Psychology and Psychotherapy-Theory Research and Practice最新文献

Objectives

Sexual minority young adults report higher rates of anxiety and depression, and affective vulnerability factors (i.e. anxiety sensitivity, distress tolerance, emotion dysregulation) may help explain these mental health disparities.

Design

The current cross-sectional study examined differences between sexual minority and heterosexual college students (n = 465; M_age = 19.84, SD = 3.51; 76.3% female) in anxiety, depression and affective vulnerability and whether affective vulnerability served as an explanatory mechanism in these associations.

Methods

Participants completed self-report measures for course credit.

Results

Sexual minority young adults reported greater anxiety, depression, anxiety sensitivity, emotion regulation difficulties and lower distress tolerance. There were also significant indirect effects for all three affective vulnerability variables for anxiety symptoms and for emotion regulation difficulties for depression symptoms.

Conclusions

Affective vulnerability, particularly emotion regulation difficulties, appears to serve as a mechanism through which sexual minority status is associated with anxiety and depression. Improving emotion regulation skills may help to reduce mental health disparities in this population.

Objectives and Design

This qualitative study aimed to explore the treatment experiences of children and young people with Post-traumatic Stress Disorder (PTSD) symptoms, participating in a randomised controlled trial evaluating the effectiveness of Cognitive-Therapy for PTSD (CT-PTSD).

Methods

Thirteen participants aged between 12 and 18 years old, who had all experienced multiple trauma and had undertaken CT-PTSD, were interviewed.

Results

Using thematic analysis, three key themes were identified: ‘Desire for difference’, ‘Journey of becoming able to talk about trauma’ and ‘Positive changes and increased ability to cope’. Prior to the study, participants described experiencing difficult emotions and avoided talking about their traumatic experiences. Participants reported wanting to get the right help and valued the opportunity to help others. Talking about trauma during treatment was perceived as difficult and emotionally draining, however participants reported a sense of relief and that it became easier over time, helping them to make sense of their traumatic experiences. This was facilitated by the therapeutic relationship, their involvement in decision making and the use of written tasks. All participants reported positive changes, both in themselves and in their ability to talk to others about their traumatic experiences.

Conclusion

Engaging in CT-PTSD and talking about traumatic experiences can be empowering for young people and allows them the opportunity to process their trauma leading to increased ability to cope.

Objectives

Whilst cognitive analytic therapy (CAT) is increasingly used as an indirect intervention, there is little evidence of how the approach can be applied to reflective practice. This study sought to develop a process model of cognitive analytic reflective practice (CARP) groups.

Design

Constructivist grounded theory approach supplemented by quantitative measures of helpfulness and group cohesion.

Methods

Twenty-four participants, working within four staff teams in a secure children's home, attended four CARP groups over a 1-year period. Sessions were audio recorded, transcribed and checked for model fidelity and then analysed using grounded theory. Theoretical sampling was achieved via conducting focus groups with teams informed by the emergent categories, and using sessional measures of group cohesion and helpfulness to confirm theoretical saturation.

Results

The model constructed had three interrelated main categories: ‘facilitator processes: establishing a reflective space’, ‘group processes: widening awareness of the self, others, and system’ and ‘outcomes: changing relational dynamics and finding exits.’ The model was validated by evidence from the measures.

Conclusions

The model offers an empirical understanding of how CAT informs reflective practice through a better understanding of reciprocity in the dynamics of care systems.

Trauma and post-traumatic stress are involved in the aetiology and maintenance of voice-hearing. It has been proposed that trauma-focused therapy (TFT) might affect voice-hearing, but previous studies are limited and remain undecided.

Objectives

We aimed to investigate the effect of TFT on voice-hearing in people with PTSD and psychosis using experience sampling method (ESM). A secondary aim was to explore how changes in voice-hearing are related to changes in PTSD.

Design

This is an adjunct longitudinal ESM study of a sub-group of participants (N = 39) from a randomised controlled trial that compared TFT to a waiting-list control group.

