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A grounded theory study exploring change processes following cognitive behavioural therapy for distressing voices 一项基于理论的研究,探索认知行为疗法对痛苦声音的改变过程
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-03-01 DOI: 10.1080/17522439.2022.2044896
Bradley Hall, M. Hayward, Rachel Terry
ABSTRACT Background Cognitive Behavioural Therapy for voice hearing (CBTv) has been shown to be effective at reducing distress. However, it is unclear why voice hearers might deteriorate or continue to benefit post-intervention. This study aimed to explore therapeutic change processes following CBTv. Methods A critical realist, grounded theory methodology was utilised. Individual interviews were conducted with 12 participants who had experienced distressing voice hearing and had completed a CBTv intervention in the last 3–12 months. Participants were recruited from a specialist hearing voices service. Results Three categories were found to be facilitative of positive change within CBTv: “New Ways of Managing”, “Overcoming Challenges” and “Gaining New Perspectives”. Five categories denoted the maintenance or furthering of positive change following intervention: “Having a Sense of Control”, “Standing on My Own Two Feet”, “Voices Are Just Part of My Life”, “Investing in Sustaining Relationships”, and “Rediscovering and Developing Identity”. Challenging circumstances faced by participants are also incorporated into a model for maintaining change following CBTv. Discussion The model adds to current literature on change processes occurring within and after CBTv. The results support the need for those working with voice hearers post-therapy to focus on rebuilding social relationships, meaning making and identity.
背景认知行为疗法(CBTv)已被证明在减少痛苦方面是有效的。然而,目前尚不清楚为什么声音听者在干预后可能会恶化或继续受益。本研究旨在探讨CBTv后的治疗改变过程。方法采用批判现实主义、扎根理论的研究方法。在过去的3-12个月中,对12名经历过痛苦的声音听力并完成了CBTv干预的参与者进行了个人访谈。参与者是从专业听音服务机构招募的。结果发现“新的管理方式”、“克服挑战”和“获得新的视角”是促进CBTv内部积极变化的三个类别。五个类别表示干预后保持或进一步的积极变化:“有控制感”,“自力更生”,“声音只是我生活的一部分”,“投资于维持关系”,以及“重新发现和发展身份”。参与者面临的挑战性环境也被纳入CBTv之后保持变化的模型中。该模型补充了目前关于CBTv内部和之后发生的变化过程的文献。研究结果表明,那些治疗后与听音者一起工作的人需要把重点放在重建社会关系、意义创造和身份认同上。
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引用次数: 0
Approche Psychotherapeutique des Psychosis (A psychotherapeutic approach to psychosis) 精神病的心理治疗方法(approach Psychotherapeutique des Psychosis)
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-02-23 DOI: 10.1080/17522439.2021.1985161
F. Davoine
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引用次数: 0
Service User Perceived Criticism and Warmth (SU-PCaW) Questionnaire 服务用户感知批评和温暖(SU PCaW)问卷
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-02-21 DOI: 10.1080/17522439.2022.2038254
Emma Izon, Karmen Au-Yeung, K. Berry, P. French
ABSTRACT Background The outcomes for a wide range of physical and mental health conditions can be influenced by the level of criticism and warmth in the family environment known in the literature as Expressed Emotion (EE). This finding is also true for individuals with an At-Risk Mental State (ARMS) for psychosis with individual’s perceptions of EE predicting transition to psychosis. While the original concept of EE incorporates both positive and negative aspects of relationships, most measures of EE and research focus on the negative aspects of relationships. Positive factors are also important and associated with improvements in functioning and reduced symptoms. However, the absence of a comprehensive, self-report measure of positive aspects of EE has hindered research in this area. Methods This study aimed to investigate the reliability and validity of a new 10-item Service User Perceived Criticism and Warmth Questionnaire (SU-PCaW) based on the 2-item Perceived Criticism and 2-item Perceived Warmth questionnaires. Results The measure was quick and easy to administer and had high internal consistency and reliability. Conclusion This measure would aid services in screening families for therapy, be helpful in evaluating family intervention in groups such as the ARMS population and a useful measure for future research developments.
