Multi-level models have been developed to illustrate the mind's processing of qualitatively different types of information, and therefore provide a useful tool for exploring the actions and interactions of different processing levels within a single theoretical framework. This paper firstly reviews a selection of multilevel models, and then constructs a detailed rationale for applying a multi-level framework to psychosis. The argument draws on a wide psychosis literature, in the areas of positive symptoms, subjective phenomena, risk factors, and cognitive phenomena. In doing so, the discussion highlights some limitations of current (single-level) cognitive models of psychosis, and argues that a multi-level framework not only offers enhanced explanatory power, but also facilitates an integration of the evidence accumulated in different areas of psychosis research. Implications of a multi-level approach are discussed with regards to understanding the ‘psychotic-like’ experiences of both clinical and non-clinical populations. In particular, the roles of emotional meaning and function of psychotic phenomena are emphasised, and the clinical therapeutic tenet of normalisation is encouraged.
APA (American Psychiatric Association) (1987). Diagnostic and Statistical Manual of Mental Disorders (3rd edn). Washington, DC: APA.
2.
BarnardP. (1985). Interacting cognitive subsystems: A psycholinguistic approach to short-term memory. In EllisA. (Ed.), Progress in the psychology of language, Vol. 2.London: Lawrence Erlbaum Associates Ltd.
3.
BarnardP.J. (2003). Asynchrony, implicational meaning and the experience of self in schizophrenia. In KircherT., & DavidA. (Eds.), The Self in Neuroscience and Psychiatry.Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511543708.007
4.
BarnardP.J., & TeasdaleJ.D. (1991). Interacting cognitive subsystems: A systemic approach to cognitive-affective interaction and change. Cognition and Emotion, 5, 1-39. http://dx.doi.org/10.1080/02699939108411021
5.
BatsonC.D., SchoenradeP., & VentisW.L. (1993). Religion and the individual: A social-psychological perspective.New York: Oxford University Press.
6.
BeckA.T. (1976). Cognitive therapy and the emotional disorders.New York: International Universities Press.
7.
BeckA.T. (1997). Beyond belief: A theory of modes, personality, and psychopathology. In SalkovskisP.M. (Ed.), Frontiers of Cognitive Therapy.New York: Guilford Press.
8.
BentallR.P. (2003). Madness explained: Psychosis and human nature.London: Penguin.
9.
BrettC.M.C., PetersE.P., JohnsL.C., TabrahamP., ValmaggiaL.R., & McGuireP. (2007). Appraisals of Anomalous Experiences Interview (AANEX): a multidimensional measure of psychological responses to anomalies associated with psychosis. British Journal of Psychiatry, 191(suppl. S1), s23-s30.
BrewinC.R., DalgleishT., & JosephS. (1996). A dual representation theory of posttraumatic stress disorder. Psychological Review, 103(4), 670-686. http://dx.doi.org/10.1037/0033-295X.103.4.670
12.
BuckleyP. (1981). Mystical experience and schizophrenia. Schizophrenia Bulletin, 7, 516-521.
13.
ChadwickP.K. (2009). Schizophrenia: The Positive Perspective (2nd edn).Hove: Routledge.
14.
ClarkeI. (2001). Psychosis and spirituality: the discontinuity model. In ClarkeI. (Ed.), Psychosis and spirituality: exploring the new frontier.London: Whurr.
15.
ClarkeI. (2002). Introducing further developments towards an ICS formulation of psychosis: a comment on Gumley et al. (1999), An interacting cognitive subsystems model of relapse and the course of psychosis. Clinical Psychology and Psychotherapy, 9(1), 47-50. http://dx.doi.org/10.1002/cpp.290
16.
DalgleishT. (1999). Cognitive theories of post-traumatic stress disorder. In YuleW. (Ed.), Post-traumatic stress disorders: Concepts and Therapy.Chichester: Wiley.
DeanK., & MurrayR.M. (2005). Environmental risk factors for psychosis. Dialogues in Clinical Neuroscience, 7(1), 69-80.
19.
