Michaela A. Swales

Specificity of autobiographical memory and mood disturbance in adolescents

The difficulty in retrieving specific memories to cue words on the autobiographical memory test has been found to be associated with a number of psychiatric disorders: depression, PTSD, obsessive-compulsive disorder, borderline personality disorder, and acute stress disorder, as well as certain forms of behaviour, notably parasuicide. This preliminary study extends the study of autobiographical memory into an adolescent population. Adolescents from a residential inpatient facility completed the autobiographical memory test alongside measures of depression and hopelessness. Their data were compared with normative data collected from a school sample. The clinical group, who were more depressed and hopeless than the normative comparison group, were less specific in their response to cue words on the autobiographical memory test. This result is comparable to that found in adult clinical groups. Unusually for studies of autobiographical memory, a positive correlation was found between specificity, depression and hopelessness in the clinical group, with the more depressed and hopeless participants being more specific. Recall of specific memories in response to negative cues tended to be associated with hopelessness in both males and females. Post-hoc analyses suggested that this was a consequence of a number of adolescents in the clinical group who had a history of parasuicidal behaviour tending to recall the same traumatic memory to more than one cue word.

Implementing Dialectical Behaviour Therapy: Programme survival in routine healthcare settings

Background The National Institute of Health and Clinical Excellence recommends considering Dialectical Behaviour Therapy (DBT), an efficacious treatment for borderline personality disorder, especially when reduction in self-harm is a clinical priority [. Borderline Personality Disorder: Treatment and Management. Leicester: The British Psychological Society and the Royal College of Psychiatrists]. Treatment teams began using DBT in the UK in 1994. Concerns have been raised, however, about the sustainability of DBT programmes in routine clinical practice [Pitman, A., & Tyrer, P. (2008). Implementing clinical guidelines for self-harm – highlighting key issues arising from the NICE guideline for self-harm. Psychology and Psychotherapy: Theory, Research and Practice, 81, 377–397]. Aims This study sought to establish the sustainability of UK DBT programmes and to explore factors that impacted on effective implementation. Method All teams trained in DBT in the UK between 1994 and 2007 were contacted. Each team was categorised as either active or inactive. The date of programme cessation was established. Team leaders of active, and as far as possible inactive, programmes were interviewed about aspects of implementation. Results The survival curve demonstrated that DBT programmes ran an increased risk of failure in the second and fifth years after training. Absence of organisational support and staff turnover were the most commonly reported implementation challenges. Conclusions Sustainable implementation of DBT, as with other evidence-based interventions, requires organisational support that incorporates a strategy for further staff training and development.