Emma Černis

Background: Mental health clinicians have been found to demonstrate stigma towards people withmental illness through both implicit and explicit methodologies. These are thought to representdistinct yet potentially related dimensions of stigma. However, the association between implicit andexplicit stigma is unclear, limiting our understanding of how these could impact clinical outcomes.Aim: This systematic review and meta-analysis aimed to synthesise research on the relation betweenimplicit and explicit stigma among mental health clinicians and examine its potential moderators.Methods: The protocol was preregistered on PROSPERO (CRD42024614725). A systematic searchwas conducted using PsycINFO, PsycArticles, MEDLINE, EMBASE, ProQuest Central, Web ofScience, CINAHL, and Scopus. A random-effects meta-analysis of r-to-z transformed correlationswas conducted along with tests of heterogeneity, moderators and publication bias. The features ofimplicit and explicit measures, methodological quality and clinical outcomes were also extracted.Results: Ten studies (n = 1,404 clinicians) with 11 independent samples were included. There was astatistically significant, but small, positive pooled correlation between implicit and explicit stigmameasures (r = 0.13; 95% CI: 0.04 to 0.23). Heterogeneity was moderate and largely accounted for bystudies examining substance use disorder, which showed a slightly stronger correlation (r = 0.27)than for other psychiatric disorders (r = 0.08). Publication bias was not detected.Conclusions: Implicit and explicit stigma appear to be weakly related, so could be considered largelydistinct constructs among clinicians. Findings underscore the importance of addressing implicit andexplicit stigma in research and practice, which may inform stigma-reduction efforts.

BackgroundDissociative experiences are common and transdiagnostic. Yet causal evidence for psychological mechanisms of dissociation remains scarce, particularly in youth. Our group has developed a translational cognitive-behavioural model of a subset of common dissociative experiences (FSA-dissociation), but causal relationships proposed within this model remain to be tested.AimsThis study sought to experimentally test three causal relationships proposed in the FSA-dissociation CBT model using an interventionist-causal paradigm. A benefit of this method is the opportunity it provides to simultaneously develop targeted therapeutic techniques whilst empirically testing the underlying theory.MethodWe conducted a randomised multiple baseline experimental design study with nine NHS patients (aged 16 to 23), targeting three hypothesised mechanisms of change: cognitive appraisals of dissociation, perseverative thinking, and affect intolerance. The study was registered on ClinicalTrials.gov (NCT06054009). Each participant received four sessions of individual CBT with a clinical psychologist targeting one hypothesised mechanism. ResultsAnalysis indicated successful targeting of cognitive appraisals, and partial success for affect intolerance and perseverative thinking. Findings tentatively support cognitive appraisals and affect intolerance as candidate causal mechanisms in youth dissociation. Any effect of targeting perseverative thinking was better accounted for by reduced cognitive appraisals. DiscussionAlthough phase instability limited inference, this study offers novel causal insights into transdiagnostic dissociation and informs early-stage treatment development for this presentation. Namely, it suggests that future psychological interventions for transdiagnostic dissociation in youth should incorporate targeting of cognitive appraisals, but that further research is required to determine whether affect intolerance constitutes a therapeutic target in this context.

Introduction: Emerging adulthood is a significant period of developmental transition, and recent increases have been observed in mental health diagnoses and service use among people at this stage of life. Coinciding with these increases is a perceived decrease in young people's quality of life across advanced economies such as the UK, on account of rising economic, social and political precarity. The disparity between the relative stability experienced by previous generations and the instability with which younger generations contend is known in policy spaces as ‘intergenerational injustice’. Despite its importance, no study has examined how intergenerational disparities are subjectively impacting young people's mental health. To address this gap, our study sought to understand (1) how intergenerational injustice is subjectively experienced by young people in the UK? and (2) how intergenerational inequities impact young people's mental health. Methods: A qualitative descriptive approach was used. 18 young people participated in semi‐structured interviews addressing the research questions. Interviews were transcribed verbatim and analysed using reflexive thematic analysis to generate themes and patterns from the data. Results: Our analysis generated three interrelated themes: (1) political abandonment, (2) greater precarity around the means to support one's existence and potential, and (3) limited opportunities for living a full, healthy life. Discussion: This is the first qualitative study to explore how intergenerational injustice subjectively impacts young people's lives and mental health. Governments, policymakers, and researchers should better address intergenerational inequalities, given the importance of emerging adulthood for life trajectories, including mental health diagnoses.

