Charles Heriot-Maitland

A compassionate‐focused therapy group approach for acute inpatients: Feasibility, initial pilot outcome data, and recommendations

OBJECTIVES This study aimed to examine the feasibility of running and evaluating a compassion-focused therapy (CFT) group adapted for acute inpatient settings, characterized by unpredictable lengths of admission, presentations, and diagnoses. DESIGN AND METHODS This pilot project used a mixed methods design to assess the impact of offering CFT-informed group sessions on an acute inpatient unit. Pre- and post-session ratings of distress and calmness, and ratings of understanding and helpfulness, were gathered from participants over a 6-month period. Semi-structured interviews were conducted with four participants to gather their experience of the group. RESULTS Fifty-seven complete sets of rating measures were generated from 82 participants recruited for the study (attrition rate 30%), from a total pool of 93 inpatients attending group sessions. Pre- to post-CFT session data highlighted a significant decrease in distress ratings and a significant increase in calmness ratings. A thematic analysis of four interviews identified themes relating to understanding compassion, experience of positive affect, and the experience of common humanity. CONCLUSIONS This is the first attempt to explore the effects of a CFT-informed approach in acute mental health settings. These groups were well received by staff and patients, with some therapeutic impact despite being comparatively short and set against the background of a busy inpatient ward. These groups can be open and transdiagnostic, with stand-alone topics and practices having positive impacts on distress and calmness. Future studies need to focus on adapting content and pacing for this group of people based on ongoing feedback from participants.

Tackling Social Cognition in Schizophrenia: A Randomized Feasibility Trial.

BACKGROUND Social cognition difficulties in schizophrenia are seen as a barrier to recovery. Intervention tackling problems in this domain have the potential to facilitate functioning and recovery. Social Cognition and Interaction Training (SCIT) is a manual-based psychological therapy designed to improve social functioning in schizophrenia. AIMS The aim of this study is to evaluate the feasibility and acceptability of a modified version of SCIT for inpatient forensic wards. The potential benefits of the intervention were also assessed. METHOD This study is a randomized single blind controlled design, with participants randomized to receive SCIT (N = 21) or treatment as usual (TAU; N = 15). SCIT consisted of 8-week therapy sessions twice per week. Participants were assessed at week 0 and one week after the intervention on measures of social cognition. Feasibility was assessed through group attendance and attrition. Participant acceptability and outcome was evaluated through post-group satisfaction and achievement of social goals. RESULTS The intervention was well received by all participants and the majority reported their confidence improved. The SCIT group showed a significant improvement in facial affect recognition compared to TAU. Almost all participants agreed they had achieved their social goal as a result of the intervention. CONCLUSIONS It is feasible to deliver SCIT in a forensic ward setting; however, some adaptation to the protocol may need to be considered in order to accommodate for the reduced social contact within forensic wards. Practice of social cognition skills in real life may be necessary to achieve benefits to theory of mind and attributional style.

Mysticism and madness: Different aspects of the same human experience?

Associations between mysticism and madness have been made since earliest recorded history, and the striking resemblance between self-reports of both mystical and psychotic experience suggests that similar psychological processes may be involved in their occurrence. By exploring the similarities, and proposing a common element to mystical and psychotic experience (referred to here as the experience of “oneness”), this paper aims to place mysticism and madness onto the same experiential continuum. However, in contrast to much of the previous literature, the intention is not to pathologize mystical experience, but rather to normalize psychotic experience. The paper argues not only that the experience of oneness is entirely genuine and available to all humans, but also that it has an important psychological (and evolutionary) function. Using cognitive terminology, it then attempts to explain the processes determining whether an individual enjoys a fulfilling mystical experience, or suffers a debilitating psychotic breakdown (i.e., how “oneness” is experienced). Finally, this paper turns to look at some of the important implications such an approach might have for clinical practice and for the mental health of people in general.

National survey of alcohol treatment agencies in England: Characteristics of treatment agencies

Background: To map and contact all specialist alcohol treatment services in England and to investigate the characteristics of responding agencies. Methods: A national cross-sectional survey of alcohol treatment agencies in England. A questionnaire was designed to gather information about agency characteristics, including the service structure, staffing, modalities of treatment, and associated funding. Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7%) responded to the survey. Variations in agency characteristics were noticed across geographical regions, as well as across sectors. The estimated annual spending on alcohol treatment was £217 million. Conclusions: Whereas the regional variation in agency characteristics has implications for access to particular types of treatment, the inter-sector variation has implications for the allocation of funding. The estimated annual spending of £217 million is greater than previous national estimates. A national framework for alcohol service mapping could benefit identification of areas for improvement and lead to more successful treatment outcomes.

