Anna Tickle

‘Schizophrenia is a dirty word’: service users’ experiences of receiving a diagnosis of schizophrenia

Aims and method To explore service users’ experiences of receiving a diagnosis of schizophrenia and the stigma associated with the diagnostic label. Seven participants were interviewed about their perceptions of these experiences. Interviews were analysed using interpretative phenomenological analysis. Results Five superordinate themes resulted from the analysis: (1) avoidance of the diagnosis of schizophrenia; (2) stigma and diagnostic labels; (3) lack of understanding of schizophrenia; (4) managing stigma to maintain normality; (5) being ‘schizophrenic’. These, together with their subthemes, highlighted avoidance of the term schizophrenia by participants and use of alternative terms by professionals, which limited opportunities for understanding the label and challenging associated stigma. Participants strived to maintain normality despite potential stigma. Clinical implications There is a need to address the process of giving a diagnosis as a phenomenon of consequence within its own terms. Implications relate to how professionals deliver and discuss the diagnosis of schizophrenia.

The Efficacy of Cognitive Behavioral Therapy for Adults With ADHD: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Objective: To systematically review the literature on published randomized controlled trials (RCTs) of cognitive behavioral therapy (CBT) for adult ADHD and to establish the effectiveness of CBT in reducing ADHD symptoms. Method: A systematic review of nine RCTs and two subsequent meta-analyses of eight of the studies were conducted. Results: Just nine studies were identified, of generally good quality but with some limitations. Four trials (total N = 160) compared CBT with waiting list controls, and three trials (total N = 191) compared CBT with appropriate active control groups. Meta-analyses showed that CBT was superior to waiting list with a moderate to large effect size (standardized mean difference [SMD] = 0.76, 95% confidence interval [CI] [0.21, 1.31], p = .006) and superior to active control groups with a small to moderate effect size (SMD = 0.43, 95% CI [0.14, 0.71], p = .004). Conclusion: These results give support to the efficacy of CBT in reducing symptoms of ADHD post-intervention.

Exploring the experience of hearing voices from a first person perspective: A meta‐ethnographic synthesis

PURPOSE The purpose of this review was to identify, appraise, and synthesize the current peer-reviewed qualitative literature which explores the phenomenon of hearing voices from a first person perspective. METHODS A comprehensive systematic search of the literature was conducted. Seven studies utilizing various qualitative methodologies met the criteria to be included in the synthesis. An appraisal tool (Walsh & Downe, 2005, J. Adv. Nurs., 50, 204-211) was used to assess their quality. A meta-ethnographic approach was used to synthesize the data extracted from them. RESULTS The interpretation of the findings suggested five key themes: identity of the voice(s), power of the voice(s), impact of hearing voices on relationships, relationship with the voice(s), and the distinction between thoughts and voices. The identity of the voices seemed inextricably linked to the perceived power the voice(s) wielded over the voice hearer. The quality of the studies included in the synthesis varied greatly. CONCLUSIONS The findings of this synthesis highlight the importance of the voice hearers individual frame of reference for understanding their experience. Clinical implications include the need for mental health professionals to explore an individuals understanding of their experience of hearing voices and address the perceived power of the voice(s). Further research is indicated in this area with a focus of improving the quality of qualitative research studying this phenomenon. PRACTITIONER POINTS There are multiple frames of reference in which to understand an individuals experience of hearing voices. Mental health professionals should attend to the meaning and understanding voice hearers give to the experience.

From end user to provider: making sense of becoming a peer support worker using interpretative phenomenological analysis

Purpose – There has been extensive growth in the employment of mental health peer support workers (PSWs) over the last decade. However, limited research exists when exploring how PSWs make sense of the transition of entering and enacting the role. The purpose of this paper is to explore the lived experience of NHS employed PSWs’ transition from their own experiences of mental health problems to provide a service to support individuals with their mental health problems. Design/methodology/approach – The study used purposive sampling to recruit seven participants who were individually interviewed using a semi-structured interview schedule. Interviews were transcribed verbatim and analysed using interpretative phenomenological analysis (IPA). Findings – Three superordinate themes were identified: fluctuating identities, PSW role and organisational culture. These were interpreted as interdependent with interrelating subordinate themes. Research limitations/implications – Participants considered the complex, i...

Effects of employment as a peer support worker on personal recovery: a review of qualitative evidence

Purpose – The purpose of this paper is to systematically identify, appraise and synthesise qualitative research into how working as a peer support worker (PSW) affects personal recovery. Design/methodology/approach – Ten articles were identified through a systematic search of seven databases, grey literature, reference lists, citations and contact with authors in the field. Identified articles were critically appraised and their results synthesised using metaethnography. Findings – There is potential to significantly improve the quality of the research in this field. Four categories were constructed to synthesise the findings of the reviewed studies, which demonstrated that being a PSW has the potential to be both facilitative of and detrimental to personal recovery. Research limitations/implications – The quality of existing studies varies widely. Further, high-quality research is required to specifically investigate the effects of employment as a PSW on personal recovery. Practical implications – The fi...

