Psychology and Psychotherapy-Theory Research and Practice最新文献

Objectives: In recent decades, research has increasingly highlighted the devastating effects of childhood trauma and relational processes that violate human development. However, the unique dynamics of such early-life deprivations in adults who practice meditation, a context where the complexity of such wounding (and healing) may become apparent, remains underexplored. The objectives of this study were to explore how individuals with a history of inconsistent evolved developmental niche (EDN) care experience their meditation journeys, and to understand the emotional and relational processes that emerge in this context.

Design: A qualitative design using interpretative phenomenological analysis (IPA) was adopted to capture participants' lived experiences.

Methods: Six adults with a history of inconsistent EDN care and at least 3 months of regular meditation practice participated in semi-structured interviews. Transcripts were analysed using IPA to identify key experiential themes.

Results: Three themes emerged from the data: (1) 'An inconsistent EDN in childhood left lasting emotional and relational wounds into adulthood', (2) 'Meditation eased inner turmoil but revealed different ways of dealing with emotions and the body', and (3) 'Meditation offered a space to explore relating to the self and others, areas complicated by their inconsistent EDN'. Findings illustrated the inheritance and development of immature defence mechanisms alongside emotional and relational challenges. Participants described feelings of increased calmness and closeness with others as benefits of meditation, though for some, pre-existing difficulties persisted or were amplified.

Conclusion: These results raise awareness of the long-term effects surrounding unresolved traumatic dynamics and the importance of delivering trauma-informed care. They also highlight the potential of meditation to uncover psychological dynamics and experiences rooted in early life which have the emotional potency to pose risks to individuals coming into contact with them.

Objectives: Despite studies showing that persons with hearing impairments (HI) or vision impairments (VI) have an increased risk of developing mental health disorders, mental health services frequently are not accessible and suited to the specific needs of both populations. However, there is limited research addressing how mental health services can be improved to meet these needs.

Design: This qualitative interview study explores barriers and strategies to improve accessibility in mental health services for persons with HI or VI in Germany, as viewed with a multi-perspective approach.

Methods: Using problem-centred interviews, which combine a flexible interview guide with a focus on specific issues, we applied a participatory research approach to gather insights from 58 participants, including mental health professionals specialised in treating persons with HI or VI and persons with HI or VI with lived experience as clients in mental health services.

Results: The qualitative content analysis yielded 44 inductive subcategories within a category system of seven deductive main categories. Key barriers included communication, limited visual accessibility and environmental challenges, while improvement strategies focused on tailored therapeutic adaptations as well as proactive and collaborative practices between therapists and clients.

Conclusions: Our findings highlight the need for structural changes and expanded mental health services that cater to the specific needs of persons with sensory impairments. These insights should contribute to improving mental health services, training programs for professionals and emphasise the importance of including persons with HI or VI, both professionals and clients, in the participatory development of accessible care.

Objectives: Accessing psychological therapy presents unique challenges for Muslims, who are underrepresented in primary care mental health services in the United Kingdom. This qualitative study sought the narratives of British Muslims to gain insight into the perceived barriers and facilitators to engagement with therapy.

Methods: Eighty participants responded to an online free-text survey question enquiring about their views on therapy with a non-Muslim therapist after completing a short experimental study. A structured tabular approach grounded in reflexive thematic analysis was used to analyse data.

Results: Three main themes were identified in our analysis: 'Fundamental differences', 'It's not worth the risk' and 'Overcoming barriers'. Within these themes we explore perceived interpersonal and systemic tensions, as well as facilitators to engagement with psychological therapy.

Conclusions: These findings are discussed in terms of implications for clinicians working with Muslim clients, with a focus on the importance of understanding and attending to faith and relational concerns.

Purpose: Body image is a transdiagnostic construct that seems poorly understood in psychosis. Poor body image is associated with paranoia, which makes it a theoretically meaningful treatment target in psychosis. We systematically reviewed associations between body image and psychosis symptoms in both the 'general' population and people living with psychotic disorders, synthesised known correlates of negative body image in people living with psychotic disorders and performed a meta-synthesis to understand the lived experience of body image in people with psychosis.

Methods: Ovid MEDLINE, OVID Embase, OVID APA PsycINFO, EBSCOhost Cinahl and the Cochrane Central Register of Controlled Trials were searched in January 2024. The methodological quality and risk of bias were assessed using the mixed-methods appraisal tool.