摘要背景一系列身心健康状况的结果可能会受到文献中称为表达情感(EE)的家庭环境中的批评和温暖程度的影响。这一发现也适用于患有精神病高危精神状态(ARMS)的个体,个体对EE的感知预测了向精神病的转变。虽然最初的EE概念包含了关系的积极和消极方面,但大多数EE测量和研究都集中在关系的消极方面。积极因素也很重要,与功能改善和症状减轻有关。然而,由于缺乏对EE积极方面的全面、自我报告的测量,阻碍了该领域的研究。方法在2项感知批评和2项感知温暖问卷的基础上,研究新的10项服务用户感知批评和温暖问卷(SU PCaW)的信度和有效性。结果该方法快速简便,具有较高的内部一致性和可靠性。结论该措施将有助于筛查家庭接受治疗,有助于评估ARMS人群等群体的家庭干预,并为未来的研究发展提供有用的措施。
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引用次数: 1
Psychotic disorders in college students: demographic and care considerations 大学生精神障碍:人口学和护理考虑
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-02-14 DOI: 10.1080/17522439.2022.2039273
Nicholas C. Borgogna, S. Aita, C. Trask, G. Moncrief
ABSTRACT Background We examined differences in demographics, access to mental healthcare, and perceived treatment barriers in college students with a history of receiving a psychotic disorder diagnosis compared to non-clinical (no history of diagnosis) and clinical (history of non-comorbid depression) control students. Methods Data came from the 2018–2019 Healthy Minds Study (HMS), n=159 students reported having been diagnosed with a psychotic disorder (0.27% prevalence). Comparison groups included 159 randomly drawn non-clinical and 159 clinical control participants. Results Students with a history of psychotic disorder diagnosis were more likely to identify as non-heterosexual (53.5%) and gender non-conforming (17%), were more likely to have a medication prescribed in the past 12 months (84.7%), have a history of participating in counseling (95.5%), received significantly more prescriptions from different medication classes, reported higher perceived need for treatment, and reported experiencing significantly more barriers to treatment compared to control groups. No differences were evident across groups regarding knowledge of campus treatment resources, sex assigned at birth, and race. Discussion College students with a history of psychotic disorder diagnosis face multiple barriers to receiving adequate treatment. University healthcare systems should consider adjusting treatment needs to this population.
摘要背景我们研究了有精神病性障碍诊断史的大学生与非临床(无诊断史)和临床(无共病抑郁症史)对照学生在人口统计学、获得心理保健和感知治疗障碍方面的差异。方法数据来自2018-2019年健康心理研究(HMS),据报道,159名学生被诊断为精神病性障碍(0.27%的患病率)。对照组包括159名随机抽取的非临床参与者和159名临床对照参与者。结果有精神障碍诊断史的学生更有可能被认定为非异性恋(53.5%)和性别不合(17%),更有可能在过去12个月内开过药(84.7%),有参与咨询的历史(95.5%),从不同药物类别获得的处方明显更多,据报道,与对照组相比,患者对治疗的感知需求更高,并经历了明显更多的治疗障碍。在校园治疗资源、出生性别和种族的知识方面,各组之间没有明显差异。讨论有精神病病史的大学生在接受充分治疗方面面临多重障碍。大学医疗保健系统应该考虑根据这一人群调整治疗需求。
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引用次数: 2
Medication resistant psychosis: how many CBT sessions might be needed for recovery? A case report with psychodynamic commentary 耐药精神病:需要多少次CBT治疗才能恢复?附心理动力学评论的个案报告
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-02-09 DOI: 10.1080/17522439.2022.2038255
Robert Reiser, D. Turkington, M. Garrett
ABSTRACT Background When clinicians adopt the standard 16–26 session maximum suggested by CBTp efficacy research, clients with long-term medication resistant psychosis may receive an inadequate dose of therapy. Building engagement and trust can take significantly longer for clients who have been given a stigmatizing medical explanation for their difficulties. Methods We present a case study of successful long-term CBTp consisting of 200 sessions over a 6-year period. Supervision aided the recovery process over the last 2 years of therapy. Results A client with a 30-year history of medication resistant persecutory delusions, voices, stigma and prominent negative symptoms gradually formed a working alliance with the therapist. A CBT formulation emphasizing activating the adaptive mode led to later targeted work to reduce distress and social avoidance and address underlying trauma. Social recovery was achieved with increased independence and enhanced creativity. A commentary is provided by a senior clinician from a psychodynamic perspective. Discussion Clients with long-term medication resistant psychosis often need an increased number of CBT sessions but can still recover. Ongoing supportive supervision prevents early discharge and a failure to achieve a recovery trajectory. We should not accept that medication resistant clients are CBT resistant following a brief course of therapy.
