Poppy Brown

All Publications

• Paranoia and unusual sensory experiences in Parkinson's disease. Aging & mental health Brown, P., Freeman, D., Loe, B. S., Dow, R., Johns, L. 2025: 1-16

  Abstract

  There has been limited exploration into the nature and development of psychotic experiences (PEs) in Parkinson's disease (PD). We aimed to comprehensively assess the frequency, severity, and associated distress of paranoia and unusual sensory experiences (USEs) in PD, and to assess what variables are significantly associated with these experiences, focussing on psychological processes central to understanding PEs in non-PD groups.A questionnaire battery was completed by 369 individuals with PD with a mean age of 66 years and mean time since diagnosis of 5 years. Recruitment was via Parkinson's UK, social media, and local community groups. For a subset of measures, comparisons were made to age-matched controls using pre-existing data.182 (49%) participants reported USEs, including almost half of those not taking dopaminergic medication. For 83 (23%), the experience was distressing. Paranoia across the sample was significantly lower than in age-matched controls. However, specific paranoid concerns around abandonment (16%) and spousal betrayal (10%) were reported by some. Depression, anxiety, loneliness, and stigma and desire for support with PEs were high across the sample. Almost all psychological variables were significantly associated with PEs in structural equation models.PEs in PD are common, even in those not taking dopaminergic medication. For a small subset, these experiences are distressing and not resolved by existing treatment. Cognitive-affective variables like depression and anxiety could play a maintaining role in PEs in PD thus providing easy avenues for trialling intervention.

  View details for DOI 10.1080/13607863.2025.2450258

  View details for PubMedID 39817786

• Worry Intervention in an Older Adult With a Persecutory Delusion: A Single Case Experimental Design. Clinical psychology in Europe Brown, P., Crabtree, A. 2023; 5 (3): e11173

  Abstract

  This report presents the single case of Jack, a 67-year-old referred to our Older Adult Community Mental Health Team (OA CMHT) for his distressing persecutory delusion and high levels of worry. Jack also reported learning difficulties and autistic traits, although neither were formally diagnosed.Ten sessions of worry intervention taken from The Feeling Safe Programme worry module were used to reduce Jack's time spent worrying and increase his engagement in meaningful activity. Weekly face-to-face sessions were held, with Jack's brother acting as a co-therapist. Adaptations to the intervention were made based on Jack's learning preferences. An AB single case experimental design was adopted to compare Jack's scores on measures of worry, paranoia and delusional conviction, and wellbeing and daily functioning before and after intervention.Results demonstrate the worry intervention improved Jack's scores on all measures to a clinically significant degree.This is the first known report of applying the worry intervention to an older adult. The results show the intervention can be of considerable benefit in terms of reducing worry and paranoia, in the context of both older age and suspected neurodiversity.

  View details for DOI 10.32872/cpe.11173

  View details for PubMedID 38356897

  View details for PubMedCentralID PMC10863639

• "It seems impossible that it's been made so quickly": a qualitative investigation of concerns about the speed of COVID-19 vaccine development and how these may be overcome. Human vaccines & immunotherapeutics Brown, P., Waite, F., Larkin, M., Lambe, S., McShane, H., Pollard, A. J., Freeman, D. 2022; 18 (1): 2004808

  Abstract

  The speed of COVID-19 vaccine development has been identified as a central concern contributing to hesitancy in acceptance. We conducted qualitative interviews to gain a greater understanding into these concerns and to identify what might address them. Twelve qualitative interviews were conducted with participants identifying as hesitant for COVID-19 vaccination and reporting concern about the speed of vaccine development. Interpretative Phenomenological Analysis (IPA) was used. Concerns about speed comprised the linked themes of i) difficulty understanding the pace, and, ii) worry about the implications for vaccine safety. Uncertainties concerning the pandemic led to a notable desire for credible and understandable information regarding the vaccines, which many participants felt was not available. Four routes to resolving uncertainty about whether to be vaccinated were identified. First, waiting for more information about the vaccines, such as about their contents and impact on transmission. Second, a growing perception that the vaccines must be safe given the large numbers already vaccinated. Third, viewing the vaccines as necessary - even if unappealing - for ending the pandemic. Finally, a feeling that there would be no choice but to have a vaccine. Examples of what might reduce hesitancy were given, including interviews with vaccine developers and knowing others of similar age having safely been vaccinated. The pace of development broke expectations set earlier in the pandemic. This was interpreted negatively due to a perceived lack of credible information. Most participants could envisage ways their concerns could be resolved, enough for them to have a vaccine.