Results: 20,565 participants were included from 31 studies, of which 2127 (10.3%) were living with psychotic conditions, 18,294 from the general population, 129 people with other conditions being compared to psychosis (such as bipolar disorder) and 15 carers. There were 25 quantitative studies (24 cross-sectional, 1 prospective), 5 qualitative studies and 1 mixed-methods study. Cross-sectional evidence suggests associations between negative body image and psychotic symptoms, especially paranoia, as well as wider mental and physical health outcomes. Potential factors contributing to the persistence of poor body image include psychotic symptoms, worries about appearance-related judgements, negative self-concept, body ambivalence, appearance-related safety-seeking behaviours and traumatic memories.

Conclusions: Negative body image is relevant to the lives of people with psychosis spectrum conditions. Recommendations to guide and improve future research are reported.

Objective: The integration of religious beliefs is considered an essential component of evidence-based practice; however, clients from faith-based communities frequently report that their beliefs are overlooked in therapy. While existing research primarily centres on therapists' perspectives, there is limited understanding of how Muslim clients themselves make sense of therapy when their religious identity is not acknowledged, particularly within mental health systems often grounded in Western psychological models. This study, therefore, aimed to explore the mental healthcare experiences of Muslim therapy users in the UK who received therapy where their religion was perceived as minimised or excluded, despite its personal significance.

Design: A qualitative approach was adopted, underpinned by a critical realist epistemology. Semi-structured interviews were conducted with 25 Muslim participants, aged 18-56 years. These interviews were conducted remotely via Teams and subsequently transcribed for analysis. Data analysis was performed using reflexive thematic analysis.

Results: Three overarching themes were generated through the analysis: feeling powerless and unseen when attempting to bring Islam, shaking my foundation and feeling compelled to choose between my faith or therapy. Participants described a significant emotional impact when Islam was excluded or minimised.

Conclusion: These findings highlight the need for therapists to actively explore and integrate clients' religious worldviews, and for services to consider culturally responsive practices. The findings also suggest a need for enhanced cultural competence training and systemic changes to improve the therapeutic experience for Muslim clients. This study offers insight for developing more inclusive and effective mental health practices as well as implications for clinical practice.

Objectives: Individuals with post-traumatic stress disorder related to childhood maltreatment (PTSD-CM) show limited response to treatment on pre-post-symptom measures. While a nuanced understanding of nonresponse is crucial for improving treatment, quantitative measures may not fully capture clinically meaningful processes of change from the patients' perspectives. We therefore explored how individuals with PTSD-CM who showed no or limited numerical improvement after trauma-focused psychodynamic psychotherapy (TF-PDT) experienced change.

Design: This qualitative study was embedded in a large randomized controlled trial on PTSD-CM (DRKS00021142).

Method: From 75 qualitative post-treatment interviews, we purposively sampled eight TF-PDT recipients meeting criteria for numerical nonresponse, defined as current PTSD diagnosis and less than 50% reduction in the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5). Client Change Interviews were analysed using Critical-Constructivist Grounded Theory.

Results: We derived two clusters ('Progress-A Double-Edged Sword', 'When Building Trust Collides with the Therapeutic Framework') and one overarching core category ('Unfinished Business'), which captured a dialectic process. Within a responsive therapeutic relationship, patients began confronting their relational trauma, experiencing relief, increased emotional regulation and hope. However, this very engagement surfaced emotional challenges that exceeded what could be addressed within the limited therapeutic framework, leaving the process meaningful but unfinished.

Conclusion: What is often labelled as numerical nonresponse in PTSD-CM may reflect a dynamic interplay of emerging improvement and emotional distress that needs more time to unfold. Moreover, the results underscore the value of integrating qualitative, patient-reported outcomes into treatment evaluation and relationship-focused treatment tailored to patients' individual needs.

Background: The current Mental Health Practitioner (MHP) workforce within NHS primary care is without a competency framework to guide job planning, interviews and service provision.

Aims: This paper aims to present an inclusive level-based framework for MHPs in primary care.

Materials and methods: The competency framework is based on previous frameworks and the results of service evaluation projects. Research into other existing competency frameworks allowed for the expansion of the identified competencies to ensure a thorough and complete framework was produced. The document was circulated to stakeholders and sense checked with colleagues working in primary care mental health service delivery.

