Simon P. Clarke

Verbal overshadowing of perceptual discrimination

We examined effects of verbal interference on a perceptual discrimination task. Participants were presented with a series of faces, described (or did not describe) an additional face, and then made face/ nonface decisions to both the original faces and new faces, intermingled with nonfaces. This enabled us to examine the effect of making a verbal description, relative to an unrelated filler task in a control condition, on the perceptual discrimination of faces seen for the first time and faces encountered previously, and also on repetition priming (i.e., the facilitative effect of an encounter with a stimulus on subsequent processing of the same stimulus). Verbalization interfered with performance on both new and studied faces, but it did not interfere with priming. We argue that verbalization encouraged a relatively long-lasting shift (over a number of trials) toward greater visual processing of individual facial features at the expense of more global visual processing, which is generally beneficial for the recognition of faces and important for discriminating faces from nonfaces in the face decision task.

Outcomes of therapeutic community treatment for personality disorder

Purpose – The purpose of this paper is to review quantitative research since 1999 evaluating the effectiveness of democratic therapeutic community (DTC) treatment for individuals with personality disorders (PD) with reference to interpersonal and offending risk outcomes. Design/methodology/approach – A systematic search resulted in the review of ten studies. All of the studies investigated DTCs treating PD in community, inpatient residential and forensic settings. Only peer-reviewed, English-language articles employing a quantitative design were included. Findings – The majority of studies were conducted poorly and of low methodological quality, with limitations located in the representativeness of participants, limited use of control and comparison groups, follow up periods and controls for confounders. Heterogeneity remained in use of measures and limited consideration was given to the validity of interpersonal measures used. While improved interpersonal outcomes post DTC treatment were noted in forensic and residential settings, results were mixed in day and mini TC settings. Inconsistent findings in offending risk outcomes were also indicated. A study with increased methodological rigour indicated residential treatment had limited effects on interpersonal outcomes, when compared to combination treatment (residential TC and step-down treatment). Originality/value – The study provided an evaluation of the limitations of DTC research across a range of settings and highlighted a combination of residential TC and step-down treatment may achieve superior outcomes to residential TC treatment alone in a community inpatient population. Recommendations are made for future research to contribute to the treatment of PD.

Evaluation of a group acceptance commitment therapy intervention for people with knee or hip osteoarthritis: a pilot randomized controlled trial

Abstract Objectives: The aim was to evaluate an Acceptance commitment therapy (ACT) intervention for people with knee or hip osteoarthritis; a related aim was to compare treatment effects from Rasch-transformed and standard scales. Methods: Participants were recruited from a research database and outpatient rheumatology and orthopaedic clinics at two hospitals. Eligible participants were randomly allocated to either intervention or usual care. Intervention comprised six-sessions of group ACT. Outcomes were assessed two and four months after randomization. Rasch-transformed and standard self-report measures were compared. Qualitative interviews also explored the acceptability of the intervention. Results: Of 87 people assessed for eligibility, 31 (36%) were randomized. The main reason for non-randomization was that participants received surgery. Of the 16 participants randomized to intervention, 64% completed ≥50% of the scheduled group sessions. Follow-up data was complete for 84% participants at two months and 68% at four months. Outcome analysis demonstrated important differences between the Rasch-transformed and standard scales. There were significant differences between the groups in pain. Qualitative interviews with seven participants suggested the intervention was acceptable. Conclusions: ACT for osteoarthritis is likely to be an acceptable treatment option for people with osteoarthritis. Progress to a definitive trial is warranted. Rasch-transformed outcome scales are preferable in clinical trials where possible. Implications for Rehabilitation Acceptance commitment therapy (ACT) is an effective treatment for many pain conditions andcould be a useful intervention for people with osteoarthritis who have high levels of pain. Rasch analysis is a measurement technique that may enable greater precision in detectingmeaningful treatment effects in routine clinical outcomes. The ACT intervention was successful in reducing pain and sleep difficulties and there werenotable differences in effects between standard and Rasch-transformed scales. In a relatively small trial, ACT may to be an acceptable intervention for people with osteoarthritisand progress to a definitive trial is warranted.

Examining fast and slow effects for alcohol and negative emotion in problem and social drinkers

Abstract Attentional bias (AB) for alcohol-related stimuli has been consistently demonstrated in social and problem drinkers. The aims of this study were to: investigate whether AB for alcohol-related stimuli could be described as a slow effect as well as a fast effect; how these effects relate to drinking behaviour; and the influence of the experimental procedure on priming effects. Two experiments were designed. In experiment 1, problem drinkers in treatment at a community alcohol service (N = 62) and a group of social drinking controls (N = 60) were assessed using the modified Stroop task with alcohol, negative emotion and neutral words. Drinking patterns were also recorded on the Khavari Alcohol Test. In experiment 2, social drinking controls (N = 40) completed the same procedure but were blinded to the study’s aims. In experiment 1, both groups demonstrated slower response times to alcohol-related than neutral stimuli in both fast and slow processes. Difference scores for alcohol compared to neutral words in the slow process were positively correlated with increases in drinking levels for both groups. In experiment 2, AB to alcohol-related stimuli disappeared when participants were unprimed. The findings highlight the importance of investigating the role of fast and slow processes in continued and problem drinking, alongside priming effects from the experimental procedure.

