Feeling de-humanised by distressing psychotic voices: Developing our understanding and psychological therapy.
John Grace QC PhD Scholarship 2021 - Bath University
Supervisors: Professor Paul Chadwick & Dr. Pamela Jacobsen
Hearing voices, also called auditory hallucinations, is a common experience for people with mental health difficulties such as psychosis, schizophrenia, schizoaffective disorder, bipolar depression, and severe depression. Some people who hear voices have reported that one of the most upsetting things about the experience, is the feeling that it sets them apart from other people in some way, and makes them less than ‘human’. This experience of ‘de-humanisation’ has been little explored in psychosis so far, but may be crucial in understanding how to reduce distress and increase quality of life for people affected by it. Our proposal is for a study which would first map out what we know about de-humanisation already, both in psychosis and in other health conditions. We would do this by searching thoroughly through the existing published literature, using a transparent and replicable method known as a systematic review. The next stage of the study would be a qualitative study of the experience of de-humanisation in people with a diagnosis of psychosis, or schizophrenia, who hear voices. This would involve individual, in-depth, interviews with participants, which would be audio-taped and transcribed for analysis. We would involve people with lived experience of hearing voices in the design and planning of the qualitative study, including designing the list of questions to be asked during the interviews. The final stage of the study would be developing and trying out a group-based therapy which would be designed to help reduce feelings of de-humanisation for people who hear voices.
To develop a psychological model of the process of feeling dehumanised by distressing voices, and to pilot a psychological therapy which targets key processes that underlie and maintain dehumanisation in voice-hearing.
Research Student: Tom Jenkins
Hi, my name is Tom and I am about to commence my PhD studies at the Bath Centre for Mindfulness and Compassion with Professor Paul Chadwick and Dr. Pamela Jacobsen. The work will seek to understand more about the de-humanisation experienced by people who hear voices and aim to develop a group-based mindfulness therapy to reduce associated distress.
I originally studied Sport and Exercise Science at the University of Birmingham and then worked as a Healthcare Assistant in a psychiatric hospital. This experience sparked my passion for mental health and created a strong desire to pursue a career within the field. Following work in other healthcare roles, I am now completing a Psychological Science MSc Conversion course at the University of Glasgow. I am particularly interested in mindfulness, therapeutic interventions and the etiology of mental health conditions. Alongside my studies, I work as a Support Worker for a mental health charity providing living assistance to people experiencing addictions and homelessness.
I am incredibly grateful for the opportunity and scholarship provided by MHRUK and look forward to undertaking this project.
Progress report Year 2, 2023
The past year, my focus has been on data collection for my main PhD project, which is the development of a questionnaire for measuring ‘self-dehumanisation’ in psychosis. Self-dehumanisation is when a person feels less, or other than human. To do this, I first conducted a literature review to identify previous measures and conceptualisations of self-dehumanisation. Secondly, I gathered data from a qualitative study conducted by a colleague on experiences of dehumanisation in psychosis. I then worked with a group of People with Personal Experience (PPE) to develop a list of statements describing how self-dehumanisation can be experienced to create a first draft of the questionnaire. This long list of statements has now been put into a Delphi study – a process by which expert stakeholders (in our case, this is people with experience of psychosis, carers of people with psychosis, mental health professionals, and dehumanisation researchers) decide on the importance of each statement for measuring self-dehumanisation. The Delphi aims to reach a consensus between all groups of stakeholders, with the hope of ensuring that the statements deemed to be most important will be those which most accurately reflect self-dehumanisation.
We are currently midway through the Delphi study, which is due to be completed by the end of August. Once the data for this has been analysed, a refined version of the questionnaire will be available. I will then conduct cognitive interviews, whereby people with psychosis will be invited to complete the questionnaire, verbalise their thought processes for each statement, and comment on the content of the questionnaire. This will allow us to gain valuable feedback and amend the questionnaire to make it more comprehensible and user-friendly. Once this is complete, we will ask a large sample of people with psychosis to complete the questionnaire and conduct statistical analyses on their responses to ascertain the measure is both reliable and valid.
I have had three articles published this year. These are available open access and include the a chapter from my PhD (‘Dehumanization and mental health: clinical implications and future directions’), a mindfulness for voices experimental study, and a discussion on the challenges in the field of mindfulness research. I have recently acted as a peer reviewer for a journal, which was a very insightful experience, and enhanced my skills in critically evaluating research.
I have presented my PhD research at several conferences this year, including British Association for Behavioural and Cognitive Psychotherapies (BABCP) 2022, Beckfest 2023, and 7th Annual Patient Reported Outcome Measures (PROMs) 2023 conference. I have found these to be enriching and rewarding experiences, and have enjoyed sharing our research, meeting other researchers, and hearing about innovative ideas.
Alongside my PhD, I have worked as a Graduate Teaching Assistant in the department, working on the first year undergraduate Quantitative Research Methods module, and an introduction to learning R course for postgraduates and staff.
I am very thankful to all at MHRUK for the ongoing funding and support, my brilliant supervisors Paul Chadwick and Pamela Jacobsen, and the University of Bath.
Progress Report Year 1, 2022
It has been almost a year since beginning my research at the University of Bath, and I am hugely grateful for the experience thus far. After settling in, meeting members of the department and other doctoral students, my focus has been on reading, planning and writing about theory and ideas which underpin my PhD research.
So far, I have produced two main pieces of writing. The first is a conceptual review of dehumanisation, which defines the concept of dehumanisation, evaluates its theories, and describe how it is felt by the self – ‘self-dehumanisation’. This piece will form the first chapter of my thesis. The second piece of writing is a collaboration with a colleague from the USA, who I met at a
conference in Tenerife. This is an opinionated review article discussing dehumanisation and mental health, outlining suggestions for therapeutic interventions and future directions for research. We have recently submitted this to the journal and are awaiting a response from the editor. It will form the second chapter of my thesis. Currently, I am writing the third chapter of my thesis, which is a critique of questionnaires that have previously been used to measure self-dehumanisation. I have presented these ideas and plans at the aforementioned conference in Tenerife (E.A.S.P - 20 Years of Dehumanisation: Confronting Social Discourses that Treat People like Non-Human Beings) – a conference that I am very grateful to have received a grant from MHRUK to attend (pictured). I will soon be presenting at BABCP 2022, at Imperial College in London.
Soon, I will begin to work on my first empirical study - the development of a questionnaire to measure feelings of self-dehumanisation. This will be co-created with people with lived experience of psychosis, to ensure that the questions are meaningful to those who will be using the questionnaire. Upon development, the questionnaire will then be tested for reliability and validity, meaning we will perform robust statistical tests to check that it measures self-dehumanisation accurately, as we hope it would. As part of the validation, we plan to give the questionnaire to a sample of people with psychosis, to understand more about the impact that self-dehumanisation may have on mental distress.
Alongside my PhD, I am involved in several collaborative projects with other members of the department. These include a systematic review about service user discharge in psychiatric hospitals; a lab-based mindfulness study; and an article about challenges within mindfulness research. I have also been working as a Graduate Teaching Assistant for the Quantitative Research Methods course for first year Psychology undergraduate students.
I am incredibly thankful to all at MHRUK for your funding and support, and to my two fantastic supervisors, Paul Chadwick and Pamela Jacobsen for all of their advice and guidance. I look forward to the upcoming year, collecting my first bits of data, and developing the questionnaire.