Laura Lea

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: study protocol for a pilot randomised controlled trial

BackgroundObsessive Compulsive Disorder (OCD) is a distressing and debilitating condition affecting 1-2% of the population. Exposure and response prevention (ERP) is a behaviour therapy for OCD with the strongest evidence for effectiveness of any psychological therapy for the condition. Even so, only about half of people offered ERP show recovery after the therapy. An important reason for ERP failure is that about 25% of people drop out early, and even for those who continue with the therapy, many do not regularly engage in ERP tasks, an essential element of ERP. A mindfulness-based approach has the potential to reduce drop-out from ERP and to improve ERP task engagement with an emphasis on accepting difficult thoughts, feelings and bodily sessions and on becoming more aware of urges, rather than automatically acting on them.Methods/DesignThis is a pilot randomised controlled trial of mindfulness-based ERP (MB-ERP) with the aim of establishing parameters for a definitive trial. Forty participants diagnosed with OCD will be allocated at random to a 10-session ERP group or to a 10-session MB-ERP group. Primary outcomes are OCD symptom severity and therapy engagement. Secondary outcomes are depressive symptom severity, wellbeing and obsessive-compulsive beliefs. A semi-structured interview with participants will guide understanding of change processes.DiscussionFindings from this pilot study will inform future research in this area, and if effect sizes on primary outcomes are in favour of MB-ERP in comparison to ERP, funding for a definitive trial will be sought.Trial registrationCurrent Controlled Trials registration number ISRCTN52684820. Registered on 30 January 2014.

Now I have a voice: service user and carer involvement in clinical psychology training

Purpose – This paper aims to describe the challenges and rewards of service user and carer involvement in clinical psychology training as experienced in one training centre.Design/methodology/approach – After outlining the major challenges of involvement in higher education and in clinical psychology training, the paper describes the work carried out by the authors. Members of the service user and carer advisory group Salomons Advisory Group of Experts by Experience (SAGE) recount their experiences of working with them in clinical psychology and Increasing Access to Psychological Therapies (IAPT) training. The challenges of inclusion and specific approaches that are used to work with these are explored.Findings – Members of SAGE have experienced their contributions to the work in positive ways. However, inclusion in this context requires everyone involved to fully acknowledge the social and historical barriers in order to work together to overcome them.Practical implications – Some of the approaches to me...

Aims for service user involvement in mental health training: staying human

Purpose The purpose of this paper is to examine the impact of service user involvement in mental health training but little is known about what staff, trainees and service users themselves want to achieve. Design/methodology/approach Three separate focus groups were held with service users, training staff and trainees associated with a clinical psychology training programme. Thematic analysis was used to identify aims for involvement. Findings All groups wanted to ensure that future professionals “remained human” in the way they relate to people who use services. Service user and carer involvement was seen as a way of achieving this and mitigating the problem of “them and us thinking”. The authors found that groups had some aims in common and others that were unique. Service users highlighted the aim of achieving equality with mental health professionals as an outcome of their involvement in teaching. Research limitations/implications The samples were small and from one programme. Practical implications Common aims can be highlighted to foster collaborative working. However, the findings suggest that service users and carers, staff and trainees may also have different priorities for learning. These need to be recognised and addressed by mental health educators. Originality/value This was the first study to explore in depth the differing aims of different stakeholder groups for service user involvement. Clarification of aims is a vital first step in developing any future measure of the impact of service user involvement on mental health practice.

Mindfulness-based exposure and response prevention for obsessive compulsive disorder: Findings from a pilot randomised controlled trial

BACKGROUND Only about half of people with obsessive compulsive disorder (OCD) show clinically significant improvement following the recommended therapy, exposure and response prevention (ERP), partly due to poor therapy acceptability. A mindfulness-based approach to ERP (MB-ERP) has the potential to improve acceptability and outcomes. METHODS This was an internal pilot randomised controlled trial (RCT) of group MB-ERP compared to group ERP. 37 participants meeting DSM-IV OCD criteria were randomly allocated to MB-ERP or ERP. RESULTS Both groups improved in OCD symptom severity. However, MB-ERP did not lead to clinically important improvements in OCD symptom severity at post-intervention compared to ERP - the minimum clinically important difference was not contained in the 95% confidence intervals. There were negligible between-group differences in engagement and MB-ERP did not appear to have broader benefits compared to ERP on depression, wellbeing or OCD-related beliefs. Conversely, MB-ERP led to medium/medium-large improvements in mindfulness compared to ERP. CONCLUSIONS MB-ERP is unlikely to lead to clinically meaningful improvements in OCD symptom severity compared to ERP alone. We underline the importance of adhering to treatment guidelines recommending ERP for OCD. Insufficient attention may have been given to mindfulness practice/discussion in MB-ERP and further research is recommended to explore this possibility.

Learning from service user and carer involvement in clinical psychology training

Purpose – The purpose of this paper is to build a theoretical model of how and what clinical psychologists learn from service user and carer involvement in their training. Design/methodology/approach – A qualitative research design was adopted, and verbatim transcripts of semi-structured interviews conducted with 12 clinical psychologists were analysed using grounded theory methodology. Findings – Findings indicated that clinical psychologists learned from service user and carer involvement in a variety of ways and a preliminary model was proposed, encompassing four main categories: “mechanisms of learning”, “relational and contextual factors facilitating learning”, “relational and contextual factors hindering learning” and “impact”. Research limitations/implications – Further research is required to establish to what extent the current findings may be transferrable to learning from service user and carer involvement in the context of educating professionals from other disciplines. Additionally, participa...

Mentoring trainee psychologists: learning from lived experience

Purpose The purpose of this paper is to examine service-users’ experiences of mentoring trainee clinical psychologists as part of an involvement initiative on a doctoral training course. Design/methodology/approach Seven service-users were paired with trainee clinical psychologists. Pairs met for one hour monthly over six months. Meetings were unstructured, lacked a formal agenda and were not evaluated academically. All seven mentors were interviewed. They were asked about positive and negative experiences, as well as about the support provided. Transcripts were subject to thematic analysis and themes were reviewed by mentors in a follow-up meeting. Findings Overall, the results demonstrate that service-users can be involved in training in a way that they find meaningful and contribute to their recovery. Seven themes were identified: giving hope and optimism; making a difference; personal and professional development; the process; practicalities/logistics; support (positives); and support (areas for improvement). Practical implications The importance of designing involvement initiatives in a way which implicitly supports service-user values was highlighted. Recommendations for designing effective support structures are given. The authors were also involved in the scheme which could have introduced bias. Originality/value The research exploring service-users’ experiences of involvement in training health professionals is limited. This was the first study to explore in depth service-users’ perspectives of involvement in a scheme such as the mentoring scheme. If initiatives are to seriously embrace the values of the service-user movement then seeking service-users’ perspectives is vital.

Finding the personal in the clinical psychology swamp

Purpose – The purpose of this paper is to explore the interface between the professional and personal, and particularly personal realities reflected in the Equality Act (2010), within a clinical psychology training context.Design/methodology/approach – An innovative action research process involving discussions, seminars and focus groups. The first author was a trainee on the programme and had been an informal carer. The other two authors are programme staff with service user experience. In the cycle presented here, six staff members and 14 trainees attended five 50‐minute reflective group sessions. Data were collected by focus group and analysed using thematic analysis.Findings – Participants voiced continuing uncertainty about the personal‐professional interface alongside increased understanding of ways to enact it. Parenthood, class and mental health were identified as important domains and competition between these emerged as a theme.Research limitations/implications – The reflective groups and focus ...