Exploration of the relationship between interpersonal trauma in childhood and wellbeing in the context of auditory hallucinations: testing for moderating effects of appraisals and coping.
Background: The first aim of this thesis was to systematically review the evidence for the impact of interpersonal trauma in childhood on appraisals of auditory hallucinations in adulthood. Informed by this systematic review and cognitive models of psychosis, potential moderators of the relationship between trauma and distress were proposed. Hypotheses: It was hypothesised that the experience of interpersonal trauma in childhood would predict ‘self blaming’ and ‘danger to self’ appraisals made by voice hearers about their auditory hallucinations. It was predicted that these appraisals would interact with the use of avoidant and non avoidant coping strategies and that this would predict wellbeing. Method 1 and results: In order to measure voice appraisals, the Interpretation of Voices Inventory was adapted. It was completed by one hundred and thirteen voice hearing participants and confirmatory factor analysis was used to test the predicted factors. Most items covaried with their respective factors acceptably. A number of items did not load well and it was recommended that they be removed from the measure. The amended factor structure improved the fit of the measure to an acceptable standard. Method 2 and results: Sixty two participants completed additional measures of interpersonal trauma in childhood and wellbeing. Structural equation modeling provided support for a link between severity of childhood trauma and ‘danger to self’ appraisals. ‘Danger to self’ appraisals predicted the use of acceptance based coping and this predicted wellbeing. Independent of this model, interpersonal coping was shown to predict the use of psychological explanations for the experience of auditory hallucinations. Psychological explanations did not predict acceptance or wellbeing. Discussion: It may be clinically helpful to test acceptance based interventions using ‘danger to self’ appraisals as an outcome measure in the future. Possible factors that may have influenced the results were reflected on. The potentially negative impact of insight on wellbeing was discussed. Stigma was highlighted as a potential barrier to non avoidant coping