Methods

Voice-hearing participants filled in 10 daily voice-hearing-related questionnaires for six consecutive days at baseline and post-treatment at pseudo-random times during the day. PTSD symptom severity was assessed at baseline and post-treatment. Multilevel linear regression was used to test the effect of TFT on voice-hearing and to analyse the relationship between changes in voice-hearing and changes in PTSD.

Results

The intention-to-treat analysis showed a significant interaction effect between time and treatment condition (p < .00001) with a small effect size (dppc2 = −0.27), indicating a larger decrease in voice-hearing in the TFT group than in the waiting-list control group. Also, a significant association was observed between changes in PTSD symptoms and changes in voice-hearing (p < .00001).

Conclusions

Our findings tentatively suggest that, even when voices are not targeted directly, TFT for PTSD can alleviate distressing voices.

Objectives

Disrupted emotion processes are commonly linked to the onset and maintenance of auditory verbal hallucinations. However, a comprehensive approach using an extended emotion model has not previously been applied to voice-hearers to distinguish impairments in emotion processes from non-clinical populations. The present study hypothesised voice-hearers, as compared to controls, would have (1) higher reactivity to negative emotions and lower reactivity to positive emotions, (2) more difficulties regulating negative and positive emotions, (3) more maladaptive strategy use, and (4) higher alexithymia.

Method

T-tests tested these hypotheses, comparing self-report measures of emotional reactivity, emotion regulation and alexithymia in voice-hearers (n = 50) to controls (n = 53).

Results

There were no group differences in emotional reactivity to positive or negative emotions. Compared to controls, voice-hearers showed difficulties in both positive and negative emotion regulation, were more likely to use expressive suppression, and were more likely to be alexithymic.

Conclusions

These findings may help researchers and clinicians identify difficulties in voice-hearers' emotion processing, providing better direction for case formulation and treatment.

Objectives

Lesbian and Gay people (LGP) experience higher rates of mental health difficulties, including self-harm, suicidal behaviours, as well as inequalities in health care, than their heterosexual peers. Dialectical Behaviour Therapy (DBT) is an evidence-based treatment for self-harm and suicidal behaviours, though there is little research on LGP's experiences of DBT. This research aims to explore LGP's experiences of completing a full DBT programme.

Design

A qualitative design with semi-structured individual interviews was utilised. The results were analysed using Interpretative Phenomenological Analysis.

Methods

Six lesbian and two gay adults, aged between 22 and 47 years, living in the United Kingdom took part. All participants had completed a full programme of DBT within the 2 years prior to the interview.

Results

Four superordinate themes emerged from the data: (1) The DBT journey; (2) Connections and Sense of Community during DBT; (3) Sexuality both visible and invisible in DBT and (4) A Gender, Sexuality and Relationship Diverse (GSRD) affirmative future for DBT.

Conclusions

Several clinical implications are suggested to improve DBT for LGP, for example to consider having other LGP within DBT groups, to create a more GSRD-affirming DBT (changes to the DBT manual, DBT therapists, DBT programme and physical DBT space), to adapt DBT techniques to manage sexuality-related difficulties and to adopt a GSRD-centric framework. Overall, DBT appears to be beneficial for LGP.

Background

Non-suicidal self-injury (NSSI) is a significant public health concern. Research and treatment interventions largely focus on stopping self-injury. People who self-injure do not necessarily equate recovery to cessation. Qualitative accounts allow greater understanding of personal recovery narratives. This study aimed to synthesise personal conceptualisations of NSSI recovery.

Methods

Participants had lived experience of NSSI and discussed their recovery. Papers not written in English or had a quantitative design were excluded. Four databases (PsycInfo, CINAHL, Medline and Web of Science) were systematically searched. The quality of each paper was assessed using the CASP quality assessment tool. Data were synthesised using a meta-ethnographic approach.

Results

Thirteen studies comprising 159 participants were included. Three overarching themes were developed. While ceasing NSSI was an important aspect of recovery for some, recovery was typically viewed more holistically, encompassing developments within the self and relationships. Recovery was regarded an ongoing non-linear journey. The personal and multifaceted nature of the recovery process emerged through a line of argument synthesis.

