Eleanor Longden, Alison Branitsky, Wendy Jones, Sarah Peters
Purpose
The purpose of the study was to investigate service-users' experiences of a therapist engaging with their voices (auditory hallucinations) using psychological formulation and direct dialogue.
Method
A nested qualitative study was conducted within a randomised controlled trial of a novel intervention for supporting voice hearers with a diagnosis of psychosis (Talking With Voices: TwV). Of 24 participants allocated to therapy, 13 (54%) consented to a semi-structured, in-depth interview which was audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.
Results
Participants described their experiences of using the intervention to improve the relationship between themselves and their voice(s). The findings are organised within three themes and associated subthemes: (1) A desire for suitable help (Motivation to reduce voice-related distress, Limitation of other treatment options); (2) Engaging with voices (Challenges, Support and safety, Exploration and revelation); and (3) Contemplating the future (The aftermath of adversity, Living well with voices, Resources for moving forward).
Conclusion
Despite the emotional challenges of the work, many participants experienced tangible gains in the ways they related to their voices post-intervention. For those who responded well, the development of safety strategies, including a strong therapeutic alliance, could facilitate a basis for developing new insights about the origin/nature of the voices which could then be applied in constructive ways. Further research is needed to understand which client characteristics indicate suitability for TwV as opposed to relational therapies that require less direct engagement with voices and/or the psychosocial conflicts with which they may be associated.
目的：本研究的目的是调查治疗师使用心理公式和直接对话处理他们的声音（幻听）的服务用户体验。方法：在一项随机对照试验中进行了一项嵌套的定性研究，该试验采用了一种新的干预措施来支持被诊断为精神病的听力者（Talking with Voices:TwV）。在被分配接受治疗的24名参与者中，13人（54%）同意进行半结构化的深入访谈，访谈内容为录音、逐字转录并使用归纳主题分析进行分析。结果：参与者描述了他们使用干预措施改善自己和声音之间关系的经历。研究结果分为三个主题和相关的子主题：（1）对适当帮助的渴望（减少与声音相关的痛苦的动机，其他治疗选择的局限性）；（2） 参与声音（挑战、支持与安全、探索与启示）；以及（3）展望未来（逆境的后果，与声音一起生活，前进的资源）。结论：尽管工作在情感上存在挑战，但许多参与者在干预后与声音相关的方式上都取得了实实在在的收获。对于那些反应良好的人来说，制定安全策略，包括建立强有力的治疗联盟，可以为开发关于声音来源/性质的新见解奠定基础，然后以建设性的方式应用这些见解。需要进一步的研究来了解哪些客户特征表明适合TwV，而不是需要较少直接参与声音和/或与其相关的心理社会冲突的关系疗法。
{"title":"When therapists talk to voices: Perspectives from service-users who experience auditory hallucinations","authors":"Eleanor Longden, Alison Branitsky, Wendy Jones, Sarah Peters","doi":"10.1111/papt.12489","DOIUrl":"10.1111/papt.12489","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>The purpose of the study was to investigate service-users' experiences of a therapist engaging with their voices (auditory hallucinations) using psychological formulation and direct dialogue.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A nested qualitative study was conducted within a randomised controlled trial of a novel intervention for supporting voice hearers with a diagnosis of psychosis (Talking With Voices: TwV). Of 24 participants allocated to therapy, 13 (54%) consented to a semi-structured, in-depth interview which was audio-recorded, transcribed verbatim and analysed using inductive thematic analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Participants described their experiences of using the intervention to improve the relationship between themselves and their voice(s). The findings are organised within three themes and associated subthemes: (1) A desire for suitable help (<i>Motivation to reduce voice-related distress, Limitation of other treatment options</i>); (2) Engaging with voices (<i>Challenges, Support and safety, Exploration and revelation</i>); and (3) Contemplating the future (<i>The aftermath of adversity</i>, <i>Living well with voices, Resources for moving forward</i>).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Despite the emotional challenges of the work, many participants experienced tangible gains in the ways they related to their voices post-intervention. For those who responded well, the development of safety strategies, including a strong therapeutic alliance, could facilitate a basis for developing new insights about the origin/nature of the voices which could then be applied in constructive ways. Further research is needed to understand which client characteristics indicate suitability for TwV as opposed to relational therapies that require less direct engagement with voices and/or the psychosocial conflicts with which they may be associated.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"96 4","pages":"967-981"},"PeriodicalIF":3.4,"publicationDate":"2023-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10326484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angus MacBeth, Hope Christie, Lisa Golds, Francisca Morales, Aigli Raouna, Vilas Sawrikar, Karri Gillespie-Smith
Background
There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the ‘First 1000 Days’ from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an intergenerational approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches.
