Universität zu Köln

Mehl, Stephanie, Hesse, Klaus, Schmidt, Anna-Christine, Landsberg, Martin W., Soll, Daniel, Bechdolf, Andreas, Herrlich, Jutta, Kircher, Tilo ORCID: 0000-0002-2514-2625, Klingberg, Stefan ORCID: 0000-0001-8081-7181, Mueller, Bernhard W., Wiedemann, Georg, Wittorf, Andreas, Woelwer, Wolfgang and Wagner, Michael ORCID: 0000-0003-2589-6440 (2020). Theory of mind, emotion recognition, delusions and the quality of the therapeutic relationship in patients with psychosis - a secondary analysis of a randomized-controlled therapy trial. BMC Psychiatry, 20 (1). LONDON: BMC. ISSN 1471-244X

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Abstract

Background Cognitive models of psychosis postulate an important role of Theory of mind (ToM) in the formation and maintenance of delusions, but research on this plausible conjecture has gathered conflicting findings. In addition, it is still an open question whether problems in emotion recognition (ER) are associated with delusions. We examined the association of problems in ToM and ER with different aspects of delusions in a large sample of patients with psychosis enrolled in a therapy trial. This also enabled us to explore the possible impact of ToM and ER on one part of patients' social life: the quality of their therapeutic relationship. Methods Patients with psychotic disorders and delusions and/or hallucinations (n = 185) and healthy controls (n = 48) completed a ToM picture sequencing task and an ER task. Subsequently, patients were enrolled in a randomized-controlled Cognitive Behavior Therapy (CBT) trial (ISRCTN29242879). Patients and therapists rated the quality of the therapeutic relationship during the first five sessions of therapy. Results In comparison to controls, patients were impaired in both ToM and ER. Patients with deficits in ER experienced more severe delusional distress, whereas ToM problems were not related to delusions. In addition, deficits in ER predicted a less favorable therapeutic relationship and interactional problems viewed by the therapist. Impaired ER also moderated (increased) the negative influence of delusions on the therapeutic relationship and interactional difficulties viewed by the therapist. Conclusions Cognitive models on the formation and maintenance of delusions should consider ER as a potential candidate that might be related to the formation and maintenance of delusional distress, whereas problems in ToM might not be directly related to delusions and secondary dimensions of delusions. In addition, problems in ER in patients with psychosis might have an impact on the quality of the therapeutic relationship and patients with problems in ER are more likely to be viewed as problematic by their therapists. Nevertheless, training ER might be a way to improve the quality of the therapeutic relationship and potentially the effectiveness of CBT or other interventions for patients with psychosis.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Mehl, Stephanie UNSPECIFIED UNSPECIFIED UNSPECIFIED Hesse, Klaus UNSPECIFIED UNSPECIFIED UNSPECIFIED Schmidt, Anna-Christine UNSPECIFIED UNSPECIFIED UNSPECIFIED Landsberg, Martin W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Soll, Daniel UNSPECIFIED UNSPECIFIED UNSPECIFIED Bechdolf, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Herrlich, Jutta UNSPECIFIED UNSPECIFIED UNSPECIFIED Kircher, Tilo UNSPECIFIED orcid.org/0000-0002-2514-2625 UNSPECIFIED Klingberg, Stefan UNSPECIFIED orcid.org/0000-0001-8081-7181 UNSPECIFIED Mueller, Bernhard W. UNSPECIFIED UNSPECIFIED UNSPECIFIED Wiedemann, Georg UNSPECIFIED UNSPECIFIED UNSPECIFIED Wittorf, Andreas UNSPECIFIED UNSPECIFIED UNSPECIFIED Woelwer, Wolfgang UNSPECIFIED UNSPECIFIED UNSPECIFIED Wagner, Michael UNSPECIFIED orcid.org/0000-0003-2589-6440 UNSPECIFIED
URN:	urn:nbn:de:hbz:38-345081
DOI:	10.1186/s12888-020-2482-z
Journal or Publication Title:	BMC Psychiatry
Volume:	20
Number:	1
Date:	2020
Publisher:	BMC
Place of Publication:	LONDON
ISSN:	1471-244X
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language COGNITIVE-BEHAVIORAL THERAPY; FACIAL AFFECT RECOGNITION; SYMPTOM RATING-SCALES; SOCIAL COGNITION; UNDERSTANDING INTENTIONS; 1ST-EPISODE PSYCHOSIS; PERSECUTORY DELUSIONS; SCHIZOPHRENIA; ALLIANCE; IMPAIRMENTS Multiple languages Psychiatry Multiple languages
URI:	http://kups.ub.uni-koeln.de/id/eprint/34508