Understanding the Lived Experience of Illusory Social Agents in Psychosis: A Corpus Linguistics Analysis Lisha Shiel D.Clin.Psy Thesis (Volume 1), 2020 University College London UCL Doctorate in Clinical Psychology Thesis declaration form I confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Signature: Name: Lisha Shiel Date: 19.06.2020 2 Overview Several studies have shown that positive symptoms of psychosis are highly social in nature. The presence of illusory social agents in psychosis have been reported in studies spanning a number of years in different cultures and etiologies. However, there is currently a limited understanding of the social phenomenology of psychosis and the presence of illusory social agents in the positive symptoms. Part 1 of this thesis is a conceptual introduction that provides an overview of the literature on the social phenomenology of psychosis. The introduction highlights gaps in the literature, including a need for more research that explores illusory social agent representation in the lived experience of psychosis. Part 2 is an interdisciplinary study exploring the characterisation of illusory social agents in the lived experience of community and ward based participants. Corpus linguistics was used to analyze phenomenological data that was gathered using semi-structured interviews. Frameworks from Clinical Psychology and Corpus Linguistics were used to interpret the findings. Illusory social agents were represented as active and dynamic beings that engaged in a range of verbal, mental, behavioural and material processes. Part 2 discusses the impact of these behaviours on participants lives. It concludes with clinical and research implications and ideas for future research. Part 3 offers the considered thoughts on the process of undertaking the study. It considers the strengths and limitation of the study and offers thoughts on how these could be addressed by future researchers. 3 Impact Statement Part 1 of this thesis provides an overview of the literature on the social phenomenology of psychosis. It highlights findings on the presence of illusory social agents in positive symptoms, and identifies the methodological limitations and conceptual gaps that have resulted in a limited understanding of the social phenomenology of psychosis. The need for further research grounded in phenomenological accounts of psychosis utilizing systematic methods is identified. This has implications for shaping future research and extending the explanatory power of dominant models of psychosis. Part 2 of this thesis provides a characterisation of illusory social agents in the positive symptoms of psychosis. The findings of this study offer a deeper understanding of how illusory social agents are experienced including the different behaviours and linguistic choices associated with them. It provides an analysis of how these representations influence participants’ levels of distress and contribute to power asymmetries in the relationship. These findings have implications for clinical practice. It can be used to develop assessment tools that enable clinicians to get a comprehensive understanding of the types, roles and behaviours of illusory social agents in in psychosis. This could contribute to tailoring existing interventions to meet the individual needs of people living with psychosis. These findings could also be used to develop and refine interventions that place the focus on live interactions between the person and illusory social agents to better address the various interpersonal aspects that increase levels of distress. These findings also have implications within academia. The insights to illusory social agent representation could contribute to the development of theories that go beyond describing hallucinations and delusions as perceptual errors and also focus on 4 understanding the intersubjective nature of these experiences. Understanding illusory social agents as arising from a breakdown in social agent representation might also provide important insights to normal social cognition which could have implications for other diagnoses. The application of corpus linguistics and linguistic frameworks in the analysis has highlighted the benefits of interdisciplinary research. Adopting a similar approach could enhance future research because models in corpus linguistics offer different ways of understanding the phenomenon which could lead to novel insights. The dissemination of these findings in conferences, national journals, and sources that are accessible to service users could contribute to an incremental understanding of the social phenomenology of psychosis. 5 Table of Contents Acknowledgements .............................................................................................................. 8 Part 1: Conceptual Introduction .............................................................................................. 9 Abstract .............................................................................................................................. 10 Overview of Literature ....................................................................................................... 13 Conclusion .......................................................................................................................... 43 References ......................................................................................................................... 46 Part 2: Empirical Paper .......................................................................................................... 63 Introduction ....................................................................................................................... 65 Method .............................................................................................................................. 68 Results ................................................................................................................................ 78 Discussion ........................................................................................................................ 103 Conclusion ........................................................................................................................ 110 References ....................................................................................................................... 115 Part 3: Critical Appraisal ...................................................................................................... 122 Introduction ..................................................................................................................... 123 Ethnic Representation in Recruitment ............................................................................. 123 Use of Corpus Linguistics.................................................................................................. 128 Service User Involvement ................................................................................................ 132 Conclusion ........................................................................................................................ 133 References ....................................................................................................................... 134 Appendices .......................................................................................................................... 138 Appendix 1: Health Research Authority Ethical Approval ................................................ 138 Appendix 2: Sample Invitation Letter to Participants ....................................................... 143 Appendix 3: Information Sheet ........................................................................................ 145 Research Participant Information Sheet (PIS) .................................................................. 145 Appendix 4: Community Consent Form ........................................................................... 149 Appendix 5: Clinical Consent Form................................................................................... 151 Appendix 6: Topic Guide .................................................................................................. 154 Appendix 7: Keyword List ................................................................................................. 156 Appendix 8: Semantic Grouping based on key words ...................................................... 170 Appendix 9: ‘AvhAgent’ Referent Terms .......................................................................... 180 Appendix 10: ‘Agent’ Referent Terms .............................................................................. 182 6 List of Tables Conceptual Introduction Table 1. Definitions and Prevalence of Delusional Themes 24 Empirical Paper Table 1. Most Frequent Referents for Social Agents 83 Table 2. Adjective Collocates associated with Illusory Social Agents 91 Table 3. Activities of Vocal Social Agents 95 Table 4. Intentions and Desires of Vocal Social Agents 98 Table 5. Activities of Other Social Agents 100 Table 6. Intentions and Desires of Other Social Agents 104 List of Figures Empirical Paper Figure 1. Concordancing in #LancsBox 73 Figure 2. Collocates associated with AvhAgent 89 7 Acknowledgements I am grateful to the participants who gave up their time to take part in this study. It was a privilege to