DudleyR.E.J., & OverD.E. (2003). People with delusions jump to conclusions: A theoretical account of research findings on the reasoning of people with delusions. Clinical Psychology and Psychotherapy, 10(5), 263-274. http://dx.doi.org/10.1002/cpp.376
FreemanD., & GaretyP.A. (2004). Paranoia: The Psychology of Persecutory Delusions.Hove: Psychology Press.
23.
FreudS. (1966). Draft H. In StracheyJ. (Ed.), The standard edition of the complete works of Sigmund Freud (Vol. 1, pp. 206-213). London: Hogarth Press.
24.
FrithC.D. (1979). Consciousness, information processing and schizophrenia. British Journal of Psychiatry, 134, 225-235. http://dx.doi.org/10.1192/bjp.134.3.225
GaretyP.A., KuipersE., FowlerD., FreemanD., & BebbingtonP.E. (2001). A cognitive model of the positive symptoms of psychosis. Psychological Medicine, 31(2), 189-195. http://dx.doi.org/10.1017/S0033291701003312
27.
GaretyP.A., & FreemanD. (1999). Cognitive approaches to delusions: a critical review of theories and evidence. British Journal of Clinical Psychology, 38, 113-154. http://dx.doi.org/10.1348/014466599162700
28.
GrayJ.A., FeldonJ., RawlinsJ.N.P., & SmithA.D. (1991). The neuropsychology of schizophrenia. Behavioural and Brain Sciences, 18, 617-680.
29.
GreenbergL.S. (2004). Emotion Special Issue: Introduction. Clinical Psychology and Psychotherapy, 11, 1-2. http://dx.doi.org/10.1002/cpp.387
HayesS.C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioural and cognitive therapies. Behavior Therapy, 35(4), 639-665. http://dx.doi.org/10.1016/S0005-7894(04)80013-3
32.
HemsleyD.R. (2005). The development of a cognitive model of schizophrenia: placing it in context. Neuroscience and Biobehavioural Reviews, 29, 977-988. http://dx.doi.org/10.1016/j.neubiorev.2004.12.008
Heriot-MaitlandC. (2008). Mysticism and madness: Different aspects of the same human experience?Mental Health, Religion and Culture, 11(3), 301-325. http://dx.doi.org/10.1080/13674670701287680
35.
Heriot-MaitlandC., KnightM., & PetersE. (in press). A qualitative comparison of psychotic-like phenomena in clinical and non-clinical populations. British Journal of Clinical Psychology.
36.
JacksonM.C. (2001). Psychotic and spiritual experience: A case study comparison. In ClarkeI. (Ed.), Psychosis and Spirituality: Exploring the new frontier (pp. 165-190). London: Whurr.
37.
JacksonM.C., & FulfordK.W.M. (1997). Spiritual Experience and Psychopathology. Philosophy, Psychiatry and Psychology, 1, 41-65.
38.
JaspersK. (1913). General Psychopathology. Translated by J. Hoenig & M.W. Hamilton (1963). Manchester: Manchester University Press.
39.
JohnsonM.K., & MalthaupK.S. (1992). Emotion and MEM. In ChristiansonS-A. (Ed.), The handbook of emotion and memory: Research and theory.Hillsdale, NJ: Lawrence Erlbaum Associates.
40.
JonesS.H. (2001). Circadian rhythms, multilevel models of emotion and bipolar disorder – an initial step towards integration?Clinical Psychology Review, 21(8), 1193-1209. http://dx.doi.org/10.1016/S0272-7358(01)00111-8
LeventhalH, & SchererK. (1987). The relationship of emotion to cognition: A functional approach to a semantic controversy. Cognition and Emotion, 1, 3-28. http://dx.doi.org/10.1080/02699938708408361
46.
Le DouxJ.E. (1993). Emotional networks in the brain. In LewisM., & HavilandJ.M. (Eds.), Handbook of emotions.New York: Holt.
LovattA., MasonO., BrettC, & PetersE. (2010). Psychotic-Like Experiences, Appraisals, and Trauma. Journal of Nervous and Mental Disease, 198(11), 813-819. http://dx.doi.org/10.1097/NMD.0b013e3181f97c3d
49.
MenninD. (2006). Emotion regulation therapy: An integrative approach to treatment-resistant anxiety disorders. Journal of Contemporary Psychotherapy, 36, 95-105. http://dx.doi.org/10.1007/s10879-006-9012-2
50.