Conclusions

This was the first qualitative synthesis of personal conceptualisations of NSSI recovery. The findings highlighted the personal and multifaceted nature of NSSI recovery and supported person-centred models of self-injury recovery. Clinical implications include the importance of expanding self-injury recovery beyond cessation within research and clinical practice, and for collaborative and person-centred approaches to be embraced when supporting those who self-injure.

Objective

Antipsychotics remain the first-line treatment for people diagnosed with psychotic disorders despite adverse effects which lead many people to stop their medication. Many stop without the support of the prescriber, who may fear relapse. The objective of this study is to better understand the process of withdrawal from antipsychotics, from the perspective of people taking antipsychotics.

Design

Online survey.

Methods

An international online survey elicited quantitative responses about pre-withdrawal planning (560) and qualitative responses about what was helpful and unhelpful when withdrawing from antipsychotics (443). Responses came from users of antipsychotics in 29 countries.

Results

Forty-seven per cent did not consult their psychiatrist before discontinuing. Only 40% made preparations, most commonly making a plan, gathering information and informing family. The most frequently reported helpful factors were focussing on the benefits of getting off the drugs (including ending adverse effects and feeling more alive), information about withdrawal symptoms and how to withdraw safely, withdrawing slowly, and support from psychologists, counsellors and psychotherapists. The most common unhelpful factor was the psychiatrist/doctor, largely because of their lack of knowledge, refusal to support the patient's wishes and the threat or use of coercion.

Conclusions

Evidence-based, respectful, collaborative responses to patients' concerns about adverse effects and desires to withdraw would probably reduce relapse rates and improve long-term outcomes. It would definitely help end pervasive breaching of the principle of informed consent and human rights legislation.

Background

Many young people (YP) struggle with their mental health and look online for help. To capitalise on their digital presence, we need to better understand how and where they seek information online and what they think of what they find.

Method

We recruited 24 YP (aged 13–18 years). Online interviews were co-conducted by research team members and trained young researchers. We presented a persona with depression symptoms and asked about potential sources of information/support they might seek. They were also asked to think aloud while searching online and reviewing mental health resources (NHS, Young Minds). We used reflexive thematic analysis.

Results

Analysis generated four themes: (1) the online help-seeking process, showcasing where YP look for information and why; (2) the mismatch between the information YP expected to find and the reality; (3) the strategies YP employed to determine a source's trust and credibility and (4) individual differences that can influence help-seeking.

Conclusion

Participants initiated their online search by Googling symptoms. They trusted NHS websites for basic medical information, while charities provided detailed content. Despite scepticism about content, social media offered validation. Online resources should prioritise visual appeal, user-friendliness, age-appropriate and personalised content and peer insights. Codesign is imperative to ensure high-quality, impactful research.

Background

The adolescent borderline personality disorder (BPD) diagnosis has been widely debated for many years. Strikingly, young people's experiences of both receiving a diagnosis of BPD, and of living with BPD, are largely under-explored. The current study seeks to address these gaps in the literature in a multi-perspectival design utilising young people–parent dyads.

Methods

Young people (aged 16–18 years) with a diagnosis of BPD (n = 5) and their mothers (n = 5) were recruited from two NHS Community Mental Health Services in the West Midlands and participated in semi-structured interviews. Data were analysed using interpretative phenomenological analysis [IPA].

Findings

Analysis identified two superordinate themes with five subthemes: (1) The “ugly” reality of living with BPD (providing a stark insight into what it is like to live with the unpredictable nature of experiences labelled as BPD), and (2) The diagnosis that dare not speak its name (highlighting the complexities of how the diagnosis itself is experienced by participants as a symbol of personal and permanent defectiveness and danger).

Discussion

Findings highlight a clear commonality of experience centred around the intensity of the young people's emotional distress and the accompanying pressure on parents to keep young people safe, both of which services must strive to do more to contain. Ultimately, the costs of receiving a BPD diagnosis appear to outweigh the benefits, and this paper adds support to calls for change in respect to how we conceptualise difficulties labelled as BPD and how we communicate about these difficulties, in order to avoid causing harm.