My research initially focused on reasoning processes related to the unusual beliefs and experiences in psychosis and, in 1988, I was the first to identify the jumping to conclusions reasoning bias, since demonstrated to be consistently associated with unusual beliefs (‘delusions’) in psychosis and now considered to be a phenotype of delusion liability.  My early work in delusional beliefs also characterised them as multi-dimensional phenomena, on a continuum with everyday beliefs and involving emotional as well as cognitive processes.  This conceptualisation of delusional beliefs gave rise to new research strategies, examining the continuities as well as differences between delusional  and other beliefs in reasoning and other cognitive processes, and the development of a number of new theoretically derived measures, for example, the Peters et al Delusions Inventory (PDI); and the Maudsley Assessment of Delusions schedule (MADS).  These findings also led on to the development of therapeutic approaches for problems associated with psychosis, drawing on and adapting the new cognitive behavioural therapy for anxiety and depression of A T Beck and colleagues.  I was one of a small number of UK-based clinical researchers in the late 1980s and early 1990s who initiated this approach.  Our research group, formed in the early 1990s, with Fowler, Kuipers, Dunn, Bebbington and later Freeman, published one of the first controlled trials and manuals of Cognitive Behavioural Therapy for Psychosis and we have continued to work together and have conducted a number of influential clinical trials of this CBT approach.

Alongside the work of evaluating CBT and implementation research, our group has continued to develop theory and to conduct theoretically based investigations.  We published a highly-cited cognitive model of the positive symptoms of psychosis in 2001, updated in 2007, which has been the basis for our programme of empirical work into cognitive, social and emotional processes in psychosis. 

We are continuing to develop  innovative therapeutic interventions, most recently  digitally supported cognitive behavioural interventions targeted on emotional (anxiety) and reasoning (belief flexibility) processes  in paranoia, initially in  CITADEL study (Computerised Interventions for Thinking and Anxiety Delusions) and now with the SlowMo Trial – evaluating a novel digital therapy for people who fear harm from others - https://www.rca.ac.uk/research-innovation/helen-hamlyn-centre/research-projects/2015-projects/slowmo/.

https://www.rca.ac.uk/research-innovation/helen-hamlyn-centre/research-projects/2015-projects/slowmo/

for more information on our partnership with the Helen Hamlyn Centre for Design, Royal College of Arts.

I have also worked on the AVATAR trial, with Professor Tom Craig and colleagues. This is a randomized controlled trial of a novel therapy for people with distressing voices, which works through a digital representation of the entity which is the source of the voice. It involves creating a trialoge between the voice hearer, the avatar and the therapist, with the goal of changing the voice hearer’s  relationship with their voice, so that the voice hearer is assisted to experience more control and power in the relationship.

http://www.avatartherapy.co.uk/

https://www.kcl.ac.uk/ioppn/news/records/2017/11-November/Avatar-therapy-may-help-to-reduce-auditory-hallucinations-for-people-with-schizophrenia.aspx

The results of the trial are published in Lancet Psychiatry (see research outputs, Nov 2017) and showed a large effect on reducing distress and frequency of voices at the end of therapy, compared with a supportive counselling control.

I have long been interested in service development and involved in the implementation of research into practice.  With colleagues, I have developed and evaluated new services for people with psychosis, particularly early intervention services incorporating CBT.  I co-led, with Tom Craig, the first UK RCT which demonstrated clinical and social benefits of a community-based assertive outreach Early Intervention service.  I served as psychological interventions lead on the Guideline Development Group of the National Institute of Clinical and Health Excellence (NICE) Schizophrenia Guideline (2003) and the Schizophrenia Update (2009).  Recently we have developed brief, focussed cognitive behavioural interventions for anxiety and depression in psychosis, delivered by frontline staff, in an effort to extend the availability of CBT.  We investigated  this (with Craig, Waller and colleagues) in the GOALS study funded by the NIHR.

Our work on widening access to evidence-based psychological therapies for psychosis has been boosted by our Trust being selected in 2012, in a national competition, as a national demonstration site for the implementation of evidence-based psychological therapies for psychosis (IAPT-SMI).

I studied philosophy and psychology at Cambridge University before qualifying in 1981 in clinical psychology at the Institute of Psychiatry, where I also completed my PhD, under the supervision of David Hemsley.  My first appointment was as a lecturer in clinical psychology at the Institute of Psychiatry and as a clinical psychologist at the Bethlem Royal and Maudsley hospitals.  I developed my clinical skills working in community clinical settings for people with psychosis, and was strongly influenced by the pioneering work of social psychiatrists Douglas Bennett and Jim Birley.  I subsequently held appointments at Oxford, as Academic Director of the Oxford regional clinical psychology training course and, in 1997, was appointed as Professor of Clinical Psychology at the United Medical and Dental School of Guy’s and St Thomas’s Hospitals and Head of Psychology for Lambeth Healthcare NHS Trust.  I returned to work in Camberwell in 2001 as Professor of Clinical Psychology at the Institute of Psychiatry, King’s College London and Trust Head of Psychology at the South London and Maudsley NHS Trust.

From 2010-2017 I was Clinical Director and Joint Leader for the Psychosis Clinical Academic Group, South London and Maudsley NHS Foundation Trust, King’s Health Partners.  The Psychosis Clinical Academic Group is the largest group of clinicians and researchers in psychosis in the world.  The CAG combines innovative clinical services in stage-specific care pathways, with an extensive portfolio of psychosis research and training, under the auspices of Kings Health Partners, an Academic Health Sciences Centre.  2015-2017, I was Chair of the Early Intervention in Psychosis (EIP) London NHS Clinical Reference Group (CRG), providing clinical advice to London NHS Trusts, commissioners and the London Strategic Clinical Network on the implementation of the new national EIP Standard.

I was made a Fellow of the British Psychological Society in 1995 and was given the Shapiro Award in 2002 for eminence in clinical psychology by the Division of Clinical Psychology of the British Psychological Society.  I have been accredited as a cognitive and behavioural therapist by the UK BABCP - and am a member of the Academy of Cognitive Therapy (US).  I was appointed as a Senior Investigator of the National Institute of Health Research (NIHR) from 2008 until 2015 and am now NIHR Senior Investigator Emerita.