Aims and Methods
In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health.
Results
We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health.
Discussion
Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.
{"title":"Thinking about the next generation: The case for a mentalization-informed approach to perinatal and intergenerational mental health","authors":"Angus MacBeth, Hope Christie, Lisa Golds, Francisca Morales, Aigli Raouna, Vilas Sawrikar, Karri Gillespie-Smith","doi":"10.1111/papt.12483","DOIUrl":"10.1111/papt.12483","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There has been substantial progress made across multiple disciplines to emphasize the importance of perinatal mental health both for parents and offspring. This focuses on what has been termed the ‘First 1000 Days’ from conception to the child's second birthday. We argue that our understanding of this issue can go further to create an <i>intergenerational</i> approach to mental health. Despite the existence of theoretical frameworks and practical approaches to implementation, there are gaps in the understanding of perinatal and intergenerational mental health including which psychological mechanisms are implicated in the transmission of risk and resilience within the perinatal period; and how to leverage these into treatment approaches.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims and Methods</h3>\u0000 \u0000 <p>In this paper, we explore the potential for mentalization as a candidate psychological approach to intergenerational mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We contextualize this issue in terms of the points of contact between mentalization and broader theoretical models such as the social determinants of health and the Developmental Origins of Health and Disease (DoHaD) model. Further, we provide an overview of the existing evidence base for the relevance of mentalization to perinatal mental health.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Finally, we sketch out an outline model for integrating mentalization into perinatal and intergenerational mental health, highlighting several areas of opportunity to develop research and practice from diverse geographies and demographics. Here, we suggest that integration of mentalization with other conceptual frameworks such as DoHaD can mutually enrich the understanding of each model, pointing the way towards more effective early and preventative interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"97 S1","pages":"1-15"},"PeriodicalIF":2.6,"publicationDate":"2023-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/papt.12483","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9981796","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nicola McGuire, Andrew Gumley, Ilanit Hasson-Ohayon, Stephanie Allan, Warut Aunjitsakul, Orkun Aydin, Sune Bo, Kelsey A. Bonfils, Anna-Lena Bröcker, Steven de Jong, Giancarlo Dimaggio, Felix Inchausti, Jens Einar Jansen, Tania Lecomte, Lauren Luther, Angus MacBeth, Christiane Montag, Marlene Buch Pedersen, Gerdina Henrika Maria Pijnenborg, Raffaele Popolo, Matthias Schwannauer, Anne-Marie Trauelsen, Rozanne van Donkersgoed, Weiming Wu, Kai Wang, Paul H. Lysaker, Hamish McLeod
Purpose
Negative symptoms are a persistent, yet under-explored problem in psychosis. Disturbances in metacognition are a potential causal factor in negative symptom development and maintenance. This meta-analysis uses individual participant data (IPD) from existing research to assess the relationship between negative symptoms and metacognition treated as summed scores and domains.
Methods
Data sets containing individuals with negative symptoms and metacognition data, aged 16+ with psychosis, were identified according to pre-specific parameters. IPD integrity and completeness were checked and data were synthesized in two-stage meta-analyses of each negative symptoms cluster compared with metacognition in seemingly unrelated regression using restricted maximum likelihood estimation. Planned and exploratory sensitivity analyses were also conducted.