  View details for DOI 10.1080/21645515.2021.2004808

  View details for PubMedID 35172678

  View details for PubMedCentralID PMC8928812

• Automated Virtual Reality Cognitive Therapy (gameChange) in Inpatient Psychiatric Wards: Qualitative Study of Staff and Patient Views Using an Implementation Framework. JMIR formative research Brown, P., Waite, F., Lambe, S., Jones, J., Jenner, L., Diamond, R., Freeman, D. 2022; 6 (4): e34225

  Abstract

  Automated virtual reality (VR) therapy could allow a greater number of patients to receive evidence-based psychological therapy. The aim of the gameChange VR therapy is to help patients overcome anxious avoidance of everyday social situations. gameChange has been evaluated with outpatients, but it may also help inpatients prepare for discharge from psychiatric hospital.The aim of this study is to explore the views of patients and staff on the provision of VR therapy on psychiatric wards.Focus groups or individual interviews were conducted with patients (n=19) and National Health Service staff (n=22) in acute psychiatric wards. Questions were derived from the nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability framework. Expectations of VR therapy were discussed, and participants were then given the opportunity to try out the gameChange VR therapy before they were asked questions that focused on opinions about the therapy and feasibility of adoption.There was great enthusiasm for the use of gameChange VR therapy on psychiatric wards. It was considered that gameChange could help build confidence, reduce anxiety, and "bridge that gap" between the differences of being in hospital and being discharged to the community. However, it was reflected that the VR therapy may not suit everyone, especially if they are acutely unwell. VR on hospital wards for entertainment and relaxation was also viewed positively. Participants were particularly impressed by the immersive quality of gameChange and the virtual coach. It was considered that a range of staff groups could support VR therapy delivery. The staff thought that implementation would be facilitated by having a lead staff member, having ongoing training accessible, and involving the multidisciplinary team in decision-making for VR therapy use. The most significant barrier to implementation identified by patients and staff was a practical one: access to sufficient, private space to provide the therapy.Patients and staff were keen for VR to be used on psychiatric wards. In general, patients and staff viewed automated VR therapy as possible to implement within current care provision, with few significant barriers other than constraints of space. Patients and staff thought of many further uses of VR on psychiatric wards. The value of VR therapy on psychiatric wards now requires systematic evaluation.RR2-10.2196/20300.

  View details for DOI 10.2196/34225

  View details for PubMedID 35412462

  View details for PubMedCentralID PMC9044147

• A compassionate imagery intervention for patients with persecutory delusions. Behavioural and cognitive psychotherapy Forkert, A., Brown, P., Freeman, D., Waite, F. 2022; 50 (1): 15-27

  Abstract

  Negative beliefs about the self, including low self-compassion, have been identified as a putative causal factor in the occurrence of paranoia. Therefore, improving self-compassion may be one route to reduce paranoia.To assess the feasibility, acceptability, and potential clinical effects of a brief compassionate imagery intervention for patients with persecutory delusions.Twelve patients with persecutory delusions received an individual four-session compassionate imagery intervention. Assessments of self-concept and paranoia were completed before treatment, immediately after treatment, and at 1-month follow-up. A qualitative study exploring participants' experiences of the treatment was also completed.Twelve out of 14 eligible patients referred to the study agreed to take part. All participants completed all therapy sessions and assessments. Post-treatment, there were improvements in self-compassion (change score -0.64, 95% CI -1.04, -0.24, d = -1.78), negative beliefs about the self (change score 2.42, 95% CI -0.37, 5.20, d = 0.51), and paranoia (change score 10.08, 95% CI 3.47, 16.69, d = 0.61). There were no serious adverse events. Three themes emerged from the qualitative analysis: 'effortful learning', 'seeing change' and 'taking it forward'. Participants described a process of active and effortful engagement in therapy which was rewarded with positive changes, including feeling calmer, gaining clarity, and developing acceptance.This uncontrolled feasibility study indicates that a brief compassionate imagery intervention for patients with persecutory delusions is feasible, acceptable, and may lead to clinical benefits.