背景:当临床医生采用CBTp疗效研究建议的标准16-26疗程时,长期耐药精神病患者可能接受的治疗剂量不足。对于那些对自己的困难给出了带有污名化的医学解释的客户来说,建立接触和信任可能需要更长的时间。方法我们提出了一个成功的长期CBTp案例研究,包括6年期间的200次会话。在过去2年的治疗中,监督帮助了康复过程。结果一名30年有抗药性妄想、声音、污名化和明显阴性症状的患者逐渐与治疗师形成了工作联盟。强调激活适应模式的CBT公式导致后来有针对性的工作,以减少痛苦和社会回避,并解决潜在的创伤。实现了社会复苏,独立性增强,创造力增强。一位资深临床医生从心理动力学的角度进行了评论。患有长期药物抵抗性精神病的患者通常需要增加CBT疗程的次数,但仍然可以恢复。持续的支持性监护可防止早期出院和无法实现恢复轨迹。我们不应该接受抗药性患者在短暂疗程后就对CBT产生抗药性的说法。
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引用次数: 0
From evidence to realities: psychosocial intervention provision in Australian routine community mental health practice 从证据到现实:澳大利亚常规社区精神卫生实践中的社会心理干预提供
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-02-04 DOI: 10.1080/17522439.2021.2023615
E. Fossey, C. Harvey, P. Ennals, A. Wiggins, J. Farhall
ABSTRACT Background This study explored care co-ordinator reports about provision of six evidence-based psychosocial interventions (PSIs) for people living with psychosis, to better understand decision-making about provision. Methods Conducted as an adjunct to the Second Australian National Survey of Psychosis in one catchment area, care co-ordinators completed a structured interview about evidence-based PSIs provided to 33 consumers as part of their community mental health care. Descriptive analyses were conducted. Results Care co-ordinators reported most consumers were provided at least one of the PSIs during the previous year; all were provided at least one non-evidence-based, typically briefer or simpler, alternative. Relapse Prevention Planning using early warning signs was reported as most provided; Family Psychoeducation was the least provided but rated as most helpful. The primary reason for non-provision of PSIs was that they had not been offered, with lack of relevance the most cited explanation. Conclusions PSIs may be more commonly provided than previously reported, if non-evidence-based alternatives are also considered: reasons for not offering evidence-based PSIs require further study. Meaningful guidelines are needed about when and how to offer PSIs in collaborative practice, including briefer or simpler interventions when preferred over more complex interventions.
摘要背景本研究探讨了护理协调员关于为精神病患者提供六种循证心理社会干预措施的报告,以更好地了解有关提供的决策。方法作为第二次澳大利亚全国精神病调查的一部分,在一个地区,护理协调员完成了一次关于向33名消费者提供循证精神病服务的结构化访谈,作为他们社区精神卫生护理的一部分。进行描述性分析。结果护理协调员报告称,在前一年,大多数消费者至少获得了一种PSIs;所有人都得到了至少一个非基于证据的、通常更简短或更简单的替代方案。据报告,使用早期预警标志的复发预防规划提供最多;家庭心理教育是提供最少的,但被评为最有帮助的。没有提供PSIs的主要原因是没有提供,引用最多的解释是缺乏相关性。结论如果也考虑非基于证据的替代方案,PSIs可能比以前报道的更常见:不提供基于证据的PSIs的原因需要进一步研究。关于何时以及如何在合作实践中提供PSIs,需要有意义的指导方针,包括更简短或更简单的干预措施,而不是更复杂的干预措施。
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引用次数: 0
Attitudes toward schizophrenia among Tunisian family medicine residents and non-medical students 突尼斯家庭医学院居民和非医学生对精神分裂症的态度
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-02-02 DOI: 10.1080/17522439.2022.2032291
F. Fekih-Romdhane, Fayhaa Hamdi, H. Jahrami, M. Cheour
ABSTRACT Background Although primary care physicians are highly involved in the detection and management of schizophrenia since the early stages, prior research has shown that they hold negative attitudes toward patients diagnosed with schizophrenia. We aimed to compare attitudes towards schizophrenia between family medicine residents and non-medical students. Method This was a cross-sectional study. A 18-item questionnaire concerning attitudes toward schizophrenia was used. Results The two participant groups held similar attitudes in terms of “social distance”, “belief of dangerousness” and “skepticism regarding treatment”. After controlling for confounders, help-seeking intentions contributed negatively to the prediction of attitudes toward schizophrenia in the non-medical students, and accounted for 5.3% of their variance. Conclusions Implementing anti-stigma programs in medical schools, reviewing the current medical curriculum and the family medicine residency programme to help improve future physicians’ attitudes and prepare them to provide primary mental health care to young help-seekers who experience psychosis should be given priority attention.
