The Cognitive and Behavioural Consequences of Psychotic Experiences

  • Sarah Tully

Student thesis: Phd


This thesis explored the ways in which people experiencing psychosis respond to their distressing experiences. Mixed methodology was used to address the research questions. Chapter two included a thorough systematic review and meta-analysis to investigate the relationship between safety seeking behaviours and psychosis. This review concluded that safety seeking behaviours, avoidance and resistance were associated with increased distress whereas engagement was associated with reduced distress. The review also highlighted some conceptual difficulties with differentiating between safety seeking and coping in this population. Study one, a qualitative exploration of how people respond to the experience of psychosis is presented in chapter four. This study found three key themes relating to perceived importance of responses, accuracy of threat appraisals and perceptions of ability to control experiences. An overarching theme of fighting a daily battle to maintain functioning was also identified. This analysis provided some support for the model of safety seeking responses but also demonstrated additional complexities in the way that people respond to their distressing experiences. Chapter five presents study two, the development and validation of a measure of responses to psychosis. Principal Components Analysis identified three subscales: threat monitoring and avoidance, social control and reassurance seeking and conscious self-regulation attempts. The subscales were found to have good internal consistency and convergent validity. To build on this work, study three used Structural Equation Modelling to test an integrative cognitive and metacognitive model of voice hearing (chapter six). In support of this model, it was found that voice hearing predicted beliefs and beliefs predicted responses and negative affect. Responses were not predicted either by voice hearing or negative affect. It was also found that both schematic beliefs and meta-worry mediated the relationship between avoidance and negative affect. Finally, in study four, presented in chapter seven, the response styles of attentional avoidance and attentional focusing were manipulated in response to an ambiguous auditory task in an experimental study. It was found that the attentional avoidance response resulted in a significantly greater increase in words heard during the task. However, the manipulation did not have an impact on distress levels. This thesis has demonstrated significant relationships between response styles, distress, appraisals and voice hearing. This, therefore, confirms the important role of responses to unusual experiences in models of psychosis. It appears that avoidance is likely to be unhelpful however, it should not be assumed that other responses are either helpful or unhelpful as this is likely to be person and context specific. The clinical and research implications of this are discussed.
Date of Award1 Aug 2017
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorAnthony Morrison (Supervisor) & Adrian Wells (Supervisor)


  • Psychosis
  • Schizophrenia
  • Safety seeking behaviour
  • Coping

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