  View details for DOI 10.1017/S1352465821000229

  View details for PubMedID 34078499

  View details for PubMedCentralID PMC9019554

• Does raising heart rate prior to a behavioural test enhance learning in cognitive therapy for anxiety? An experimental test for the treatment of fear of heights using virtual reality. Behaviour research and therapy McInerney, J., Brown, P., Bird, J. C., Nickless, A., Brown, G., Freeman, D. 2021; 144: 103928

  Abstract

  A key clinical issue is how to maximise the belief change central to cognitive therapy. Physiological arousal is a key internal cue confirming threat beliefs in anxiety disorders. Deeper extinction of anxiety may occur if catastrophizing responses to physiological arousal are inhibited prior to joint exposure with external phobic stimuli. The aim of the study was to test whether increasing physiological arousal using exercise increases the benefits of behavioural tests.Sixty individuals with a fear of heights had one session of VR cognitive treatment. They were randomised to have the treatment either with periods of intense physical exercise (cycling at 80% of maximum heart rate) prior to exposures or without. Linear mixed effects models were used to check the manipulation and test the primary hypothesis of a group difference in degree of conviction in the phobic threat belief.Heart rate was significantly higher in the exercise group throughout compared with the control group. Both groups showed significant reductions in threat beliefs after the VR treatment (d = 1.0, p < 0.001) but there was no significant group difference (d = 0.1, p = 0.56).An increase in physiological arousal achieved via exercise did not enhance cognitive change in beliefs about feared stimuli.

  View details for DOI 10.1016/j.brat.2021.103928

  View details for PubMedID 34246887

• Parenting behaviour and paranoia: a network analysis and results from the National Comorbidity Survey-Adolescents (NCS-A). Social psychiatry and psychiatric epidemiology Brown, P., Waite, F., Freeman, D. 2021; 56 (4): 593-604

  Abstract

  Parenting behaviours-including the extent to which parents are protective, hostile, or caring-likely impacts whether a child develops a sense of vulnerability that carries forward into adulthood. Ideas of vulnerability are a contributory factor to the occurrence of paranoia. Our aim was to assess whether there is an association between specific parenting behaviours and paranoia.We examined cross-sectional associations of parenting and paranoia in an epidemiologically representative cohort of 10,148 adolescents (National Comorbidity Survey-Adolescents; NCS-A) and a second dataset of 1286 adults in Oxfordshire. Further, a network analysis was conducted with paranoia, parenting behaviours, and cognitive-affective variables (compassion, self-esteem, anxiety, and depression). Overprotectiveness, verbal abuse, physical abuse, and amount of care were assessed in mothers and fathers separately.Nearly all parenting variables were significantly associated with paranoia, with parental verbal and physical abuse showing the largest associations. For example, the odds of reporting paranoia was over four times higher for those in the adult sample reporting a lot of paternal verbal abuse, compared to those reporting none (OR = 4.12, p < 0.001, CI 2.47-6.85). Network analyses revealed high interconnectivity between paranoia, parenting behaviours, and cognitive-affective variables. Of the parenting variables, paranoia most strongly interacted with paternal abuse and maternal lack of care.There are associations between participants' self-reported experiences of parental behaviours and paranoia. Despite being associated with paranoia, cognitive-affective variables did not appear to mediate the relationship between parenting and paranoia, which is surprising. What might explain the link therefore remains to be determined.

  View details for DOI 10.1007/s00127-020-01933-6

  View details for PubMedID 32812085

  View details for PubMedCentralID PMC8053155

• The revised Green et al., Paranoid Thoughts Scale (R-GPTS): psychometric properties, severity ranges, and clinical cut-offs. Psychological medicine Freeman, D., Loe, B. S., Kingdon, D., Startup, H., Molodynski, A., Rosebrock, L., Brown, P., Sheaves, B., Waite, F., Bird, J. C. 2021; 51 (2): 244-253