摘要背景尽管初级保健医生从早期就高度参与精神分裂症的检测和管理,但先前的研究表明,他们对诊断为精神分裂症患者持负面态度。我们旨在比较家庭医学院住院医师和非医学院学生对精神分裂症的态度。方法采用横断面研究。使用了一份关于精神分裂症态度的18项问卷。结果两组受试者在“社交距离”、“危险性信念”和“对治疗持怀疑态度”方面态度相似。在控制了混杂因素后,寻求帮助的意图对非医学生对精神分裂症态度的预测有负面影响,占其方差的5.3%。结论应优先关注在医学院实施反污名化计划,审查当前的医学课程和家庭医学住院计划,以帮助改善未来医生的态度,并为他们为经历精神病的年轻寻求帮助者提供初级心理健康护理做好准备。
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引用次数: 3
Preliminary point prevalence of Cognitive Behavioral Therapy for psychosis (CBTp) training in the U.S. and Canada 美国和加拿大精神病认知行为疗法(CBTp)培训的初步流行程度
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-01-14 DOI: 10.1080/17522439.2021.1971744
S. Kopelovich, E. Nutting, Jennifer Blank, H. Buckland, C. Spigner
ABSTRACT Background Cognitive Behavioral Therapy for psychosis (CBTp) is recommended by psychosis treatment guidelines in the U.S. and Canada, however accessibilty has not been systematically established and little is known about trainer or training characteristics in these countries. This paper represents the first effort to estimate the population of CBTp practitioners, characterize trainer qualifications and training practices, and calculate a CBTp accessibility estimate. Methods We oversampled from a known cluster of the target population and supplemented with chain-referral sampling. Respondents completed an online survey pertaining to workforce training conducted since 2005. An accessibility estimate was calculated using published disease prevalence data and national workforce census data. Results Twenty-five CBTp trainers completed the questionnaire. Respondents were predominantly white female psychologists in hospital or academic settings. Their estimates of practitioners trained in the past 15 years yielded a point prevalence of 0.57% of the combined mental health workforce, corresponding to 11.5–22.8 CBTp-trained providers for every 10,000 people diagnosed with a psychotic disorder. Survey results showed several differences in training approaches, settings, and funders. Discussion This preliminary study suggests that CBTp remains inaccessible across these two countries. Future studies should refine the sampling methods to provide a more robust prevalence estimate within each country.
背景:美国和加拿大的精神病治疗指南推荐使用精神病认知行为疗法(CBTp),但其可及性尚未系统建立,对这些国家的培训师或培训特点知之甚少。本文首次尝试估算CBTp从业人员的数量,描述培训师资格和培训实践,并计算CBTp可及性估计。方法从已知的目标人群中进行过采样,并辅以连锁转诊抽样。受访者完成了一项自2005年以来开展的有关劳动力培训的在线调查。使用已公布的患病率数据和国家劳动力普查数据计算了可及性估计。结果25名CBTp培训师完成问卷调查。受访者主要是医院或学术机构的白人女性心理学家。他们估计,在过去15年里接受过培训的从业人员中,有0.57%的人接受过cbtp培训,相当于每10000名精神病患者中有11.5-22.8名接受过cbtp培训的从业人员。调查结果显示,在培训方法、环境和资助者方面存在一些差异。这项初步研究表明,在这两个国家,CBTp仍然无法获得。未来的研究应改进抽样方法,以便在每个国家内提供更可靠的患病率估计。
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引用次数: 5
A grounded theory analysis of care-coordinators’ perceptions of family growth associated with an experience of first episode psychosis 护理协调员对家庭成长与首发精神病经历相关的认知的理论分析
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-01-14 DOI: 10.1080/17522439.2021.1971743
E. Thornhill, C. Sanderson, Anjula Gupta
ABSTRACT Background Growth associated with a first episode of psychosis (FEP) is taken from post-traumatic growth literature, where positive changes are perceived following adverse circumstances. FEP is a critical period in which care-coordinators play a key role in working with families. Care-coordinators’ perceptions influence the way in which they work with families. Methods Eleven care-coordinators described their perceptions of growth within families with FEP through semi-structured interviews. Transcripts were analysed using social constructivist grounded theory. Results Care-coordinators perceived the existence of family growth in the form of enhanced communication, as well as less explicit forms of growth including distancing from unhelpful relationships and a re-establishment of norms and boundaries. Growth was inhibited by the construct of the “perfect family” model, a mis-trust in services due to suspiciousness or prior negative experiences of services. Discussion These inhibitors limit engagement with interventions and prevent open exploration of difficulties. Future work may consider how these findings align with the views of families.