Background: Research indicates dissociative experiences (DE) are prevalent in adolescents. However, the exact phenomenology and underlying mechanisms of dissociation in adolescence have yet to be clarified. The current study explores the presentation of, and possible psychological factors maintaining, dissociation in this population. Methods: Two online self‐report surveys captured data from 3076 adolescents aged 13–18 years. Participants completed the Černis Felt Sense of Anomaly (ČEFSA) scale of felt sense of anomaly‐type dissociation, alongside measures of mechanisms chosen to test the relevance of a cognitive‐behavioural model of dissociation in adults (cognitive appraisals, alexithymia, healthy affect regulation, and affect intolerance in the form of expressive suppression (ES)). N = 409 completed the ČEFSA scale at a second timepoint, one month later, enabling exploration of proposed maintenance factors. Results: Most (91.87%) adolescents endorsed at least one ČEFSA item. The mean number of endorsed items was 13.00 (SD = 9.67). The most endorsed factors of the ČEFSA were Altered Sense of Agency (82.96%), Anomalous Experience of the Self (76.76%), and Altered Sense of Connection (73.76%). Mediation analysis indicated that affect intolerance (ES) mediated the relationship between Time One and Time Two dissociation scores: greater suppression was associated with greater dissociation 1 month later. No other tested variables showed statistically significant mediation. Conclusion: Adolescents are likely to experience dissociation as detachment and disconnection, particularly relating to their selfhood and external world (i.e., depersonalisation and derealisation). This study suggests that the key element of a recent cognitive‐behavioural model of DE in adults—that affect intolerance perpetuates dissociation—may also be applicable in adolescence.

ObjectiveResearch indicates higher prevalence of dissociative experiences in adolescents than in adults. However, the exact phenomenology and underlying mechanisms of dissociation in adolescence have yet to be clarified. The current study explores the presentation of, and possible psychological factors underlying, dissociation in this population.MethodTwo online self-report surveys captured data from 3076 adolescents aged 13 to 18 years. Participants completed the Černis Felt Sense of Anomaly (ČEFSA) scale of felt sense of anomaly-type dissociation, alongside measures of mechanisms implicated in a cognitive-behavioural model of dissociation in adults (cognitive appraisals, alexithymia, and affect intolerance). N=409 completed the ČEFSA scale at a second timepoint, one month later.ResultsMost (91.87%) adolescents endorsed at least one ČEFSA item. The mean number of endorsed items was 13.00 (SD = 9.67). The most endorsed factors of the ČEFSA were Altered Sense of Agency (82.96%), Anomalous experience of the Self (76.76%), and Altered Sense of Connection (73.76%).Mediation analysis indicated that emotion regulation (expressive suppression) mediated the relationship between Time One and Time Two dissociation scores: greater suppression was associated with greater dissociation one month later. No other tested variables showed statistically significant mediation.ConclusionsAdolescents are likely to experience dissociation as detachment and disconnection, particularly relating to their selfhood and external world (i.e., depersonalisation and derealisation). This study suggests that the key element of a recent cognitive-behavioural model of dissociative experiences in adults – that affect intolerance perpetuates dissociation – may also be applicable in adolescence.

Background and Hypothesis: Dissociative and psychotic experiences are closely linked, with particularly high co-occurrence at non-clinical levels. This suggests the possibility of shared mechanisms between psychotic-like experiences (PLEs) and dissociation. This study investigates the meta-memory function reality monitoring (RM) and cognitive bias ‘fast thinking’ as potential shared processes. It compares these functions across dissociation and PLEs to identify potential mechanistic overlap at these early stages and thus guide clinical priorities for patients presenting with this initial state.Study Design: Dissociation, PLEs (paranoia and unusual sensory experiences), and fast thinking were measured via self-report questionnaire in 162 general population participants. RM was measured with an auditory word-generation task and memory test and modelled using hierarchical Bayesian signal detection. Bayesian network models of the cognitive factors were compared across dissociation and PLEs. Study Results:Dissociation and PLEs were highly intercorrelated. RM was weakly positively correlated with unusual sensory experiences only, and there were no significant differences between the RM-mental health correlations. The network models revealed that fast thinking was positively related to paranoia and dissociation, but not to unusual sensory experiences. Paranoia showed the strongest association with fast thinking.Conclusions: Non-clinical dissociation was strongly related to PLEs. Dissociation and paranoia both related to fast thinking, whereas unusual sensory experiences did not show this trend. This illustrates heterogeneity within potential cognitive mechanisms PLEs and demonstrates that the dissociation-PLEs relationship is equally nuanced. The current study indicates mechanisms may overlap between dissociation and PLEs but that further work investigating other cognitive processes is needed.