  Abstract

  The Green et al., Paranoid Thoughts Scale (GPTS) - comprising two 16-item scales assessing ideas of reference (Part A) and ideas of persecution (Part B) - was developed over a decade ago. Our aim was to conduct the first large-scale psychometric evaluation.In total, 10 551 individuals provided GPTS data. Four hundred and twenty-two patients with psychosis and 805 non-clinical individuals completed GPTS Parts A and B. An additional 1743 patients with psychosis and 7581 non-clinical individuals completed GPTS Part B. Factor analysis, item response theory, and receiver operating characteristic analyses were conducted.The original two-factor structure of the GPTS had an inadequate model fit: Part A did not form a unidimensional scale and multiple items were locally dependant. A Revised-GPTS (R-GPTS) was formed, comprising eight-item ideas of reference and 10-item ideas of persecution subscales, which had an excellent model fit. All items in the new Reference (a = 2.09-3.67) and Persecution (a = 2.37-4.38) scales were strongly discriminative of shifts in paranoia and had high reliability across the spectrum of severity (a > 0.90). The R-GPTS score ranges are: average (Reference: 0-9; Persecution: 0-4); elevated (Reference: 10-15; Persecution: 5-10); moderately severe (Reference: 16-20; Persecution:11-17); severe (Reference: 21-24; Persecution: 18-27); and very severe (Reference: 25+; Persecution: 28+). Recommended cut-offs on the persecution scale are 11 to discriminate clinical levels of persecutory ideation and 18 for a likely persecutory delusion.The psychometric evaluation indicated a need to improve the GPTS. The R-GPTS is a more precise measure, has excellent psychometric properties, and is recommended for future studies of paranoia.

  View details for DOI 10.1017/S0033291719003155

  View details for PubMedID 31744588

  View details for PubMedCentralID PMC7893506

• Power posing for paranoia: A double-blind randomised controlled experimental test using virtual reality. Behaviour research and therapy Brown, P., Waite, F., Rovira, A., Freeman, D. 2020; 132: 103691

  Abstract

  Paranoia is theorised to build upon feelings of inferior social rank. Power posing has been shown to increase feelings of power, and hence could reduce paranoia. One hundred participants with current paranoia and 50 individuals without paranoia were recruited. Using a double-blind randomised controlled experimental design, participants twice held powerful or neutral postures before entering neutral virtual reality social environments. In the paranoid sample, those who held a powerful pose did not significantly increase in feelings of power by the end of testing in comparison to controls (group difference = 0.67, C.I. = -1.12; 1.46; p = 0.098), or decrease in paranoia (group difference = -0.23, C.I. = -1.17; 0.72; p = 0.634). In the non-paranoid sample, there was a small significant increase in powerful feelings by the end of testing in the powerful group (group difference = 1.13, C.I. = 0.23; 2.02; p = 0.013), but no significant decrease in paranoia (group difference = -0.71, C.I. = -2.16; 0.74; p = 0.338). Paranoia status was not a modifier on the relationship between condition and feelings of power. We conclude that power posing results in only very small changes in self-reported feelings of power and has no subsequent effect on paranoia.

  View details for DOI 10.1016/j.brat.2020.103691

  View details for PubMedID 32688047

• Virtual reality clinical-experimental tests of compassion treatment techniques to reduce paranoia. Scientific reports Brown, P., Waite, F., Rovira, A., Nickless, A., Freeman, D. 2020; 10 (1): 8547

  Abstract

  Paranoia may build on negative beliefs held both about the self and others. Compassionate imagery may be one way of reducing such negative beliefs, and hence paranoia. Two studies tested this idea, one targeting compassion for the self and one targeting compassion for others. Two-hundred individuals from the general population scoring highly for paranoia were recruited. The studies used a randomised controlled experimental design, with embedded tests for mediation. Study one targeted self-compassion via creation of a compassionate coach (CC) image. Study two targeted compassion for others via loving kindness meditation (LKM). Individuals repeatedly entered neutral virtual reality social environments. Changes in compassion and paranoia were assessed. Compared to controls, the CC group increased in self-compassion (group difference = 2.12, C.I. = 1.57;2.67, p = <0.0001, d = 1.4) and decreased in paranoia (group difference = -1.73, C.I. = -2.48; -0.98, p = <0.0001, d = 0.8). Change in self-compassion explained 57% of change in paranoia. Compared to controls, the LKM group increased their compassion for others (group difference = 3.26, C.I. = 2.72;3.80, p = <0.0001, d = 1.7), and decreased in paranoia (group difference = -1.70, C.I. = -2.50; -0.89, p = <0.0001, d = 0.8). Change in compassion for others explained 67% of change in paranoia. Targeting negative beliefs about the self and others using compassionate imagery causes reductions in paranoia. Tests in clinical populations are indicated.