摘要背景与第一次精神病发作(FEP)相关的生长取自创伤后生长文献,在这些文献中,在不利的环境下可以感知到积极的变化。FEP是护理协调员在与家庭合作中发挥关键作用的关键时期。护理协调员的看法会影响他们与家人合作的方式。方法11名护理协调员通过半结构化访谈描述了他们对FEP家庭成长的看法。使用社会建构主义基础理论对成绩单进行分析。结果护理协调员以加强沟通的形式感知到家庭成长的存在,以及不那么明确的成长形式,包括远离无益的关系和重新建立规范和界限。“完美家庭”模式的构建抑制了增长,这种模式是由于怀疑或之前对服务的负面体验而对服务产生的不信任。讨论这些抑制剂限制了干预措施的参与,并阻止了对困难的公开探索。未来的工作可能会考虑这些发现如何与家庭的观点相一致。
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引用次数: 2
Experience of psychosis during the COVID-19 pandemic among hospitalized patients 新冠肺炎大流行期间住院患者的精神病体验
IF 1.2 4区 医学 Q4 PSYCHIATRY Pub Date : 2022-01-06 DOI: 10.1080/17522439.2021.2009548
J. Lebovitz, C. AhnAllen, T. Luhrmann
ABSTRACT Background The content of auditory hallucinations (AHs) and delusions is malleable and reflects the social environment and the local culture. COVID-19 is a significant new feature of the social environment, yet research has not yet determined how the phenomenology of psychosis has changed since the COVID-19 outbreak. Methods Adult patients (N = 17) receiving care within an acute inpatient psychiatric care setting in Boston were recruited to participate in an hour-long Zoom interview about their psychosis phenomenology and the potential impact of COVID-19. Results Thematic analysis of interview data found that for many, ideas about COVID-19 were present in the content of their AHs and shaped their paranoid ideation. Some felt that the frequency and loudness of the AHs had increased. However, not all participants spoke in ways that suggested the virus had affected their experience. Discussion Results demonstrate that COVID-19 influenced the content of psychosis for many, but the effect of COVID-19 on psychosis was not uniform. The increased social isolation, financial insecurity, and socio-political climate of the period also seemed to negatively impact individuals with psychosis. Understanding how COVID-19 specifically has influenced psychosis helps to illustrate how societal and external factors may shape this experience.
摘要背景幻听和妄想的内容具有可塑性,反映了社会环境和当地文化。新冠肺炎是社会环境的一个重要新特征,但研究尚未确定自新冠肺炎爆发以来精神病现象发生了怎样的变化。方法招募波士顿急性住院精神病治疗环境中接受治疗的成年患者(N=17)参加为期一小时的Zoom访谈,了解他们的精神病现象学和新冠肺炎的潜在影响。结果访谈数据的主题分析发现,对许多人来说,关于新冠肺炎的想法存在于他们的AHs内容中,并塑造了他们的偏执思维。一些人觉得AHs的频率和响度都增加了。然而,并非所有参与者的发言方式都表明病毒影响了他们的体验。讨论结果表明,新冠肺炎对精神病的含量有很大影响,但新冠肺炎对精神病影响并不一致。这一时期日益严重的社会孤立、经济不安全和社会政治气候似乎也对精神病患者产生了负面影响。了解新冠肺炎如何具体影响精神病,有助于说明社会和外部因素如何影响这种体验。
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引用次数: 1
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Psychosis-Psychological Social and Integrative Approaches
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