Lorna Farquharson

Patient experience of negative effects of psychological treatment: results of a national survey†.

BACKGROUND To make informed choices, patients need information about negative as well as positive effects of treatments. There is little information about negative effects of psychological interventions. AIMS To determine the prevalence of and risk factors for perceived negative effects of psychological treatment for common mental disorders. METHOD Cross-sectional survey of people receiving psychological treatment from 184 services in England and Wales. Respondents were asked whether they had experienced lasting bad effects from the treatment they received. RESULTS Of 14 587 respondents, 763 (5.2%) reported experiencing lasting bad effects. People aged over 65 were less likely to report such effects and sexual and ethnic minorities were more likely to report them. People who were unsure what type of therapy they received were more likely to report negative effects (odds ratio (OR) = 1.51, 95% CI 1.22-1.87), and those that stated that they were given enough information about therapy before it started were less likely to report them (OR = 0.65, 95% CI 0.54-0.79). CONCLUSIONS One in 20 people responding to this survey reported lasting bad effects from psychological treatment. Clinicians should discuss the potential for both the positive and negative effects of therapy before it starts.

Anxiety, depression, and fall-related psychological concerns in community-dwelling older people.

OBJECTIVES Establish the association between affect and fall-related psychological concerns (fear of falling, fall-related self-efficacy, balance confidence, and outcome expectancy). METHODS A total of 205 community-dwelling older people (mean age 81, SD 7.5 years) completed the Geriatric Depression Scale-15, Geriatric Anxiety Inventory, Modified Survey of Activities and Fear of Falling, Falls-Efficacy Scale- International, Activity-Specific Balance Confidence Scale, and the Consequences of Falling Scale. RESULTS Hierarchical regression models showed that anxiety was independently associated with all fall-related psychological concerns; depression was only associated with falls efficacy. Associations between fall-related psychological concerns and age, gender, accommodation,medications, self-rated physical health, falls history, mobility, and sensory aids are also discussed. CONCLUSION This is the first study that investigates the association between affect and the four fall-related psychological concerns. Anxiety was a significant factor associated with all four, whereas depression was only associated with activity avoidance. Implications for healthcare providers are discussed.

Rumination and negative symptoms in schizophrenia

Rumination is thought to be an important maintaining factor in depression. Depressive symptomatology is also a prominent feature in schizophrenia. However, little is known about the relationship between rumination and symptoms, such as depression and negative symptoms, in schizophrenia. The present study examined associations between rumination and symptoms in a group of 37 stable medicated patients with schizophrenia. All participants were clinically assessed on their symptoms and completed self-reported measures of depression and rumination. The findings showed that negative symptoms, especially emotional withdrawal and stereotyped thinking, but not depressive symptomatology, were associated with rumination in the present sample of patients with schizophrenia. If the findings are replicated, interventions that reduce rumination and rigid thinking might be helpful to reduce some negative symptoms of psychosis.

Travel clinic communication and non-adherence to malaria chemoprophylaxis *

Many travellers fail to take malaria chemoprophylaxis, despite receiving pre-travel advice. This study examined whether non-adherence could be predicted from verbal communication in the pre-travel consultation, and whether non-adherence was related to the quality of clinician-traveller communication. The consultations of one hundred and thirty consecutive travellers at a UK travel clinic were audiotaped and a follow-up telephone interview was used to assess adherence to malaria chemoprophylaxis. Experienced travel clinic staff were asked to predict adherence and rate the quality of communication from eighteen transcripts of consultations (nine good and nine poor adherence). Clinic staff predicted adherence to malaria chemoprophylaxis significantly better than chance. Poor adherence was related to poor quality communication. Clinic staff provided criteria for good quality clinician-traveller communication. It is concluded that predictors of non-adherence can be identified during the pre-travel consultation. Clinic staff could employ specific communication strategies to improve the effectiveness of consultations.

Patient preference in psychological treatment and associations with self-reported outcome: national cross-sectional survey in England and Wales

BackgroundProviders of psychological therapies are encouraged to offer patients choice about their treatment, but there is very little information about what preferences people have or the impact that meeting these has on treatment outcomes.MethodCross-sectional survey of people receiving psychological treatment from 184 NHS services in England and Wales. 14,587 respondents were asked about treatment preferences and the extent to which these were met by their service. They were also asked to rate the extent to which therapy helped them cope with their difficulties.ResultsMost patients (12,549–86.0 %, 95 % CI: 85.5–86.6) expressed a preference for at least one aspect of their treatment. Of these, 4,600 (36.7 %, 95 % CI: 35.8–37.5) had at least one preference that was not met. While most patients reported that their preference for appointment times, venue and type of treatment were met, only 1,769 (40.5 %) of the 4,253 that had a preference for gender had it met. People who expressed a preference that was not met reported poorer outcomes than those with a preference that was met (Odds Ratios: appointment times = 0.29, venue = 0.32, treatment type = 0.16, therapist gender = 0.32, language in which treatment was delivered = 0.40).ConclusionsMost patients who took part in this survey had preferences about their treatment. People who reported preferences that were not met were less likely to state that treatment had helped them with their problems. Routinely assessing and meeting patient preferences may improve the outcomes of psychological treatment.