Results
Thirty-three eligible data sets were identified with 21 with sufficient similarity and availability to be included in meta-analyses, corresponding to 1301 participants. The strongest relationships observed were between summed scores of negative symptoms and metacognition. Metacognitive domains of self-reflectivity and understanding others' minds, and expressive negative symptoms emerged as significant in some meta-analyses. The uncertainty of several effect estimates increased significantly when controlling for covariates.
Conclusions
This robust meta-analysis highlights the impact of using summed versus domain-specific scores of metacognition and negative symptoms, and relationships are not as clear-cut as once believed. Findings support arguments for further differentiation of negative symptom profiles and continued granular exploration of the relationship between metacognition and negative symptoms.
{"title":"Investigating the relationship between negative symptoms and metacognitive functioning in psychosis: An individual participant data meta-analysis","authors":"Nicola McGuire, Andrew Gumley, Ilanit Hasson-Ohayon, Stephanie Allan, Warut Aunjitsakul, Orkun Aydin, Sune Bo, Kelsey A. Bonfils, Anna-Lena Bröcker, Steven de Jong, Giancarlo Dimaggio, Felix Inchausti, Jens Einar Jansen, Tania Lecomte, Lauren Luther, Angus MacBeth, Christiane Montag, Marlene Buch Pedersen, Gerdina Henrika Maria Pijnenborg, Raffaele Popolo, Matthias Schwannauer, Anne-Marie Trauelsen, Rozanne van Donkersgoed, Weiming Wu, Kai Wang, Paul H. Lysaker, Hamish McLeod","doi":"10.1111/papt.12484","DOIUrl":"10.1111/papt.12484","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>Negative symptoms are a persistent, yet under-explored problem in psychosis. Disturbances in metacognition are a potential causal factor in negative symptom development and maintenance. This meta-analysis uses individual participant data (IPD) from existing research to assess the relationship between negative symptoms and metacognition treated as summed scores and domains.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data sets containing individuals with negative symptoms and metacognition data, aged 16+ with psychosis, were identified according to pre-specific parameters. IPD integrity and completeness were checked and data were synthesized in two-stage meta-analyses of each negative symptoms cluster compared with metacognition in seemingly unrelated regression using restricted maximum likelihood estimation. Planned and exploratory sensitivity analyses were also conducted.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Thirty-three eligible data sets were identified with 21 with sufficient similarity and availability to be included in meta-analyses, corresponding to 1301 participants. The strongest relationships observed were between summed scores of negative symptoms and metacognition. Metacognitive domains of self-reflectivity and understanding others' minds, and expressive negative symptoms emerged as significant in some meta-analyses. The uncertainty of several effect estimates increased significantly when controlling for covariates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This robust meta-analysis highlights the impact of using summed versus domain-specific scores of metacognition and negative symptoms, and relationships are not as clear-cut as once believed. Findings support arguments for further differentiation of negative symptom profiles and continued granular exploration of the relationship between metacognition and negative symptoms.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"96 4","pages":"918-933"},"PeriodicalIF":3.4,"publicationDate":"2023-08-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9920820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Internalized stigma is known to be high in bipolar disorder (BD). Concepts such as self-compassion and psychological resilience have recently begun to be studied as protective factors for BD. The aim of the current study was to examine the relationships between internalized stigma, self-compassion and resilience among individuals with BD.
Method
One hundred and thirty-two male and female (18-65 years of age) participants with a DSM 5 diagnosis of BD (BD- I & BD- II) were included. The remission criteria (YMRS< 5 and HDRS< 7) was evaluated using clinician-administered measures and all participants were found to be remitted. Correlation and mediation analyses were performed. Participants completed the Internalized Stigma in Mental Illness Scale (ISMI), the Self-Compassion Scale (SCS) and the Resilience Scale for Adults (RSA).