Personal experience of osteoarthritis and pain questionnaires: mapping items to themes

Abstract Purpose: The aim of this study was to examine the correspondence between qualitative and quantitative methods of coding experience of pain reported by participants with osteoarthritis (OA) of the knee. Methods: A mapping grid was produced to record the correspondence between subthemes that emerged from thematic analysis of interviews with 24 participants with knee OA, and from questionnaire items which were used in a study of 192 knee OA participants. Items were rated according to their degree of correspondence between subthemes and questionnaire items, and an overall correspondence score was produced for each subtheme and questionnaire measure. Results: The subthemes that corresponded well with the questionnaire items were those that related to socio-emotional functioning, the overall experience of pain and the impact of pain on physical functioning. The questionnaire items did not relate to participants’ knowledge about their condition and their experience of the medical system. Conclusions: The study indicated that many aspects of pain experience reported by patients in qualitative interviews are also assessed by commonly used questionnaire outcome measures for people with pain. However, although participants reported that knowledge about their condition and their experience of the medical system were important aspects of the overall pain experience, these are rarely used as outcome measures. Questionnaires that address these additional aspects of the pain experience could be useful to further evaluate the experience of pain and may help to address important concerns raised by patients with OA of the knee. Implications for Rehabilitation Existing questionnaires in pain research may not adequately capture all aspects of the pain experience for osteoarthritis patients. Patient experience of the healthcare system and their knowledge of the disease appear to be areas particularly neglected in questionnaire-based studies. Iatrogenic aspects of the medical system and its impact on pain and mood need to be taken into account more fully when working with patients with osteoarthritis pain.

Home-based pre-surgical psychological intervention for knee osteoarthritis (HAPPiKNEES): a feasibility randomized controlled trial

Objective: To determine the feasibility of conducting a trial of a pre-surgical psychological intervention on pain, function, and mood in people with knee osteoarthritis listed for total knee arthroplasty. Design: Multi-centre, mixed-methods feasibility randomized controlled trial of intervention plus usual care versus usual care. Setting: Participants’ homes or hospital. Participants: Patients with knee osteoarthritis listed for total knee arthroplasty and score >7 on either subscales of Hospital Anxiety and Depression Scale. Intervention: Up-to 10 sessions of psychological intervention (based on cognitive behavioural therapy). Main measures: Feasibility outcomes (recruitment and retention rates, acceptability of trial procedures and intervention, completion of outcome measures), and standardized questionnaires assessing pain, function, and mood at baseline, and four and six months post-randomisation. Results: Of 222 people screened, 81 did not meet inclusion criteria, 64 did not wish to participate, 26 were excluded for other reasons, and 51 were randomized. A total of 30 completed 4-month outcomes and 25 completed 6-month outcomes. Modal number of intervention sessions completed was three (range 2–8). At 6-month follow-up, mood, pain, and physical function scores were consistent with clinically important benefits from intervention, with effect sizes ranging from small (d = 0.005) to moderate (d = 0.74), and significant differences in physical function between intervention and usual care groups (d = 1.16). Feedback interviews suggested that participants understood the rationale for the study, found the information provided adequate, the measures comprehensive, and the intervention acceptable. Conclusion: A definitive trial is feasible, with a total sample size of 444 people. Pain is a suitable primary outcome, but best assessed 6 and 12 months post-surgery.

Hurting and healing in therapeutic environments: How can we understand the role of the relational context?

Abstract It has long been recognised that relationships are key to good mental health service delivery and yet the quality of the relational context remains poorly understood. This article brings together three studies that utilize very different methodologies to explore the various ways in which a process of therapeutic change can be aided or prevented by relational factors. All three studies took place within the context of therapeutic communities. The first study uses narrative ethnography and interaction ritual theory to explain how the mechanisms of everyday encounters in two therapeutic communities transform negative feeling into a sense of belonging and positive emotions such as confidence. The second study uses grounded theory to explore how the relational setting and the altered context of the researcher in a therapeutic faith community environment induces either a positive or negative quality of relationships. The final study uses a novel autoethnographic methodology to inform understanding of the relational experience of mental health treatment by comparing and contrasting multiple perspectives of different treatment environments. The paper concludes by identifying the expression and containment of affect in a congruent environment, belonging and hope, and fluid hierarchies of relational structures as key aspects of the relational context informing change.

Psychological therapies for improving outcomes after total hip or knee replacement in people with osteoarthritis and rheumatoid arthritis

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effectiveness of psychological therapies on post-surgical outcomes following knee or hip joint replacement surgery in people with osteoarthritis. Secondary questions are whether some psychological therapies confer more benefits than others, and whether effectiveness differs with type of arthritis and site of surgery.

Clinical effectiveness of a pain psychology service within an outpatient secondary care setting

Purpose – Data gathered from routine clinical settings is complementary to evidence garnered from controlled efficacy trials. The purpose of this paper is to present individual-level analysis of changes in a group of patients discharged from psychological therapy within an outpatient pain service. The service had recently shifted from a traditional cognitive-behavioural approach to one underpinned by Acceptance and Commitment Therapy. Design/methodology/approach – Reliable and clinically significant change methodology was applied to CORE-10 outcomes for 27 patients discharged during 2013-2014. Outcomes were compared to 2012-2013. A patient satisfaction questionnaire was administered and functional outcomes were collated. Findings – Outcomes were not adversely affected by the shift in service focus as clients demonstrating reliable improvement increased from 2012-2013; 81 per cent reliably improved, 44 per cent made a clinically significant improvement. Increases in returning to work/unpaid activities at p...

Madhouse and the whole thing there

ABSTRACT This article presents an autoethnography in the form of a short story of the experiences of a mental breakdown, and subsequent involuntary detainment, alongside the experiences of conducting PhD research outside the mainstream of the discipline of psychology. In response to criticisms of narrative approaches that they are methodologically solipsistic and present a socially atomised self, this narrative combines patient medical records with narrative recollections and reflections on the research process from a contemporary perspective. In doing so, the narrative explores and interrogates themes relevant to creative practice in psychological research, including the notion of authenticity, methodological issues of researching personal experience, the problem of subjectivity and, ultimately, the nature of madness and psychological distress, including its nonlinearity and otherness.