The feasibility and acceptability of a cognitive-behavioural self-help intervention for adolescents with obsessive-compulsive disorder.

BACKGROUND Breaking Free from OCD is a cognitive behavioural self-help book for young people with obsessive compulsive disorder (OCD). The book is written for 11-16 year olds as a first step intervention for reducing mild to moderate symptoms of OCD. AIMS This report describes a preliminary evaluation of the feasibility and acceptability of the book as a self-help intervention. METHOD Using a case-series design, eight 11-16 year olds with OCD were monitored for symptom stability 3 weeks prior to receiving Breaking Free from OCD for use over an 8-week period. Weekly telephone calls were received to complete the CY-BOCS for symptom severity and to monitor adherence to the intervention. The CHOCI and SDQ were sent to participants and their parents pre-, mid- and post-intervention. RESULTS There was a significant reduction in CY-BOCS symptom severity over the course of the intervention; however, there were no statistically significant changes on the self-report measures. The intervention was well received by the majority of young people who took part. CONCLUSIONS Breaking Free from OCD may help young people with OCD and is an acceptable low intensity intervention. This evaluation is the first step in developing low intensity approaches for child OCD.

A Brief Goal-Setting and Planning Intervention to Improve Well-Being for People with Psychiatric Disorders

The aim of the current study was to develop the evidence for a brief intervention that targets goal-setting and planning skills (GAP) to improve well-being. Having goals for the future and being able to make progress towards them are key components of many theoretical approaches to well-being [9] and GAP has shown promising results with non-clinical populations [10] , as well as for people with depression [6] and forensic inpatients [7] . We investigated whether GAP could be effectively implemented for people with psychiatric disorders accessing specialist mental health services. As a secondary aim, the study design allowed for some exploration of the feasibility of mental health professionals incorporating a brief intervention focused on well-being into their routine practice. A total of 82 service users were recruited through a large mental health trust in the Greater London area. Participants were eligible for the study if they were: (1) aged 18 or over, (2) in contact (or eligible for contact) with specialist mental health services provided by the trust and (3) willing to take part in a group. Insufficient understanding of verbal and written English was used as an exclusion criterion due to the nature of the intervention. A cross-over design was used, with participants initially randomly allocated to either the intervention or a waiting-list control group. Participants allocated to the waiting-list condition were offered the intervention after they had completed their measures as controls and follow-up measures were taken from all participants 1 month after completing the intervention (see fig. 1 ). Recent policy developments in the UK [1, 2] and internationally [3] have highlighted the need for mental health professionals to adjust their working practices and place more emphasis on promoting well-being. However, it has also been recognised that workforce skills in this area may be lacking and that more emphasis should be placed on developing the evidence base to help mental health professionals promote well-being and support recovery [4] . The benefits of incorporating approaches from positive psychology into existing understandings of mental health problems have been discussed [4, 5] and there have been a few recent studies that have taken preliminary steps to establish the efficacy of interventions focused on well-being with particular clinical groups [6–8] . However, the research literature in this area is still very limited. Received: March 29, 2013 Accepted after revision: October 9, 2013 Published online: January 22, 2014

The experiences of security industry contractors working in Iraq: an interpretative phenomenological analysis.

Objective: To explore the occupational experiences of private security contractors working in a war zone and how it impacts on their mental health. Methods: Semistructured interviews were conducted with seven contractors employed by a large UK-based private security company. Interpretative phenomenological analysis was used to analyze the interview transcripts. Participants also completed the 12-item General Health Questionnaire and the Posttraumatic Stress Disorder Checklist. Results: Four overarching themes emerged: the appeal of the job; vulnerability; keep going; and seeking help for stress in the workplace. No clinically significant levels of distress were reported. Conclusions: Contractors are frequently exposed to stressors known to increase risk of psychiatric difficulty in military personnel. A number of potential protective factors were identified. Only a minority of participants were open to seeking help for mental health difficulties.

Resilience, recovery style, and stress in early psychosis

Aim: To investigate relationships between stress, resilience, recovery style, and persecutory delusions in early psychosis. Methods: Thirty-nine participants completed questionnaires in a cross-sectional design. Results: Higher stress, lower resilience, and a sealing-over recovery style predicted higher delusional severity and accounted for 31% of the variance in delusion severity. Conclusions: Enhancing stress-coping strategies, building resilience, and facilitating an integrative recovery style may be helpful intervention targets for reducing the severity of persecutory delusions in patients with early psychosis.