Dataset Information

The experience of body image concerns in patients with persecutory delusions: 'People don't want to sit next to me'.

ABSTRACT: OBJECTIVE:Persecutory delusions typically build on feelings of inter-personal vulnerability linked to negative views of the self. Negative body image is an overlooked aspect of this link between the self-concept and paranoia. DESIGN:This study explores body image from the first-person perspective of patients with persecutory delusions. METHOD:Semi-structured interviews, analysed using interpretative phenomenological analysis, were conducted with twelve patients with persecutory delusions in the context of psychotic disorders. RESULTS:Four super-ordinate themes emerged. First, appearance as a source of threat accounted for how negative body image increased feelings of vulnerability and fed into the content of paranoia and voices (e.g., 'I feel that everybody is noticing that I'm getting bigger and bigger and laughing at me'). Second, there was the negative impact of uncontrollable and unwanted weight gain, especially following antipsychotic medication (e.g., 'I ballooned up to 23 stone'). Third, feeling stuck captured the hopelessness and resignation in relation to appearance (e.g., 'I've become so accustomed to being overweight that I've accepted it as my lot'). Finally, looking well symbolises feeling well represented the importance of appearance in determining mental well-being (e.g., 'If I've got clean clothes and I put makeup on, at least I feel that I'm looking after myself'). CONCLUSIONS:Patients with persecutory delusions described appearance-related concerns making them feel negative towards themselves, inferior to other people, and vulnerable to harm. Appearance-related distress was broader than weight gain, including dissatisfaction with skin, clothing, and attractiveness. Negative body image may be a contributory factor in the occurrence of paranoia. PRACTITIONER POINTS:Body image concerns may be of particular relevance in patients with persecutory delusions due to weight gain, inactivity, and medication side effects. Body image concerns include weight gain and broader aspects of appearance. Negative body image contributes to feelings of vulnerability, potentially worsening paranoid fears. It may be helpful for practitioners to explore the psychological impact of weight gain and body image concerns in patients with psychosis.

SUBMITTER: Marshall E

PROVIDER: S-EPMC7496653 | biostudies-literature | 2020 Sep

REPOSITORIES: biostudies-literature

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The experience of body image concerns in patients with persecutory delusions: 'People don't want to sit next to me'.

Marshall Emily E Freeman Daniel D Waite Felicity F

Psychology and psychotherapy 20190810 3

<h4>Objective</h4>Persecutory delusions typically build on feelings of inter-personal vulnerability linked to negative views of the self. Negative body image is an overlooked aspect of this link between the self-concept and paranoia.<h4>Design</h4>This study explores body image from the first-person perspective of patients with persecutory delusions.<h4>Method</h4>Semi-structured interviews, analysed using interpretative phenomenological analysis, were conducted with twelve patients with persecu ...[more]

PMID: 31400080

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Project description:BackgroundSit-stand desk interventions have the potential to reduce workplace sedentary behaviour and improve employee health. However, the extent of sit-stand desk use varies between employees and in different organisational contexts. Framed by organisational cultural theory and product design theory, this study examined employees' lived experience of taking part in a workplace sit-stand desk intervention, to understand the processes influencing feasibility and acceptability.MethodsParticipant observations and qualitative interviews were conducted with 15 employees from two office-based workplaces in the UK, as part of a process evaluation that ran alongside a pilot RCT of a workplace sit-stand desk intervention. Observational field notes and transcripts were analysed using thematic analysis.ResultsThree themes related to the experience of using a sit-stand desk at work were generated: employees' relationship with their sit-stand desk; aspirations and outcomes related to employee health and productivity; and cultural norms and interpersonal relationships. The perceived usability of the desk varied depending on how employees interacted with the desk within their personal and organisational context. Employees reported that the perceived influence of the desk on their productivity levels shaped use of the desk; those who perceived that standing increased energy and alertness tended to stand more often. Sit-stand desks were voiced as being more acceptable than intervention strategies that involve leaving the desk, as productivity was conflated with being at the desk.ConclusionsThe findings indicate a range of organisational, social-cultural and individual-level factors that shape the feasibility and acceptability of sit-stand desk use, and suggest strategies for improving employees' experiences of using a sit-stand desk at work, which might positively influence sedentary behaviour reduction and health.Trial registrationClinicaltrials.gov identifier NCT02172599, 22nd June 2014 (prospectively registered).

Project description:BACKGROUND:Persecutory delusions are a major psychiatric problem and are associated with a wide range of adverse outcomes. Our theoretical model views these delusions as unfounded threat beliefs which persist due to defence behaviours (e.g. avoidance) that prevent disconfirmatory evidence being processed. The treatment implications are that patients need to (1) go into feared situations and (2) not use defence behaviours. This enables relearning of safety and hence paranoia diminution. However, this is very difficult for patients due to their severe anxiety. A solution is to use virtual reality (VR) social situations, which are graded in difficulty and which patients find much easier to enter. We have now automated the provision of cognitive therapy within VR using an avatar coach, so that a therapist is not required and the treatment is scalable. In the THRIVE trial, the automated VR cognitive treatment will be tested against a VR control condition. It will contribute to our wider programme of work developing VR for patients with psychosis. METHODS:Patients with persistent persecutory delusions in the context of non-affective psychosis will be randomised (1:1) to the automated VR cognitive treatment or VR mental relaxation (control condition). Each VR treatment will comprise approximately four sessions of 30 min. Standard care will remain as usual in both groups. Assessments will be carried out at 0, 2, 4 (post treatment), 8, 16, and 24?weeks by a researcher blind to treatment allocation. The primary outcome is degree of conviction in the persecutory delusion (primary endpoint 4?weeks). Effect sizes will be re-established by an interim analysis of 30 patients. If the interim effect size suggests that the treatment is worth pursuing (d?>?0.1), then the trial will go on to test 90 patients in total. Secondary outcomes include real world distress, activity levels, suicidal ideation, and quality of life. Mediation will also be tested. All main analyses will follow the intention-to-treat principle. The trial is funded by the Medical Research Council Developmental Pathway Funding Scheme. DISCUSSION:The trial will provide the first test of automated cognitive therapy within VR for patients with psychosis. The treatment is potentially highly scalable for treatment services. TRIAL REGISTRATION:ISRCTN, ISRCTN12497310 . Registered on 14 August 2018.

Dataset Information

The experience of body image concerns in patients with persecutory delusions: 'People don't want to sit next to me'.

Publications

The experience of body image concerns in patients with persecutory delusions: 'People don't want to sit next to me'.

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