Psychology and Psychotherapy-Theory Research and Practice最新文献

Background

Many people who engage in non-suicidal self-injury (NSSI) do not access support from health services, and evidence regarding the effectiveness of interventions is mixed. Despite this, NSSI prevalence rates decrease from adolescence into adulthood. Little is known about what helps alleviate difficulties with NSSI beyond psychological or medical intervention. This study sought to understand factors influencing naturalistic improvements in NSSI.

Methods

Semi-structured interviews were conducted over video call with 16 participants who believed their difficulties with NSSI had improved due to factors not attributed to psychological or medical intervention. Interviews were audio recorded and transcribed verbatim for analysis.

Results

A reflexive thematic analysis revealed four main themes. Increased insight into NSSI experiences promoted self-compassion and self-acceptance and enabled participants to reflect on the conflicting role of NSSI. Safe and supportive relationships helped alleviate loneliness, and developing alternative coping strategies enhanced feelings of control over self-injury. Creating a life guided by personal values promoted independence, choice, and self-esteem.

Conclusions

The findings of the study highlight several internal and external naturalistic processes deemed meaningful in improving difficulties with NSSI. Clinical implications include the importance of developing and embedding these approaches within services and interventions to improve outcomes for individuals who self-injure while promoting a person-centred approach.

Background

One in three people with psychosis experience visions. However, little is known about what people see, and current treatments have limited benefits.

Objectives

To improve the understanding and treatment of visions, this study explored the phenomenology of visions in people with psychosis.

Methods

Twelve people with psychosis participated in semi-structured interviews. Reflective thematic analysis was used.

Results

Three main themes were generated covering important aspects of phenomenology: ‘Content’, ‘Coherence’ and ‘Quality’. The first theme ‘Content: People see people’, demonstrated that the most distressing visions were of people. The second theme ‘Coherence: Visions of people who behave like people’, captured how visions were coherent with real human behaviour, often by being multimodal experiences that spoke to and touched the observer. The third theme, ‘Quality: They look too real’ highlighted the compelling sense of authenticity of the visions, making them indistinguishable from reality.

Conclusion

Visions represent what we expect to see in everyday life: people, who act and look real. This powerful combination provides insight into the absorbing and all-encompassing nature of visions and their impact on participant's lives. The framework of ‘Content’, ‘Coherence’ and ‘Quality’ provides guidance to support clinicians and researchers to better explore the phenomenology of visions in psychosis.

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.