Results
Significant correlations were found between internalized stigma, sub-dimensions of self-compassion (self-kindness, self-judgement, common humanity, isolation, mindfulness, and over-identification), and resilience in the expected directions like negative correlations between internalized stigma and positive dimensions of self-compassion (self-kindness, common humanity and mindfulness). Self-judgement and self-kindness mediated the relationship between internalized stigma and psychological resilience.
Conclusions
The findings of the study shed light on which dimensions of self-compassion might be more beneficial to work with in order to increase resilience when working with internalized stigma in BD. This strengths-based investigation would be valuable to enrich psycho-social interventions for the prevention of relapse in BD.
{"title":"The mediating role of self-compassion in the relationship between internalized stigma and psychological resilience in bipolar disorder","authors":"Zeynep Mackali, Saadet Çetinkaya, Nur Ay","doi":"10.1111/papt.12488","DOIUrl":"10.1111/papt.12488","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Internalized stigma is known to be high in bipolar disorder (BD). Concepts such as self-compassion and psychological resilience have recently begun to be studied as protective factors for BD. The aim of the current study was to examine the relationships between internalized stigma, self-compassion and resilience among individuals with BD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>One hundred and thirty-two male and female (18-65 years of age) participants with a DSM 5 diagnosis of BD (BD- I & BD- II) were included. The remission criteria (YMRS< 5 and HDRS< 7) was evaluated using clinician-administered measures and all participants were found to be remitted. Correlation and mediation analyses were performed. Participants completed the Internalized Stigma in Mental Illness Scale (ISMI), the Self-Compassion Scale (SCS) and the Resilience Scale for Adults (RSA).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Significant correlations were found between internalized stigma, sub-dimensions of self-compassion (self-kindness, self-judgement, common humanity, isolation, mindfulness, and over-identification), and resilience in the expected directions like negative correlations between internalized stigma and positive dimensions of self-compassion (self-kindness, common humanity and mindfulness). Self-judgement and self-kindness mediated the relationship between internalized stigma and psychological resilience.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The findings of the study shed light on which dimensions of self-compassion might be more beneficial to work with in order to increase resilience when working with internalized stigma in BD. This strengths-based investigation would be valuable to enrich psycho-social interventions for the prevention of relapse in BD.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"96 4","pages":"952-966"},"PeriodicalIF":3.4,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10256136","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ilanit Hasson-Ohayon, Libby Igra, Adi Lavi-Rotenberg, Gil Goldzweig, Paul H. Lysaker
Background
Research has suggested that people diagnosed with schizophrenia experience challenges in their abilities to reflect upon themselves, others and their actions in the world. One emerging approach to addressing these forms of subjective disturbance is Metacognitive Reflection and Insight Therapy (MERIT).
Aims
In this study, a randomized delayed trial was conducted to assess the effects of MERIT upon metacognition, psychiatric symptoms and quality of life.
Materials and Methods
Following recruitment and randomization, data from 54 adults diagnosed with schizophrenia were analysed.
Results
Findings included significant interaction effects between group (immediate intervention or waiting condition) and time (pre- and post intervention) with regard to the metacognition general score and its domain of mastery, as well as with regard to negative, positive and cognitive symptoms.
Discussion
Participating in MERIT seems to improve one's ability to use reflective knowledge to cope with psychological challenges and to improve, or at least maintain, level of symptomatology.
Conclusions
These findings are discussed within the framework of agency as an important aspect of recovery.