MinasR.K., & ParkS. (2007). Attentional window in schizophrenia and schizotypy: insight from negative priming. Applied and Preventive Psychology, 12, 140-148. http://dx.doi.org/10.1016/j.appsy.2007.09.003
51.
MorrisonA.P. (2001). The interpretation of intrusions in psychosis: An integrative cognitive approach to psychotic symptoms. Behavioural and Cognitive Psychotherapy, 29, 257-276. http://dx.doi.org/10.1017/S1352465801003010
52.
NeumannA., BlairyS., LecompteD., & PhilippotP. (2007). Specificity deficit in the recollection of emotional memories in schizophrenia. Consciousness and Cognition, 16, 469-484. http://dx.doi.org/10.1016/j.concog.2006.06.014
53.
NICE (2004a). Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders.London: NICE.
54.
NICE (2004b). Management of depression in primary and secondary care.London: NICE.
55.
NICE (2009). Core interventions in the treatment and management of schizophrenia in adults in primary and secondary care.London: NICE.
56.
ParnasJ., & HandsetP. (2003). Phenomenology of anomalous self-experience in early schizophrenia. Comprehensive Psychiatry, 44(2), 121-134. http://dx.doi.org/10.1053/comp.2003.50017
57.
PhilippotP., BaeyensC., DouilliezC., & FrancartB. (2004). Cognitive regulation of emotion: Application to clinical disorders. In PhilippotP., & FeldmanR.S. (Eds.), The Regulation of Emotion.Mahweh, NJ: Lawrence Erlbaum Associates.
58.
PoultonR., CaspiA., & MoffitT. (2000). Children's self-reported psychotic symptoms and adult schizphreniform disorder: a 15-year longitudinal study. Archives of General Psychiatry, 57, 1053-1058. http://dx.doi.org/10.1001/archpsyc.57.11.1053
59.
PowerM., & DalgleishT. (1997). Cognition and emotion: From order to disorder.Hove: Psychology Press.
60.
PowerM., & DalgleishT. (2008). Cognition and emotion: From order to disorder (2nd ed.)Hove: Psychology Press.
61.
SchneiderK. (1959). Clinical Psychopathology.Translated by M.W. Hamilton. New York: Grune and Stratton.
62.
SegalZ.V., WilliamsJ.M.G., & TeasdaleJ.D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse.New York: Guilford Press.
63.
SmithC.A., & KirbyL.D. (2000). Consequences require antecedents: towards a process model of emotion elicitation. In ForgasJ.D. (Ed.), Feeling and thinking: the role of affect in social cognition.New York: Cambridge University Press.
64.
SteelC., FowlerD., & HolmesE. (2005). Trauma-related intrusions and psychosis: An information processing account. Behavioural and Cognitive Psychotherapy, 33, 139-152. http://dx.doi.org/10.1017/S1352465804001924
65.
TeasdaleJ.D. (1997). The interacting cognitive subsystems approach. In PowerM., & BrewinC.R. (Eds.), The transformation of meaning in psychological therapies: Integrating theory and practice.Chichester: Wiley.
66.
TeasdaleJ.D., & BarnardP.J. (1993). Affect, cognition and change: Remodelling depressive thought.Hove: Lawrence Erlbaum Associates.
67.
van OsJ., HansenM., BijlR., & RavelliA. (2000). Strauss (1969) revisited: evidence for a psychosis continuum in the general population?Schizophrenia Research, 45, 11-20. http://dx.doi.org/10.1016/S0920-9964(99)00224-8
68.
VerdouxH., Maurice-TisonB., GayB., van OsJ., SalamonR., & BourgeoisM. (1998). A survey of delusional ideation in primary-care patients. Psychological Medicine, 28, 127-134. http://dx.doi.org/10.1017/S0033291797005667
69.
WallasG. (1926). The art of thought.New York: Harcourt.
70.
WellsA., & MatthewsG. (1996). Modelling cognition in emotional disorder: The S-REF model. Behaviour Research and Therapy, 34(11/12), 881-888. http://dx.doi.org/10.1016/S0005-7967(96)00050-2
