Independence of 'reaction to hypothetical contradiction' from other measures of delusional ideation

Abstract

Background: Given the increasing pressure on Community Mental Health Teams to provide effective services for people with serious mental health problems and the relative scarcity of clinicians working therapeutically with this group, the ongoing search for reliable prognostic factors has both economic and clinical implications. Although previously somewhat overlooked, 'reaction to hypothetical contradiction' (RTHC) has been described as a potential predictor of amenability to psychological treatment for people holding delusional beliefs.

Method: A one-way between-groups design was used to explore the independence of RTHC (accepting vs. non-accepting) from a range of other clinical variables, using a mixed-diagnosis group of 50 people holding delusional beliefs.

Results: Associations were found between RTHC and a range of other clinical variables, including the existence of perceptual experiences and the impact and extent of delusional beliefs. These factors can be difficult to measure, and it is argued that RTHC may be easier to assess than these other variables. RTHC was found to be independent from other variables such as insight, degree of conviction, degree of preoccupation, anxiety and depression.

Implications: Previous research has shown that RTHC is a potential predictor of both spontaneous recovery and response to treatment for people holding delusional beliefs and that assessment of RTHC should be incorporated into initial screening procedures for cognitive-behaviour therapy. The current research found that RTHC was associated with the extent to which delusional beliefs influence thoughts, behaviour and distress levels. One of the major implications of this study is that evaluation of RTHC at initial screening assessments may be important as it provides information not available from mental-state assessments and assessment of insight.