{"title":"Findings from a randomized controlled trial of Metacognitive Reflection and Insight Therapy for people with schizophrenia: Effects on metacognition and symptoms","authors":"Ilanit Hasson-Ohayon, Libby Igra, Adi Lavi-Rotenberg, Gil Goldzweig, Paul H. Lysaker","doi":"10.1111/papt.12485","DOIUrl":"10.1111/papt.12485","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Research has suggested that people diagnosed with schizophrenia experience challenges in their abilities to reflect upon themselves, others and their actions in the world. One emerging approach to addressing these forms of subjective disturbance is Metacognitive Reflection and Insight Therapy (MERIT).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>In this study, a randomized delayed trial was conducted to assess the effects of MERIT upon metacognition, psychiatric symptoms and quality of life.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Following recruitment and randomization, data from 54 adults diagnosed with schizophrenia were analysed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Findings included significant interaction effects between group (immediate intervention or waiting condition) and time (pre- and post intervention) with regard to the metacognition general score and its domain of mastery, as well as with regard to negative, positive and cognitive symptoms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Participating in MERIT seems to improve one's ability to use reflective knowledge to cope with psychological challenges and to improve, or at least maintain, level of symptomatology.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings are discussed within the framework of agency as an important aspect of recovery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"97 S1","pages":"75-90"},"PeriodicalIF":2.6,"publicationDate":"2023-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/papt.12485","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9925183","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
It is a half-century since the coalescence of social psychiatry and systemic family therapy approaches started to inform condition-specific therapeutic work with families to reduce relapse and hospital readmission for people with schizophrenia. Today, family interventions are a cornerstone of international guidelines for the treatment of psychosis, and of workforce development initiatives. Effect sizes for clinical and economic outcomes are large, and the evidence base is robust and reliable, not only for outcomes but also for the underpinning theoretical models, which are coherent and consistent. Few, if any, psychological therapies, have so powerful a framework to drive widespread implementation. Nevertheless, delivery in clinical services is variable, often lagging behind that of individual cognitive behavioural therapy, notwithstanding its considerably weaker implementation framework. Our aim in this article is to formulate this translation failure and offer potential solutions.
Method
We summarise the model/intervention and supporting evidence, then consider why delivery remains problematic.
Results
We highlight the inter-linked issues of conceptual confusion between and conflation of, different approaches to working with families; of addressing diagnostic uncertainty, complex comorbidity and adapting interventions for specific populations; and of translation from gold-standard research trial practice, through educational curricula and training programmes, to routine delivery in frontline services.
Conclusion
We present our view of clinical, research and workforce development priorities to address these issues and continue the collective effort, moving into the next half-century, to work more effectively with people with psychosis and their families, to further improve outcomes.
{"title":"State of the art in psychological therapies for psychosis: Family interventions for psychosis","authors":"Suzanne Jolley, Sarah Grice","doi":"10.1111/papt.12487","DOIUrl":"10.1111/papt.12487","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Purpose</h3>\u0000 \u0000 <p>It is a half-century since the coalescence of social psychiatry and systemic family therapy approaches started to inform condition-specific therapeutic work with families to reduce relapse and hospital readmission for people with schizophrenia. Today, family interventions are a cornerstone of international guidelines for the treatment of psychosis, and of workforce development initiatives. Effect sizes for clinical and economic outcomes are large, and the evidence base is robust and reliable, not only for outcomes but also for the underpinning theoretical models, which are coherent and consistent. Few, if any, psychological therapies, have so powerful a framework to drive widespread implementation. Nevertheless, delivery in clinical services is variable, often lagging behind that of individual cognitive behavioural therapy, notwithstanding its considerably weaker implementation framework. Our aim in this article is to formulate this translation failure and offer potential solutions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We summarise the model/intervention and supporting evidence, then consider why delivery remains problematic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We highlight the inter-linked issues of conceptual confusion between and conflation of, different approaches to working with families; of addressing diagnostic uncertainty, complex comorbidity and adapting interventions for specific populations; and of translation from gold-standard research trial practice, through educational curricula and training programmes, to routine delivery in frontline services.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>We present our view of clinical, research and workforce development priorities to address these issues and continue the collective effort, moving into the next half-century, to work more effectively with people with psychosis and their families, to further improve outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"97 1","pages":"19-33"},"PeriodicalIF":3.4,"publicationDate":"2023-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9890950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Laura P. Strachan, Georgie Paulik, David A. Preece, Peter M. McEvoy
Background
A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area.
Aims
This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model.
Materials
The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire.
