing, and facilitated communication, as well as in such phenomena as spirit possession, dissociative identity disorder, and trance channeling. The result is a book that sidesteps endless debates to focus, more fruitfully, on the impact on our lives of the illusion of conscious will.