Background: Dissociative experiences are common transdiagnostically, and particularly prevalent in psychosis. Such experiences have long been under-recognised in routine clinical practice, despite evidence that dissociation is related to clinical complexity and increased risk of self-harm and suicidality. Adopting a symptom-specific, targeted approach to conceptualisation and intervention for dissociation may help improve outcomes. Aims: The evidence base for psychological treatments targeting dissociation is building, but training and guidance for clinicians remains sparse. This review outlines a preliminary approach to the treatment of a subtype of dissociative experience (felt sense of anomaly dissociation), based on emerging research evidence and clinical practice. The guidance is tailored to the context of psychosis, and may also have broader clinical relevance. Method: We present symptom-specific guidance for clinicians, including factors to consider in the assessment, formulation, and intervention for felt sense of anomaly dissociation in the context of psychosis, and reflections on process issues. We present a cognitive behavioural model, where affect-related changes are interpreted as an internal threat, driving a maintenance cycle of catastrophic appraisals and safety behaviours. Using this formulation, evidence-based therapy techniques familiar to most readers can then be applied. Conclusions: It is important for clinicians to consider dissociation. As well as generating new avenues for translational intervention research, we anticipate that the novel insights and specific advice outlined here will be of use to professionals working with dissociation in psychosis (and beyond). Encouragingly, we demonstrate that widely used, evidence-based skills and techniques can be employed to address distress arising from dissociation.

Past research on dissociation has predominantly relied on broad questionnaires, presenting ambiguous and overlapping themes in describing dissociative experiences. A new measure, the Černis Felt Sense of Anomaly (ČEFSA) scale ( Černis et al., 2021 ), assesses a subgroup of dissociative experiences where felt sense of anomaly is inherent. In this article, we present a German translation of the 35-item ČEFSA scale. In Study 1 ( N = 130), we investigated the factor structure of the initial translation. We describe how necessary revisions were implemented. In Study 2 ( N = 243), we show that the seven ČEFSA subscales had an appropriate factor structure and sufficient reliability. In terms of validity, the convergent, discriminant, and criterion correlations were mostly as expected. Some subscales showed high intercorrelations, making it difficult to distinguish them. We conclude that the German version of the ČEFSA scale provides a reliable and valid tool for the detailed assessment of dissociation.

Objectives: A recent randomized controlled feasibility trial showed that sleep problems in young people at risk of psychosis can be successfully treated with psychological therapy and that this may bring additional benefits such as reducing depression, anxiety and paranoia. Here we report participants' qualitative experience of sleep problems and therapy. Design: A peer‐methods qualitative study employing reflexive thematic analysis. Methods: Semi‐structured interviews, co‐facilitated by peer researchers, were conducted with 16 young patients at risk of psychosis and having sleep problems who participated in the SleepWell Trial (ISRCTN85601537). Ten interviewees had received the 12‐week sleep therapy. Results: Four themes were generated: (1) the challenge to access mental health treatment (‘bouncing between services’), (2) sleep problems and mental health difficulties are intertwined (‘an obvious link’), (3) flexibility in therapy provision matters (‘tailored to me as a person’) and (4) improving sleep leads to wider benefits (‘fixing the sleep helped everything else’). Participants described a frustrating journey to access mental health treatment, marked by rejection and invalidation, which resulted in hopelessness and often resignation. The interaction between sleep disruption and other mental health difficulties was seen as obvious. Treatment for sleep problems was highly valued. The clear focus, therapeutic style and flexible delivery of the treatment was seen to create patient ownership, active engagement and hope. Participants described transformative changes: better sleep, fewer voices and fears and improved mood and confidence. Improving sleep made a difference to everyday life. Conclusions: Treating sleep problems in people at risk of psychosis is highly valued and often brings rapid and widespread improvements across a range of domains.