Methods
We used path analysis in a non-clinical sample (N = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation.
Results
Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (βs = .14–.61) and indirect pathways (βs = .01–.08) were significant (ps < .001).
Discussion
Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation.
Conclusion
Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.
{"title":"Pathways from trauma to unusual perceptual experiences: Modelling the roles of insecure attachment, negative affect, emotion regulation and dissociation","authors":"Laura P. Strachan, Georgie Paulik, David A. Preece, Peter M. McEvoy","doi":"10.1111/papt.12486","DOIUrl":"10.1111/papt.12486","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>A range of traumas have been linked to voices (auditory verbal hallucinations) and unusual perceptual experiences (UPEs) in other perceptual-sensory domains. Models of PTSD and positive symptoms of psychosis are insufficient in explaining the relationship between trauma and voices. The trauma-related voices (TRV) model was developed to generate novel research in this area.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>This study aimed to investigate pathways from trauma to the frequency of UPEs based on a subset of hypothesised relationships in the TRV model.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials</h3>\u0000 \u0000 <p>The PTSD Diagnostic Scale for DSM-5, State Adult Attachment Measure, Depression Anxiety and Stress Scales-21, Perth Emotion and Regulation Competency Inventory, Dissociative Experiences Measure Oxford, and Multi-modality Unusual Perceptual Experiences Questionnaire.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used path analysis in a non-clinical sample (<i>N</i> = 528) to model indirect effects from diverse trauma experiences to the frequency of multi-sensory UPEs via a subset of mediators within the TRV model: insecure attachment, emotion regulation deficits, negative affect and dissociation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Our model was an excellent fit to the data and accounted for 37.1% of variance in UPE frequency, and all direct (<i>β</i>s = .14–.61) and indirect pathways (<i>β</i>s = .01–.08) were significant (<i>p</i>s < .001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our findings suggest that insecure attachment may link diverse trauma experiences to emotion regulation deficits and negative affect, which are linked to UPE frequency via dissociation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our findings provide preliminary evidence for a subset of relationships within the TRV model. Future studies are needed to gather stronger evidence of temporality and causation between these factors, and to test broader pathways within the TRV model.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"96 4","pages":"934-951"},"PeriodicalIF":3.4,"publicationDate":"2023-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9873781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The objectives for this study were to explore Black people's experiences of being asked about ACEs by mental health or counselling professionals, both broadly, and also as part of routine enquiry with a commonly used ACE questionnaire. An additional aim was to understand their perspectives on how services should be asking about ACEs.
Methods
This study used a qualitative methodology, with a critical realist reflexive thematic analysis approach. Ten people who identified as Black and had been asked about ACEs by a mental health professional or counsellor, were interviewed about their experiences and perspectives using semi-structured interviews.
Results
Four overarching themes, some with subthemes, were established: Trust and safety as individual and systemic (subthemes: Distrust in the system; Distrust in the clinician; Racism in health care; Keeping safe); It is the person, not the questions (subthemes: Being heard and understood; Similarity and difference); Engaged client, ‘hard-to-reach’ clinician? and People are not tick-boxes.
Conclusions
The results highlight that people find it important and useful to be asked about ACEs, if it is done in an appropriate manner. Establishing trust and a therapeutic relationship is key to fostering this. Participants stated that the ACE questionnaire might miss important context, and they relayed a preference for being asked about ACEs using more inclusive definitions of ACEs.
