Appraisals and intention to regulate psychotic-like experiences

Experiences are believed to exist on a continuum from mundane to anomalous. There is also evidence suggesting that psychosis symptoms exist on a continuum and psychotic-like experiences (PLEs) have been found to exist in the general population. Not much research has focused on the question of when does a person intend to “do something” to change the way they feel about an experience. Intending to change an experience or how someone feels about an experience may include seeking help but it may include a range of other behaviours. The cognitive model of psychosis suggests that how PLEs are appraised is important for mental health outcome and whether a person is diagnosed with a psychotic disorder or not. The aims of this thesis are: 1. To better understand current research on how appraisals of a range of PLEs impact mental health outcomes; and 2. To investigate the factors involved in when a person decides to “do something” to regulate psychotic-like experiences. The first part of this thesis is comprised of a systematic literature review of appraisals of PLEs and their impact on mental health. The search strategy identified forty-two eligible studies. Most of the studies were cross-sectional in design. All studies measured the association between appraisal and mental health outcome. Twenty-four studies evaluated appraisal of voice, seven measured psychotic-like experiences generally, and eleven focused on delusions and hallucinations. Appraisals of PLEs were mostly comparable across experiences in how they impacted mental health outcomes. Appraised threat, intrusiveness, omnipotence, lack of support, conviction, and externality were associated with poorer mental health outcomes across several experiences. Appraising the experience as spiritual or normalising was also associated with better mental health outcomes across experiences. This review has found evidence for an association between appraisal type and mental health outcomes and this was mainly consistent across different types of experiences. Future research would benefit from longitudinal studies, investigating the use of different therapies, having more robust designs, and considering the interplay between appraisals and how they impact mental health. The results support the use of cognitive behavioural approaches and to consider other factors which might contribute to poorer mental health outcomes. The second part of this thesis reports the findings of a cross-sectional study looking at what factors are involved in intention to regulate PLEs. The theory of planned behaviour was used as a framework to help answer our research question. 198 volunteers from the general population participated. Participants were asked to report if they had ever had a range of experiences from the Community Assessment of Psychic Experiences (CAPE), including depressive experiences and positive and negative psychotic-like experiences. Attitudinal, normative, and control beliefs were associated with intention to regulate psychotic-like and depressive experiences, to varying degrees. Perceived behavioural control had the most consistent association with intentions to regulate. Descriptive norms were also found to be consistently associated with intentions to regulate. It would be helpful for future research to consider the role of cultural beliefs. The research also highlights the importance of perceived control and creating environments where people feel like change is possible if they want it.