Results: The framework provided has an explicit focus on seven key features: (1) knowledge for primary care-based MHPs, (2) core relational skills, (3) core clinical skills, (4) personal characteristics and values, (5) leadership and working with teams, (6) self-care and support and (7) competencies for primary care services supporting MHPs.

Discussion: Consideration of the competencies presented can help develop job descriptions, interview content and service provision requirements for MHPs across a variety of primary care settings.

Conclusion: Following this paper further evaluation as to acceptability and implementation of this framework within primary care settings may be a beneficial undertaking.

Objectives: To understand the impact of and subsequent reactions to exposure to extreme violence in young adults in South Africa exposed during school years. In particular, to get an in-depth understanding of its immediate consequences and factors that ameliorate or exacerbate it.

Design: An exploratory qualitative research design was used, using purposive sampling.

Methods: Semi-structured interviews with 21 young South African adults aged 19-31 were conducted online. Transcripts were analysed using thematic analysis.

Results: Violence exposure was found to result in trauma reactions with themes of a continued sense of being unsafe, feeling damaged and defective because of having these reactions, and mistrust towards others. In terms of coping reactions, a theme of avoidance and/or reacting with aggressive behaviour was identified, which likely exacerbated the challenges they experienced. By contrast, a more positive theme was identified in some, focused on having a sense of community and connectedness, which was experienced as ameliorating these challenges.

Conclusions: Exposure to community and school violence in childhood has a lasting impact on mental health and adjustment in later life. The impact is likely worsened by mistrust of others, a continued sense of feeling unsafe and counterproductive coping mechanisms, while connectedness and community seem to lessen the impact. Further research can refine these findings to build an understanding of these mechanisms to inform secondary prevention and treatment interventions in low- and middle-income countries.

Objectives: Early emerging emotional and behavioural problems can have a significant adverse impact on children's wellbeing, mental health and educational outcomes that can persist through adolescence and adulthood. A growing body of research highlights children's ability to recognise and understand emotions as a transdiagnostic intervention target. Interventions aimed at helping parents support this ability in their child could lead to benefits. Therefore, the current study aimed to systematically develop a brief parenting intervention to support children's emotional understanding.

Design: We followed Medical Research Council (MRC) guidance for developing complex interventions and used the Delphi method to gather consensus on the content and delivery of the intervention.

Methods: In Round 1, interviews were conducted with academics, clinicians, parents and child and family practitioners with relevant experience. Thematic analysis of interviews generated themes and subthemes which were used to create a survey. In Round 2, this survey was shared with participants and they rated how important different potential elements of the intervention were to include in the manual.

Results: Round 1 interviews generated themes including practicalities, creating a safe group space and intervention content. In Round 2, all participants (response rate: 86.4%) were asked to complete the survey and results indicated all items achieved at least moderate consensus for inclusion.

Conclusions: How results were used to inform the intervention is discussed and implications for clinical practice addressed. This research has informed the development of a new parenting intervention which will be further researched in a feasibility trial.

Objectives: To coproduce an evaluation of the effectiveness cognitive analytic therapy (CAT) for emotionally unstable personality disorder (EUPD) conducted during a psychiatric inpatient admission.

Design: A four-phase mixed methods single-case experimental design (i.e. A-B-C-FU design). The first three phases (A-B-C) were conducted on an inpatient ward and the follow-up phase (1 month) coincided with discharge.

Methods: The intervention was a protocol-driven eight-session CAT. Intervention competency was assessed using the CCAT measure. Recognition and revision of three target problems (TPs) and associated target problem procedures (TPPs) were rated at each session. Five idiographic measures (i.e., anxiety, connecting to others, manic mood, obsessional intensity and people-pleasing) were rated daily across all phases. Nomothetic outcomes (i.e., PHQ-9 and GAD-7) were completed at assessment, termination and follow-up. A change interview with the patient participant was conducted at discharge and follow-up. The patient participant provides a commentary on the process and outcome of the therapy.

Results: CAT was delivered competently. Change in TP and TPPs synchronized with CAT phases. Most change in idiographic outcomes occurred during the follow-up, with discharge being associated with deterioration. There was a reliable improvement to PHQ-9 and GAD-7 scores. Changes were rated by the patient as being personally important, impactful and unlikely without CAT. The patient participant's account of the therapy noted the importance of the inpatient psychological help, the tools of CAT being useful and the ending being painful.

Conclusions: Brief CAT can be competently delivered on inpatient wards and appeared an acceptable and effective intervention for this EUPD admission. Research directions are provided.