Qualitative systematic literature review: the experience of being in seclusion for adults with mental health difficulties

Purpose The purpose of this paper is to conduct a systematic search of the peer-reviewed qualitative literature investigating the lived experience of seclusion for adults with mental health difficulties, to appraise the quality of the existing literature and synthesise findings. Background: seclusion is a controversial intervention for the short-term management of unsafe behaviours in inpatient mental health services. There has been some sporadic interest in service users’ experiences of this. Design/methodology/approach Systematic literature review and meta-synthesis: data sources – databases MEDLINE, EMBASE, CINAHL and PSYCINFO were searched in July 2015; review methods – the Joanna Briggs Institute’s Qualitative Assessment and Review Instrument tools for critical appraisal and data extraction were used to review papers and synthesise findings. Findings A small number of papers were found, which were of mixed quality. Originality/value The existing research is limited in both quantity and quality. Although most participants from the existing research described seclusion as mostly negative with the potential for causing iatrogenic harm, some described more positive experiences, often in the context of compassionate interactions with staff.

The transition into adulthood for children with a severe intellectual disability: parents’ views

Abstract Objectives: This study used the grounded theory to explore parents’ views of the transition into adulthood of their child with a severe intellectual disability. The study also sought to explore the processes that parents engage in for making psychological adjustments, to appreciate their role during this transition. This study is imperative for developing a psychologically informed theory that can be understood by both parents and clinicians. Methods: Twelve parents of 11 children with a severe intellectual disability were recruited for interview from charitable organizations accessed by parents (e.g. Mencap). Data collection used a combination of open-ended structured questions and non-directed probing. NVivo 10 software was used to assist the grounded theory coding and analysis process. Results: The analysis developed five processes that parents engaged in during their child’s transition into adulthood: ‘defining adulthood’, ‘noticing adult development’, ‘perceiving barriers to adulthood’, ‘worrying,’ and ‘making psychological adjustments’. Common to these was seen to be a core process of ‘making comparisons with perceived “norms”’. Contrasting findings are critically discussed alongside extant literature. Additionally, a transition model of parents’ views and adjustments is proposed, grounded in the study findings. Conclusions: Parents engage in a series of interactional processes throughout the transition trajectory, which are likely to influence how they make adjustments. Clinical interventions could challenge parent perceptions; encourage peer support; embrace systemic ways of working with parents through their child’s transition into adulthood; and use the presented model to help parents understand their experiences and any adjustment-related problems.

What are the factors that influence parental stress when caring for a child with an intellectual disability? A critical literature review

Abstract Objectives: This article critically reviewed empirical studies identifying factors that may influence parental stress when caring for a child with an intellectual disability. Understanding the factors influencing parental stress is important for several reasons, which include improving parental/child quality of life, supporting parental needs, and thus reducing potential economic burden in the long term. This review is also imperative for ensuring high quality research within this field. Methods: AMED, CINAHL Plus (EBSCOhost), EMBASE, Medline and PsycINFO were accessed to conduct a critical literature review. A total of 17 articles were reviewed. A bespoke quality assessment tool was developed to examine the susceptibility to bias for each of the included studies. Results: The review outlined a range of child, parent and socio-environmental factors that may influence parental stress. More specifically, factors associated with greater parental stress included child behavioral difficulties (e.g. challenging behavior), ineffective parental coping strategies (including avoidance and self-blame), and poor family environment (e.g. lack of cohesion amongst family members). These factors are critically discussed alongside contrasting evidence that was illuminated within this review. Conclusions: Parents of a child with an intellectual disability are not a homogenous group and are likely to show variability in the factors that affect their stress levels. Future clinical and research implications are proposed in light of the methodological limitations identified within the studies reviewed. For example, future research could investigate the bi-directional effects that occur between variables; how specific factors influence parental stress; and potential mediating/moderating factors of parenting stress.

“From the same mad planet”: a grounded theory of service users’ accounts of the relationship within professional peer support

Purpose Peer support (PS) workers are being employed despite uncertain evidence for clinical and cost-effectiveness. Psychological theories have been proposed to explain the mechanisms of PS but these lack empirical validation and specificity to professional PS. The purpose of this paper is to develop a substantive interpretive grounded theory of service-users’ experience of professional PS work. Design/methodology/approach Constructivist grounded theory was used throughout. Semi-structured interviews were conducted with ten service-users who had engaged with a professional PS worker. Findings Three overarching themes were constructed. “The process of disclosure” describes how disclosure of mental health difficulties, experiences as a service-user and wider disclosure about life experiences, interests and values facilitate the development of a shared identity with the PS worker. “The product of disclosure” highlights the sense of being understood as a result of the disclosure and marks a deepening of the relationship. “Dual roles” describes the tenuous position of holding both a professional relationship and friendship. Research limitations/implications Future research should seek to refine the theory developed and compare the effects of therapist self-disclosure with that found within PS. There were limitations within the study, including limited diversity within the sample as well as difficulties with recruitment. Originality/value This study connects service-users’ accounts of receiving PS with existing psychological theory to move towards an understanding of the relationship between receivers and providers of professional PS.

The recovery-orientation of three mental health units

Purpose – The purpose of this paper is to measure service user and staff views of the recovery orientation of three mental health rehabilitation units; two “open” and one “locked”. It identified elements of recovery that were important to service users. It measured the units’ performance on domains of recovery, attending to differences between staff members’ and service users’ perceptions and between the locked and open units. Design/methodology/approach – A cross-sectional design was used. Staff and service users completed the “Developing Recovery Enhancing Environment Measure (DREEM)”. Findings – Findings revealed some differences between staff and service user views. Service users in the locked unit reported the organisational climate to be more recovery oriented on some domains than those in the open units. Service users’ responses highlighted potential areas for service improvement. Research limitations/implications – The sample was small but reflected the applied setting. Some service users were not...