  View details for DOI 10.1038/s41598-020-64957-7

  View details for PubMedID 32444619

  View details for PubMedCentralID PMC7244556

• Research into student mental health: where have we come and how can we improve? JOURNAL OF PUBLIC MENTAL HEALTH Brown, P. 2020; 19 (1): 9-12

  View details for DOI 10.1108/JPMH-11-2019-0097

  View details for Web of Science ID 000524882600001

• 'Twisting the lion's tail': Manipulationist tests of causation for psychological mechanisms in the occurrence of delusions and hallucinations. Clinical psychology review Brown, P., Waite, F., Freeman, D. 2019; 68: 25-37

  Abstract

  Over the past 20 years the importance of psychological processes in psychosis has gained increasing attention. However, it is key to determine the causal status of these processes in order to inform understanding and identify treatment targets. Studies that directly manipulate a psychological mechanism provide the most robust causal evidence. This review evaluates for the first time the extent of manipulationist causal evidence for the role of specific psychological mechanisms in delusions and hallucinations. A systematic search identified controlled experiments or targeted interventions that both manipulated a specific psychological mechanism and measured the effect on individual psychotic experiences. Forty-three manipulationist studies were found of which 40 measured paranoia, 11 measured hallucinations, and two measured grandiosity. Twenty-eight studies were experiments and 15 were targeted intervention trials. Only 18 used clinical samples. Manipulation of the specified psychological mechanism was demonstrated in 35 cases. Of these, 28 found a subsequent change in a psychotic experience. Negative affect and related psychological processing in relation to paranoia have been most tested. There is a small body of direct causal evidence for the role of psychological mechanisms in psychotic experiences - that highlight important novel treatment directions - but the manipulationist approach has been used too infrequently.

  View details for DOI 10.1016/j.cpr.2018.12.003

  View details for PubMedID 30617014

• Automated psychological therapy using immersive virtual reality for treatment of fear of heights: a single-blind, parallel-group, randomised controlled trial. The lancet. Psychiatry Freeman, D., Haselton, P., Freeman, J., Spanlang, B., Kishore, S., Albery, E., Denne, M., Brown, P., Slater, M., Nickless, A. 2018; 5 (8): 625-632

  Abstract

  Engaging, interactive, and automated virtual reality (VR) treatments might help solve the unmet needs of individuals with mental health disorders. We tested the efficacy of an automated cognitive intervention for fear of heights guided by an avatar virtual coach (animated using motion and voice capture of an actor) in VR and delivered with the latest consumer equipment.We did a randomised trial of automated VR versus usual care. We recruited adults aged older than 18 years with a fear of heights by radio advertisements in Oxfordshire, UK. We diagnosed fear of heights if participants scored more than 29 on the Heights Interpretation Questionnaire (HIQ). We randomly allocated participants by computer in a 1:1 ratio to either automated VR delivered in roughly six 30-min sessions administered about two to three times a week over a 2-week period (intervention group) or to usual care (control group). Randomisation was stratified by severity of fear of heights. The research team, who were unaware of the random allocation, administered three fear-of-height assessments, at baseline (0 weeks), at the end of treatment (2 weeks), and at follow-up (4 weeks). The primary outcome measure was HIQ score (range 16-80, with higher scores indicating greater severity). This trial is registered with the ISRCTN registry, number ISRCTN11898283.Between Nov 25, 2017, and Feb 27, 2018, 100 individuals were enrolled and underwent randomisation, of whom 49 were assigned to the VR treatment group and 51 to the control group. All participants completed the 4-week follow-up. The mean total treatment time in VR was 124·43 min (SD 34·23). Compared with participants in the control group, the VR treatment reduced fear of heights at the end of treatment (mean change score -24·5 [SD 13·1] in the VR group vs -1·2 [7·3] in the control group; adjusted difference -24·0, 95% CI -27·7 to -20·3; Cohen's d=2·0; p<0·0001). The benefit was maintained at follow-up (mean change score -25·1 [SD 13·9] in the VR group vs -1·5 [7·8] in the control group; adjusted difference -24·3, 95% CI -27·9 to -20·6; Cohen's d=2·0; p<0·0001). The number needed to treat to at least halve the fear of heights was 1·3. No adverse events were reported.Psychological therapy delivered automatically by a VR coach can produce large clinical benefits. Evidence-based VR treatments have the potential to greatly increase treatment provision for mental health disorders.Oxford VR, and the National Institute of Health Research Oxford Health Biomedical Research Centre.

  View details for DOI 10.1016/S2215-0366(18)30226-8

  View details for PubMedID 30007519

  View details for PubMedCentralID PMC6063994