{"title":"Black people's experiences of being asked about adverse childhood experiences in the UK: A qualitative study","authors":"Eirill Høyland Sødal, Vyv Huddy, Juliet McKenzie","doi":"10.1111/papt.12482","DOIUrl":"10.1111/papt.12482","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>The objectives for this study were to explore Black people's experiences of being asked about ACEs by mental health or counselling professionals, both broadly, and also as part of routine enquiry with a commonly used ACE questionnaire. An additional aim was to understand their perspectives on how services should be asking about ACEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study used a qualitative methodology, with a critical realist reflexive thematic analysis approach. Ten people who identified as Black and had been asked about ACEs by a mental health professional or counsellor, were interviewed about their experiences and perspectives using semi-structured interviews.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Four overarching themes, some with subthemes, were established: <i>Trust and safety as individual and systemic</i> (subthemes: <i>Distrust in the system; Distrust in the clinician; Racism in health care; Keeping safe</i>); <i>It is the person, not the questions</i> (subthemes: <i>Being heard and understood; Similarity and difference</i>); <i>Engaged client, ‘hard-to-reach’ clinician?</i> and <i>People are not tick-boxes</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The results highlight that people find it important and useful to be asked about ACEs, if it is done in an appropriate manner. Establishing trust and a therapeutic relationship is key to fostering this. Participants stated that the ACE questionnaire might miss important context, and they relayed a preference for being asked about ACEs using more inclusive definitions of ACEs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"96 4","pages":"902-917"},"PeriodicalIF":3.4,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9886845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melissa G. A. Remeeus, Maaike L. Smits, Anna M. Bal-Bax, Dine J. Feenstra, Patrick Luyten
Objectives
Although treatments of patients with borderline personality disorder (BPD) were historically associated with relatively high dropout rates, dropout rates in contemporary evidence-based treatments for BPD are typically substantially lower. However, only a few studies have investigated dropout rates in mentalization-based treatment (MBT), and even fewer have investigated predictors of dropout in this type of treatment. In this study, we investigated dropout rates in two types of MBT (day hospital MBT [MBT-DH] and intensive outpatient MBT [MBT-IOP]) using data from a recent multicenter randomized clinical trial. Given the central importance of attachment considerations in MBT, we also investigated the relationship between dropout in these two treatments and attachment dimensions.
Design
Within a multicenter randomized clinical trial, 114 BPD patients were randomized to MBT-DH (n = 70) or MBT-IOP (n = 44).
Methods
Dropout in both types of MBT was investigated using descriptive analyses, and its association with attachment anxiety and attachment avoidance, as measured by the Experiences in Close Relationships questionnaire at baseline, was investigated using regression analyses.
Results
Dropout rates were relatively low (10.5% across both types of MBT) and did not significantly differ between groups (11.4% in MBT-DH, 9.1% in MBT-IOP). Attachment avoidance and attachment anxiety did not impact dropout, nor did their interaction or the interaction with the type of MBT.
Conclusions
Low dropout rates in both types of MBT indicate a high level of engagement of patients in both programmes. Attachment dimensions were not associated with dropout, consistent with the principle that MBT is tailored to each individual's needs. More research is needed, however, to investigate to what extent attachment is a dynamic context-bound adaptive process rather than a static personality feature.
{"title":"Attachment as a predictor of dropout in mentalization-based treatment","authors":"Melissa G. A. Remeeus, Maaike L. Smits, Anna M. Bal-Bax, Dine J. Feenstra, Patrick Luyten","doi":"10.1111/papt.12478","DOIUrl":"10.1111/papt.12478","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>Although treatments of patients with borderline personality disorder (BPD) were historically associated with relatively high dropout rates, dropout rates in contemporary evidence-based treatments for BPD are typically substantially lower. However, only a few studies have investigated dropout rates in mentalization-based treatment (MBT), and even fewer have investigated predictors of dropout in this type of treatment. In this study, we investigated dropout rates in two types of MBT (day hospital MBT [MBT-DH] and intensive outpatient MBT [MBT-IOP]) using data from a recent multicenter randomized clinical trial. Given the central importance of attachment considerations in MBT, we also investigated the relationship between dropout in these two treatments and attachment dimensions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>Within a multicenter randomized clinical trial, 114 BPD patients were randomized to MBT-DH (<i>n</i> = 70) or MBT-IOP (<i>n</i> = 44).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Dropout in both types of MBT was investigated using descriptive analyses, and its association with attachment anxiety and attachment avoidance, as measured by the Experiences in Close Relationships questionnaire at baseline, was investigated using regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Dropout rates were relatively low (10.5% across both types of MBT) and did not significantly differ between groups (11.4% in MBT-DH, 9.1% in MBT-IOP). Attachment avoidance and attachment anxiety did not impact dropout, nor did their interaction or the interaction with the type of MBT.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Low dropout rates in both types of MBT indicate a high level of engagement of patients in both programmes. Attachment dimensions were not associated with dropout, consistent with the principle that MBT is tailored to each individual's needs. More research is needed, however, to investigate to what extent attachment is a dynamic context-bound adaptive process rather than a static personality feature.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"97 S1","pages":"45-57"},"PeriodicalIF":2.6,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9834755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
To evaluate the accuracy of patient information leaflets about electroconvulsive therapy (ECT) used in Northern Ireland, Scotland and Wales, and their compliance with the principle of informed consent.