The Perceived Challenges Facing Alcohol Treatment Services in England: a qualitative study of service providers

Background: Although there is currently a high level of need for alcohol treatment in the United Kingdom, there has been a lack of research into alcohol treatment to date. This study reports on what the current challenges to alcohol treatment services in England are, what resources might help to improve services, and which groups are poorly served by alcohol treatment services, as perceived by service providers. Methods: Qualitative data was obtained in three open-ended questions from a sample of 207 alcohol treatment agencies that responded to the national alcohol needs assessment postal survey. Results: Lack of funding, a general lack of resources to provide services, inadequate access to detoxification and rehabilitation services, and a lack of trained staff to deliver services were key challenges presented. More staff, improved access to detoxification and rehabilitation services, better premises, more funding allocation, improved links with other services, and better resources in general to provide services were the key factors reported to improve services. Clients with complex needs (e.g., dual diagnosis, brain damage), women with children, homeless people, and ethnic minorities were perceived to be poorly served by alcohol treatment services. Conclusions: Alcohol treatment services in England face many challenges which should be incorporated into future alcohol treatment service development.

Exploring the compatibility of biomedical and psychological approaches to treating psychosis

The recent UK clinical guidelines for psychosis require an integration of biomedical and psychological treatment approaches that may present challenges to the structure and delivery of services. This review briefly outlines these two approaches before presenting arguments both for and against their compatibility. Although this discussion recognises attempts at integrating the approaches in modern mainstream services, it argues that their fundamental theoretical differences entail very different treatment methods, and often require conflicting demands of clients. Not only is this potentially confusing and unhelpful to the clients, but it also interferes with the goals and processes of each approach. Some of the main challenges to integration are discussed, and suggestions are made regarding the future direction of multidisciplinary treatments for psychosis. This review argues that an open, critical examination of existing professional models and practices is required to ensure that optimal service provision.

National survey of alcohol treatment agencies in England: Characteristics of clients

Background: To map and contact all alcohol treatment services in England offering Tier 2, 3 and 4 interventions and describe the characteristics of their service-users. Methods: A national cross-sectional survey of alcohol treatment providers in England, designed to gather information about the characteristics of clients referred, assessed, and treated in the financial 2003/4. Results: A total of 696 alcohol treatment agencies were mapped, of which 388 (55.7 %) responded to the survey. The majority of clients were men, particularly within residential and non-statutory agencies. A higher proportion of residential clients were highly alcohol dependent, homeless and neurologically impaired, whereas, community clients were more likely to be offenders or to have mental health problems. Non-statutory services were more likely to see homeless clients, offenders, and clients with mental health problems and neurological deficits than statutory services who, typically, see a more dependent population. Conclusions: Findings support the need for more specialist service provision for severely dependent offenders and dependent drinkers with serious mental illness. To aid future mapping of alcohol services, which allows areas of need to be identified, it is recommended that services have a monitoring system similar to that for drug misuse with the National Drug Treatment Monitoring System.

Multi-level models of information processing, and their application to psychosis

Multi-level models have been developed to illustrate the minds processing of qualitatively different types of information, and therefore provide a useful tool for exploring the actions and interactions of different processing levels within a single theoretical framework. This paper firstly reviews a selection of multilevel models, and then constructs a detailed rationale for applying a multi-level framework to psychosis. The argument draws on a wide psychosis literature, in the areas of positive symptoms, subjective phenomena, risk factors, and cognitive phenomena. In doing so, the discussion highlights some limitations of current (single-level) cognitive models of psychosis, and argues that a multi-level framework not only offers enhanced explanatory power, but also facilitates an integration of the evidence accumulated in different areas of psychosis research. Implications of a multi-level approach are discussed with regards to understanding the ‘psychotic-like’ experiences of both clinical and non-clinical populations. In particular, the roles of emotional meaning and function of psychotic phenomena are emphasised, and the clinical therapeutic tenet of normalisation is encouraged.