Do psychosocial interventions for psychotic disorders improve quality of life in adults with psychotic disorders in forensic settings?: a systematic review and narrative synthesis and Modified metacognitive training for negative symptoms in psychosis - a feasibility study
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Date
03/07/2018Author
Eriksson, Linda Kristina
Metadata
Abstract
This thesis focuses on psychosocial interventions for psychosis. It consists of two
parts: a systematic review on quality of life in forensic settings and an empirical
study on negative symptoms. The systematic review follows the publication
guidelines of the journal International Journal of Forensic Mental Health whilst the
empirical study follows the publication guidelines of the journal Clinical Psychology
and Psychotherapy. Reasonable adjustments have been made to the formatting of
this thesis to enhance readability.
Purpose: The systematic literature review aimed to summarise and critically
appraise studies that have evaluated the effects of psychosocial interventions for
psychotic disorders in forensic settings on quality of life. The empirical study aimed
to evaluate the feasibility of Metacognitive Training (MCT) for negative symptoms
and to identify mechanisms of change.
Methods: The literature was systematically searched (using four databases) for
research that included any quantitative measure of quality of life (i.e. self-esteem,
quality of life, life satisfaction, and/or self-efficacy in relation to life-goals). In the
empirical study, a new intervention was developed by modifying MCT for negative
symptoms and four aspects of feasibility were evaluated: acceptability, practicality,
demand and limited efficacy. The quantitative approach was supplemented with
qualitative interviews on participants’ views of the intervention. In addition,
potential mechanisms of change were evaluated using a promising new method for
analysing data from case-series: multilevel modeling. Results: In total, 10 papers met the inclusion criteria in the systematic review.
Significant improvements in quality of life were found in five studies. The modified
version of MCT showed good feasibility as demonstrated by the attendance rate, the
positive oral feedback from participants and the multidisciplinary team, and the
improvements on negative symptoms that were found following the intervention.
Multilevel modeling proved useful in explaining the variance attributable to three
different predictors: depression, internalised stigma, and reflective functioning.
Conclusions: It was found that quality of life can be improved in forensic settings
using psychosocial interventions. The pilot study indicated that MCT for negative
symptoms has high feasibility and that changes in negative symptoms can partially
be explained by depression, stigma, and reflective functioning.