Design and Methods
To replicate an audit in England, Freedom of Information Act requests were sent to the 26 providers of ECT for their ECT patient information leaflet. These were scored, by two independent raters, on the same 40-item accuracy measure used in the England audit.
Results
The number of accurate statements (out of a possible 29) ranged from seven to 20, with a mean of 16.9. The most frequently omitted statements included: cardiovascular risks (mentioned by five leaflets), that it is not known how ECT works (3), risk of mortality (2), risks from multiple general anaesthetic procedures (2), how to access a legal advocate (2) and that that there is no evidence of long-term benefits (1). The leaflets made between six and nine inaccurate statements (out of 11) with a mean of 7.0. Nineteen minimised memory loss, blamed the memory loss on depression, claimed that ECT is the ‘most effective treatment’ and asserted it has very high response rates without mentioning similar placebo response rates. All 23 leaflets wrongly told patients that ECT saves lives.
Conclusions
Electroconvulsive therapy information leaflets in these three nations are barely more accurate than those in England and do not comply with the ethical principle of informed consent. Patients and families across the UK are systematically being misled about the risks they are taking and the limited nature of ECT's benefits.
{"title":"An independent audit of electroconvulsive therapy patient information leaflets in Northern Ireland, Scotland and Wales","authors":"John Read, Lisa Morrison, Chris Harrop","doi":"10.1111/papt.12481","DOIUrl":"10.1111/papt.12481","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>To evaluate the accuracy of patient information leaflets about electroconvulsive therapy (ECT) used in Northern Ireland, Scotland and Wales, and their compliance with the principle of informed consent.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design and Methods</h3>\u0000 \u0000 <p>To replicate an audit in England, Freedom of Information Act requests were sent to the 26 providers of ECT for their ECT patient information leaflet. These were scored, by two independent raters, on the same 40-item accuracy measure used in the England audit.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The number of accurate statements (out of a possible 29) ranged from seven to 20, with a mean of 16.9. The most frequently omitted statements included: cardiovascular risks (mentioned by five leaflets), that it is not known how ECT works (3), risk of mortality (2), risks from multiple general anaesthetic procedures (2), how to access a legal advocate (2) and that that there is no evidence of long-term benefits (1). The leaflets made between six and nine inaccurate statements (out of 11) with a mean of 7.0. Nineteen minimised memory loss, blamed the memory loss on depression, claimed that ECT is the ‘most effective treatment’ and asserted it has very high response rates without mentioning similar placebo response rates. All 23 leaflets wrongly told patients that ECT saves lives.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Electroconvulsive therapy information leaflets in these three nations are barely more accurate than those in England and do not comply with the ethical principle of informed consent. Patients and families across the UK are systematically being misled about the risks they are taking and the limited nature of ECT's benefits.</p>\u0000 </section>\u0000 </div>","PeriodicalId":54539,"journal":{"name":"Psychology and Psychotherapy-Theory Research and Practice","volume":"96 4","pages":"885-901"},"PeriodicalIF":3.4,"publicationDate":"2023-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9832221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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