Nick Maguire

Phenomenological Evidence for Two Types of Paranoia

Objective: Two types of paranoia have been identified, namely persecution (or ‘Poor Me’) paranoia, and punishment (or ‘Bad Me’) paranoia. This research tests predicted differences in phenomenology – specifically, in person evaluative beliefs, self-esteem, depression, anxiety, and anger. Method: Fifty-three people with current paranoid beliefs were classified as Poor Me, Bad Me, or neither (classification was reliable). Key dependent variables were measured. Results: All predictions were supported, except the one relating to anger, where the two groups did not differ. The Bad Me group had lower self-esteem, more negative self-evaluative thinking, lower negative evaluations about others, higher depression and anxiety. Importantly, the differences in self-esteem and self-evaluations were not fully accounted for by differences in depression. Conclusion: Data support the presence of two distinct topographies of paranoia. Future research is needed to explore the theory further and examine clinical implications.

Intensive Interaction with a Woman with Multiple and Profound Disabilities: A Case Study

Intensive interaction (II) recognises the pre‐verbal nature of adults with profound learning disabilities and mimics the early attachment process to develop the very beginnings of communication and sociability. This paper Reports on the use of II with a remote and withdrawn adult with severe learning disabilities and visual impairments, who engaged in serious self‐injurious behaviour. The results indicate that the intervention was successful in facilitating the development of the first stages of social and communication skills.

What works in inclusion health: overview of effective interventions for marginalised and excluded populations

Inclusion health is a service, research, and policy agenda that aims to prevent and redress health and social inequities among the most vulnerable and excluded populations. We did an evidence synthesis of health and social interventions for inclusion health target populations, including people with experiences of homelessness, drug use, imprisonment, and sex work. These populations often have multiple overlapping risk factors and extreme levels of morbidity and mortality. We identified numerous interventions to improve physical and mental health, and substance use; however, evidence is scarce for structural interventions, including housing, employment, and legal support that can prevent exclusion and promote recovery. Dedicated resources and better collaboration with the affected populations are needed to realise the benefits of existing interventions. Research must inform the benefits of early intervention and implementation of policies to address the upstream causes of exclusion, such as adverse childhood experiences and poverty.

Cognitive Behavioural Therapy and Homelessness: A Case Series Pilot Study

This paper describes a project set up to treat four homeless men using cognitive behavioural therapy (CBT). The referral criteria were that individuals had alcohol and/or substance misuse problems, were roofless (i.e. sleeping rough) immediately before the intervention began and found it difficult or impossible to access hostel places in Southampton. Excessive alcohol use, violence (against self, others and property) and prison sentences were all features of their presentation. The project involved three levels of CBT intervention provided by the clinical psychologist: 1) training for the staff to enable them to work within this model; 2) continued supervision within model to ensure consistency and sustainability; 3) individual formulation (description of the problem within the CBT framework) and psychotherapy. The house itself was also run on a collaborative basis. A number of measures including mental health and social functioning constructs were used to evaluate the project, in addition to some qualitative data. All residents reduced incidents of theft, violence and alcohol consumption. Risk to self and others was also reduced for all residents. Perceived self-efficacy increased slightly for all residents, and staff perceived that they could be more effective, less hopeless, and therefore possibly less stressed as a result of training. More data will be gathered over time.

An evaluation of the choices for well-being project

The relationship between mental health, self-esteem and unemployment is well established. Emerging research suggests that interventions such as Cognitive Behavioural Therapy (CBT) can counter the negative effects of unemployment and may improve re-employment. This study evaluated the effectiveness of a manual-based programme, which combines CBT with job skills training, in improving the psychological health and job- seeking skills of unemployed individuals within the UK. One hundred and nine unemployed individuals, suffering mild to moderate mental health problems, were referred to the programme. Of these, 47 completed the programme and 32 attended follow-up. The impact of the manualised course was evaluated using a randomised control trial with a waiting list control. On completion of the programme, participants showed improvements in mental health, self- esteem and job-search self-efficacy as well as a reduction in the occurrence of negative automatic thoughts. Twenty participants gained employment and improvements persisted at follow-up. Considering the initial levels of psychological distress and mental health problems among the unemployed sample, the need for adequate service provision for the unemployed is recommended.

Emotions, Traits and Negative Beliefs as Possible Mediators in the Relationship between Childhood Experiences of being Bullied and Paranoid Thinking in a Non-Clinical Sample

This paper describes a study investigating whether negative beliefs, traits or emotions mediate the relationship between an adverse early life experience, being a victim of bullying, and psychotic like phenomena, paranoid thinking, in a non-clinical population. A cross-sectional research design was utilised with 135 undergraduate students completing self-report questionnaires. The results revealed that negative beliefs about self and depression significantly mediated the relationship between indirect aggression and paranoid thinking, whereas negative beliefs about others mediated the relationship between direct verbal aggression and paranoid thinking. These findings suggest that negative beliefs and depression are the mediators of the relationship between bullying and paranoid thinking thus further contributing to the understanding of the association between adverse early life experiences and paranoid thinking.

Experts by experience: peer support and its use with the homeless

The homeless population has complex needs. Peers with experience of homelessness offer unique perspectives in supporting those experiencing homelessness. Peer support fostered and developed by professional organisations, termed intentional peer support (IPS), formalises this process. This review aims to assess the effectiveness of IPS as an intervention with young adults and adult homeless persons (including streetdwelling and those within services). PyscINFO, Web of Science, MEDLINE, and CINAHL were searched, resulting in ten studies, involving 1,829 participants. Peer support has significant impacts on quality of life, drug/alcohol use, and social support. Common elements of peer support are identified, suggesting possible processes that underlie effective peer support. Shared experiences, role modelling, and social support are suggested to be vital aspects of peer support and moderate changes in homeless clients. One study was deemed to have moderate/high quality; the remaining studies had low and moderate quality. Limitations of each are discussed.

Resilients, overcontrollers and undercontrollers: A systematic review of the utility of a personality typology method in understanding adult mental health problems

The person-centred typological approach to personality makes the distinction between overcontrolled and undercontrolled personality types. This review systematically searched for research on the utility of these personality types in adult mental health. A total of 43 papers were included, which were divided broadly into cross-sectional studies, longitudinal studies and studies with clinical populations. Three personality types have been largely replicated in both normal and clinical populations: resilients, overcontrollers and undercontrollers. These types show utility in predicting long-term functioning and mental health, understanding heterogeneous personalities within clinical subgroups and have implications for treatment. Some disagreement on the number of personality types deemed replicable across samples and differing methodologies do exist, with some finding a dimensional approach to personality to have greater predictive utility. These personality types have been shown to be important in a number of mental health problems such as eating disorders, which may prove helpful in developing new psychological interventions. These studies point to the importance of overcontrolled personality types as well as undercontrolled in mental health. More research is needed with a greater range of clinical populations.

Personal experiences of home haemodialysis: patients’ and carers’ experiences

The discussions from a patient-led session at a national home haemodialysis conference are described. A number of discussion themes are described, together with patients’ views on technical and social aspects of home dialysis. Issues highlighted included the preparation for home systems and the role of intrinsic motivation to change regimens and practice. A number of conclusions are drawn from the discussion, highlighting the role of patient beliefs about conducting haemodialysis at home.